Community-based active case finding in India can test and treat more people with TB in hard-to-reach tribal areas

Community-based active case finding in India can test and treat more people with TB in hard-to-reach tribal areas

In India, many people with tuberculosis (TB) are missed by health interventions that are not able to access communities in remote or conflict-affected areas. Community-based active case-finding – i.e. systematically screening high-risk groups for active TB through a door-to-door approach, rather than waiting for people to visit health centres, normally after the disease has further developed – is proven to identify more people with TB in these hard-to-reach areas, and can address the barriers that communities face in accessing treatment.  

A Union project in Chhattisgarh, India, is conducting active case-finding among tribal communities in Narainpur and Kondagoan districts. These communities are affected by an ongoing conflict which makes it difficult for the majority of the tribal populations, who live in densely forested areas of the state, to access health care. This project is funded by TB REACH, which provides grants for projects testing innovative approaches and technologies which can increase the number of people diagnosed and treated for TB in the world’s poorest communities. 

Working in collaboration with two local community-based organisations, The Union’s project teams are training health workers in TB prevention, diagnosis and care, so that they can conduct systematic TB screening in the communities. Volunteers assist by transporting sputum samples to diagnostic facilities and by supporting patients to complete their treatment.

Since the project began in March 2019 it has provided 18,000 tribal households with information about TB, and identified and facilitated Gene-Xpert testing of 1162 presumptive TB patients, resulting in diagnosis and treatment of 121 people with TB.

Among the TB patients was 45 year-old Agantin who lives in Ingra village of the Kondagaon district in Chhattisgarh. Her family belong to the Gond tribe who subsist on agriculture. Agantin had been coughing for over two years and was so weak that she could not stand for more than ten minutes. When Community Volunteer Bharti – who was undertaking active case-finding in the village – saw Agantin’s symptoms, she collected her sputum and had it tested at the District TB Centre. The test showed that Agantin had a strain of TB which was resistant to the most effective medicine, Rifampicin. Bharti facilitated Agantin’s treatment by coordinating with the local authorities of the National TB Programme.

The treatment for drug-resistant TB is long, intensive, and can cause uncomfortable side-effects. When Bharti saw that Agantin had started to refuse her medicine because it made her vomit, she sent her to the district hospital for consultation and counselled her on the benefits of the treatment, and supported Agantin to continue her treatment. Now, Agantin is on regular treatment and her health has improved dramatically.

Results of a similar TB REACH project in India, published recently in The Union’s International Journal of Tuberculosis and Lung Disease, also demonstrate the success of community-based active case-finding in tribal Saharia communities. A 52 percent increase in people tested at laboratories and an 84 percent increase in TB case notifications was achieved, with slightly increased treatment success.

India has the world's highest TB burden and sees a TB related death every two minutes. Prime Minister Narendra Modi has committed to ending TB in India by 2025, five years ahead of the globally agreed target set in the Sustainable Development Goals. In order to achieve this ambitious target, The Union advocates for wider implementation of active case-finding in India which can test and treat people with TB in remote areas where help is needed the most.