2by4: Theme 1: Women and Tuberculosis

As part of the ongoing 2by4 communications and advocacy campaign the first mini-series of e-consultation and key informant interviews is on the theme: Women and TB. 2by4 campaign focusses on two key populations (women and children) and four key issues (multidrug-resistant tuberculosis (MDR-TB); laboratory and diagnostics; private-public partnerships (PPP); TB-HIV collaborative activities).

GUIDING QUESTIONS:
1- Are women more at risk of TB and do they face heightened stigma and discrimination related to TB because of deeply entrenched gender-based inequalities? Please share examples and testimonies if any. What should be done to bring in the desired change?

2- What can be done to early diagnose women with TB, confirm the diagnosis and provide standard treatment and support to them to get successfully cured?

3- Are there specific challenges faced by women with MDR-TB? How can we address these challenges?

4- Are there best practice examples of private-public partnership (PPP) that have improved TB care for women?

5- Are there best practice examples of successfully implemented TB-HIV collaborative activities that address issues faced by women co-infected with TB and HIV? Please share.

Please send your responses by 10th March 2013.

RESOURCES
Stop TB Strategy
Global Plan to Stop TB: 2011-2015 
World TB Day website
Global Tuberculosis Control Report 2012
Whole Is Greater Than Sum Of Its Parts: CNS report 2011

Looking forward to your active participation.

PARTNERS | 2by4 is endorsed by:
Abhinav Bharat Foundation
American Thoracic Society
Asha Parivar 
Citizen News Service - CNS
Global Alliance for TB Drug Development (TB Alliance)
Global Stop-TB eForum
National Alliance of People's Movements (NAPM) 
Partnership for TB Care and Control in India
SEA-AIDS (Asia Pacific Regional eForum on HIV)
SMLS Trust (Amalapuram, AP, India) 
TB Alert
Vote For Health campaign

Kind regards

Citizen News Service – CNS
 Email: stopTB@citizen-news.org

22 comments:

  1. Dear Stop-TB members,

    I have seen very little discussion on the problem of diagnosing sputum negative TB.

    This could be extra pulmonary TB or miliary TB which is common with HIV.

    I found a high proportion of TB cases who were sputum negative in Zambia and South Africa in the 1990s and after no response to an antibiotic did improve over 2 weeks with TB specific drugs. What is your experience?

    Dr Theresa Watts
    Email: teew@keme.co.uk

    ReplyDelete
  2. Comment from Payel Bhattacharya, India
    ------------
    A PENNYWORTH EXPERIENCE

    I have been suffering from a rare genetic disorder called Von Hippel Lindau (VHL) Syndrome since my early childhood. This disorder results in excess blood flow due to hypoxia inducible factor (HIF) resulting in repeated tumor growths in different organs of my body. VHL is a lifetime disease. Patients need to be constantly checked and treated/operated for the tumors and cysts that develop at various sites in the central nervous system and visceral organs throughout their lifetime. Because of the complexities associated with management of the various types of tumours in this disease, treatment is multidisciplinary.

    VHL, LIVER TRANSPLANT AND MDR-TB
    Very often timely aggressive surgical intervention is the only cure. As a VHL liver transplant patient, I have undergone and 9 surgeries one brain tumor removal, besides grappling with MDR-TB which was diagnosed in 2010. I developed MDR-TB.

    Manifestation of my latent TB happened under immune compromised situation, confirmed by a radiological conference facilitated by Dr Randeep Guleria at All India Institute of Medical Sciences (AIIMS). I developed pulmonary, bone and lymph involvement, to such an extent that it gnaws my bones and I walk with help of a four-toed stick.

    The latest CT study of my chest reveals multiple nodules, many of them calcified, and also fibroatelectatic lesions in both lung fields. The appearance is consistent with chronic tubercular lesions. Compared with previous CT chest studies of 2010 and 2011, there is relative regression of the lung parenchymal lesions. CT study of head reveals an enhancement in right cavernous sinus as well as right convexity. In view of the size of lesion and my age (33years), radiosurgery-- cyber knife—has been suggested by doctors at Medanta Medicity Hospital.

