Kiosk: An Innovative Client Centric Approach to Tuberculosis Prevention and Care

Kiosk is a client centric drop-in centre for TB information and services established in urban and peri-urban (slum) settings to provide outreach services under project Axshya. The main objective of the study was to demonstrate the efficacy and feasibility of scaling-up of the model to provide TB services. The assessment was carried out with the help of project recording and reporting formats used to document the information and services provided in the Kiosk from April 2016 to March 2017. The results from retrospective data analysis for services provided at 20 kiosks benefited 16,871 clients;of these 11,252 (66.7%), 1339 (7.9%), 848 (5%), 2911 (17.2%), (1.4%), 273 (1.6%) benefited with TB information, Flexi-DOT, sputum-collection-transportation (SCT), counselling, and domiciliary care respectively. Through active case finding (ACF);126,893 households were visited and 3593 presumptive-TB-patients received SCT services. A total of 329 TB patients were identified and linked to treatment services of national TB programme. “Kiosk” as a client centric approach would be a novel concept to ensure TB information, TB related services and contribute to ongoing efforts of TB case finding.

Adding Sputum Collection and Transportation Services for Early Identification TB Cases in Hard-to-Reach Difficult Terrain—Will It Help?

A community engagement project was designed and implemented to reach 10.6 million population in 13 districts of Uttarakhand state—India, to identify presumptive TB patients (PTBPs) and link to free diagnostics services, either through referral or sputum collection and transportation (SCT). The objective of this study is to determine additional yield of TB patients achieved by providing SCT services in comparison to referrals of PTBPs identified in hard-to-reach areas. This was before and after comparative study conducted between April-June 2014 (2Q2014-before) to July-September 2014 (3Q2014-after). SCT was advised for all PTBPs identified from community level interventions between July-September 2014 (3Q2014-after). In 3Q2014, additional 279 (34%) PTBPs were examined in the microscopy centre with an additional 36 (51%) new smear positive (NSP) patient diagnosed. A total of 46 NSP (128%) were contributed by SCT alone. Higher proportion (94%) of TB patients was initiated on treatment in 3Q2014 in comparison to 2Q2014 (91%). SCT as a strategy for early case detection in hard-to-reach difficult terrain yields positive results in comparison to mere referral of PTBPs.

Asymptomatic Screening of Clients on Opioid Substitution Therapy for Tuberculosis: An Experience from India

Clients on Opioid Substitution Therapy (OST) may be at risk of TB. We screened for tuberculosis in asymptomatic OST clients using Chest-X-ray (CXR) and sputum from those with CXR suggestive of TB were tested using Xpert MTB/Rif. Among 472 who underwent CXR, 0.1% had CXR suggestive of TB. The number needed to screen was 118 clients for one CXR suggestive of TB. All four clients with CXR suggestive of TB underwent MTB/Rif assay and one was diagnosed with TB. The TB patient was asymptomatic and could have been missed through the passive approach. We recommend further studies to explore ACF among OST clients.