Tuberculosis treatment outcomes and patient support groups, southern India.

Research Tuberculosis treatment outcomes and patient support groups, southern India Rajaram Subramanian Potty,a Karthikeyan Kumarasamy,a Joseph F Munjattu,a Ramesh C Reddy,b Rajesham Adepu,c Anil Singarajipura,b Mohan H Lakkappa,a Reuben Swamickan,d Amar Shah,d Vikas Panibatlae & Reynold Washingtonf Objective To assess treatment outcomes in tuberculosis patients participating in support group meetings in five districts of Karnataka and Telangana states in southern India. Methods Tuberculosis patients from five selected districts who began treatment in 2019 were offered regular monthly support group meetings, with a focus on patients in urban slum areas with risk factors for adverse outcomes. We tracked the patients’ participation in these meetings and extracted treatment outcomes from the Nikshay national tuberculosis database for the same patients in 2021. We compared treatment outcomes based on attendance of the support groups meetings. Findings Of 30 706 tuberculosis patients who started treatment in 2019, 3651 (11.9%) attended support groups meetings. Of patients who attended at least one support meeting, 94.1% (3426/3639) had successful treatment outcomes versus 88.2% (23 745/26 922) of patients who did not attend meetings (adjusted odds ratio, aOR: 2.44; 95% confidence interval, CI: 2.10–2.82). The odds of successful treatment outcomes were higher in meeting participants than non-participants for all variables examined including: age ≥ 60 years (aOR: 3.19; 95% CI: 2.26–4.51); female sex (aOR: 3.33; 95% CI: 2.46–4.50); diabetes comorbidity (aOR: 3.03; 95% CI: 1.91–4.81); human immunodeficiency virus infection (aOR: 3.73; 95% CI: 1.76–7.93); tuberculosis retreatment (aOR: 1.69; 1.22–2.33); and drug-resistant tuberculosis (aOR: 1.93; 95% CI: 1.21–3.09). Conclusion Participation in support groups for tuberculosis patients was significantly associated with successful tuberculosis treatment outcomes, especially among high-risk groups. Expanding access to support groups could improve tuberculosis treatment outcomes at the population level. Introduction Estimates indicate that India has the largest number of tuberculosis patients (26%) and tuberculosis-related deaths (36%) in the world.1 India’s success in tackling tuberculosis is critical to achieving the global goal of ending tuberculosis by 2030. India’s national strategic plan on tuberculosis 2017–2025 envisages achieving a treatment success rate of 92% and 75% among individuals with drug-sensitive and drug-resistant tuberculosis, respectively, by 2025.2 Overall, the treatment success rate for drug-sensitive and drug-resistant tuberculosis was 81% (1 665 016/2 049 517) and 48% (16 668/34 621), respectively, in 2018.3 These figures highlight the need for highly effective and rapidly scalable interventions to accelerate the success rate in tuberculosis treatment outcomes. Treatment approaches that include patients and their family members in a person-centred care process are more likely to be successful.4,5 Processes for empowering and involving tuberculosis patients in the prevention and control of their disease are of increasing interest to policy-makers, programme managers and health-care providers concerned with tuberculosis control.6 Many studies on other disease conditions show that empowering and involving patients is feasible using forums that facilitate sharing and learning from other patients’ experiences, challenges and successes.6–12 Peer support for tuberculosis patients has been attempted in many countries with varying degrees of success.13–16 In India, strategies for peer support and patient involvement have rarely been implemented and studied. In this paper, we describe implementation of support group meetings for tuberculosis patients and assess tuberculosis treatment outcomes in patients participating in these meetings. Methods Study setting The Tuberculosis Health Action Learning Initiative, funded by the United States Agency for International Development, was implemented in selected districts of two states in southern India during 2016–2020. In total, 46 tuberculosis units from urban areas of Bellary, Bengaluru Urban and Koppal districts in Karnataka state and Warangal and Hyderabad districts in Telangana state were selected for the implementation of support group meetings in 2019. In consultation with state and district tuberculosis programme staff, districts with higher proportions of the urban population living in slums were selected. Karnataka Health Promotion Trust (KHPT), IT Park, Rajajinagar Industrial Area, Behind KSSIDC Administration Office, Rajajinagar, Bengaluru, Karnataka, India 560044. Office of the Joint Director, Lady Willingdon State TB Centre, Bengaluru, India. c Office of the Joint Director, Commissionerate of Health and Family Welfare, Hyderabad, India. d Tuberculosis and Infectious Diseases Division, United States Agency for International Development India, New Delhi, India. e TB Alert India, Hyderabad, India. f St John’s Research Institute, Bengaluru, India. Correspondence to Rajaram S Potty (email: ). (Submitted: 4 April 2022 – Revised version received: 14 October 2022 – Accepted: 21 October 2022 – Published online: 15 November 2022 ) a b 28 Bull World Health Organ 2023;101:28–35A | doi: http://dx.doi.org/10.2471/BLT.22.288237 Research Tuberculosis treatment outcomes, India Rajaram Subramanian Potty et al. Implementation We locally recruited community health workers (CHWs) from urban communities in 2016.17 In 2019, senior technical tuberculosis programme staff and technical staff of the project trained the CHWs and tuberculosis programme field staff to jointly organize and conduct monthly support group meetings within the public health facilities offering tuberculosis services. These health workers and programme staff formed support groups for tuberculosis patients who started treatment in 2019. Family members and/or caregivers of the patients and individuals who had previously completed tuberculosis treatment were included in the support groups. Tuberculosis patients who were very ill were excluded from participating. Support group members received information on the date and time of the meetings from CHWs or the tuberculosis programme staff. Initially, the health workers or programme staff provided this information during home or clinic visits. Later, district tuberculosis programme managers designated a specific day and time for the support group meetings and this information was stamped on the patientheld treatment card. The project provided CHWs and programme staff with a list of topics and behaviour change communication materials to facilitate the meetings, and they encouraged participants to actively interact during the meeting. Topics included stigma and disclosure, treatment adherence, nutrition, healthy living and protection of other family members from tuberculosis. Each meeting lasted for 60–90 minutes during which participants discussed only one topic (...truncated)