Mapping of Priority Vulnerable Populations to bridge the gaps in the delivery of TB prevention and care services

Introduction and Rationale

The National Strategic Plan for Elimination of Tuberculosis has recommended that vulnerable populations be the focus of TB prevention and control activities. Identifying these populations and the geographic pockets is crucial to devise population-specific strategies. Under the USAID-funded Breaking the Barriers (BTB) project, supported by KHPT in association with TB Alert India, we adopted a robust mapping process in 2020 in selected districts of Telangana. 

Objectives

The mapping exercise was one of the key foundational activities that systematically collected and collated information on the spread of the vulnerable population, their socio-demographic details, and also information on affordability and availability of health care services, socio-cultural barriers etc. The core objectives of mapping were:

• Identification and prioritization of localities/sites where vulnerable populations are concentrated
• Identification and listing of community structures - informal groups including Self-Help Groups, labour unions, and youth associations - working in these localities, which can support sustainable behaviour change for the prevention of TB, improved case detection, and successful treatment outcomes

Overall Approach and Key strategies

The districts for intervention were selected through due deliberations with the state project teams and NTEP officials. In Telangana, the focus in Hyderabad and Warangal districts was on the urban vulnerable, while in Mahabubabad and Sangareddy districts, tribal and industrial workers, respectively, were considered as priority populations. We conducted mapping in 23 Tuberculosis Units (TUs) in the selected four districts of Telangana, with a population of 6.9 million.

The TUs were finalized based on the proportion of the vulnerable populations from the key informant interviews against the town population, as well as the 2019 TB notification rate. In Step 1, we conducted interviews with key informants involved in the National TB Elimination Programme (NTEP) to list specific vulnerable populations and the hotspots. Step 2 involved collation and prioritization of population groups after consolidating the findings from Step-1 and a review of Ni-kshay data. Finally, in Step-3, the information collated was validated by visiting each geographic location/area and conducting group discussions with members of the vulnerable population, local health workers, and not-for-profit agencies. 

Implementation

The mapping exercise was conducted in Telangana during September 2020-March 2021. Data was collected by the Community Coordinators (CCs) employed by the BTB project for implementation of the project activities. Involvement in data collection provided them with the opportunity to get familiar with the community, as well as build a rapport with the NTEP staff and community leaders. In each of the states, a two-day orientation was organized to train the CCs on the tools, selection of key informants, and ethics of data collection. Following the orientation, practice sessions were conducted.

Outcomes

Overall, 97 key informant interviews (KII) were conducted in Step-1 in Telangana over six months. We identified 770 population clusters, which included a vulnerable population size of 2.1 million with 55% men and 45% women. Out of these, the urban population majorly residing in slums was the dominant vulnerable group contributing to 72% of the total estimated population size; this was because mapping was carried out mostly in urban TU clusters. Apart from this population, 11% were factory or industrial workers, 13% tribal, 3% construction site workers, and another 2% belonged to various other vulnerable groups. Additionally, it was found that around 40% of the sites reported the presence of persons with TB, over 60% of the were situated within 1-2 km distance from the nearest public health institution. Around 43% of the sites reported the presence of community structures who work with vulnerable groups, out of which nearly 70% were self-help groups (SHGs). 

Key Recommendations

There are no proven models/approaches that demonstrate success in addressing TB in the unique socio-cultural and economic contexts of these population groups which are identified as ‘vulnerable’ as per the national guidelines. The learnings from this mapping exercise can potentially help in identification of the clusters of specific key priority populations in the context of TB.

The mapping process adopted helped in identifying priority populations and to understand their geographic spread, which are essential to devise relevant TB response strategies that will help to detect TB and improve treatment outcomes among these groups, thereby accelerating TB response at the national level. It is recommended that this approach be implemented across all TUs of NTEP districts.

Potential for replication and scale-up

Keeping in mind the importance of identifying clusters of specific priority populations to develop relevant TB response strategies, there is potential for replication and scale-up of this activity.

Source : TBC India