Toggle nav Stars Foundation

Stars Foundation invests in organisations and ideas that transform the lives of disadvantaged children and their communities globally.

Read more.

Treating TB in Urban India and Rural Uganda

Posted by: Camille on 24 Mar 2014
in Blog

With more than three million deaths from tuberculosis in 2012, it is difficult to imagine that the international community was celebrating the eradication of the disease in the 1950s.

However, with no surveillance or monitoring systems in place, the epidemic silently re-emerged and in 1993 TB was declared a medical emergency by the World Health Organisation (WHO). This is the "medical failure" that Gandy and Zumla were referring to in their book The Return of the White Plague.

Today, the spread of a TB and HIV 'co-infection', the apparition of multiple drug resistant forms of TB (MDR-TB) and the recurrence of TB in high-income countries like the UK constitute the modern crisis that the WHO aims to address with its Stop TB Strategy.

This strategy also supports the development of new and effective tools to prevent, detect and treat the disease.

And two Stars Impact Awards holders have developed interventions to effectively address the contraction and spread of TB in their own communities.

Bwindi Community Hospital: decentralised intervention in rural Uganda

TB is the one of the most opportunistic infections for people living with HIV. This has contributed to a reduction in life expectancy in rural Uganda from 64- to just 49-years-old.

Many TB programmes in rural Africa aim to decentralise treatment to peripheral health centres in order to fight and control TB in face of the surge of the HIV epidemic. This is particularly important in rural Uganda where patients walk long distances – sometimes more than 30km – to access treatment.

In Southwestern Uganda, in the Kanungu district, the Bwindi Community Hospital runs a high quality mobile HIV and TB education, testing and treatment service.

More about Bwindi:

  • The Hospital serves a very remote area; Bwindi Community Hospital is the only hospital in a day's walk from all directions for the community. The healthcare need is overwhelming in the area, which has high prevalence of malaria, malnutrition, HIV/AIDS and TB being the main life threatening conditions.
  • With its Stars Impact Award funding, Bwindi updated its data management system, now collecting and analysing data in from its admissions, vaccinations, outpatient, PMTCT (prevention of mother-to-child transmission), TB and surgery departments.
  • The number of children accessing healthcare has increased by 13%. And more than 16,000 children are enrolled on the eQuality program, a long-term insurance programme for financing healthcare. This has led to a remarkable increase in the accessing of health services by the community's most vulnerable groups.

Between 2011 and 2012, Bwindi Community Hospital brought down TB prevalence from 8% to 4.4% and TB treatment compliance reached 97%.

Operation Asha: treating TB in urban India  

With almost a quarter of the world's total TB burden, tuberculosis has become a major public health concern in India. Urban densities and widespread slums pose significant challenges to address the rampant epidemic.

With high levels of poverty and insufficient access to healthcare, TB patients poorly adhere to their daunting six-month therapy plans. This leads to an increase in drug resistance levels in the community where a MDR-TB epidemic could have devastating consequences.

Operation Asha (OpAsha) has developed an innovative system, tailored to the realities of urban Indian life, in order to contain TB. This system is based on:

  • Close collaboration with the national TB programme and the WHO-sponsored DOTS programme.
  • A network of community-based treatment centres: OpAsha uses existing corner shops, health clinics or religious places within the community to administer treatments and refer patients to government facilities for diagnosis. Patients have access to their treatment well past office hours and within 10-minutes' walk from their homes.
  • Awareness and education: the social stigma associated with the disease is responsible for more than 100,000 TB-infected women and 300,000 children to be abandoned by their families or forced to leave school every year. Trained community providers and OpAsha staff educate key stakeholders, patients and their families to ensure that patients adhere to the treatment and are well taken care of.
  • Biometric technology:  In partnership with Microsoft Research, OpAsha created the Ecompliance system that uses SMS and biometric technology to track and monitor patients and their therapy adherence.

By making TB treatment easy and accessible, OpAsha has developed an efficient way to tackle the TB crisis in the hard-to-reach slums of India. It is providing treatment to 4.8 million people with only 2.75% of its patients defaulting on treatment plans in 2010, compared to almost 60% for other organisations working in similar environments in India.

This post was written by Camille Warambourg & Alessio Kolioulis