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Kerala's multi-layered approach to #endTB

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Private sector participation:

Private sector involvement has been there since 2004 with support of the Indian Medical Association (IMA). Statewide trainings for IMA doctors have been organised to train them in standards of TB care and treatment protocols. Patients diagnosed in the private sector are offered free treatment in the public sector.

Another initiative for better engagement with the private sector is the opening of STEPS (System for TB Elimination in Private Sector) centres in private hospitals. These centres, launched in 2018 by the then WHO Deputy Director Dr Soumya Swaminathan (now Chief Scientist at WHO), act as a link between the public and private sector. They provide a single window for TB case notification, linkage to treatment support, and they also ensure that all public health and social welfare schemes offered to RNTCP patients are available to patients in the private sector too. This has helped in ensuring good treatment adherence in the private sector at par with the public sector.

Some other state wide initiatives:

- School children are provided with handkerchiefs and trained in cough etiquette. There is also a legislation against spitting in public places.

- Token system in hospitals controls overcrowding of patients in OPDs, as overcrowding in hospitals abets TB transmission. A fast tracking mechanism for presumptive TB cases or those diagnosed with TB is in place so that they are fast tracked to the doctor to reduce the time gap between diagnosis and treatment initiation.

- All TB patients are given a financial incentive of 1000 INR every month for nutritional support.

Prevent TB to end TB

Kerala has taken many initiatives to prevent the spread of TB infection and to promote air borne infection control measures in public places. With its successful mapping of vulnerable populations and surveillance system, the state is all geared up for programmatic management of LTBI. Its proposal for a pilot in at least two districts (Idukki and Wayanad) to diagnose and treat LTBI has been approved by the government of India. The primary diagnostic test is interferon gamma release assay (IGRA) and primary treatment regimen is 3HP (once weekly dose of isoniazidrifapentine for 12 weeks). It will be rolled out as soon as the national policy on LTBI management is announced.

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