RT Journal Article
SR Electronic
T1 Lessons Learned From a Peer-Supported Differentiated Care and Nutritional Supplementation for People With TB in a Southern Indian State
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2300504
DO 10.9745/GHSP-D-23-00504
VO 12
IS 4
A1 Shewade, Hemant Deepak
A1 Jaisingh, A. James Jeyakumar
A1 Ravichandran, Prabhadevi
A1 Pradeep, S. Kiran
A1 Pandurangan, Sripriya
A1 Mohanty, Subrat
A1 Rajasekar, T. Daniel
A1 Vijayaprabha, R.
A1 Kiruthika, G.
A1 Suma, K.V.
A1 Pathinathan, Delphina Peter
A1 Chidambaram, Deiveegan
A1 Sivagami, K.
A1 Srinivasan, Anupama
A1 Swamickan, Reuben
A1 Goswami, Amrita
A1 Sivaranjani, D.
A1 Ananthakrishnan, Ramya
A1 Frederick, Asha
A1 Murhekar, Manoj V.
YR 2024
UL http://www.ghspjournal.org/content/12/4/e2300504.abstract
AB Key FindingsTB champions—individuals who have been affected by TB, have completed treatment, and subsequently been trained to provide support and counseling—provided baseline and additional counseling for more than 95% of severely ill people with TB and facilitated nutritional supplementation for 60% of those with severe undernutrition.The unique ability of TB champions to draw on their personal experiences of TB to motivate others is evident.Key ImplicationsStrong coordination must be established between the TB program and TB champions to maximize their participation.Policymakers can learn from TB champions’ experiences regarding enablers and barriers to implementation for policy adaptation.Two critical components of patient support systems for people with TB are regular counseling and locally managed nutritional support. As part of an ongoing differentiated TB care initiative called Tamil Nadu Kasanoi Erappila Thittam (meaning TB death-free initiative in Tamil, TN-KET) to reduce TB deaths, adults with TB with very severe undernutrition, respiratory insufficiency, or poor performance status are identified at diagnosis (triage-positive) and prioritized for referral, comprehensive clinical assessment, and inpatient care. Between January and June 2023, in 6 districts, a pilot exercise was conducted in which trained TB survivors, known as TB champions, provided baseline counseling and additional counseling (if required) to triage-positive people with TB at diagnosis. Additionally, people with TB with severe undernutrition were prioritized for nutritional supplementation for at least 3 months. Among 652 people with TB who were triage-positive at diagnosis, the program staff shared details of 145 (22%), and all were counseled by TB champions (baseline counseling). Program staff identified 74 (11%) triage-positive people with TB who required additional counseling (i.e., those refusing referral or admission or continued admission), and 71 (96%) were counseled by TB champions. Among these, 54 (76%) were admitted or readmitted and successfully discharged. In addition, among 1,042 people with TB with severe undernutrition, program staff shared details of 390 (38%), of which 60% received nutritional supplementation through the efforts of TB champions. We conclude that TB champions were able to provide quality and timely peer support through direct counseling and by mobilizing local resources for nutritional support. The engagement of TB champions can be further strengthened by establishing robust coordination mechanisms with the TB program. Lessons from this pilot will contribute to the Tamil Nadu State TB Cell’s plans to expand the role of TB champions and enhance community participation to end TB in India.