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.

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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.

Avahan in Andhra Pradesh: Expanded Access and Increased Impact

ai_avahan_cover_low resAvahan India AIDS Initiative is a focused prevention initiative funded by the Bill & Melinda Gates Foundation that works in six states of India to reduce HIV transmission and the prevalence of sexually transmitted infections (STIs) in vulnerable high-risk populations—female sex workers (FSWs), men who have sex with men (MSM) and transgenders—through prevention education and services. The programme’s main components are condom promotion, STI management, behavior change communication, community mobilisation, and advocacy. Avahan also supports the creation of an enabling environment through individual and organisational capacity building to increase the effectiveness of the HIV response.

India HIV/AIDS Alliance is a state lead partner for Avahan in Andhra Pradesh. Alliance India’s efforts in the state have strengthened the capacity of NGOs and CBOs to implement quality HIV and STI programming in close partnership with the State AIDS Control Society (SACS) and in accordance with the National AIDS Control Programme.

Alliance India’s work with Avahan in Phase I covered 13 districts of the Telangana and Rayalseema regions in Andhra Pradesh and reached nearly 72,000 FSWs and MSM. Now in Phase II, Alliance India is transitioning programme activities to the state government as planned and supporting efforts to further strengthen community mobilisation with beneficiary groups to ensure sustainability of prevention activities under government support.

To learn more about our Avahan work in Andhra Pradesh, please download our brochure here.

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The author this post, Dr. M. Ravikanth, is Documentation & Communication Specialist, India HIV/AIDS Alliance.

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, specifically 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.

Increasing Civil Society Involvement in the Fight Against HIV in China

Chinese delegates with Alliance India members in New Delhi

India HIV/AIDS Alliance recently hosted a study tour of the Pehchan project for the China Association of STD and AIDS Prevention and Control (AIDS Association). This tour came in the wake of a significant decision made by the Chinese Government a few years ago to support the increased involvement of civil society organisations (CSOs) in the response to AIDS in China.  To support this goal, the AIDS Association was selected by the Global Fund to handle its contribution of $18 million for Community Based Organisations (CBOs). The journey ahead for the AIDS Association is an exciting one especially given the scale of its responsibilities, which include establishing an independent grant management mechanism managed by civil society.

The visiting team, consisting of delegates from the AIDS Association, China CDC, Ministry of Health, Chengdu Gay Care Organisation (CGCO), State Council AIDS Working Committee Office (SCAWCO) and UNAIDS China, were given a complete overview of the National AIDS Control Programme in India. They met with various stakeholders in NACO, SACS, UNAIDS, and the Bill & Melinda Gates Foundation to understand the role of the government, UN agencies and big donors in promoting the participation of the CSOs in the national AIDS response. The delegates also visited a Hijra CBO in Hyderabad, supported by the Andhra Pradesh State AIDS Control Society (APSACS), which offered them the opportunity to interact with CSO members and hear their experiences about working with the government.

The team learned about Alliance India’s work, particularly the Pehchan programme, and received technical inputs on developing systems and mechanisms in the areas of M&E and finance. They also learned about the various systems which have been developed by Alliance India to provide technical support to CSOs and to build their capacities in the effective management of data and grants.

As the visit came to an end, the Chinese delegates shared a few insights gathered from their trip which resonated strongly with them. Amongst these was Pehchan’s ability to reach the hard-to-reach populations which the government would otherwise find difficult to make contact with. These interventions serve as a bridge to build the capacities of CBOs and to link communities to government supported HIV programmes. The delegates also stated that Pehchan’s ability to align the cost of the Global Fund programme with the Government’s unit costs is essential for the sustainability of the programme once the Global Fund’s support has ended.

You can learn more about the work being done on HIV and MSM by civil society organisations in China by clicking on Alliance China’s report, Community Response to HIV among Men who have sex with Men in China.

