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Tackling Tuberculosis in the Slums of India

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MONTREAL, Quebec — Worldwide, tuberculosis is one of the deadliest diseases, taking nearly two million lives annually. Approximately 20% of tuberculosis cases occur in India, the country with the second-highest population worldwide. In India, low socioeconomic status among families forces millions into unsanitary slums. The high population density of these unfavorable living conditions facilitates the spread of tuberculosis. Additionally, there are few qualified healthcare professionals who choose to work in the slums because there is little money to be made and the living conditions are dire. Despite tuberculosis being curable and antibiotics being available from the Indian government, the government does not recognize the situation in the slums as a matter of urgency. Nonetheless, organizations are tackling tuberculosis in the slums of India.

Operation ASHA

Operation ASHA (OpASHA) is based in a small office in Delhi and has become the largest organization that fights tuberculosis in India. Presently, it uses a community-based approach and caters to around four million disadvantaged people. OpASHA recognizes that along with facing higher rates of tuberculosis, low-income communities struggle with long commutes to healthcare facilities, longer waiting times, excessive treatment costs and missed workdays due to health constraints. The organization, therefore, utilizes the Directly-Observed Treatment, Short-Course (DOTS) strategy in both urban and rural Indian areas to address these concerns. The strategy increases accessibility and ensures compliance with treatment, which is very important for tuberculosis.

Compliance Issues

A large issue with tuberculosis treatment is that patients often do not finish their treatment. Tuberculosis medication is a commitment that can require taking up to seven pills at a time for three days per week over a six to 10-month period. Many patients stop treatment once symptoms disappear. When patients do not complete the full course of treatment, however, there is an increased risk of the formation of fatal drug-resistant strains of the disease.

Given this compliance issue, OpASHA partnered with a group of researchers from Microsoft Corp. and developed a low-cost biometric system to track the progress of patients and to alert counselors if patients are skipping treatment. Every time a patient goes in to pick up medication, they must scan their fingerprint to record the dose. If they do not scan their finger, and therefore missed a dose, an OpASHA counselor receives a text message. These counselors then have 48 hours to find the patient and administer the medication. After a year of using the software, the observed patient default rates were lowered from 2.75% to 0.5%. Overall, OpASHA reported that 6.2 million individuals in India have received treatment and the average treatment success is 88%.

German Leprosy and Tuberculosis Relief (DAHW)

The German Leprosy and Tuberculosis Relief (DAHW) recognizes that treatment is not accessible for all and is tackling tuberculosis in the slums of India. Although the government does provide medication and treatment resources for tuberculosis, those living in impoverished areas do not always benefit from this aid. The DAHW, therefore, bridges the gap between the government and affected patients living in slums. The organization ensures care for underserved populations and will support individual patients if they are having adverse reactions to the drug or if they cannot adequately care for their families during this period.

DAHW launched a community-based standardized TB treatment program, which consists of community DOTS providers who care for patients in a specific area. These are volunteers who are offered a small remuneration for this role. Through the program, patients are monitored on an individual basis to ensure completion of the full course of treatment. Additionally, each patient receives their medication from a counselor to avoid walking long distances and at a time most suitable for them.

Looking Ahead

Despite the developed world keeping tuberculosis under control, developing countries are still struggling to keep their rates low. Although India has the highest incidence of tuberculosis, its government committed to ending the epidemic by 2025. In order to achieve this goal, the government’s plan includes rapid testing resources, free tuberculosis drugs to patients under the government’s care and the introduction of new drugs. It has also mandated a tuberculosis reporting and monitoring system. With the help of organizations, initiatives and adequate tracking methods, tackling tuberculosis in India will be easier.

Sarah Frances
Photo: Flickr

https://www.borgenmagazine.com/tackling-tuberculosis/

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