Early TB testing is vital for an effective AIDS response: Government and civil society come together to reinforce this pledge on World TB Day

At the World TB Day press conference, representatives from the Department of AIDS Control, Central TB Division, civil society and affected communities discussed the need for early TB testing for PLHIV.

World TB Day is observed every year on March 24^th. To mark this occasion, India HIV/AIDS Alliance today joined the Department of AIDS Control (DAC) and the Central TB Division (CTD) to create awareness about the importance of early detection and treatment of tuberculosis (TB) among people living with HIV (PLHIV) and strengthening HIV/TB collaborative activities at all levels.

In collaboration with DAC and with support from the Global Fund, Alliance India implements Vihaan, a care & support programme for PLHIV in 31 states and territories. The programme works with 17 regional and state level partner organisations and is establishing 350 Care & Support Centres across India that will help expand access to services, increase treatment adherence, reduce stigma and discrimination, and improve the quality of life of PLHIV.

Vihaan is actively working to ensure that its frontline workers are supporting a range of HIV/TB collaborative activities in coordination with the district level TB units. James Robertson, Executive Director of India HIV/AIDS Alliance commented, “Vihaan is committed to increasing awareness of TB among the PLHIV served by the programme and, through intensified testing, ensuring that co-infected clients are fully supported to complete the full course of treatment.”

Tuberculosis (TB) is a major concern for PLHIV as their impaired immune systems make them particularly vulnerable to the disease. In spite of this, it remains difficult to persuade PLHIV to undergo testing for TB. The double stigma of TB and HIV often keeps PLHIV from visiting clinics to learn their TB status.

Manoj Pardesi, General Secretary of the National Coalition of PLHIV in India (NCPI+) said, “PLHIV are among the most vulnerable to falling ill with TB. We need to do more to diagnose PLHIV infected with TB and reach out to them with treatment.”

The total number of PLHIV in India is currently estimated at 21 lakh, which is third highest in the world (Source: Annual Report 2012-13, Department of AIDS Control). India is also has the highest TB burden in the world with an estimated 2.2 million new TB cases occurring annually. TB is the most common Opportunistic Infection (OI) among PLHIV in India.

Dr. R.S. Gupta, Deputy Director General, CTD, said at the event, “Regular screening of all PLHIV for TB is utmost important for prevention of TB mortality in this group.”

HIV and TB co-infection can be fatal. It is estimated that nearly 25% of AIDS deaths in India are TB-related. TB infection increases progression of HIV infection to AIDS and contributes to accelerated mortality. In 2007, it was estimated that 4.85% of TB cases in India are in patients who are also HIV-positive. Of more than 100,000 presumptive TB cases identified among PLHIV at ART Centres, more than 20% were found to have TB (Source: TB India 2011-Annual Status Report).

Dr. A.S. Rathore, Deputy Director General, Care, Support and Treatment at DAC observed, “It is important for PLHIV in India to get tested for tuberculosis. A lack of early testing increases morbidity and mortality in HIV/TB co-infected patients.”

Mona Balani, a woman living with HIV, noted that, “In too many cases, detection of TB happens too late. Many PLHIV patients reach treatment facilities at a terminally-ill stage.”

Early detection of HIV/TB co-infection and prompt provision of Antiretroviral Treatment (ART) and Anti-TB Therapy (ATT) are key interventions to reduce mortality in this population. Increased joint action by government and civil society to initiate early detection of TB among PLHIV is an important step toward addressing the challenge of HIV/TB co-infection and improving the health and wellbeing of PLHIV in India.

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India HIV/AIDS Alliance (Alliance India) is a diverse partnership that brings together committed organisations and communities to support sustained responses to HIV in India. Complementing the Indian national programme, Alliance India works through capacity building, knowledge sharing, technical support and advocacy. Through our network of partners, Alliance India supports the delivery of effective, innovative, community-based HIV programmes to key populations affected by the epidemic.

