Advocacy: Coordinated interventions, designed to place TB high on the political and development agenda, foster political will, and increase financial and other resources.
Communication: Create and improve knowledge among the general public about TB (e.g. its symptoms and curability), TB control services (e.g. diagnosis and treatment) and improve interpersonal communication between patients and program providers.
Social Mobilization: Securing broad consensus and social commitment within civil society to fight stigma and eliminate TB as a public health threat.
The goal of ACSM is to improve case detection and treatment adherence, to combat stigma and discrimination, to empower people affected by TB and to mobilize political commitment and resources for TB.
ACSM for TB control should help to maintain current case detection and case cure rates in situations where DOTS services are assured, (as in India), ACSM could increase these rates by as much as 5–10%*.
ACSM goals can be achieved through five key strategic components: building ACSM capacity, inclusion of patients and affected communities, ensuring political commitment and accountability, building ACSM partnerships, adapting and building on good ACSM practice.
ACSM strategies are most effective when ACSM programming fully and broadly engages governments, NGOs, patients and communities, and other sectors of society such as private enterprises and the media.
Six fundamental principles for action: knowledge is critical, knowledge is not enough, ACSM should be integral to NTEP, should be nondiscriminatory and rights-based and requires capacity building.
Monitoring and evaluation indicators should be designed and selected in the context of the two main NTEP goals: 90% TB case detection and 90% TB case cure.
*World Health Organisation. Advocacy,Communication and social mobilization to fight TB: A 10-year framework for action. 2006.
KEY FACTS ABOUT XDR TB
It is vital that clinicians caring for TB patients are aware of the possibility of drug resistance and have access to laboratories that can provide early and accurate diagnosis.
Effective treatment requires that all six classes of second-line drugs are available to clinicians who have special expertise in treating such cases.
XDR-TB (extensively drug-resistant tuberculosis) can develop when second-line drugs are also misused or mismanaged and therefore also become ineffective.
MDR-TB occurs when the TB bacteria are resistant to at least isoniazid and rifampicin, the two most powerful anti-TB drugs.
XDR-TB is TB that is resistant to any fluoroquinolone, and at least one of three injectable second-line drugs (capreomycin, kanamycin, and amikacin), in addition to MDR-TB1.
The most important thing is for a patient to continue taking all their drugs exactly as prescribed in right dose, duration and combination.
Countries can prevent XDR-TB by ensuring that the work of their national TB control programmes, and all practitioners dealing with patients of TB, is carried out according to the International Standards for TB Care2.
XDR-TB & HIV co-infection is likely to be a deadliest combination. Highest mortality reported from Kwa-zulu Natal province in S. Africa3.
Good TB control prevents the emergence of drug resistance in the first place, and proper treatment of MDR-TB prevents the emergence of XDR-TB, in line with the new Stop TB Strategy launched in 2004.
and treatment adherence, to combat stigma and discrimination, to empower people affected by TB and to mobilize political commitment and resources for TB.
World Health Organisation. Extensively drug-resistant tuberculosis (XDR TB): recommendations for prevention and control. Weekly Epidemiol Record 2006;81:430-432.
International Standards For Tuberculosis Care (ISTC) January 2006
Gandhi NR, Moll A, Sturm AW et al. Extensively drug resistant tuberculosis as a cause of death in patients coinfected with tuberculosis and HIV in a rural area of South Africa Lancet 2006;368:1575-80.
WHO Geneva; Stop TB strategy, March 2006.
EPIDEMIOLOGY OF TUBERCULOSIS
India is classified along with the sub-Saharan African countries to be among those with a high burden1.
Incidence of infection as studied in younger age groups is the appropriate index to measure the tuberculosis situation in a community.
Mathematical estimation, using the figures on the prevalence of infection in younger children (0-14 yr) is termed the annual risk of infection (ARI).
Prevalence of real smear-positive cases is likely to be a good epidemiological index, when the intervention measure is either very effective or when there is no treatment at all.
The incidence : prevalence ratio in India is about 1:32. In case an efficient tuberculosis programme, targeting a sufficient number of sputum-positive prevalence cases in the community, is run for a sufficiently long period of time, it could bring down the prevalence, till probably the point when incidence and prevalence become equal in the community (1:1)3.
A series of tuberculosis infection surveys, carried out at intervals of 7-10 years, depending on and related to the intervention efficiency in a given area, could give a trend, following intervention.
It is suggested that for developing countries, the natural decline of 0-2 per cent may have to be augmented to be between 5-10 per cent following an intervention, for it to be cost-effective3.
The sustained maintenance of >90% cure rate and case detection of >90% among NSPs is likely to bring down incidence by 7-12% per year in the absence of HIV3.
People infected with tubercle bacilli and HIV are 10 times more likely to develop active tuberculosis in a given year, than those infected with tuberculosis alone.
WHO Geneva; WHO Report 2006: Global Tuberculosis Control; Surveillance, Planning and Financing.
Prevalence and incidence of tuberculosis infection and disease in India: a comprehensive review. 1997, WHO / TB / 97. 231, p 1-26 (+ attachment). Geneva: World Health Organization.
Epidemiology of tuberculosis: Current status in India. Indian J Med Res 120, October 2004, pp 248-276.
KEY FACTS ABOUT SMOKING
India has the world’s second largest tobacco growing industry and consumer of tobacco. Tobacco is the most important preventable cause of death and disease among adults.
There are 1.3 billion smokers worldwide and 70% of them live in the developing world1. The prevalence of tobacco use among men has been reported to be high (exceeding 50%) from almost all parts of India. Women from most parts of India report smokeless tobacco use and the prevalence varies between 15% and 60%2.
Among 13-15 year old school-going children, the current use of any tobacco product varies from 3.3% in Goa to 62.8% in Nagaland.
The major smoking problem in India is beedi smoking, and a large part of the overall tobacco problem is the oral use of smokeless tobacco products.
The World Health Organization (WHO) estimates that worldwide 5 million deaths are caused prematurely by smoking every year.
WHO predicts that India will have the fastest rate of rise in deaths attributable to tobacco in the first two decades of the twenty first century. In India, over 600,000 men in the age group 25-69 years die due to smoking every year.
Second-hand smoke, also known as “passive smoking” or “environmental tobacco smoke” (ETS), causes serious diseases, including lung cancer and heart disease, in non-smokers, as well as other conditions in children such as asthma, respiratory infections, cough, wheeze and middle ear infection.
Recent research results from India have demonstrated that smoking increases the risk of death among TB patients and causes 200,000 extra TB deaths.
Tobacco control requires a comprehensive multi-component strategy which is implemented through coordinated multi-sectoral measures. Interventions at the community level involve programmes for empowering people, especially vulnerable sections, with the knowledge, motivation and skills required to abstain from or abandon the use of tobacco habit.
International Union Against Tuberculosis and Lung Disease. Ten facts about tobacco. Available at http//www.iuatld.org.
Report on Tobacco Control in India. Ministry of Health & Family Welfare, New Delhi 110011, India.