    FATHER'S DEMISE, MOUNTING PROBLEMS, and VHL-RELATED TUMOURS
    My father’s sudden demise in 2010 has left me and my mother in a penniless situation, and my younger brother is now the sole earning member of the family. We are left with nothing to carry on my treatment. We are homeless, being evicted by landlords as and when they feel I am contagious because of my TB. At present I am living in a crummy rented place with narrow stairs, without ventilation, which is having adverse effects on my lung lesions, bone TB and hypoxia related VHL tumors which are growing fast. Initial support was provided by my friends and well-wishers but they and my brother can no longer pull the economy of my diseases together.

    APPEAL
    I hence appeal to you to give me a helping hand. So far, I have gathered plenitude of experience but not lost the verve to live. Cyber knife doesn’t make me faze out with fear, but lack of funds and understanding makes the feelings worse. Please help me live the joyous life with a rare disorder as I am a survivor and not merely a sufferer.

    Regards

    Payel Bhattacharya
    Email: Payel.bh@gmail.com
    Mobile: +91-9711197537

    ReplyDelete
  3. Comment from Paula Perdigao, Mozambique
    ------------------
    TB IN PREGNANT WOMAN AND CHILDREN IS A GREAT PROBLEM

    Dear Stop-TB members,

    I could not agree more with Theresa. In my country, Mozambique, smear negative TB cases (pulmonary, extra-pulmonary and children) represents 70% of TB cases.

    I have seen too many patients with active TB (pulmonary and extra-pulmonary) for months without being diagnosed….most of them HIV+.

    GeneXpert is not in use all over the country and not yet in use for extrapulmonary TB (ETB) and childhood TB. TB in pregnant woman and children is a great problem in my country.

    Paula Perdigao, Mozambique
    Email: paulazen@tropical.co.mz

    ReplyDelete
  4. Contact tracing must be done very well when a TB patient comes to a clinic and her/his TB is confirmed. Counseling on proper infection control practices must be done in the best possible manner. How a woman is supposed to protect TB transmission to her child, or to protect herself if getting a child treated, or to protect her family from anyone - male or female - who is confirmed with TB - should be advocated with solutions that are possible in a person's context.

    Anjali Dwivedi

    ReplyDelete
  5. There are lot of problems which women with TB face and which prevents them from coming up for diagnosis.

    They do not get family and/or emotional support, so, that’s why they shy away from diagnosis and even if they know at times about their status they don’t tell.

    Their nutritional status is also not good. Also they need help from somebody to bring them to the DOTS centre to get their follow ups done or look into any adverse drug reactions. So diagnosis and follow up gets delayed.

    Also, adverse drug reactions are often not reported on time. One of the side effects of MDR-TB medication is depression or altered behavior but very often women with TB either do not tell us or are sent back to the village even before they can recognize the symptoms.

    Family members think that it’s a part of TB that she is behaving like this.

    Dr Neeta Singla
    LRS Institute of TB and Respiratory Diseases
    New Delhi
    (told to Citizen News Service - CNS in an interview)

    ReplyDelete
  6. WOMEN WITH TB ‘LOSE THEIR HOME’: INDIAN HEALTH MINISTER
    (March 2008)

    "...Stigma is known to impede the responses to HIV and TB, and although many may feel that TB-related stigma is a story of the yesteryears, the studies done by Tuberculosis Research Centre in India establish the fact that significant number of women with TB become homeless once diagnosed with TB.

    India’s Health and Family Welfare minister Dr Anbumani Ramadoss said at the recently concluded Fifth International Microbicides Conference 2008 that: “studies done at Tuberculosis Research Centre in Chennai showed that women who develop Tuberculosis, 1 in 1000 lose their home. TB is the major co-infection of HIV.”

    Just a week ago, the body of a woman who died of TB in India, was not handed over to relatives for cremation but driven in a car for 5 days by her employers. It is clear that the TB-related stigma attains a worse magnitude and impact for women with TB.

