To improve counselling and treatment follow up of tuberculosis (TB) patients, the Revised National Tuberculosis Control Programme (RNTCP) officials are now planning to roll out a programme, TB Sathi. These sathis or assistants will help RNTCP officials in counselling enrolled patients during their prolonged treatment.
“We are calling these patients TB champions or TB Sathi. They will act as counsellors for patients,” said Dr Daksha Shah, Mumbai district in-charge for TB, adding that they will also address family issues arising out of TB for patients.
Mumbai has witnessed a rise in TB patients due to better diagnosis and contact tracing. In 2015, 38,667 and in 2016, 42,115 drug-sensitive patients were diagnosed. In 2017, the count touched 45,675. M-East ward, covering Govandi, holds the maximum burden of TB.
Across Mumbai, multi-drug resistant TB (MDR-TB) saw a similar rise from 3,608 in 2015 to 4,891 in 2017. While normal TB may require at least six months medication under the standard treatment regime, MDR patients require at least two years of medication. The side-effects attached with such treatment, such as hallucination, loss of appetite, weakness and hearing problems, also remain high for MDR-TB patients.
“Such patients often drop out of treatment. We have to take help from social workers, sometimes police, to get them back into the treatment regime. In such cases, a cured TB patient’s counselling would help such patients,” said a counsellor attached with RNTCP from Sion clinic. There is also a dearth of counsellors for patients. In Sewri’s Group of Tuberculosis (GTB) hospital, for instance, post for medical social worker remains vacant. The hospital has counsellors from Tata Institute of Social Sciences and Medicines Sans Frontieres to aid drug-resistant patients.
From each of the 24 wards in Mumbai now, four to five TB Sathi will be chosen and given honorary incentives to counsel patients for treatment adherence.
The central government has fixed deadline 2025 to eliminate TB, even as the global deadline by World Health Organisation is by 2030. India holds the maximum pool of drug-resistant patients, with highest hotspot in Mumbai. The count of extensively drug-resistant patients, who have stopped reacting to most of first and second line of drugs, has risen from 556 in 2015 to 670 in 2017 in Mumbai, a 20 per cent jump.
Meanwhile, the RNTCP has initiated direct benefit transfer of Rs 500 for every TB patient enrolled under RNTCP to cater to their nutritional needs. At least 50 per cent of TB patients are currently undergoing treatment in private sector. Under a memorandum of understanding with NGO Path, RNTCP has treated 50,000 patients for free in private sector where government pays private doctors and chemists for treating TB patients for free.