Har Ghar Dastak: A state-level initiative for Active Case Finding

Introduction and Rationale

“Har Ghar Dastak”, a state-level initiative for intensified active case finding (ACF) was initiated on the instructions of the higher authorities to screen the whole population. The primary objective was to find missing cases and move towards TB elimination targets in all districts of Kashmir Division, with the help of ground staff available at Tuberculosis Unit (TU) level.

Objectives

• Screening the whole population to detect active/presumptive TB case, reducing the risk of poor treatment outcomes, and adverse social and economic consequences of TB for the individual, which in turn can reduce the prevalence and deaths from TB.
• Reducing the duration of TB transmission through active case finding.
• Screening to help identify people who are at a particularly high risk of developing active TB in the future and thus may require repeated screening.

Overall approach and Key strategies

• House to house intensified ACF to cover the whole population in Kashmir Division
• NTEP Staff were deputed in a group of three members, including the concerned Senior Treatment Supervisor, Community Health Officer and ASHA
• A sputum sample was collected on the spot if any presumptive TB case was identified; it was later transported to the nearest Designated Microscopy Centre/Lab for testing
• If any positive case was detected, contact tracing was immediately initiated
• All basic TB services were provided to the concerned person with TB (PwTB)
• Awareness and sensitization sessions were conducted within the vicinity
• Ni-kshay IDs were created for the concerned PwTB to keep track of progress
• All symptomatic contacts were made to undergo further assessment

Implementation

The Har Ghar Dastak initiative was started on December 6, 2021, and continued until the end of April 2022, covering all districts of Kashmir division and a target population of rural, urban, tribal, and hardto-reach areas. Through this initiative, a total of 109554 presumptive person were identified, out of which 17 persons with confirmed TB were detected.

Outcomes

Initially, 56513 presumptive persons were identified, of which 7 with TB were detected in December 2021. There was an increasing trend of identification and detection, and by the end of April 2022, 109554 presumptive persons had been identified, and 17 persons had been detected with TB. 

Key Recommendations

All basic facilities should be made available across all health facilities for scaling up of initiatives like this to achieve targets.

Potential for replication and scale-up

For TB elimination in Kashmir Division and to achieve our vision of a TB-Free Kashmir ahead of 2025, these initiatives play a vital role and can be replicated in any part of the country which can scale up the process of finding more TB cases and provide better services at the nearest health facility.

Source : TBC India