World TB Day 2014: New poster campaign to increase awareness among PLHIV of TB co-infection (Hindi version)

March 24 is World TB Day. Tuberculosis (TB) is a major concern for people living with HIV (PLHIV) as their impaired immune systems make them particularly vulnerable to the disease. Providing the right care & support to PLHIV with TB co-infection remains a priority to reduce related morbidity and mortality.

With support from the Global Fund, our Vihaan programme is launching a national campaign on March 24, World TB Day 2014, to increase TB testing and treatment among vulnerable PLHIV. Under the campaign, Vihaan Care & Support Centres (CSCs) will launch posters and organise TB/HIV co-infection awareness activities for clients across the country. A look at the posters launched today:

Poster: Promoting early testing of TB among PLHIV

Poster: Encouraging adherence to TB treatment among PLHIV

Poster: Encouraging completion of DOTS for TB treatment among PLHIV

World TB Day 2014: New poster campaign to increase awareness among PLHIV of TB co-infection (English version)

March 24 is World TB Day. Tuberculosis (TB) is a major concern for people living with HIV (PLHIV) as their impaired immune systems make them particularly vulnerable to the disease. Providing the right care & support to PLHIV with TB co-infection remains a priority to reduce related morbidity and mortality.

With support from the Global Fund, our Vihaan programme is launching a national campaign on March 24, World TB Day 2014, to increase TB testing and treatment among vulnerable PLHIV. Under the campaign, Vihaan Care & Support Centres (CSCs) will launch posters and organise TB/HIV co-infection awareness activities for clients across the country. A look at the posters launched today:

Poster: Promoting early testing of TB among PLHIV

Poster: Encouraging adherence to TB treatment among PLHIV

Poster: Encouraging completion of DOTS for TB treatment among PLHIV

World TB Day 2014: Increasing PLHIV Access to TB Testing and Treatment in India

India has the highest TB burden in the world, and it is estimated that nearly 25% of AIDS deaths in India are TB-related. (Photo of Mycobacterium tuberculosis bacteria, courtesy of CDC/Dr Ray Butler/Janice Haney Carr)

Tuberculosis (TB) is a major concern for people living with HIV (PLHIV) as their impaired immune systems make them particularly vulnerable to the disease. In spite of this, it remains difficult to persuade PLHIV to undergo testing for TB. The double stigma of TB and HIV often keeps PLHIV from visiting clinics to learn their TB status. Unfriendly attitudes of clinical staff only makes things worse.

Take the case of Shanti (name changed), a PLHIV from East Godavari district in Andhra Pradesh. She was found bedridden by an outreach worker (ORW) from our Vihaan programme during a routine visit. Shanti’s son explained that she had rapidly lost weight in the previous weeks and was coughing continuously. The ORW noted some other symptoms possibly indicating TB and suggested that Shanti get a TB test. She refused as during earlier visits clinic staff had not treated her well due to her positive status. She remembered how they had made her rush from one department to other for a simple test.

After much persuasion by the ORW and assurance that she will be treated respectfully, Shanti agreed to visit the district medical centre. She was found TB-positive and was immediately put on Directly Observed Treatment, Short-Course (DOTS). Shanti is now three months into her treatment course. She has regained weight and is on her way back to good health.

Shanti’s experience is all too familiar. India has the highest TB burden in the world, with an estimated 2.2 million new TB cases occurring annually. It is estimated that nearly 25% of AIDS deaths in India are TB-related. In most cases, detection of TB happen too late. Many patients reach the hospital at a terminally-ill stage. Managing side-effects and complications of anti-TB treatment (ATT) and anti-retroviral treatment (ART) is another major challenge for co-infected patients. Ensuring adherence to both treatment regimens remains an uphill task. It has been observed that when some clients show improvements within four to six months, they stop taking their ATT, believing they are fine. But incomplete treatment can lead to further complications, including multi-drug-resistant (MDR) TB.

