India-TB/HIV Co-infection Management

Background: TB/HIV collaboration is mostly health-system centric which means the activities aim generally to medical management of co-infected cases without considering much the importance of community sensitization and mobilization.  The NGO-consortium led by World Vision India (WV India) made meaningful contribution to bring the TB/HIV collaborative programs at community level. It strengthened key linkages which not only enhanced notification of TB/HIV co-infected cases and TB cases in HIV high-risk groups but also improved their service-utilization. 


Intervention: Under the GF-supported TB Project (Axshya) WV India and 6 partners established linkages with 1) 65 district level networks of PLHIV and 2) 450 Targeted Intervention (TI) HIV projects in 74 districts of 8 states of India. Using specially designed training modules, 1617 PLHIV and 374 Program Managers of the TI projects were sensitized on TB by Project Axshya from Apr’13 to Dec’14. They were also assisted in developing and implementing their organizational TB action plans including creating case-wise line-lists of the referrals to TB services and their outcomes.  These activities enabled PLHIV and HIV high risk groups to gain knowledge and awareness on TB, reduce stigma and myths and subsequently utilize the services under the national TB & AIDS programs.


Results: The PLHIV networks have identified 986 presumptive TB cases (following WHO’s standard symptom selection criteria) through community level TB education and active case search, 953 of them tested in local RNTCP-affiliated laboratories, 83 of them found to be SS+ Pulmonary TB and put on DOT. They were also initiated ART and CPT.  The HIV-TI projects referred 504 presumptive TB cases from the high risk groups like FSWs, IDUs, migrants, MSM/TG and truckers, 493 of them tested in RNTCP, 23 detected with SS+ Pulmonary TB and put on DOT. The project spent around 30 USD to help the PLHIV networks and TI-HIV projects to detect one TB case.


Conclusions:
The interventions establishing linkages with PLHIV networks and TI projects created the road-map to effective community-based TB/HIV collaborative programs where dual infected, affected and vulnerable community groups and networks are sensitized, de-stigmatized and mobilized to optimally utilize the existing services with the help of a NGO-consortium under the GF-supported TB project.