Women in a village in Andhra Pradesh

Andhra Pradesh accounts for a disproportionately high percentage of India’s overall TB and HIV cases. All too many of these are not even being diagnosed, and even among those who are, high numbers drop out of treatment. This can have a huge impact on their own health, as well as increasing the spread of TB among their community.

In a study, TB Alert found that Andhra Pradesh’s most disadvantaged groups such as tribal communities and the rural and urban poor knew very little about TB and HIV. TB is the most common killer of people with HIV and it can kill within months. Poverty, lack of awareness and stigma can mean that people often do not seek treatment, and those who do often wait until their health has got very bad.

UK Aid logoTackling TB-HIV in vulnerable communities

TB Alert launched the TB Advocacy Project (TAP) in 2011 to curb the spread of TB-HIV infections by helping these communities learn more about the illnesses and how they can access free medical care. The programme, which was funded by the Department for International Development, ended in 2014. You can read the external project evaluation here.

Community-based activities

TAP’s trained staff and volunteers hold a wide range of community-based activities. These range from one-to-one sessions through to mass rallies where people can freely discuss issues around TB and HIV.

Support groups, meanwhile, provide advice for those affected by TB-HIV, such as grandparents raising children orphaned by AIDS or even children who may be ill with TB-HIV or have lost a loved one to the illness. These children are offered play-based support and life skills training to help them grieve and to cope with the stigma from their peers, as in Swami’s case.

Swami portraitSwami’s story

A TB-HIV orphan shares his experiences to save others.

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Training private healthcare providers and traditional healers

The project recognises that private medical practitioners and traditional healers are often the first point of call for people who fall ill. These providers are known and trusted by the local communities in which they are based. However, their knowledge around TB is often limited and their prescribed treatments costly and ineffective. TAP staff and volunteers arrange meetings with private medical practitioners and traditional healers to train them on TB and HIV, and how they can refer patients to government health clinics for an accurate diagnosis and free treatment.

A helping hand with transport costs

Because government health clinics may be some distance away, it can be difficult for people living in poverty to make the journey for testing and treatment. TAP helps out with transport costs for people who struggle with the costs of such travel — these are often the poorest of the poor, including orphans, tribal people and fisher-folk.

Culturally appropriate activities and materials

Dance and drama are also used as an engaging and effective means to convey information about TB and HIV, particularly in areas with low literacy levels. Highly visible information materials, meanwhile, are displayed in busy areas such as post offices, schools, health centres and even on buses and boats.

TB snakes and ladders board

Snakes and ladders

Find out how a simple game is helping children learn how to manage TB and HIV treatment.

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Advocating for better TB services

TAP’s close involvement in the community give it a deeper understanding of the local issues affecting TB care and treatment. This enables the staff, who are trained in advocacy techniques, to push for improved services at the local and state levels.

TAP is currently calling on the state government of Andhra Pradesh to make available more sputum microscopy and chest x-ray facilities within easy reach of local communities. They are also urging the state government to offer a nutritional support package for children aged six or below who are infected or affected by TB.  This scheme is already provided by the national government to children living with HIV.