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Ground zero: Frontline champions lead the fight to #endTB as global meet opens in India

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Shobha Shukla CNS

(L to R) G Swamy Reddy, Pallavi, Shobha Shukla of CNS, and Raj Shekhar
(L to R) G Swamy Reddy, Pallavi, Shobha Shukla of CNS, and Raj Shekhar
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It was indeed a humbling experience for me to interact with a few frontline healthcare workers who are courageously fighting the #endTB battle on the ground in Hyderabad, India (the venue for the 50th Union World Conference on Lung Health). My day began with meeting G Swamy Reddy, project officer at Lepra Society in Hyderabad. He has been involved with leprosy and more recently TB care and control activities of Lepra since 1989.

Lepra has been working in the field of TB since 2002. It is now managing 5 out of the 53 Designated Microscopy Centres or DMCs (which are under the Indian government's Revised National Tuberculosis Control Programme - RNTCP) in the city of Hyderabad. About 1000 additional new TB cases get diagnosed and cared for due to these 5 DMCs every year.

We visited one such DMC situated in King Koti, where it was amazing to see the well-coordinated manner in which the work was being done. The laboratory technician of this DMC, Raj Shekhar, explained the treatment algorithm that is followed for all presumptive TB patients coming to the clinic. Not only is their sputum microscopy done, their HIV status and blood-sugar levels are also tested and a chest x-ray taken - all of this on the patients' first visit to the centre on day 1. Moreover the sputum is also sent for CBNAAT testing (Cartridge Based Nucleic Acid Amplification Testing, such as Gene Xpert) and to Intermediate Reference Laboratory for TB drug-resistance profiling.

Sputum test negative but Gene Xpert positive

He said that on an average 10-20% of the patients who test smear-sputum negative by microscopy are diagnosed positive for TB by GeneXpert, due to the superiority of molecular testing. Also 4-5% of those who are diagnosed with TB, also test positive for HIV. All patients' data is recorded meticulously for Nikshay (Indian government's real-time online data-management system). Once diagnosis of TB is confirmed a health visitor visits the patient's house and the patient is immediately put on appropriate TB treatment. If the patient is from some other area (not under the jurisdiction of this DMC), he/ she is immediately referred to the concerned centre and records updated after confirmation is received. Patients are provided with a 28-day supply of fixed-dose combination pills as per their weight. Thus they have to visit the centre only once a month to collect their medicines.

Many patients from the private sector are also referred to this centre. I happened to meet one such female patient who was under treatment for extra-pulmonary drug-sensitive TB. She was a student of B.Com but from her frail appearance looked to be no more than 13-14 years old and weighed less than 34 kg. Two months ago she had recurring low-grade fever, weight loss and loss of appetite. She showed herself to a private doctor who diagnosed TB of the lymph nodes and then referred her to this centre to avail of the free TB treatment in the public health system. Her intensive phase of treatment was about to end and she seemed happy with her progress.

There seemed to be a good collaboration with private doctors. G Swamy Reddy of Lepra informed that, "We have mapped all private doctors in the 5 DMC areas and we sensitise them and interact with them on a regular basis. They now refer many of their patients to us. Many of them have become DOTS providers also - we give them the DOTS boxes so their patients can take the free medications from them only."

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