Purohit Vidula S, Karvande Shilpa Santosh, Shah Daksha Y, Vallepawar Omprakash B, Yadav Omprakash J, Mistry Nerges F
Community Health Division, Foundation for Medical Research, Mumbai, Maharashtra, India.
Public Health Department, Brihanmumbai Municipal Corporation, Mumbai, Maharashtra, India.
Indian J Community Med. 2025 Jan-Feb;50(1):225-229. doi: 10.4103/ijcm.ijcm_744_23. Epub 2025 Jan 23.
Finding missing tuberculosis (TB) cases from the "under-reached" population of urban slums and connecting them with TB services is a priority and ongoing challenge for India. It requires the effective engagement of community health workers including urban Accredited Social Health Activists (U-ASHAs). The study aimed to understand the current engagement of U-ASHAs in TB care and their commensurate preparedness in terms of TB knowledge and training. An exploratory study was conducted in Mumbai and Pune cities of Maharashtra during 2022-23. The study used a mixed-methods approach, including a semi-structured survey of U-ASHAs (n = 222) and in-depth interviews with relevant stakeholders (n = 33). The statistical analysis used was descriptive statistics using MS Excel. The average age and work experience of U-ASHAs were 35.4 (21-50) years and 2.7 (0.5-6) years, respectively. They considered maternal child health services as their main portfolio and TB as an ancillary program. They were mainly involved in a biannual active case finding (ACF) and were recently envisioned as TB treatment supporters with poor clarity about other roles in TB care. Just half-day training for TB as part of 8-day general induction training, brief updates before ACFs, and the absence of an on-the-job supervisory structure resulted in TB knowledge gaps particularly for the latest diagnostic tests, adverse drug reactions, government schemes for TB patients, and contact tracing. Conclusions: Intermittent TB activities coupled with insufficient training impede U-ASHAs' functionality in TB care. Clarity of TB-related roles, integration of TB activities in daily tasks, comprehensive training, and on-the-job supervisory structures have merit in strengthening U-ASHAs' engagement in urban TB care.
从城市贫民窟“难以触及”的人群中找出失踪的结核病患者，并将他们与结核病服务联系起来，这是印度的一项优先任务且一直面临挑战。这需要社区卫生工作者的有效参与，包括城市认证社会健康活动家（U-ASHAs）。该研究旨在了解U-ASHAs目前在结核病护理方面的参与情况以及他们在结核病知识和培训方面相应的准备情况。2022 - 2023年期间在马哈拉施特拉邦的孟买和浦那市进行了一项探索性研究。该研究采用了混合方法，包括对U-ASHAs进行半结构化调查（n = 222）以及对相关利益攸关方进行深入访谈（n = 33）。所使用的统计分析是使用MS Excel进行描述性统计。U-ASHAs的平均年龄和工作经验分别为35.4（21 - 50）岁和2.7（0.5 - 6）年。他们将母婴健康服务视为主要工作内容，而结核病作为辅助项目。他们主要参与半年一次的主动病例发现（ACF），最近还被设想为结核病治疗支持者，但对于结核病护理中的其他角色却不太明确。作为为期8天的一般入职培训的一部分，结核病培训只有半天时间，在ACF之前有简短更新，并且缺乏在职监督结构，这导致了结核病知识差距，特别是在最新诊断测试、药物不良反应、针对结核病患者的政府计划以及接触者追踪方面。结论：间歇性的结核病活动加上培训不足阻碍了U-ASHAs在结核病护理中的功能。明确与结核病相关的角色、将结核病活动融入日常工作、进行全面培训以及建立在职监督结构，对于加强U-ASHAs在城市结核病护理中的参与度具有重要意义。