    Millennium development goals speak about promoting gender equality, empowerment of women and improved maternal health to combat HIV. “It will be very difficult to achieve the above millennium development goals if the current trend of increasing HIV infections in women continues” said Dr Ramadoss.

    However what Dr Ramadoss said now, WHO had alerted in 1998 stating that “TB is the single biggest killer of young women.”

    "Wives, mothers and wage earners are being cut down in their prime and the world isn't noticing," had said Dr Paul Dolin of WHO's Global Tuberculosis Programme in a 1998 press release of WHO. "Yet the ripple effect on families, communities and economies will be felt long after a woman has died."

    Women, are biologically, socially and physiologically more prone for HIV transmission than men. “AIDS in India is not only a health issue, it is a social issue, it is an economic issue” said Dr Ramadoss.

    TB being the most common opportunistic infection for people living with HIV, it is vital for TB programmes to be accessible for women, especially those women who are most underserved and economically disadvantaged.

    The WHO recommended treatment for TB, Directly Observed Treatment Short-course (DOTS), should function in a manner so as to reduce the gender inequities. TB education programmes should reach women, especially those in hard-to-reach settings. The TB treatment centres should be more accessible and safer places to women to go regularly for their medicines.

    HEALTH FOR MANY WOMEN IS THE LAST ON THE PRIORITY
    Health for many women is the last on the priority in a family. So it is not surprising that women get late in getting diagnosed for TB and eventually for treatment. Nutritionally the food they receive in many settings in India is often the least nutritious and inadequate in a family. Women with TB need not only to adhere to TB treatment but also to the nutrition they receive.

    It is high time for those working on reducing gender inequities and disease control interventions be it HIV or TB, to work more closely together.

    With closely approaching International Women’s Day (8 March) and the World TB Day (24 March), let us bring different stakeholders together to change the situation so that the most disadvantaged women can also ably say: ‘I can stop TB’..."

    ReplyDelete
  7. A WOMAN'S COURAGEOUS JOURNEY THROUGH TB TREATMENT

    In 2005, Tariro Jack, 27, fell ill with Tuberculosis (TB) during her first year at college. She said that she struggled to cope not only with her own health but also managing people's perceptions. TB is an infectious disease that spreads through the air. The disease mostly affects young adults in their most productive years and 95% of TB deaths are in the developing world. Estimated TB incidence rates are highest in sub-Saharan Africa with over 350 cases per 100,000 population. Among African nations, Zimbabwe is one of those most heavily affected by TB. The deadly combination of TB and HIV epidemics is igniting a silent and uncontrollable epidemic of drug resistant TB that will negate previous national health gains.

    "I had TB at 21 in my first year at college and I know people thought that I was dying; I struggled a lot," Jack said, adding that when she was put on the World Health Organisation (WHO) -recommended Directly Observed Treatment Shortcourse (DOTS), matters only got worse as her health further deteriorated.

    "My skin was very smooth. When I started taking pills, I developed a rash and my legs became sore to the extent that I couldn't walk," she said.

    "Every time that I took the pills I would feel more sick that before and after, I used to throw up a lot. I used to go to the toilet frequently because the pills upset my whole system."

    To complicate matters, her doctor at the time told her that she was not responding well to the medication and recommened that she go and see a specialist. Other health officials did not help the situation by predicting Jack's demise.

    "I remember there is one time I was admitted to hospital and the sister-in-charge told the nurses not to waste their time on me because I was good as dead. That gave me strength to fight for my life," she said.

    Due to the close association between TB and HIV, Jack said that she had to contend with another struggle, that of being suspected to be HIV-positive. TB is a leading cause of illness and death for people living with HIV - about one in five of the world’s 1.8 million AIDS-related deaths in 2009 was associated with TB. The majority of people living with HIV and TB are in sub-Saharan Africa. In spite of this close association, it is not automatic that when one has TB, they're also HIV positive. Stigma around this association is portent though and can lead affected to shun seeking medical attention.