Providing the right care & support to PLHIV with TB co-infection remains a priority to reduce related morbidity and mortality. With support from the Global Fund, our Vihaan programme is launching a national campaign on March 24, World TB Day 2014, to increase TB testing and treatment among vulnerable PLHIV. Under the campaign, Vihaan Care & Support Centres (CSCs) will launch a poster campaign and organise TB/HIV co-infection awareness activities for clients across the country. The CSCs will also hold special sensitisation workshops for stakeholders on the need for friendly and responsive services for co-infected patients.

Over the course of the following month, CSCs will hold support group meetings (SGMs) on TB/HIV co-infection. District TB Officers (DTOs) will be engaged to train CSC staff across India on TB/HIV co-infection, the importance of early detection, verbal screening and TB care. Wherever feasible, DTOs and other medical officers will be called to facilitate discussion in these SGMs. Since more than 50% of staff at CSCs are from the PLHIV community, staff members will also be encouraged to go for TB screening to set an example to fellow community members.

In solidarity with World TB Day, Vihaan is committed to increasing awareness of TB among the PLHIV served by the programme and, through intensified testing, ensuring that co-infected clients are fully supported to complete DOTS. As our campaign posters say, TB can be cured! Access to TB care is a basic human right, and Vihaan will do all we can to ensure that PLHIV in India have full access to TB testing and treatment!

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The author of this post, Mona Balani, is Programme Officer: Vihaan at India HIV/AIDS Alliance in New Delhi.

With support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, Vihaan is establishing 350 Care & Support Centres across India that will help expand access to services, increase treatment adherence, reduce stigma and discrimination, and improve the quality of life of PLHIV. The centres will support PLHIV, including those from underserved and marginalized populations who have had difficulty in accessing treatment including women, children and high-risk groups in 31 states and territories.

World TB Day 2013: Reducing tuberculosis burden through verbal screening of most-at-risk populations in Andhra Pradesh, India

Under the verbal TB screening programme, peer educators and outreach workers identify clients with TB symptoms during couselling sessions and refer suspected cases for testing. (Photo by Prashant Panjiar for India HIV/AIDS Alliance)

India’s tuberculosis (TB) burden accounts for one-fifth of the global cases of the disease. In 2011, there were an estimated 3.1 million Indians affected by active TB. The problem is further compounded by HIV/AIDS, which is driving the resurgence of TB not only globally but also in India. HIV increases TB risk approximately seven-fold. Of the estimated 1.42 million TB deaths across the world, 430,000 die due to HIV/TB co-infection.

Typically, the integration of TB interventions into HIV services has focused on generalised HIV epidemics, with less emphasis on key populations, including sex workers, men who have sex with men (MSM), and people who use drugs. Yet the engagement and participation of key populations can be a vital strategy to address HIV/TB co-infection and improve access to diagnostic and treatment services toward the goal of achieving zero TB deaths.

Recognising the vulnerability of key populations and the difficulties they face in accessing TB services, India HIV/AIDS Alliance under the Bill & Melinda Gates Foundation’s Avahan India AIDS Initiative has implemented a verbal TB screening programme in Andhra Pradesh since 2007. Under the screening programme, peer educators at health clinics and outreach workers in the field identify TB symptoms in key population clients and refer suspected cases for sputum testing.

Take the case of Satyanandam, a member of the local MSM community. During a regular medical check-up at one of Alliance India’s Mythri clinics, he was found through verbal screening to be suffering from symptoms of TB: cough and night sweats. He was referred to a designated microscopic centre for sputum testing. An outreach worker accompanied him to the facility where he was found positive for TB.

Satyanandam was then supported by a local non-profit organisation (NGO) to ensure he successfully completed treatment. An outreach worker kept tabs on his medicine intake and advised him to stop smoking and practice good cough etiquette. After six months of treatment, Satyanandam was cured of TB. “Thanks to the Mythri clinic, the outreach workers, and NGO staff who cared for me during my illness. Because of their support, my family and I are healthy and happy now,” he said.

