Active Case Finding for Tuberculosis through TOUCH Agents in Selected High TB Burden Wards of Kolkata, India: A Mixed-methods Study on Outcomes and Implementation Challenges

Abstract

Background: Active case finding for TB was implemented in selected sixty high TB burden wards of Kolkata, India. Community volunteers called TOUCH agents (TAs) identified and referred presumptive TB patients (PTBPs) to health facilities for TB diagnosis and treatment. We aimed to describe the ‘care cascade’ of PTBPs identified during July to December, 2018 and to explore the reasons for attrition as perceived by TAs and PTBPs. Methods: An explanatory mixed methods study with quantitative phase of cohort study using routinely collected data followed by descriptive qualitative study with in-depth interviews was conducted. Results: Of the 3, 86,242 individuals enumerated, 1132 (0.3%) PTBPs were identified. Only 713 (63.0%) PTBPs visited referred facility for TB diagnosis. TB was diagnosed in 177 (24.8%) and the number needed to screen for one TB was 2,183 individuals. The potential reasons for low yield were stigma and apprehension about TB, distrust about TA, wage loss for attending health facilities and substance abuse among PTBPs. Conclusion: The yield of ACF was suboptimal with low PTBP identification rate and high attrition rate. Interviewing each individual for symptoms of TB and supporting PTBPs for diagnosis through sputum collection and transport can be adopted to improve the yield.

Risk Analysis of COVID‐19 Infections in Kolkata Metropolitan City: A GIS‐Based Study and Policy Implications

“…We believed that case fatality rates could be higher in south Kolkata compared to other parts of KMC due to poor health and hygiene conditions. Additionally, the large parts of east and south Kolkata together with several pockets in slums areas north and west of Kolkata coincided with high TB burden (Figure ; Dey et al., 2019). Studies showed that the TB is associated with a 2.1‐fold increased risk of a severe COVID‐19 disease (MOHFW, 2020).…”

“…Lastly, we have calculated a health and hygiene index to address vulnerable areas where people have the greater likelihood of a weak immune system due to lack of access to clean drinking water, sanitation, and hygiene and thereby increasing the risk of COVID‐19 infections (Das et al., 2020). Such areas are typically prone to greater incidences of TB and other infectious diseases (Dey et al., 2019). Therefore, we have considered the following variables: Percentage of households having drinking water from untreated sources (typically contain pathogens, toxic trace elements such as As, Fe, and Mn, and chances of waterborne viruses, Chakraborti et al., 2017).…”

“…The use of water from untreated sources is likely to cause weak immune systems due to the presence of pathogens, and toxic trace elements such as As, Fe, and Mn (Chakraborti et al., 2017). In India, the poorer section of the community is highly susceptible to Tuberculosis (TB) and poses greater risk of COVID‐19 infections (Dey et al., 2019; MOHFW, 2020). Hence, arsenic (As) concentration in untreated groundwater used for drinking, cancer risk in southern KMC wards, and TB burden were used in the analysis (data from Chakraborti et al., 2017 and Dey et al., 2019).…”

Treatment adherence status of the TB patients notified from private sector and its associated factors: Findings of a secondary data analysis from West Bengal, India

“…The large number of patients in private sector has raised concerns about: delayed diagnosis; suboptimal quality of care; incorrect diagnostic treatment protocols; lack of systems for treatment adherence patient support; a high drop-out rate, thus raising the risk of drug resistance to first-line /or second-line drugs 3 . Purba Medinipur with an aim to improve the quality of TB care by introducing innovative solutions [4][5][6][7][8][9] . With the help of THALI project these districts were able to notify nearly 8000 10000 privately treated TB patients respectively during 2017 2018 10,11 .…”