    "When I had TB, everyone seemed to think I was HIV positive. I went for countless HIV tests and everytime they came out negative. This was to prove a point but I later realised I didn't live for people but for my self," Jack said.

    "I finally got better as I followed the treatment course until I was fine and I thank God because people who did not know me at the time cannot in any way tell that I once had TB."

    She said that the negative attitude that she received from some of the health personnel is still like a fresh scar in her memory.

    "To people with TB, whether you're HIV-negative or living with HIV, what you've to know is that TB is curable. You should just believe in your self and have a thick skin because people will always talk but I thank God because He gave me strength and now I can tell everyone of my experience. TB does not kill. Don't let anyone lie to you," she said.

    Chief K Masimba Biriwasha, Zimbabwe
    (originally written in March 2012 for CNS)

    ReplyDelete
  8. Although lot has been done to address stigma and discrimination related to HIV but very little on stigma and discrimination related to TB, which gets further compounded when we talk about MDR-TB, and that too in context of a female patient.

    Amir Siddiqui

    ReplyDelete
  9. Women are less likely to get diagnosed early - that is a structural issue and addressing gender-based discrimination and inequalities are fundamental to improving other outcomes such as those related to TB care and control.

    Ahmad Hasan, Bangladesh

    ReplyDelete
  10. Comment from a father of female MDR-TB patient
    ----------------------

    Father of female MDR TB patient (aged around 20 years) at LRS Institute of TB and Respiratory Diseases, New Delhi said to Citizen News Service - CNS in a key informant interview last week:

    TB RETURNED
    "our greatest curse is poverty. My daughter was diagnosed with TB 4 years ago, when she was around 14 years old. She completed a 6 months course of TB. Treating TB is like spraying a mosquito repellant—most of them die but a few which remain multiply later. The same thing happened in my daughter’s case. Her TB returned after sometime.

    TREATMENT DISRUPTED
    I started her treatment again, but then she got married (at the age of 16 years) and her treatment was disrupted at her in-laws place. Eventually she was diagnosed with MDR-TB 20 months ago.

    MDR-TB POSITIVE: IN-LAWS TURNED HER OUT
    Her in-laws have since turned her out of their house and I am taking care of her. She has been on MDR TB treatment since 18-20 months and is almost cured now, but her lungs have been damaged and she has to be on constant support of oxygen cylinder, which I cannot afford, as one day use of the cylinder costs Rs 300. Her condition worsens when she does not get the support of the oxygen cylinder. She is in and out of this hospital all the time. My wife and I do not keep good health. My son is a daily wage earner and I also do odd jobs when I am not in the hospital with my daughter. Treatment is free in the hospital but they cannot keep her here forever. Life is too difficult at the moment. There is not enough for all of us to have two meals a day, let alone give better nutritional diet to her."

    ReplyDelete
  11. Dear Members,

    In Afghanistan, women suffer from and are affected more by TB as compared to men. WHO recently published a data which shows64% of TB cases are notified among women. Poverty and limited access to health care and health education have been potential factors for high TB burden in the country while Afghan women are at increased risk of getting TB infection and developing TB disease due to following socio-culturally constructed gender-based inequalities:

    o The majority of women don’t have access to income and hence they have minimal role in families’ decisions including decisions on their health care seeking.

    o Women in almost all parts of the county have limited outdoor activities. They have to stay longer within rooms and inhale the unhealthy, dusty and smoky air which is hazardous for lung health. However, the women victims of such air don’t have awareness about. Lengthy and harsh winters increases the risk several folds as room’s ventilation and lightening is at its minimal during winters.

    o Traditionally, women preserve good food for male members of the families. In some rural areas of the country, the situation is even worse as male members have their meals with good food first and then female members have theirs.

    o Afghan women are the main care takers of their ill family members. This situation puts Afghan women exposed for contamination and sufferings.

    o In most of the rural areas of the country, girls are married at their very early ages and they have to deliver multiple pregnancies without their consents. As a result, Afghan women have weakened bodies which are suitable prey for Koch Bacilli.

