100-Day TB Elimination Campaign: How ASHA workers fighting to rid tuberculosis of social stigma

New Delhi: Ranjana Chaudhary, a 28-year-old ASHA worker in Uttar Pradesh's Siddharthnagar visits six to seven houses in Madhubeniya village every day with the aim to eradicate the stigma behind Tuberculosis and encourage villagers to get screened for the disease.

Social stigma is still a major impediment due to which people do not readily come forward for testing for the deadly contagious air-borne disease.

Displaying the characteristic reluctance, 70-year-old Vimala Devi (name changed) who had come to a health camp for various ailments immediately gets defensive when asked if she had come for a TB check-up.

"No no, why should I have TB?" she said irritatingly.

Chaudhary and lakhs of ASHA workers in remote areas of the country face the daunting challenge of convincing people to attend tuberculosis screening camps and are mobilising vulnerable people to such camps under the ongoing pan India 100-Day Intensified Campaign to Eliminate TB.

Aimed at accelerating efforts towards eliminating Tuberculosis from the country, the government has been proactively screening and testing vulnerable populations such as diabetics, smokers, alcoholics, those who are malnourished, people living with HIV, individuals with a history of TB or Covid, the elderly and household contacts of TB patients.

Since the launch of the 100-day campaign in December last year, the TB programme has notified over 6.1 lakh TB patients across the country of which 4.3 lakh patients were diagnosed from the 455 intervention districts.

"Often we don't tell people that it is a TB screening camp and tell them to attend it saying a free health checkup camp is being held nearby. Even if detected for tuberculosis people generally prefer to keep it under wraps for fear of isolation and social stigma," Chaudhary said.

"By virtue of the fact that TB is a communicable disease, stigma is multifold. Especially if a woman is diagnosed with the disease, the family considers it as a curse and tries to hide it for fear of the girl remaining unmarried. Lots of families also try to keep it confidential thinking they would be ostracised from the community," said another ASHA worker Sunita.

Dr Shailendra Bhatnagar said TB is a very peculiar disease. If you do not get the right treatment at the right time you may infect other family members of the family and neighbours.

"If a TB-positive patient is not treated he or she can create 15 new patients in one year. Similarly further if this new lot of 15 new patients are not treated in the second year the figure becomes 225 and similarly the chain can go on and on," he explained.

Dr Bhatnagar stressed that as soon as one gets any of the symptoms, he or she should get tested. If found positive, the entire family is examined.

Contact tracing, which became popular during the COVID-19 pandemic, is a terminology that has been used in TB programmes for several years now, Dr Bhatnagar informed.

It is being done with the intention that if one index patient gets Tuberculosis, his or her household members and the people they interact with on a routine basis in work areas or elsewhere are examined for signs of TB.

The household contacts are 10-60 times more at risk of getting the disease.

"Even if their close contacts test negative at that moment, they are put on preventive TB treatment," he said.

"However, before initiating TB preventive treatment to contacts, it is mandatory to rule out active TB disease by a qualified doctor," Dr Bhatnagar said.

The identity of TB patients is not revealed to the public, and in several cases, the Ni-kshay Poshan kit is being delivered to their doorstep, he added.

To mitigate sigma, the national TB elimination programme has adopted a multipronged approach.

TB champions/TB Vijaetas ---persons who have overcome the deadly disease are being engaged and made ambassadors of awareness, counselling, and patient support.

They routinely support patients and their families by paying them house visits, guiding them through their treatment and nutrition requirements and helping them mitigate any stigma or misinformation about the disease.

Along with them, Gram Pradhans are also being sensitised under the TB-Mukt Panchayat Abhiyaan, where they are briefed about the TB disease, how it is diagnosed, and patient entitlements.

They are also encouraged to talk about TB during their Panchayat meetings, monitor progress indicators of the program and support TB patients as Ni-kshay Mitras.

Since the launch of the campaign, around 12 lakh Ni-kshay Shivirs (TB screening camps) have been held across the country and 11 crore persons who are vulnerable to being affected by TB have been screened across the country.

Such mass mobilisation has been possible through different levers the National TB Elimination Programme has tapped into to combat stigma around TB and encourage early testing and screening.

Through the course of the campaign, over 27,000 elected representatives across different levels (union and state ministers, MPs, MLAs, MLCs, and Gram Pradhans), have been engaged to increase awareness, participate in Ni-kshay Shivirs and provide nutrition support to TB patients and their families through the Ni-kshay Mitra programme.

As part of the campaign, the Ministry of Health and Family Welfare sensitised over 250 parliamentarians during the winter session of parliament, and the Union Health Minister JP Nadda, chaired meetings with Chief Ministers/LGs and Health Ministers of implementation states, encouraging them to actively monitor and participate in campaign activities.

Subsequently, the Union Minister of Health and Family Welfare chaired a joint strategy meeting with Union Ministers and Secretaries from 22 allied ministries to urge them to utilise their expertise and resources to support TB elimination activities during the campaign.

Additionally, community organisations, gram panchayats, schools, NGOs, and allied ministries have helped execute localised awareness campaigns that have helped dispel misinformation, myths and stigma around the disease.