ICMR-National Institute of Epidemiology (ICMR-NIE), Chennai, India.
REACH (Resource Group for Education and Advocacy for Community Health), Chennai, India.
Glob Health Sci Pract. 2024 Aug 27;12(4). doi: 10.9745/GHSP-D-23-00504.
Two critical components of patient support systems for people with TB are regular counseling and locally managed nutritional support. As part of an ongoing differentiated TB care initiative called Tamil Nadu Kasanoi Erappila Thittam (meaning TB death-free initiative in Tamil, TN-KET) to reduce TB deaths, adults with TB with very severe undernutrition, respiratory insufficiency, or poor performance status are identified at diagnosis (triage-positive) and prioritized for referral, comprehensive clinical assessment, and inpatient care. Between January and June 2023, in 6 districts, a pilot exercise was conducted in which trained TB survivors, known as TB champions, provided baseline counseling and additional counseling (if required) to triage-positive people with TB at diagnosis. Additionally, people with TB with severe undernutrition were prioritized for nutritional supplementation for at least 3 months. Among 652 people with TB who were triage-positive at diagnosis, the program staff shared details of 145 (22%), and all were counseled by TB champions (baseline counseling). Program staff identified 74 (11%) triage-positive people with TB who required additional counseling (i.e., those refusing referral or admission or continued admission), and 71 (96%) were counseled by TB champions. Among these, 54 (76%) were admitted or readmitted and successfully discharged. In addition, among 1,042 people with TB with severe undernutrition, program staff shared details of 390 (38%), of which 60% received nutritional supplementation through the efforts of TB champions. We conclude that TB champions were able to provide quality and timely peer support through direct counseling and by mobilizing local resources for nutritional support. The engagement of TB champions can be further strengthened by establishing robust coordination mechanisms with the TB program. Lessons from this pilot will contribute to the Tamil Nadu State TB Cell's plans to expand the role of TB champions and enhance community participation to end TB in India.
患者支持系统的两个关键组成部分是定期咨询和本地管理的营养支持。作为一项正在进行的差异化结核病护理计划的一部分，该计划名为泰米尔纳德邦 Kasanoi Erappila Thittam（意为泰米尔语中的结核病无死亡倡议，TN-KET），旨在降低结核病死亡率，对于非常严重的营养不良、呼吸功能不全或表现状态差的结核病成人患者，在诊断时（筛选阳性）会被识别出来，并优先转介、进行全面临床评估和住院治疗。在 2023 年 1 月至 6 月期间，在 6 个地区进行了一项试点工作，其中经过培训的结核病幸存者，被称为结核病冠军，在诊断时为筛选阳性的结核病患者提供基线咨询和额外咨询（如果需要）。此外，严重营养不良的结核病患者被优先考虑至少 3 个月的营养补充。在 652 名诊断时筛选阳性的结核病患者中，项目工作人员与 145 名（22%）患者分享了详细信息，所有患者均由结核病冠军进行了咨询（基线咨询）。项目工作人员确定了 74 名（11%）需要额外咨询（即拒绝转介或住院或持续住院的患者）的筛选阳性结核病患者，其中 71 名（96%）由结核病冠军进行了咨询。在这些患者中，54 名（76%）患者入院或再次入院并成功出院。此外，在 1042 名严重营养不良的结核病患者中，项目工作人员与 390 名（38%）患者分享了详细信息，其中 60%通过结核病冠军的努力接受了营养补充。我们得出的结论是，结核病冠军能够通过直接咨询和动员当地资源提供营养支持，提供高质量和及时的同伴支持。通过与结核病项目建立强大的协调机制，可以进一步加强结核病冠军的参与。从这次试点中吸取的经验教训将为泰米尔纳德邦结核病细胞计划扩大结核病冠军的角色和加强社区参与以结束印度的结核病做出贡献。