    o More TB cases are notified among women when the source of infection is a female within the household and interaction between women is higher than men in Afghan society so exposure of women to source of TB infection would tend to be greater among women.

    o Girls with TB suffer more from stigma. Society blames them as infertile girls. Twenty one years old Jamila Bibi lived in IDPs’ camp was one of the thousands Afghan girls who were affected by TB. Due to associated stigma, she experienced her engagement breakage by her in-laws before treatment commencement. TB REACH project brought her access to TB care, revitalized her debilitated body and revived her broken engagement through providing her in-laws with accurate information about irrelevancy of lung TB with infertility.

    NTP/MoPH efforts with great contribution from International community have brought significant improvements in TB care for women during the previous decade. Still much more efforts are needed to improve TB control among women: a) work jointly with governmental and non-governmental organizations working for women, b) advocate women rights to health care and education in society among community elders and religious leaders, c) work with community health shuras (council) and women action groups to raise TB awareness and deliver right information about TB and, d) NGOs in Afghanistan can work with Community Health Workers (CHWs) to establish self help groups of TB patients both current and cured. This help group will meet as per agreed schedule with facilitation of CHWs and cured patients will share their experience with current patients. CHWs, community health Shuras, mullahs, and community will be informed that TB is curable to encourage seeking medical care and reduce the stigma related to TB.

    Dr. Ataulhaq Sanaie
    Executive Director, ACREOD
    Kabul, Afghanistan
    Phone: +93707745090
    Email: sanaie.as@gmail.com

    ReplyDelete
  12. 12. Comment from Jitendra Dwivedi
    -----------

    Women working in stone cutting or other such occupations are at a risk of silicosis and often doctors misdiagnose silicosis as TB and put them on anti-TB treatment.

    ReplyDelete
  13. TREATMENT OF SPUTUM NEGATIVE TB

    Dear Dr Theresa Watts and Stop TB Members,

    The treatment of sputum negative (pulmonary) TB will essentially be based on chest X ray reading. If the lung lesions are consistent with ‘progressive pulmonary tuberculosis’, TB medication can usually be given right away.

    When sputum smear is negative for acid fast bacilli (AFB), while pulmonary TB relapse or reactivation is suspected, then TB treatment is preferably postponed until sensitivity tests are available. TB drugs are then given accordingly. But, if treatment cannot wait due to severity of the (life-threatening) disease, TB drugs could be given according to the history of previously taken drugs (based on regularity, doses, and duration of TB drugs taken). Here we have to seriously weigh the consequences of creating drug resistant DR TB or even MDR TB.

    In our five TB clinics (integrated with general health services), patients with common chest symptoms get symptomatic treatment (corticosteroids, cough suppressants, bronchodilators).

    When signs of infection (colored sputum with or without fever and chills) are present, they would also get common antibiotics.

    But when TB is suspect (according to specific signs and symptoms), chest X ray is made. If then active lesions are suspected, routine sputum tests are done (including, culture and sensitivity tests).

    We do not use lab tests (eg. routine blood examination, lymphocyte count, blood sedimentation rate, etc). These tests are of no help for detecting TB. Also they add no value to monitor TB activity or treatment progress. They would unnecessarily increase the financial burden of the patient. Regular checking of bodyweight, we find is not only very important, but also most easy, cheap and more useful than any other tests to monitor the course and treatment progress of TB!

    Many if not all (young and old) doctors and specialists (including chest doctors) here still do the Mantoux or tuberculin tests among small children and even among very old people as well!. Such practice is far from correct, since BCG coverage is almost 100 % and the disease is endemic in Indonesia. We also don’t rely on QuantiFERON – TB testing, PCR, PAP (or any other serological tests) for diagnosing TB. We also don’t treat LTBI (latent tuberculosis infection).

