Tuberculosis

Projects

Assessment of Tuberculosis detection and care in congregate settings, Mumbai City

Principal Investigator Dr. Nerges Mistry

Co-Investigator Dr. YatinDholakia

Budget team Ms. Akshaya Patil, Dr. Chinmay Oak

Funder Bombay Community Public Trust, BCPT

Duration 7 months (January 2013- July 2013)

Budget Rs.4.20 Lakhs

Background

Mumbai houses 12% of the population of Maharashtra state, but accounts for 22% of notified cases of Tuberculosis (TB). A fast growing urban metropolis Mumbai has higher levels of MDR-TB, than in other states (24%–30% of new cases and 11%–67% of treated case). There has also been emergence of Extremely Drug Resistant TB (XDR-TB) and Total Drug resistant TB (TDR-TB). The rising incidence drug resistant TB cases in Mumbai necessitates measures for active case finding and treating identified cases successfully.

Being an airborne infection, the risk of transmission of TB is high in overcrowded, poorly ventilated settings. Malnourished individuals, people living with HIV/AIDS, Diabetes mellitus, elderly persons and children are at increased risk of infection due to poor immunity. Due to the inherent susceptibility of their residents TB prevalence is expected to be high in correctional facilities like prisons and congregate settings like old age homes, shelter homes, orphanages, etc. However not much is known about the actual prevalence of TB amongst the population of congregate or correctional settings in India. Following a comprehensive literature review prior to conducting the study it was noted that very limited information is available about the probable threats and risk of TB transmission amongst congregate settings in India. There are currently no policies or guidelines in the country for prevention or control of TB in congregate settings.

This study was therefore done in collaboration with the Municipal Corporation of Greater Mumbai (MCGM) as a collective step towards understanding the existing control and preventive measure for TB in various congregate settings across the urban metropolitan Mumbai.

The Foundation of Medical Research (FMR) conducted an assessment of tuberculosis detection and care in 33 congregate settings and 2 Correctional facilities in Mumbai between the period of January 2013 and June 2013.

Key Findings

Conclusion

It is crucial to build linkages between congregate facilities and public health system, and to advocate the significance of early TB detection and treatment to the managerial staff of congregate settings. There is need to setup protocols for comprehensive TB detection, care and follow-up of patients in these settings. Strengthen the documentation and notification system in order to understand the actual burden of tuberculosis in these set-ups.  There is a need for India to develop guidelines and formulate policies for control of TB in congregate settings.

Dissemination of study findings

  1. After completing the assessment of facilities, 3 stakeholder meetings were conducted across the city. These meeting attended by representatives of facilitates that participated in the study, 24 Mumbai District TB officers (DTO’s) as well as other MDTCS staff and Mumbai City TB Officer Dr. Minnie Khetarpal were held to present the study findings and observation to the TB officers, sensitize the facility administration about TB and to frame a SOP for TB detection and care in correctional and congregate settings.
  2. Various strategies to prevent and control tuberculosis in congregate and correctional facilities of Mumbai were discussed and proposed during these meeting. The contact details of facilities and strategies proposed during stakeholder meetings - for TB detection and care in congregate settings were shared with all the respective ward District TB officers.
      • Some of the key strategies proposed:
    • DTOs contact representatives (superintendents/Medical officers) of facilities in their respective wards for a health talk. These health talks will also focus on sensitizing the Medical Officers of facilities on recent updates in TB treatment/care and various RNTCP services.
    • DTO’s will provide contact details (names, phone numbers, email addresses) of ward DTO, MHO, STS, HV- to establish referrals and improve linkages.
    • IEC materials will be distributed to all the facilities. Stickers with names and contact details of DTOS, MOH, STS, HVs disseminated to all settings where there is a risk of TB transmission.
    • Baseline Symptom screening (cough of any duration) of all inmates to be achieved by DTO and facility MO liaison.
    • Quarterly education and awareness workshops for inmates and staff. Training sessions for staff members-management of TB patients. Volunteering staff members can be trained and suitable incentives awarded.
    • Infection control feedback will be given to facilities after visits. Feedback will be prepared after an assessment of the facilities by the respective TB offers to ascertain the factors that may be contributing to the transmission of TB in these settings.
  3. A detailed report of the study was shared with former Chief Secretary of Maharashtra Shri Jayant Kumar Banthia and former Additional Municipal Commissioner of the MCGM Ms. Manisha Mhaiskar

Follow-up activities

An action plan to carry out the proposed strategies was prepared and shared by FMR with the DTO’s.

The DTO’s of wards in which the participating facilities were located were contacted by FMR about 2 months after the initial stakeholder meetings and sharing of action plan. This was to obtain feedbacks on activities conducted towards sensitization and screening of facility staff and residents. FMR also contacted all the facilities that had agreed to be a part of the study, to get their feedback on any visits by their respective ward DTO’s. After a poor response during the first round of communication (September 2013) with the DTO’s, a much more positive response in terms of activities conducted at the participating facilities was received from the DTO’s during the second round of communication in April 2014.

Current undertaking

We are currently collating all the feedback and responses received from both the DTO’s and facilities that had participated in the study. DTO’s and facilities that have not responded yet will be contacted again. This will be done before a review appraising the various activities implemented by DTO’s and feedback from   participating facilities is prepared and circulated to all the key stake holders.

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