India has a stated goal of eliminating tuberculosis by 2025. Accelerated efforts will be required to meet this target. Tamil Nadu has taken a step towards achieving this goal by improving and focusing on services at the primary healthcare level. The State has rolled out walk-in TB centres as a one-stop solution. All services starting with screening to monetary assistance and provision of nutritional supplements will be provided under one roof.
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In an article - ‘Walk In Centre - One Stop TB Solution - A Model Game Changer in Tuberculosis Control’ - published in the State’s public health journal, officials of the directorates of Public Health and Preventive Medicine and of Medical and Rural Health Services have outlined the need for strengthening of TB-related services at primary health care facilities and how such walk-in TB centres could improve TB diagnosis, care and support.
According to the Tamil Nadu TB prevalence survey 2019-2022, the prevalence of TB in the State was 210 per lakh population. In 2022, the State had a case notification rate of 126 cases per lakh people. The aim is to achieve the Sustainable Development Goal related to TB by 2025, that is 90% reduction in TB deaths and 80% reduction in TB incidence rate by 2030 compared to the levels in 2015. Early diagnosis and treatment will play a crucial role in achieving this.
The authors - Anandan Mohan, Sudhakar Thangarasu, Palani Sampath, T.S. Selvavinayagam and Asha Frederick - observed that decentralisation of laboratory services was deemed required for patients to receive testing at neighbouring medical facilities. However in fact most testing takes place in secondary and tertiary health facilities.
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To strengthen services at primary health facilities, the State went on to adopt an idea - “Walk-in Centre - One Stop TB Solution” in which a single primary facility is designated as a walk-in TB centre in each block. Over 100 walk-in centres have been rolled out. The aim is to expand to all 424 upgraded Primary Health Centres (PHC).
Dr. Selvavinayagam, Director of Public Health and Preventive Medicine, said, so far, TB elimination was a vertical programme. “Since we are aiming at elimination, it should be community-based and decentralised. Only then is early diagnosis and identification of the infected and high risk individuals possible. Compliance with treatment can be achieved by close monitoring,” he said.
“The CB-NAAT enables accurate and quick results, and paves the way for early diagnosis,” he added.
Dr. Asha Frederick, State TB Officer, added the idea was to quicken the diagnostic process. “By making rapid molecular testing available at the designated facility, we can reduce the turnaround time to determine the resistance status,” she said.
What will the centres offer? Diagnostic tests (microscopy/Nucleic Acid Amplification Test) must be available. Appropriate linkages for chest X-ray need to be identified such as the nearest community health centres, government taluk hospital or government medical college hospitals. Patients should be initiated on treatment within 24 hours of receiving their test results. Those diagnosed with TB should be screened for other immunocompromised diseases.
Family members and close contacts will be screened for TB and preventive therapy will begin for all close contacts. Patients diagnosed with TB must get monthly clinical and laboratory follow-up at the end of the intensive phase and continuation phase. The medical officer has to ensure that every patient receives the Direct Benefit Transfer - financial incentive of Rs. 500 per month, while nutritional support with a high protein and vitamin-rich diet can be provided with the help of volunteers, NGOs and using CSR funding from industries.
Dr. Selvavinayagam added that the centres would ensure continuity of treatment, and when on the path of TB elimination, a community approach would help in sustainability and provide results.
