One Family: A TB prevention care and support service

Introduction and Rationale

In addition to medical support to persons with TB (PwTB), psychological care and guidance are of paramount importance. In the absence of appropriate care, PwTB are prone to emotional trauma, confusion, and psychological agony. PwTB hailing from economically and socially vulnerable segments face enormous stigma, deal with misconceptions, and other socio-economic challenges. All these factors adversely impact the physical and mental well-being of PwTB; this is turn contributes to poor treatment adherence, and eventually leads to unsuccessful treatment outcomes.

It has been evident through years of public health experience with PwTB that psychosocial counselling, peer support, timely guidance, and building confidence are important drivers for successful treatment outcomes. Addressing these barriers requires a multi-pronged approach that is defined and driven by individual needs and contexts of PwTB.

Bringing PwTB together as ‘One Family’ to discuss and provide mutual supportive guidance is an important and novel approach. With a vision to eliminate TB, the state of Telangana through the Breaking the Barriers, aims to provide TB prevention care and support services to PwTBs. To achieve this, the program has initiated a model of ‘Care and Support Group Meetings’ (CSGMs) to address and navigate solutions to ensure successful treatment outcomes.

Objectives

The goal of CSGMs is to empower PwTB by promoting self-confidence, and instilling hope for the future, and nurturing them into TB Champions/Advocates. The core objectives of CSGMs are:

• To enable PwTB-friendly interactions between PwTB and health care providers which help them overcome clinical doubts, psychological issues, and stigma faced by PwTB. Similarly, common concerns related to treatment, nutrition, follow-up tests, infection control, and side effects are raised through a friendly discussion.
• To serve as a platform for PwTB and their caregivers to support and motivate one another by sharing their experiences regarding treatment, consumption of nutritious food, and other concerns of stigma and discrimination faced by PwTB, and also address the supply system at facility level.

Overall approach and Key strategies

The overall approach of the intervention is based on the principle of ‘Educate to Empower to Connect to Provide’ bringing PwTB as ‘One Family’ to address both medical and non-medical needs with a human touch.

Strategically, CSGMs are organized on a fixed day once a month at Designated Microscopy Centres (DMCs) under the leadership of the Medical Officer (MO) with DMC staff support. These are organized after outpatient department (OPD) timings to avoid disturbances to the OPD. PwTB are reminded about the CSGM well in advance. At some DMCs, CSGM dates are stamped on the PwTB treatment card. This initiative is part of Breaking the Barriers (BTB) project, a USAID-funded project being implemented by KHPT in collaboration with TB Alert India in vulnerable districts of Telangana.

Implementation

CSGMs have been conducted as part of the BTB project in 23 Tuberculosis Units (TUs) across five districts in Telangana since October 2020. The key target groups are industrial workers, tribal, and urban vulnerable population groups.

The duration of the CSGMs range between 45 minutes to 1 hour, with an average participation of 6-7 PwTB and 3-4 caregivers. The MO of the DMC addresses the medical aspects while Senior Treatment Supervisors (STS) / BTB staff members brainstorm on the non-medical needs. The PwTB present are encouraged to speak and discuss solutions using the behaviour change communication materials developed by the project. 

Outcomes

About 1355 CSGMs were organized, and 107 Care Support Groups formed between October 2020 - July 2022. About 5971 individual PwTB and 2953 caregivers participated in these meetings. Similarly, 87% of these meetings (1178/1355) were facilitated by DMC staff. Around 213 TB Champions have been nurtured, who have provided peer support to during 517 CSGMs.

These meetings were not discontinued even during the COVID-19 pandemic. CSGM members formed a WhatsApp group and meetings were held virtually. Mini–CSGM Groups have been formed in tribal areas to hold meetings at local level so that people do not have to travel long distance for CSGMs to DMCs and TUs.

Key Recommendations

To sustain the intervention for improved treatment outcomes, this activity should be included as a performance indicator, which can be captured through the Ni-kshay reporting system for review and assessment for betterment. Based on the qualitative feedback and reference checks on the use and effectiveness of Behaviour Change Solutions (BCS), with specific reference to the TB Mukt Certificate (given to PwTBs who successfully complete their treatment), it is recommended for implementation across all TUs of NTEP districts.

Potential for Replication and scale-up

This is an activity that can be implemented with limited resources. The CSGM approach balances a social and medical approach to TB response. The NTEP staff is involved and has taken ownership of the initiative across districts of Telangana. This indicates the potential of replication of the initiative across all NTEP facilities. 

Source : TBC India