1. Novel interventions to enhance access to TB services for vulnerable and marginalised populations: experience from Axshya
Sripriya Pandurangan, The Union
Sripriya Pandurangan, Novel interventions to enhance access to TB services for vulnerable and marginalised populations: experience from Axshya

2. Background (Need for the intervention)
Low awareness about TB in vulnerable and marginalised population
Poor access to health services
Delay in diagnosis and further treatment
Need to involve other service providers  
Sripriya Pandurangan, Novel interventions to enhance access to TB services for vulnerable and marginalised populations: experience from Axshya

3. Axshya: Goals and Objectives
Improve access to quality TB care and control services through enhanced civil society participation
Objectives
Improve the reach, visibility and effectiveness of RNTCP through civil society support
Engage communities and community-based care providers to improve TB care and control, especially for marginalized and vulnerable populations
374 districts across 23 States
The Union – 300 districts
World Vision India - 74 districts
Sripriya Pandurangan, Novel interventions to enhance access to TB services for vulnerable and marginalised populations: experience from Axshya

4. Activities and expected outcomes
- Increased case notification
- Decrease in default rate
- Improved treatment success rates
- Universal access to quality TB services
Enhanced involvement of all health care providers
(especially AYUSH Providers, non-qualified providers)
Greater Community involvement
(Community groups –VHSC; local self govt. ; self help groups)
Increased political and Administrative commitment
(District, State and National level)
Increased access to TB control services especially by vulnerable and marginalized populations
(identification, mapping and targeted interventions)
Sripriya Pandurangan, Novel interventions to enhance access to TB services for vulnerable and marginalised populations: experience from Axshya

5. Geographical coverage and SRs
Districts
Activities
CHAI 96
Community activities
CBCI 29
CMAI 15
EHA 25
MAMTA 62
The Union 13
REACH 14
VHAI 46
PSI 60
Sripriya Pandurangan, Novel interventions to enhance access to TB services for
vulnerable and marginalised populations: experience from Axshya

6. A diverse land of over 1.2 billion people…..
India…..
A diverse land of over 1.2 billion people…..
With the World’s highest burden of TB……
Our Vision …. A TB - free India | Our Vehicle…….. Partnerships
16 million people reached in 300 districts across 21 states by 2014
1,200 Non-governmental Organisations
20,000 Community volunteers
9 Sub-recipient partners
THE UNION

7. Axshya SAMVAD
Sensitization and Advocacy in Marginalized and Vulnerable areas of District (SAMVAD)
District level mapping of vulnerable and marginalized population areas
House to house visits by trained community volunteers to increase awareness about TB
Identify and link symptomatic cases to TB services
Choice of referral/SCT for symptomatic cases. Follow up of those referred by CVs and doing SCT if necessary.
Nearly 1000 households visited every month in each district.
Sripriya Pandurangan, Novel interventions to enhance access to TB services for vulnerable
and marginalised populations: experience from Axshya

8. Results of Axshya SAMVAD
(Apr 2013 – Dec 2014)
62 %
Sripriya Pandurangan, Novel interventions to enhance access to TB services for vulnerable and marginalised populations: experience from Axshya

9. Rural Health Care Providers
First point of contact for rural and urban poor
RHCPs/AYUSH trained and engaged on TB care and control
Trained to identify symptomatic cases and refer to nearest DMCs
Encouraged to do sputum collection and transportation
Motivated them to act as community DOT providers
Trained RHCP serving as DOT Provider for 20 TB patients
Sripriya Pandurangan, Novel interventions to enhance access to TB services for vulnerable and marginalised populations: experience from Axshya

10. RHCPs – Training and engagement
Engaged-
Referral of at least 3 TB symptomatic cases per quarter
At least 1 sputum sample collected and transported per month
DOT Provision- at least 1 patient per quarter
Sripriya Pandurangan, Novel interventions to enhance access to TB services for vulnerable and marginalised populations: experience from Axshya

11. Results of RHCP engagement
No. of RHCPs trained
18879
No. of RHCPs engaged
2442
No. of TB patients referred by one RHCP 15
No. of TB patients diagnosed per RHCP 2
Sripriya Pandurangan, Novel interventions to enhance access to TB services for vulnerable and marginalised populations: experience from Axshya

12. Conclusion
Active case-finding and engagement of RHCPs through community-based organisations successfully enhances access to diagnosis and treatment of TB for vulnerable and marginalised populations.
This has resulted in yield of additional TB cases
The interventions can be replicated in other high TB burden countries
Sripriya Pandurangan, Novel interventions to enhance access to TB services for vulnerable and marginalised populations: experience from Axshya

13. Thank you
Axshya is a collaboration to support our common objective of reaching out and benefitting thousands of TB patients who continue to suffer because of ignorance and lack of access