Project EQUIP (Enhanced Use of Quality Drugs and Utilization of Innovative diagnostics for TB Management in the Private Sector) was initiated as a partnership between REACH, Greater Chennai Corporation and funded by KNCV Tuberculosis Foundation. This project was built upon the earlier REACH PPM model to demonstrate that the private sector could play a vital role in diagnosing, notifying and ensuring early access to care for people with drug resistant TB (DR-TB) using newer diagnostics and standardized treatment regimens. The initiative was from April 2015 to December 2017. Project EQUIP transitioned into the TB free Chennai Initiative during the last quarter of 2017. The operational areas for the project were two of the three districts of Chennai - Central and South districts.
To know more about the proect, read the report here.
REACH identified private hospitals and clinics to function as Public Private Mix (PPM) centres to facilitate participation of private practitioners. The doctor in-charge and the laboratory technician in these centres were trained in the TB programme's protocol. These centres offered diagnostic and treatment facilities for people with TB in the private sector. REACH assisted the PPM centres by obtaining drug boxes and TB registers from the Chennai Corporation. Mostly located within healthcare settings (private/trust hospitals), these centres have evolved as spaces for active interaction, counselling and are being used for peer experience sharing. The EQUIP Centres serve as drug collection and sputum collection points.
The project raised the awareness about the availability of newer diagnostics for TB detection such as CB NAAT. We saw a high demand and uptake for these tests among people with TB from the private sector. The project also partnered with stand-alone labs to decentralise testing and make it more accessible to people with symptoms of TB and people with TB. Under EQUIP, three 4-cartridge CB-NAAT systems were procured and testing was done at the PPM centres.
REACH identified and trained community volunteers in directly observed treatment (DOT) and provided support for get people lost to follow up back on treatment and documentation. They facilitated access to a range of services, including free X-rays, CB-NAAT testing, treatment adhrance support, psychosocial support, linkage to care for people with DR-TB diagnosed in the private sector, home visits, contact screening, drug collection, nutrition support, In order to facilitate the collection and transportation of samples, community volunteers were trained.
Provision of daily treatment with standard TB drugs was initiated through the project for private practitioners (PPs) who recommended it for their patients. PPs were offered various options for participating in the programme. They could diagnose and treat people with TB in their own clinics following TB programme guidelines or they could refer their patients to government/PPM centres for diagnosis and/or treatment under the DOTS strategy.
Ms Rasi (name changed to protect privacy)
ATechnical Advisory Group (TAG) was formed to provide strategic direction to the intervention. The members of TAG provided high level strategic and technical guidance to the project and acted as facilitators within their constituencies to identify opportunities and mobilise additional individuals, organisations or resources.
Each provider was provided with a book of coupons capturing details of the PwTB and free service tear-offs – one each for a sputum examination, X-ray and treatment support. REACH tracked the number of PwTB referred by each doctor. The EQUIP team supported the PPs with notification to the Nikshay portal.
Referrals to DOTS centres were based on the choice of the PwTB. This enabled them to take charge of their own treatment and seek care in either public or private sector. They could also choose the mode to avail medication (daily regimen/thrice a week).
PwMDR-TB were referred to government centres reason being difficulty in deciding drug combinations, dosages, bad prognosis, prolonged treatment, and difficulty in follow up. Conditional nutritional enablers were provided to those on treatment through a coupon system. .
The project EQUIP was seamlessly integrated with other REACH programmes such as Axshya and the Pharmacy Initiative. For PwTB referred from pharmacies, their doctors were contacted and sensitised on EQUIP services, broadening the catchment area of the initiative.
PwTB and PP-friendly communication materials were developed and disseminated. PwTB were educated about TB and the treatment using easy-to-understand booklets and hand-outs.