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)

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.


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.

Coffee, Noodles and Harm Reduction: A Menu to Reach Women Who Use Drugs in Manipur

A counsellor advises a client at the Chanura Kol drop-in centre in Imphal. (Photo © Prashant Panjiar for India HIV/AIDS Alliance)

A counsellor advises a client at the Chanura Kol drop-in centre in Imphal. (Photo © Prashant Panjiar for India HIV/AIDS Alliance)

In an effort to increase uptake of essential harm reduction services in Manipur, India, the Chanura Kol project did more than expand its service menu to reach women who inject drugs.

Early on, the Chanura Kol team realised that many women who inject drugs neither have the time nor inclination to stop by the project’s drop-in centre (DIC) in Imphal for counselling services or to meet a doctor. To encourage these women to avail these services, team members initiated special days when free coffee and the popular dish of chow mein noodles were served to visitors.

Soon, Chanura Kol’s ‘Chow Mein & Coffee Days’ gained popularity among community members, and the DIC saw more and more women stopping by and speaking with the doctor and counsellor on duty.

The women who visit are offered a range of services in addition to counselling: needle or syringe exchanges, free condoms, and health checks-up, including medicine for basic health conditions. Additionally, linkages to reproductive health and HIV-related care and clinic-based detoxification therapy are available along with overdose prevention education and Naloxone for overdose-related emergencies.

By offering the hospitality of a simple meal, the DIC has become a more welcoming and comfortable place for the women who use drugs that Chanura Kol is trying to reach. Many of them now refer to the DIC as a second home where they cannot only access health and harm reduction services but also build supportive connections with their peers.


India HIV/AIDS Alliance in partnership with SASO, implements the Chanura Kol project in Manipur. Funded by the Elton John AIDS Foundation, Chanura Kol was initiated in 2010 and serves to expand interventions to reduce drug relapse among female injecting drug users. Based on a holistic and sustainable approach, Chanura Kol aims to address the root causes of vulnerability and the primary causes of relapse post-detoxification for women who inject drugs in India’s north-eastern state of Manipur, many of whom are also sex workers. Chanura Kol provides these women with long-term shelter, creates opportunities for income generation outside of sex work, and encourages the rebuilding of family relationships.

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)

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.


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.