In fact, there are many Satyanandams who have been cured due to early TB detection through verbal screening. To date, 54,000 people have undergone verbal screening in Andhra Pradesh and among them, almost 2,000 each year have been referred for sputum examination. The proportion of people who accessed TB treatment increased from 83% to 94% in three years.

The intervention demonstrated that integration of TB interventions into HIV prevention services for key populations is feasible and complements the Government of India’s goals and targets under the Revised National Tuberculosis Control Program (RNTCP). Partnership with most-at-risk communities, civil society organisations, healthcare providers and government should be a key strategy to realise a world with zero deaths from TB, so that every Sathyanandam can live a long and productive life without TB.

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The author of this post, Dr. Parimi Prabhakar, is Director of Alliance India’s Regional Office in Hyderabad.

 

The Avahan India AIDS Initiative (2003-2013) is funded by the Bill & Melinda Gates Foundation. The programme aims to reduce HIV transmission and the prevalence of STIs in vulnerable high-risk populations, notably female sex workers, MSM, and transgenders, through prevention education and services such as condom promotion, STI management, behavior change communication, community mobilization, and advocacy. Avahan works in six states, and Alliance India is a state lead partner in Andhra Pradesh.

International Women’s Day 2013: Empowering Women Living with HIV

Celebrate International Women’s Day with almost one million Indian women living with HIV. (Photo © 2012 Prashant Panjiar for India HIV/AIDS Alliance)

International Women’s Day was first officially observed in 1911 and remains an annual opportunity to call for change and celebrate the many acts of courage and determination by ordinary women who play an extraordinary role in the world’s future.

It’s hardly been three months since India came to a standstill after the gruesome gang rape in New Delhi. The incident generated national and international attention and was condemned in India and abroad. It has left us determined to find answers to difficult but basic questions: Are India’s women really safe, both inside and outside their homes? Can they celebrate their freedom? How can we ensure that all women are able to pursue their dreams?

Over the years, considerable effort has gone into social, political and economic empowerment of women, but progress has been too slow. For women living with HIV (WLHIV) in India, the challenges are multiple. These women encounter daily stigma & discrimination and face barriers to accessing HIV prevention, treatment and care as well as sexual and reproductive health (SRH) services. WLHIV often lack status and decision-making power and have inadequate control over financial resources and limited mobility to travel to find better jobs. Even today, laws and policies impede their access to health care and other services.

Though the sexual reproductive health and rights of people living with HIV (PLHIV) remain largely unrealized in this country, India HIV/AIDS Alliance is working to address some of the issues faced by WLHIV through our Koshish Project. With financial support from European Commission, Koshish affirms the principles of empowerment and partnership as core strategies to tackle the problems faced by these women, including stigma & discrimination, inaccessibility and non-availability of services and the lack of comprehensive SRH for PLHIV.

Through partners in Andhra Pradesh, Gujarat, Maharashtra and Tamil Nadu including PLHIV networks in these states, Koshish works with providers and decision-makers to help make barrier-free services available and formulate sensitive and progressive policies for PLHIV and key populations. Programme partners have proactively engaged these stakeholders to advocate for quality SRH services. Advocacy has focussed on issues like maternal health services for WLHIV, cervical cancer screening, quality counselling and increased awareness of SRH and rights.

It is a now time for us to look ahead and celebrate the untapped potential and opportunities that await future generations of women including WLHIV. As we enjoy the song “One Woman”  to be released by UN on this International Women’s Day, let us dedicate our time and resources and pledge our commitment to WLHIV by mobilizing and empowering them and jointly advocating for their rights and needs in India and all over the world.

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The author of this post, Kumkum Pal, is Programme Officer for Alliance India’s Koshish programme.

