TB-REACH is an initiative with the primary objective to demonstrate the additional yield among at risk and vulnerable population in Chennai, India through an ‘Innovative Public Private NGO Partnership model’. This initiative was started in November 2014 through a Wave 4 grant of the STOP TB partnership, in collaboration with Chennai Corporation and National Institute of Research in Tuberculosis, Chennai, and continued till March 2016. The initiative involves screening of all contacts of smear positive TB patients registered in Chennai Corporation.

Innovative Process

REACH field officers met sputum positive TB patients at the respective DOTS centres and provided coupons for their contacts to undergo screening for Tuberculosis. Subsequently the contacts undergo symptom and Xray screening in the private X-ray facility using the coupons. X-ray and symptom screening is done for the contacts and if found to have symptoms of tuberculosis and /or abnormalX-ray, GeneXpert test is done using the sputum sample of those contacts to diagnose tuberculosis.

The core components of the initiative were

• Capturing family details on an electronic data base system.
• Incentive based approach for symptomatic and X-ray screening of the household contacts
• Use of GeneXpert testing for the symptomatic/contacts with X-ray abnormalities for identification
• Linking up the identified TB patients to RNTCP for treatment initiation.
• The initiative covered the inner ring of Chennai and demonstrated that with committed effort, the contact tracing strategy could be a viable option to improve the yield. The Wave 4 STOP TB grant continued till March 2016.
• In addition several collaboration meetings were held with the stakeholders.

Chennai Corporation

Regular meetings with the TB health staff of Chennai corporation in order to improve the co-ordination among the senior treatment supervisors (STS), health visitors (HV) and the REACH staff. A meeting was arranged with the RNTCP Chennai team of Senior Treatment

Supervisors (60 STS) to brief them about the activities under the TB- REACH initiative. The meeting was used as a platform to discuss the challenges faced and suggestions were invited to improve mutual support for a better integration of the project with the RNTCP.

Hitech Diagnostic Laboratory (Private facility)

Regular Meetings with the team at Hitech Diagnostic Laboratory for co-ordination of X-rays and provision of soft copies were conducted. Moreover, a sensitization meeting was carried out with X-ray radiologist in order to improve X-ray readings related to tuberculosis.

Outcome

A total of 3067 index patients (out of 3360) registered and eligible for the contact tracing in the study area (Chennai district) were met. A total of 7458 contacts of the index patients were given coupons for TB screening. Among them a total of 5553 contacts got themselves screened. A total of 1312 screened contacts (23.6% of screened contacts) were found to have presumptive Tuberculosis and were given falcon tubes for GeneXpert test (CB-NAAT) for confirmation of the diagnosis. About 965 contacts gave sample for GeneXpert test, out of which 36 were found to have tuberculosis. Among the contacts who did not provide the sample, 5 were started on treatment based on other evidences. During the same period, 47 contacts were already started on treatment by the RNTCP. In all, 5553 contacts were screened, 88 were diagnosed and started on TB treatment. The number needed to be screened was 63.