Title: TB services for the High-Risk-Groups (HRGs) of HIV programs through Targeted Intervention (TI) –TB collaboration: good practices from South-East Asia
Author: Dr Sugata Mukhopadhyay
Background: In Asia, HIV epidemic is mostly concentrated within HRGs (sex workers, IDUs, MSM/Transgender, migrants, prisoners). They are equally vulnerable to TB due to unhealthy and over-crowded living conditions, poor socio-economic status, lack of nutrition, sheer ignorance and poor infection control in overcrowded health facilities, especially within high TB burden and concentrated HIV epidemic settings. But TB case detection efforts and expanding services are still limited for those groups, who are already covered under HIV programs despite unmet TB case detection targets.
Methods: The 'Targeted Intervention' (TI) HIV Prevention projects of HRGs give platform for dissemination of key TB messages, TB case detection in HRGs and linkage development with local TB services through existing peer outreach programs. The STI clinics marked for HRGs perform regular TB screening among clinic attendees and referral. Selected peer Educators of TI projects function as community DOTS providers through training and motivation.
Results: In 2001, Sonagachi STI/HIV Project, Kolkata, India initiated TB case detection in sex workers and their clients with the assistance of City RNTCP Office and CARE West Bengal with encouraging results. In 2005, a pilot project of TI-TB collaboration in Allahabad by CARE India detected 33 TB cases in 18117 high risk population including 10 co-infected cases in 6 months. In 2004 -05, similar pilot project in Bangladesh, the attendees of a STI clinic which was earmarked for HRGs were also screened for TB and 135 TB cases detected within an year. The success of Avahan project in TI-TB collaboration (2006-07) in India prompted emergence of TB/HIV schemes in RNTCP for the NGOs though this scheme has, so far shown grossly insufficient utilization rate.
Conclusion: The initiative needs good advocacy and support to mobilize optimum resources and facilitate strategies and guidelines to saturate HIV TI projects with TB services.
(Selected for poster presentation in 43rd World Lung Conference, Nov'12 in KL)
Title: Southern Health Improvement Samity efforts to serve the underprivileged and difficult-to-reach TB affected people of the islands of Sundarban
Authors: Dr Sugata Mukhopadhyay, Mr M.A. Wohab
Aim: The abstract describes contribution of SHIS, a premier NGO of West Bengal India and partner of India’s Revised Tuberculosis Control Program (RNTCP), to provide TB services to remote islands of Sundarban Delta region at the Southern most part of West Bengal, India as part of country’s ongoing efforts of Universal TB care.
Method: Inhabitants of 54 islands of Sundarban have extremely limited civic amenities like electricity, education and healthcare. Boats and launches are only modes of commutation. Working in TB control since 1982, SHIS has so far covered 39 islands which are home to 2.56 million people. The unique mobile boat dispensary services of SHIS have been reaching marooned villages of the islands, spreading awareness through local folk singers, screening TB suspects through Sputum Microscopy and Chest X-ray as per RNTCP guidelines and providing DOTS to TB patients through local Community DOTS Providers. SHIS has developed a network of 943 of providers across Sundarban who, are mostly cured TB cases and received TB services from the initiative of SHIS.
Results: From 2009 to 2011, SHIS have screened 46866 TB suspects and detected 6707 TB cases with around 58% NSP cases in the islands. NSP case detection rate 67%, 62% and 62% in 2009, 2010 and 2011 respectively. The cure rate of the NSP is 94% in 2009, 99% in 2010 and 94% in 2011.