Alliance India works closely with PLHIV in India through its Koshish programme which aims to strengthen civil society organisations and networks that represent and work with PLHIV and other marginalised groups, such as MSM, transgenders, sex workers and IDUs, to effectively advocate for policies to improve the sexual & reproductive health and rights (SRHR) of PLHIV in India. This project is funded by the European Commission and is implemented in partnership with MAMTA, PWDS, VMM and CHETNA, along with state-level networks for PLHIV in Maharashtra, Tamil Nadu, Andhra Pradesh and Gujarat.

Mark your calendars for AIDS 2012 sessions on Sex Workers & HIV

India HIV/AIDS Alliance has been working closely with partners worldwide to make sure that the issues of sex workers are heard at the upcoming International AIDS Conference in Washington, DC. If you are attending, we encourage you to participate in the events below.

In conjunction with AIDS 2012, the Global Network of Sex Work Projects (NSWP) is hosting the Sex Worker Freedom Festival, a conference hub in Kolkata, India. The programme will focus on a variety of freedoms such as the freedom of movement and to migrate; the freedom to access quality health services; freedom from stigma and discrimination; and many more. Staff from Alliance India will participate in the Kolkata hub.

All events below take place at the Walter E. Washington Convention Center, Washington, DC, unless otherwise indicated.

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Alliance Exhibition Booth (#102)
Come visit booth #102 to learn about the Alliance’s work in India and around the world, pick up copies of our publications and find out more about the Alliance Regional Technical Support Hubs.
All week, Exhibition Hall, 10:00am-6:30pm

Satellite Session
Reaching Key Populations through SRH/HIV Integration: Opportunities for Impact
Organised by India HIV/AIDS Alliance and chaired by UNAIDS, this session will present programming experiences highlighting the challenges and successful approaches used in integrated programmes specific to key populations, including sex workers. Panelists include the Alliance’s Sunita Grote, USAID’s Clancy Broxton, CAMNAFAW’s Nathalie Nkoume, and NEPHAK’s Rahab Mwaniki.
Sunday, July 22, Global Village Session Room 1, 3:45-5:45pm

Poster Presentation
Non-Commercial Partner Relationships and HIV Risk Outcomes, HIV among Female Sex Workers in Andhra Pradesh, India (MOPE249)
Monday, July 23, Exhibition Hall, Level 2, 12:30-2:30pm

Poster Presentation
Public private partnership as a sustainable model for STI service delivery: Evidence from Avahan-supported interventions in Andhra Pradesh, India (WEPE638)
Wednesday, July 25, Exhibition Hall, Level 2, 12:30-2:30pm

Oral Poster Session
Expanding Covering and Quality: Approaches to Scaling-Up
Alliance’s Sunita Grote will present recommendations on reaching Key Populations in SRH/HIV integration, including guidance on services for sex workers, MSM, transgenders, IDUs and PLHIV. (WEPDE0102)
Wednesday, July 25, Mini Room 3, 1:00-2:00pm

Poster Presentation
Strengthening case finding through verbal TB screening among most at risk populations in concentrated epidemics: Experience from Avahan in Andhra Pradesh, India (THPE627)
Thursday, July 26, Exhibition Hall, Level 2, 12:30-2:30pm

Poster Presentation
Mobilizing community collectivization among female sex workers (FSWs) to promote STI service utilization from the government health care system: Experience from Avahan in Andhra Pradesh, India (THPE305)
Thursday, July 26, Exhibition Hall, Level 2, 12:30-2:30pm

Press Conference
Turning the Tide: Addressing SRH Needs of Key Populations in AIDS Programs
This press conference will include remarks by Daxa Patel, the Board Secretary, Gujarat State Network of PLHIV, and by Sunita Grote from the Alliance.
Thursday, July 26, Media Center, Press Conference Room 2, 3:30-4:00pm

If you have any questions, please contact us at info@allianceindia.org. You can also view our AIDS 2012 Roadmap for all India HIV/AIDS Alliance sessions at the International AIDS Conference. We hope to see you at AIDS 2012!