Advancing TB prevention and control in India

What is this project?

FIND is optimizing access to quality diagnosis, improving private sector engagement, addressing the burden of tuberculosis infection (TBI) and catalysing community action towards TB elimination, through project SHAQTI (Strengthening Health systems for sustainable Access to Quality diagnosis towards TB elimination in India); project JEET (the Joint Effort for Elimination of TB); and Unite to ACT (Amplifying Community action for TB elimination) respectively.

 

Why are we working on it?

India, which accounts for more than one-quarter (26%) of global TB burden, saw a rise in newly diagnosed people with TB from 1.2 million in 2013 to 2.2 million in 2019. But in 2020, the impact of lockdowns, TB diagnostic services being reallocated to COVID-19, and pandemic-related disruption of procurement and transportation of consumables, led to 25% fall in TB notifications compared with the same period in 2019.

The need of the hour is to mitigate this disruption, improve access to quality TB testing, and bring clinical care cascade back on track by, improving laboratory management across India’s public sector network, strengthening capacity for genome sequencing for TB surveillance and expanding laboratory capacity for drug-resistant TB treatment monitoring. Further, and in order to support the Government of India’s aim to eliminate TB by 2025, it is significant to address the TBI burden in India (JEET 2.0); sustain the gains under project JEET; and build capacity of TB-affected communities by engaging TB survivors as champions and bring TB care closer to the community.

 

What does it involve?

It involves three distinct components viz. project SHAQTI, JEET 2.0 and Unite to ACT.

Project SHAQTI is working towards improving quality of laboratories across National TB Elimination Program’s (NTEP) network, by:

Improving laboratory quality and data management

  • Strengthen implementation of quality assurance for field level molecular testing and mentor TB laboratories to achieve and maintain ISO 15189 accreditation.
  • Enhance biosafety risk management at existing TB culture and drug-susceptibility testing laboratories (TB C&DST) and upgrade their infrastructure.
  • Strengthen laboratory data management by expanding LIMS (laboratory information management system) by integrating field level molecular test technologies i.e., CBNAAT (cartridge-based nucleic acid amplification test) / GeneXpert and Truenat™ to enable real time monitoring.

Increasing access to high quality diagnostics

  • Support NTEP to deploy Truenat™ across the country and strengthen trainings, testing, connectivity, trouble- shooting and quality assurance.
  • Optimize laboratory network capacity and implement sample collection and transportation network.
  • Sustain service-delivery across existing TB C-DST laboratories via supply of consumables & reagents and maintenance of equipment.
  • Strengthen capacity for culture tests at district level to monitor response to drug-resistant TB treatment.
  • Strengthen and expand genome sequencing capacity for drug resistant TB surveillance.

JEET 2.0 is addressing the TB infection burden by tracing household contacts of pulmonary TB patients and linking them to TB infection care, across 22 districts in 4 states of India. Further, it is also sustaining and strengthening the gains under JEET by providing strategic and operational support to NTEP for transition into domestically funded PPSAs (patient provider support agency). Specifically, JEET 2.0:

  • Conducts household contact tracing of those people who have active TB
  • Identifies those eligible for TB preventive therapy – the treatment for TB infection.
  • Offers screening and treatment for TB infection by linking the household contacts to the nearest health facility
  • Provides treatment adherence support.

Unite To Act is building capacity of TB-affected communities, promoting rights-based, gender responsive and equitable services for all and accelerating the uptake of community-led activities in 10 states. Further, it is supporting 15 additional states to mainstream community engagement into NTEP policies, strategies, training and service delivery; strengthen the functioning of national, state and district TB Forums; and develop and strengthen effective engagement of communities. It is:

  • Training TB-affected communities by building knowledge and skills of TB survivors to become effective Champions and in turn expand community access to TB prevention and care.
  • Creating TB survivor-led networks and trained TB Champions through a structured mentorship program designed to support people with TB.
  • Mainstreaming community engagement into NTEP policies, strategies, training and service delivery.
  • Strengthening the functioning of national, state and district TB forums.
  • Supporting states in strengthening effective engagement of communities.

What do we expect to achieve?

Project SHAQTI is expected to support sustainable drug resistant TB diagnostic service delivery through 81 TB C&DST laboratories; facilitate quality assurance for ~4,000 CBNAAT and Truenat sites; strengthen deployment and development of training and implementation package for Truenat; mentor ~30 TB laboratories for quality improvement to achieve and maintain ISO 15189 accreditation; enhance bio safety risk management and renovate 15 TB laboratories; support 50 districts in 10 states on optimized TB testing networks with streamlined sample collection and transportation system; and support drug-resistant TB surveillance through genome sequencing.

JEET 2.0 aims to initiate >4,00,000 individuals in contact with TB patients on TB preventive therapy. Unite to ACT aims to report 88-89% treatment completion rates as well as reduction in stigma by 30% to enhance access to TB care services, within communities. Further, the project will provide patient centric services to over 200,000 people by scaling up community action for TB through a cohesive community-led response.

 

Partners and funding

This project is supported by the Global Fund.