Andhra Pradesh comprises 7% of India’s population, yet 20% of all HIV cases and 13% of all TB cases in India are found in the state. If Andhra Pradesh was a country, it would rank 15th globally among nations with the highest TB disease burden.
An estimated 65,000 cases of TB among Andhra Pradesh’s population of 84 million people go undetected every year. A further 10,000 patients in the state drop out of treatment ever year.
In a study, TB Alert found that Andhra Pradesh’s most disadvanted 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.
TB Alert launched the TB-HIV Andhra Pradesh programme (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 is funded by the Department for International Development.
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.
A TB-HIV orphan shares his experiences to save others.
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.
Snakes and ladders
Find out how a simple game is helping children learn how to manage TB and HIV treatment.
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.