    In doubtful cases (sputum negative, Ro active lesions and signs and symptoms of TB not convincing), we’d rather postpone TB treatment. However, patient will be made to fully understand and agree, that as the disease is inactive, TB drugs may not be effective. If some time later, symptoms and signs recur, patient has to return for re-evaluation. If the TB disease becomes active, treatment will be beneficial for cure.

    Hoping that some of the above information was useful.

    Any difference of opinion could be (please) voiced, sharing it with other members.

    Best regards,

    Muherman Harun, Indonesia

    ReplyDelete
  14. Dear Members,

    In Afghanistan, women suffer from and are affected more by TB as compared to men. WHO recently published a data which shows64% of TB cases are notified among women. Poverty and limited access to health care and health education have been potential factors for high TB burden in the country while Afghan women are at increased risk of getting TB infection and developing TB disease due to following socio-culturally constructed gender-based inequalities:

    o The majority of women don’t have access to income and hence they have minimal role in families’ decisions including decisions on their health care seeking.

    o Women in almost all parts of the county have limited outdoor activities. They have to stay longer within rooms and inhale the unhealthy, dusty and smoky air which is hazardous for lung health. However, the women victims of such air don’t have awareness about. Lengthy and harsh winters increases the risk several folds as room’s ventilation and lightening is at its minimal during winters.

    o Traditionally, women preserve good food for male members of the families. In some rural areas of the country, the situation is even worse as male members have their meals with good food first and then female members have theirs.

    o Afghan women are the main care takers of their ill family members. This situation puts Afghan women exposed for contamination and sufferings.

    o In most of the rural areas of the country, girls are married at their very early ages and they have to deliver multiple pregnancies without their consents. As a result, Afghan women have weakened bodies which are suitable prey for Koch Bacilli.

    o .More TB cases are notified among women when the source of infection is a female within the household and interaction between women is higher than men in Afghan society so exposure of women to source of TB infection would tend to be greater among women.

    o Girls with TB suffer more from stigma. Society blames them as infertile girls. Twenty one years old Jamila Bibi lived in IDPs’ camp was one of the thousands Afghan girls who were affected by TB. Due to associated stigma, she experienced her engagement breakage by her in-laws before treatment commencement. TB REACH project brought her access to TB care, revitalized her debilitated body and revived her broken engagement through providing her in-laws with accurate information about irrelevancy of lung TB with infertility.

    NTP/MoPH efforts with great contribution from International community have brought significant improvements in TB care for women during the previous decade. Still much more efforts are needed to improve TB control among women: a) work jointly with governmental and non-governmental organizations working for women, b) advocate women rights to health care and education in society among community elders and religious leaders, c) work with community health shuras (council) and women action groups to raise TB awareness and deliver right information about TB and, d) NGOs in Afghanistan can work with Community Health Workers (CHWs) to establish self help groups of TB patients both current and cured. This help group will meet as per agreed schedule with facilitation of CHWs and cured patients will share their experience with current patients. CHWs, community health Shuras, mullahs, and community will be informed that TB is curable to encourage seeking medical care and reduce the stigma related to TB.

    Dr. Ataulhaq Sanaie
    Executive Director, ACREOD
    Kabul, Afghanistan
    Phone: +93707745090
    Email: sanaie.as@gmail.com

    ReplyDelete
  15. Anonymous
    ---------------------

    Silicosis in areas with tribal population: these tribal people often migrate to Gujarat to work in glass or stone cutting factories and soon after they are at high risk of developing silicosis and are forced to return back. Doctors often misdiagnose silicosis as TB and put them on anti-TB therapy.

    (told to CNS at West Regional Consultative Meeting of Partnership for TB Care and Control in India held on 5-6 March 2013 in Indore)

    ReplyDelete
  16. Comment from Dr Sandeep, RNTCP consultant to Gujarat
    ---------------------

    We conduct ACSM activities such as patient-provider meetings or community meetings, but so far we have not been able to focus on vulnerable groups such as minority groups. If we conduct ACSM activities for minority groups it may help improve TB responses on the group.

