TB control needs person-centred solutions

 TB control in India calls for person-centred solutions

Even though World TB Day (March 24) has passed, recognising the needs and the interests of patients and communities must form the basis of disease elimination

 not available to every person suspected to have TB 

 1 Access to efficient and high quality care — diagnosis, treatment and support — is still not available to every person suspected to have TB or diagnosed with the disease. 

2 As India grapples with the complexities of controlling TB, we need a paradigm shift urgently — one that places those affected and their lived experiences at the centre of tackling this ancient disease.

3  the needs and the interests of patients and communities must be prioritised within the care paradigm and the health-care system. 

4 This principle, echoed by survivors, communities, health experts and policymakers, underscores the need for a person-centred approach to TB care and management.

Understanding lived experiences

 A case in point is nutritional support, which while limited, is an important step. 

Further, the growing focus on patient support, addressing stigma, and gendered aspects of TB has also been important.

Is this enough? Not entirely

1 To provide high quality, person-centred care, we need to bridge the gap between policy intent and on-the-ground realities.

 2 For instance, India needs to prioritise targeted interventions aimed at improving and expanding access to TB diagnosis and treatment. 

3 We need to expand the reach of TB testing facilities, particularly in rural and underserved areas, 

4 and ensure the availability of free, affordable and quality-assured TB drugs.

 5 Molecular testing is the gold standard and less than a quarter of symptomatic patients are getting that as their first test

6  Recent reports of drug and diagnostics stockouts are troubling and unacceptable.

Care needs to be more humane

 make care more humane

1  Hence, mental health support and gender responsive care become critically important. 

2 Efforts are also needed to strengthen

•  community-based TB care models, 
• empowering frontline health-care workers to deliver comprehensive care which addresses not just treatment but also social, economic and mental health needs and is closer to where patients live. 

stigma, discrimination and mental stress 

1 This is important as survivor narratives tell us the stigma, discrimination and mental stress they go through, not to mention the side-effects of treatment.

2 By 

• supporting frontline TB workers, 
• 
  
• strengthening supply chains 
• 
  
• and procurement mechanisms, 
• 
  
• decentralising TB services and 
• 
  
• empowering local communities, India can reduce stigma, overcome barriers to access and enhance treatment outcomes.

3 While TB can affect people of any class, religion, ethnicity, and socioeconomic status, it disproportionately affects the most marginalised in society, including children, the urban poor, prisoners, and people living with HIV/AIDS. 

TB as a economic crisis 

The disease has gone beyond being a health crisis alone. It is an economic crisis which by some estimates, costs India billions in losses each year and pushes families and communities into debt and poverty.

Addressing the socio-economic determinants of TB

requires a multi-sectoral approach. 

• Poverty alleviation, 
• 
  
• improvement in nutritional status, 
• 
  
• well-ventilated housing and
• 
  
•  better air quality will all contribute towards reducing TB.
• 
  
•  Recent research has shown that nutritional supplementation reduced TB incidence substantially in household contacts of adults with microbiologically confirmed pulmonary TB. 

Tapping technology

Leveraging technology and innovation 

it holds promise in enhancing TB care efforts in India.

 The adoption of AI and digital health solutions for TB diagnosis, adherence and surveillance can revolutionise the way TB care is delivered and accessed in the country. 

By investing in developing better vaccines, we can hope to ultimately eliminate this airborne disease.

The path to TB elimination in India requires a concerted effort to prioritise

•  person-centred care, 
• 
  
• address social determinants of health, 
• 
  
• and embrace innovation.
• 
  
•  By adopting a holistic and person-centred approach, India can overcome the barriers that stand in the way of TB control and create a healthier future for all its citizens.

source the hindu