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With support from the Global FundPehchan builds the capacity of 200 community-based organisations (CBOs) for men who have sex with men (MSM), transgenders and hijras in 17 states in India to be more effective partners in the government’s HIV prevention programme. By supporting the development of strong CBOs, Pehchan will address some of the capacity gaps that have often prevented CBOs from receiving government funding for much-needed HIV programming. Named Pehchan which in Hindi means ‘identity’, ‘recognition’ or ‘acknowledgement,’ this programme is implemented by India HIV/AIDS Alliance in consortium with Humsafar Trust, SAATHII, Sangama, and SIAAP and will reach 453,750 MSM, transgenders and hijras by 2015. It is the Global Fund’s largest single-country grant to date focused on the HIV response for vulnerable sexual minorities.

Join Alliance India Sessions on Wednesday, July 25 at AIDS 2012

India HIV/AIDS Alliance has lined up an action packed day for you today (Wednesday 25 July) at the International AIDS conference, you are cordially invited to attend all our sessions to learn more about our work in India to improve the AIDS response for communities most affected by the epidemic. Our commitment is to make sure the voices of these communities are heard at AIDS 2012 and beyond.

Our sessions today range from a panel discussion to oral presentations and poster exhibits, and highlight our experiences in a wide variety of areas, including reaching key populations in SRH/HIV integration; addressing the unmet sexual and reproductive health and rights of people living with HIV; mobilizing female sex workers to increase STI service utilization; findings from our baseline study on people who inject drugs and why we should support the decriminalisation of drug use; and more!

Panel Discussion

Criminalise Hate Not HIV: Why the HIV/AIDS community should support the decriminalisation of drug use.

Organised by INPUD, HRI, IPPF, IFRC and the Alliance, this panel is chaired by Prasada Rao, the UN Secretary-General’s Special Envoy for HIV in Asia and the Pacific and an Alliance Trustee.                                                                                              Wednesday, July 25, Global Village Harm Reduction Zone, 11:00am-12:00 noon

Oral Presentation                                                                                                   

Reaching Key Populations in SRH/HIV integration: Recommendations from a global intervention review to identify strategies to increase the responsiveness and relevance of integrated programming to the sexual and reproductive health and rights (SRHR) needs of high-risk groups, including sex workers, MSM, transgenders, IDUs and PLHIV Session Title: Expanding Covering and Quality: Approaches to Scaling-Up, Mini Room 3,  1:00-2:00pm 

Addressing the unmet sexual and reproductive health and rights (SRHR) of people living with HIV (PLHIV): The results from a baseline study in four states in India.                                                                                                                                Session Title: Expanding Covering and Quality: Approaches to Scaling-Up, Mini Room 3, 1:00-2:00pm 

Poster Exhibition                                                                                                        Wednesday, July 25, Exhibition Hall, Level 2

Beyond Heroin: Patterns of drug choice diversity among People Who Inject Drugs (PWID) in three Indian states: Findings from the Hridaya baseline study.

Identifying quality-of-life priorities for People Who Inject Drugs (PWID): Findings from the Hridaya baseline study in three Indian states.

                            

What’s harming harm reduction? Reducing HIV vulnerability among women who inject drugs in South Asia.    

 

Reaching people who use drugs (PWUD) in SRH/HIV integration: Recommendations from a global intervention review to identify strategies to increase the responsiveness    

Public private partnership as a sustainable model for STI service delivery: Evidence from Avahan-supported interventions in Andhra Pradesh, India                        

The roadmap contains a full list of posters being exhibited. You can also pick up material about our work at the Alliance exhibition booth #102. If you have any questions, please contact us at info@allianceindia.org.

Andhra Pradesh increases condom use to improve HIV prevention outcomes

Over the last four years, the southern Indian state of Andhra Pradesh (AP) has seen a 100% rise in the use of condoms, making it the fourth highest consumer of condoms among Indian states.

This noteworthy upward trend in condom use has led to a reduction in new HIV infections amongst Andhra Pradesh’s high-risk populations. The Andhra Pradesh State AIDS Control Society (APSACS), which works closely with Alliance India’s Pehchan and Avahan teams located in AP, is responsible for distributing condoms in the state, both for free and for sale through subsidized social marketing efforts.

A representative from APSACS was quoted as saying, “The situation is such that we have to plan a month in advance for the supply (of condoms) to avoid a shortage.” This is in sharp contrast to the situation four years ago when condom use was so low that APSACS officials stated that lakhs of condoms, having expired, had to be disposed of. You can read the entire story here.