Karnataka Health Promotion Trust, Bengaluru, Karnataka, India.
Office of the Joint Director (TB), Commissionerate of Health and Family Welfare, Hyderabad, Telangana, India.
J Glob Health. 2021 Jul 17;11:04042. doi: 10.7189/jogh.11.04042. eCollection 2021.
Tuberculosis Health Action Learning Initiative (THALI) funded by USAID is a person-centered initiative, supporting vulnerable urban populations to gain access to TB services. THALI trained and placed 112 Community health workers (CHWs) to detect and support individuals with TB symptoms or disease within urban slums in two cities, Hyderabad and Bengaluru, covering a population of about 3 million.
CHWs visited the slums once in a fortnight. They conducted TB awareness activities. They referred individuals with TB symptoms for sputum testing to nearest public sector laboratories. They visited those testing TB positive, once a fortnight in the intensive phase, and once a month thereafter. They supported TB patients and families with counselling, contact screening and social scheme linkages. They complemented the shortfall in urban TB government field staff numbers and their capacity to engage with TB patients. Data on CHWs' patient referral for TB diagnosis and treatment support activities was entered into a database and analyzed to examine CHWs' role in the cascade of TB care. We compared achievements of six monthly referral cohorts from September 2016 to February 2019.
Overall, 31 617 (approximately 1%) of slum population were identified as TB symptomatic and referred for diagnosis. Among the referred persons, 23 976 (76%) underwent testing of which 3841 (16%) were TB positive. Overall, 3812 (99%) were initiated on treatment and 2760 (72%) agreed for regular follow up by the CHWs. Fifty-seven percent of 2952 referred were tested in the first cohort, against 86% of 8315 in the last cohort. The annualized case detection rate through CHW referrals in Bengaluru increased from 5.5 to 52.0 per 100 000 during the period, while in Hyderabad it was 35.4 initially and increased up to 118.9 per 100 000 persons. The treatment success rate was 87.1% among 193 in the first cohort vs 91.3% among 677 in the last cohort.
CHWs in urban slums augment TB detection to care cascade. Their performance and TB treatment outcomes improve over time. It would be important to examine the cost per TB case detected and successfully treated.
由美国国际开发署（USAID）资助的结核病健康行动学习倡议（THALI）是一项以人为本的倡议，旨在支持弱势城市人口获得结核病服务。THALI 在海得拉巴和班加罗尔两个城市的城市贫民窟培训并部署了 112 名社区卫生工作者（CHW），以发现和支持有结核病症状或疾病的个人，覆盖约 300 万人。
CHW 每两周访问一次贫民窟。他们开展结核病宣传活动。他们将有结核病症状的个人转介到最近的公共部门实验室进行痰检。在强化期，他们每两周访问一次检测呈阳性的人，此后每月访问一次。他们为结核病患者及其家属提供咨询、接触筛查和社会计划联系。他们弥补了城市结核病政府外勤人员人数的不足和他们与结核病患者接触的能力。关于 CHW 为结核病诊断和治疗支持活动转诊的患者的数据被输入数据库，并进行分析，以检查 CHW 在结核病护理级联中的作用。我们比较了 2016 年 9 月至 2019 年 2 月期间六个半年转诊队列的成就。
总体而言，31617 名（约 1%）贫民窟人口被确定为有结核病症状并转介进行诊断。在转诊的人中，23976 人（76%）接受了检测，其中 3841 人（16%）呈结核病阳性。总体而言，3812 人（99%）开始接受治疗，2760 人（72%）同意由 CHW 进行定期随访。第一队列中有 57%的 2952 名转诊患者接受了检测，而最后一队列中有 86%的 8315 名转诊患者接受了检测。在此期间，班加罗尔通过 CHW 转诊的年度病例检出率从每 10 万人 5.5 例增加到 52.0 例，而海得拉巴的初始检出率为 35.4 例，增加到每 10 万人 118.9 例。第一队列中的 193 例治疗成功率为 87.1%，而最后一队列中的 677 例为 91.3%。
城市贫民窟的 CHW 增加了结核病检测到护理级联的数量。他们的表现和结核病治疗结果随着时间的推移而提高。检查每个结核病病例的检测和成功治疗的成本非常重要。
