Project Axshya

The Union’s Project Axshya, working in partnership with seven sub-recipient partners, a network of local non-governmental organisations (NGOs) and over 15,000 community volunteers, provides innovative tuberculosis (TB) interventions designed to serve traditionally hard-to-reach and at-risk populations in India.

Working in tandem with the Revised National TB Control Programme (RNTCP), Project Axshya, meaning TB free, has been able to reach key affected populations, enhance community ownership and create demand for quality services for TB control amongst communities who have the greatest difficulty in accessing TB diagnosis and treatment.

For example, Project Axshya volunteers facilitate TB testing in communities where, for reasons including distance, scarce financial resources, health concerns, or family or work commitments, residents would otherwise be unable to reach state clinics and diagnostic centres.

The Union’s Project Axshya was launched in April 2010, and is financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria.  

The Axshya Approach

The complexity of TB in India requires a concerted effort from multiple stakeholders, across all sectors, working together to tackle it. The collaborative approach has been adopted by Project Axshya to help to expand access to TB information and services, increase the accountability of service providers and empower communities.

The project has a phased approach. The first phase, which started in April 2010, successfully created a strong network of NGOs and community based organisations (CBOs) to help combat the burden of TB. Phase 2 saw the project adopt a sharper focus on ‘most at risk’ populations and affected communities, paying more attention to outcomes and impact rather in addition to the processes used. Phase 3 focused on improving the accessibility of TB services through enhanced case finding and engagement with the private sector and community. Now in phase 4, phase Project Axshya is working in 128 districts across 14 states in India with the objective “to promote early case detection and to promote the management of TB patients through active case finding in key affected populations (KAP).”

Axshya implements a host of outreach initiatives to increase awareness of TB, facilitate TB testing, and transport sputum samples in India. Initiatives include:

TB ‘kiosks’, or small, decentralised TB service centres with extended visitors’ hours where volunteers administer treatment, collect sputum samples and provide drop-in consultations.

Project Axshya has established 97 TB treatment and information kiosks in 40 cities in India to provide better and more patient-centred care. These kiosks provide TB information, counselling and directly observed treatment services to patients and their families. The kiosks address the common challenges faced by the community, including the limited opening hours of healthcare centres, difficulty in accessing care and a lack in personalised service. In 2016, over 30,000 people in vulnerable and at-risk communities benefitted from these services.

Counselling services to support people with multidrug-resistant TB (MDR-TB). In the first three years of being set up Project Axshya counselling service reached over 8,000 MDR-TB patients with services offered at health facilities such as chest clinics and DOT centres, as well as in patients’ homes. The role of counsellors is crucial to ensuring patients’ remain motivated to complete the arduous treatment regimen. Counselling focuses on treatment adherence, as well as psychosocial care, advice to families and caregivers and nutritional support.

A vast volunteer network mobilised throughout the country to address the needs of vulnerable populations with regard to TB information, screening, treatment and support. In 2016, Project Axshya ran a partnership with Muslim religious schools where trusted community leaders disseminated TB information. The project started a community radio initiative that shared information and encouraged the conversation about TB in over 2,000 hours of programming in nine languages and across 17 states. A TB telephone helpline was set up which reached over 125,000 people with easily accessible information, 12 hours a day, in regional languages across six states.

Piloting a web-based software project to provide real-time case reporting and treatment adherence support to patients receiving TB care through the private sector. In collaboration with partners, Project Axshya piloted a web-based project, which used unique software that automatically notified TB cases to India’s Revised National TB Control Program and sends patients daily text messages and twice weekly interactive voice response calls reminding them to take their medication and schedule follow-up visits and tests. In India, nearly 50 percent of TB patients rely on the private sector for treatment, which leads to incomplete data reporting at government level and a higher incidence of incomplete treatment due to a lack of follow-up procedures. The pilot phase reported a 95 percent treatment adherence rate and 90 percent patient satisfaction

The impact of Project Axshya

Since Project Axshya focused on hard-to-reach communities in 2013, the project has:

  • Facilitated the identification and testing of 2 million presumptive TB patients.
  • Offered sputum collection and transportation services, which benefitted over 1,149,000 presumptive TB patients resulting in 102,300 patients being diagnosed with TB.
  • Trained and engaged 25,000 providers who have identified nearly 235,110 presumptive TB patients resulting in diagnosis of over 24,600 TB patients.
  • Counselled over 38,000 drug-resistant TB (DR-TB) patients to support treatment adherence and provide psychosocial support. This has led to a 50 percent reduction in mortality and loss to follow up among the DR-TB patients.
  • Raised awareness of TB and TB services to 85,900 prison inmates and over 6000 qualified private practitioners.
  • Empowered TB patients, especially women, by sensitising them about their rights and responsibilities as per the Patient Charter for TB care. From 2015 to 2019, nearly 125,000 TB patients, including 38,000, women have been sensitised during this period.