The panellists included Dr Kuldeep Singh Sachdeva, Deputy Director General- Tuberculosis, CTD; Dr. Reuben Swamickan, Chief of Infectious Diseases Division, USAID/India; Dr Karuna Sagili, Senior Technical Advisor, TB & Communicable Diseases, The Union South East Asia (The Union), India; Mr Dalbir Singh, President, Global Coalition Against TB (GCAT); Mr Mohan HL, Chief Executive Officer, KHPT; and Ms. Sunitha D, a 32-year-old TB survivor from Karnataka. They presented a wide range of issues including the roles of policy and community in addressing LTBI in India, the importance of a community-centred approach, leveraging community networks and policy initiatives to address LTBI.
LTBI occurs when one is infected with TB-causing bacteria, but does not develop the disease. The people who are affected do not show symptoms and cannot spread the disease, but may develop TB if their immune system is weak. Persons with comorbidities such as HIV and diabetes, especially amongst poor, elderly and very young, or people who suffer from malnutrition, are vulnerable to developing TB in this situation. While India carries the highest burden of TB, with 2.4 million notified cases in 2019, nearly 40 percent of the country’s population harbours this ‘silent infection’. It is therefore important to provide preventive care, especially to the vulnerable populations to ensure that no one is left behind, as India moves towards its goal of eliminating TB by 2025.
“It is well established that a focus on TB alone will not contribute to the reduction in future incidence. TB preventive treatment for people with LTBI is equally important to reach our goal of eliminating TB,” said Dr. K S Sachdeva. He acknowledged the contributions of USAID,
KHPT and other partners for bringing in the much-needed focus on LTBI, through initiatives such as their Breaking the Barriers project. “To succeed, we need a collaborative and concerted effort from not only the government but also from other stakeholders such as, private sector, community organizations, civil society organizations and, most importantly, the community itself.”
Addressing the key role of global partnerships, Dr Reuben Swamickan said, “An absence of active community participation and patient-centric approaches for vulnerable populations has resulted in missing TB cases and high proportion of sub-optimal treatment outcomes. In alignment with National Strategic Plan (2017-25), USAID focuses on building resilience and self- reliance through its close engagement with CTD.” Dr Swamickan recommended that TB Preventive therapy is an essential component of a comprehensive TB care and management strategy and that the national program and its partners collaborate to enable a comprehensive roll-out of preventive services across the country.
Dr Karuna Sagili talked about the importance of leveraging community networks to address LTBI. “The active engagement of TB survivors during programmatic management of LTBI, from policy to implementation, monitoring and evaluation will ensure that we are able to plug the “leak” from the TB care cascade,” she said. “Collaborations with other health department activities like maternal and child health care could also help in the optimal utilization of limited resources.”
Mr. Dalbir Singh spoke about GCAT’s policy initiatives in helping shape the National TB program and highlighted the gaps in testing for LTBI and the need to empower communities to lead the TB response. Mr Mohan H L, CEO, KHPT, spoke about KHPT’s experience in implementing TB patient-centred interventions with a strong community engagement component, and talked about the Breaking the Barriers project, which will address the structural and underlying barriers to behaviours that exist within marginalised communities and develop strategies to improve treatment outcomes among these vulnerable populations.
Ms. Sunitha talked about her personal journey with TB, from diagnosis to recovery, and shared her message for persons with TB. “Do not be afraid if you have TB, it is not a permanent disease it is curable. You must follow proper treatment procedure and complete the course, you have to stay strong and overcome it,” she said.
KHPT is a not for profit entity that spearheads focused evidence-driven initiatives to improve the health and wellbeing of communities in India. KHPT works primarily in the fields of Maternal, Neonatal & Child health (MNCH), Tuberculosis (TB), Adolescent Health (AH), and Comprehensive Primary Health Care (CPHC). KHPT is implementing Breaking the Barriers, a four-year (2020-2024) project, supported by the United States Agency for International Development (USAID), with partners TB Alert India, World Vision India and CARE India in Karnataka, Telangana, Assam and Bihar respectively. The project aims to
develop innovative and effective behaviour change operational models that improve coverage of specific vulnerable populations, including urban vulnerable groups, tribal communities, and migrants, mining/industrial/ tea garden workers, for increased case notification, and improved successful treatment outcomes for patients with drug-sensitive TB (DS TB) and drug-resistant TB (DR TB).
For more information on KHPT or Breaking the Barriers, please visit www.khpt.org or contact Shramana Majumder, Communications Specialist, Breaking the Barriers, at [email protected] or at +91 98313 88083