Abstract
BackgroundMigrant labourers living in the slums of urban and industrial patches across India make up a key sub-population so far controlling Tuberculosis (TB) in the country is concerned. This is because many TB patients from these communities- remain under reached by the Revised National Tuberculosis Control Programme (RNTCP) of India. This marginalized community usually seeks early-stage healthcare from “friendly neighbourhood” non-formal health providers (NFHPs). Because, RNTCP has limited capacity to involve the NFHPs, an implementation research project was conceived, whereby an external partner would engage with the NFHPs to enable them to identify early TB symptomatics from this key sub-population who would be then tested using Xpert MTB/RIF technology. Diagnosed TB cases among them would be referred promptly to RNTCP for treatment. This paper aimed to describe the project and its impact.MethodsAdopting a quasi-experimental before-after design, four RNTCP units from two major urban-industrial areas of Odisha were selected for intervention, which spanned five quarters and covered 151,400 people, of which 30% were slum-dwelling migrants. Two similar units comprised the control population. The hypothesis was, reaching the under reached in the intervention area through NFHPs would increase TB notification from these traditionally under-notifying units.RNTCP notification data during intervention was compared with pre-intervention era, adjusted for contemporaneous changes in control populationResultsThe project detected 488 Xpert+ TB cases, of whom 466 were administered RNTCP treatment. This translated into notification of additional 198 new bacteriologically positive cases to RNTCP, a 30% notification surge, after adjustment for 2% decline in control. This meant an average quarterly increase in notification of 41.20(20.08, 62.31; p<0.001) cases. The increase was immediate, evident from the rise in level in the time series analysis by 50.42(10.28, 90.55; p = 0.02) cases.ConclusionEngagement with NFHPs contributed to an increase in TB notification to RNTCP from key under reached, slum-dwelling migrant populations.
Highlights
Tuberculosis (TB) is considered a major public health problem in India, with almost 3 million people developing this infectious disease every year in the country, and as many as half a million Indians succumbing to it annually[1]
This is because many TB patients from these communities- remain under reached by the Revised National Tuberculosis Control Programme (RNTCP) of India
RNTCP has limited capacity to involve the non-formal health providers (NFHPs), an implementation research project was conceived, whereby an external partner would engage with the NFHPs to enable them to identify early TB symptomatics from this key sub-population who would be tested using Xpert MTB/RIF technology
Summary
Tuberculosis (TB) is considered a major public health problem in India, with almost 3 million people developing this infectious disease every year in the country, and as many as half a million Indians succumbing to it annually[1]. The basic tenets of RNTCP include diagnosing majority of the TB cases early in the course of their diseases and treating them appropriately and completely This is to ensure that majority of the affected individuals suffer for a relatively shorter period and they do not continue to spread the infection to other uninfected individuals in the community. Migrant labourers living in the slums of urban and industrial patches across India make up a key sub-population so far controlling Tuberculosis (TB) in the country is concerned. This is because many TB patients from these communities- remain under reached by the Revised National Tuberculosis Control Programme (RNTCP) of India. This paper aimed to describe the project and its impact
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