    ReplyDelete
  17. Comment from Dr Prakash Tyagi, GRAVIS, India
    ------------------

    It is an established fact that COPD and TB are a dual epidemic that affects men due to higher tobacco consumption rates. COPD and TB rates are rising in women too particularly in rural population, because of exposure of women to tobacco smoke, secondhand tobacco smoke, indoor air pollution (in form of smoke of cook-stoves), which makes women more prone than men to TB and COPD.

    ReplyDelete
  18. Comment from Dr Sarabjit Chadha
    Project Director, International Union Against Tuberculosis and Lung Disease
    The Union South East Asia office, New Delhi
    -------------------

    Structural drivers like poverty, social stigma, less health seeking behavior, malnutrition are factors that not only increase the risk of women developing TB, but also lead to delay in diagnosis in women affected by TB. Women, especially in rural settings, do not have a similar health seeking behavior as men, and normally end up accessing the health system much later in the sequence of the disease. Also, issues of poverty and malnutrition are more relevant in case of women because of gender inequality. If you look at women and men as a part of the family, it is again related to equality--the family might take the boy to a doctor for his treatment but that would not be the case for the girl child. This could have serious implications. Malnutrition again is a serious issue. Women do not have as much access to food as men and this could be because of cultural norms as in many families a woman is supposed to eat last after feeding others. Malnutrition predisposes women to TB.

    TARGET WOMEN MORE SPECIFICALLY
    We need to target women more specifically. Right now our activities are not very gender specific. Let’s say there is a microscopy center which is located 20 kms away from the village. Men, because they go out for work, can cycle or they can take a public transport and somehow access it. But for a woman it becomes very difficult because (i) she is not educated (ii) she is economically dependent and (ii) she may not feel comfortable going out alone and accessing these services. So one thing for accelerating, intensifying the case findings would be to create awareness in women. Basically she is running the family, so if anyone in the family (including the children or the husband or the in-laws) has cough for 2 weeks or more she could be the one who could influence positive action. The second thing is that we need to bring the TB health services to their doorstep rather than expect these women to come out and travel long distances to access health services. We need to have interventions which improve access. This could be related to sputum collection, transportation or active case finding—all of which will help in reducing delay for TB diagnosis. The third thing is that the program recommends directly observed treatment and this may be an issue although in India with the ASHAs (accredited social health activist) coming in, the programme has become a little more gender sensitive. But if the community DOT provider is a male, women may not feel comfortable going to this person. So,all these factors need to be considered (and not ignored) when devising an intervention.

    Dr Sarabjit Chadha, The Union
    (excerpt from a key informant Interview CNS did with him this week)

    ReplyDelete
  19. Comment from Mr Benedict Damor
    ------------
    SILICOSIS IN AREAS WITH TRIBAL POPULATION

    Tribal people often migrate to Gujarat to work in glass or stone cutting factories and soon after they are at high risk of developing silicosis and are forced to return back. Doctors often misdiagnose silicosis as TB and put them on anti-TB therapy.

    ReplyDelete
  20. Comment from Prof Salil Bhargava
    ---------------
    SILICOSIS IS AN OCCUPATIONAL DISEASE

    Protecting workers from developing silicosis in occupations where it is a potential hazard is very important. Silicosis is an occupational disease and should be properly treated and not confused with TB. However a person who has silicosis is more at risk of serious forms of TB.

    ReplyDelete
  21. Comment from Dr Prakash Tyagi
    -------------

    GRAVIS have worked on silicosis and will be happy to share our work

    ReplyDelete
  22. Comment frm Dr Dixit Kapadiya
    TB-HIV coordinator for state of Gujarat RNTCP
    ------------------

    In Gujarat, GSNP Gujarat State Network of Positive People is totally run by HIV+ve women. We invite GSNP people to our meetings and hand them the list of TB-HIV defaulters, they follow up, and so many defaulting people have returned back to the treatment. State level positive networks help a lot in bringing defaulting patients back to the programme.

    (told to CNS at West Regional Consultative Meeting of Partnership for TB Care and Control in India held on 5-6 March 2013 in Indore)

    ReplyDelete