scale up of private sector engagement

Nakshatra Centres, which are nodal centres for providing holistic TB care, saw an overall smooth functioning under the Nakshatra Initiative of TB Free Chennai. A healthcare worker (TB Nanban, Nanban means friend in Tamil) was placed at each centre to facilitate TB diagnosis and treatment as well as provide counselling. TB Nanbans help guide and support referrals/people with TB for receiving appropriate care services. Nakshatra Centres are ‘Centres of Excellence for TB’ and a model for showcasing the involvement of the private health care sector in TB control efforts. 

Private healthcare providers were mapped as chest physicians, general and speciality practitioners and sensitised through workshops and one-to-one visits with a focus on Standards for TB care in India (STCI) guidelines and case notification. They were briefed on TB care services offered by REACH and the government. Following sensitization, the private practitioners were routinely followed up to encourage participation in the program. These were followed by Continuing Medical Education (CME) programmes for the staff working at private hospitals to sensitising the staff about our patient-centric approach, awareness about TB as well as preventing transmission in healthcare settings 

The Government of India made TB a notifiable disease in the year 2012. This mandates the healthcare sector including - private practitioners (PPs), hospitals, pharmacies and laboratories to notify the details of all people with TB seeking care in the private sector. REACH supported private sector notifications through periodic visits and sensitisation of private providers regarding the importance of notification. REACH has also created unique IDs for each private practitioner. The line list of people with TB was periodically collected from PPs and notified in the Nikshay portal. REACH also facilitated linkages of people with TB in the to Nikshay Poshan Yojana by notifying 

TB Nanbans provided the following services throughout the care cascade:

• Counselling on TB
• Risk assessment
• Treatment initiation with treatment supporter 
• House visits for adherance monitoring
• Contact screening
• Nutritional support

REACH works to empower people with TB to understand their rights and responsibilities and head towards successful completion of treatment. TB Nanbans maintain a rapport with each and every person who comes to them and use all opportunities to communicate information on TB. They encourage families to provide an enabling environment to facilitate their journey to cure.

he Cartridge Based Nucleic Acid Amplification (CB-NAAT) helps detect the presence of TB bacteria more effectively than the regular sputum smear microscopy test. CB-NAAT (brand name GeneXpert) has great potential to increase case detection and identify resistance to the anti-TB drug Rifampicin among people with TB. The TB Free Chennai Initiative has provided for free CB-NAAT testing and chest X-rays for the private health care sector, thus ensuring quality diagnosis.

The project provides services for people with TB, DM and HT by ensuring screening, diagnosis, and treatment support. These services are offered by TB Nanbans based at Nakshatra Centres, our hubs for holistic care for TB and NCDs in Chennai. Most people with TB are referred by private providers to Nakshatra centres. 

Around 200 STAMP devices were used for monitoring treatment adherence with the help of daily alerts. The device reminded people with TB to take their doses at the prescribed time and enabled TB Nanbans to concentrate on those poeple who required further support. TB Nanbans also conducted risk assessment to understand the vulnerability of referrals.

A team of lab technicians worked to ensure provision of quick results. REACH appointed community volunteers for sputum collection and transportation. When a person was detected with drug resistance, they were linked to tertiery hospitals for treatment in coordination with the TB programme.

A set of criteria was used to shortlist people who receive nutrition support. People with drug sensitive TB were provided aid to the tune of Rs. 600 per month and people with DR-TB were provided with Rs.1000 per month 

Communication materials for improving awareness on TB, notification, DBT for Nikshay Poshan Yojana etc were developed and disseminated

STAMP, an acronym for Support for Treatment Adherence and Medication Protocol, is a multi-function electronic medicine dispenser and reminds users, i.e., people on treatment for TB, to take their medicine at the same time everyday, thereby assisting them to complete their treatment successfully.