Conclusion: SHIS already achieved 85% cure rate and will soon achieve 70% NSP CDR through sustained and more intensified mobile boat dispensary services for the underprivileged islanders of Sundarban
(Selected for oral presentation in 43rd World Lung Conference, Nov'12 in KL)
Title: Scaling up of sexual & reproductive health (SRH) services for the sex workers, with the sex workers, by the sex workers – an unique model of Durbar, sex workers’ organization of Kolkata, state of West Bengal, India (35)
Authors: Dr Sugata Mukhopadhyay, Dr Smarajit Jana, bharati Dey, Mrinal Kanti Dutta, Pintu Maity, Dr Protim Roy
Background: Durbar, a sex workers’ organization of Kolkata, West Bengal, India, is working for establishing socio-political and reproductive rights of sex workers. Durbar is pivotal to provide SRH services to sex workers and their clients which were initiated in 1992 in Kolkata through WHO-supported pilot project. Since then, SRH services have been scaled up through unique empowerment model across the state of West Bengal.
Methods: Durbar followed core principles of 3Rs (Reliance, Respect, Recognition), kept sex workers in forefront of SRH project management and leadership since inception and built their capacities on SRH. This helped sex workers to meticulously map and establish effective networks with other peripherally located sex workers across the state. SRH services were scaled up in Kolkata city through 12 SRH clinics which were established between 1992-95 to cover more than 5500 sex workers and clients. By following same principles and strategies, by 2000, SRH services were expanded in 11 more districts of West Bengal with 27 SRH clinics that have been catering SRH services to local sex workers and clients. A network of about 600 well-trained peer counsellors and 30 community nurses has been created from sex workers’ communities in Durbar’s SRH projects that further empowered sex workers through direct SRH service delivery to their own community. Evening SRH clinics have been established exclusively for male clients.
Results: Durbar’s SRH services currently cover over 20,000 sex workers and 60,000 clients in the state. In 2010-11, Durbar provided STI/RTI treatment to 12701 sex workers and 5506 clients, distributed 3424827 condoms and around 50,000 OCPs, screened 22098 persons for syphilis, referred and followed up around 900 women for ANC and referred 21 women for infertility to hospitals.
Conclusions: Durbar model is a unique example of scaling up of SRH services for the sex workers, with the sex workers, by the sex workers.
(Selected for poster presentation in International AIDS Conference 2012)
Title: Total Control of Epidemic (TCE) Program of Humana People to People - A Community Driven Response to the Fight Against AIDS
Authors: Ib Hansen, Sugata Mukhopadhyay, Marie Lichtenberg
Background: The Total Control of Epidemic (TCE) Program of Humana People to People aims to reduce spread of HIV and its impact by systematically engaging individuals and communities to take control of their own risk factors, while increasing access to prevention, treatment and support services. Implemented in close partnership with respective Ministries of Health and National AIDS Councils across Sub-Saharan Africa and Asia TCE has made major impact in HIV control.
Method: TCE model works through two primary strategies:
a) Individual HIV Counselling to Prevent New Infections: Every person in target areas was provided with counselling for behaviour change and was assisted to develop individual risk reduction plan by multiple follow-up sessions of Field Officers of Humana People to People. Home-based testing consistent with country guidelines was conducted as an integrated part of the process.
b) Community Mobilization to Change Social Norms: To change social norms across the full range of HIV related issues (stigma, discrimination etc.), community-wide mobilization was carried out with local leaders, activists, PLHIV to project them as role models for others along with intensified promotion of existing services.
Results: Since the first TCE pilot in Zimbabwe in 2000, 11 million people were covered in 12 countries. 28 million individual HIV counselling sessions were delivered. As a result, 2 million people were tested for HIV and got results. Over 500,000 women attended PMTCT services. In Blantyre, Malawi, 4 times increase of PMTCT utilization within 3 years and in Ehlanzeni District, South Africa, 6 times increase of PMTCT utilization within 4 years after TCE implementation were observed. More than 600,000 community activists were trained and engaged in community mobilization activities.
Conclusion: With average cost of U$ 2/person/year, TCE model represents cost effective community-based interventions for HIV control and care with proven results, that might be replicated across the most HIV affected countries.
(Selected for oral presentation in International AIDS Conference 2012)
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