India: Patient Support Systems Encouraging TB Patients To Adhere To Treatment

Tuberculosis (TB) is an infectious disease caused by bacteria (Mycobacterium tuberculosis), an air borne disease that most often affects the lungs of infected persons; and spread to healthy person when infected patients cough, sneeze or spit.  Although TB is curable and preventable, it remains one of the top 10 causes of death worldwide.

Globally, 10 million people are estimated to have developed TB disease in 2017. The severity of national epidemics varies widely among countries. India alone is home to a quarter of the global TB burden, with 28 lakh active infected patients and 4,23,000 TB related deaths annually, where only 14 lakh patients have been captured by the system or notified to the government. Most of these incidences can be prevented through early diagnosis and adequate treatment1.

TB is five times more common among economically weaker populations, whose physical, economic, and social marginalization causes conditions conducive for the disease to thrive and act as barrier to treatment completion. The debilitating battle against TB often forces patients out of employment.

To address these socio-economic determinants and consequences of the disease, the National Strategic Plan 2017-25 (NSP), shaped by WHO's End TB Strategy and the Sustainable Development Goals (SDGs) agenda framework has introduced new strategies for TB programming in India. In addition to advancing existing programme components (case detection, diagnostics, drugs), the NSP introduced Patient Support Systems (PSS), which envisage to support patients during the treatment period with the provision of incentives, nutrition support as well as creating linkages to other social welfare programmes.

Ongoing Patient Support Systems (PSS) in country

According to "State Initiatives on Patient Support Systems for TB Elimination in India2", sixteen states namely Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Delhi, Goa, Gujarat, Himachal Pradesh, Jharkhand, Kerala, Maharashtra, Meghalaya, Madhya Pradesh, Punjab, Tamil Nadu, and Telangana were found to have already implemented some form of PSS like:

  1. Nutrition support: Fourteen out of the 16 documented states provide supplementary nutrition in the form of dry ration monthly to TB patients. Nutrition support across the 14 states was predominantly targeted at drug-resistant (DR) TB patients and patients from low income groups (in Jharkhand, Kerala Madhya Pradesh, Meghalaya, Telangana and Tamil Nadu). Chhattisgarh has been a pioneer in introducing nutrition support for all TB patients across the state. This offers a window of opportunity to counsel patients on the importance of nutrition uptake, measure weights and assess treatment adherence. Further, it allows for follow-up with patients to monitor and ensure treatment completion.
  2. Links with other social welfare schemes: Support under existing social welfare schemes targets socially and economically weaker populations with TB. For instance, Chhattisgarh has been attempting to reduce high treatment costs by providing special Multi-drug Resistant (MDR) TB packages (INR 50,000/family/annum) under Rashtriya Swasthya Bima Yojana (RSBY) and Mukhyamantri Swasthya Bima Yojana (MSBY). On the other hand, Gujarat (INR 500/patient/month), Jharkhand (INR 10,000/Patient), Kerala (INR 1000/month/patient) and Tamil Nadu (INR 1000/month/patient) link patients to state based welfare schemes that provide regular monetary support.
  3. Economic assistance in-kind: Recognizing the financial difficulties of TB affected families some states are providing economic assistance in the form of in-kind support like- Kerala (housing support), Maharashtra (Travel support), Tamil Nadu (dry rations), and Telangana (Economic Development Assistance).
  4. Psycho-social support: Psycho-social factors include stigma, social discrimination, and low awareness, as well as treatment interrupters and naysayers in the community who hinder treatment-seeking behaviour and treatment completion. To address this, community-based groups are created to undertake mobilization activities to tackle negative psycho-social implications of TB. The groups typically comprise of PRI members, AWWs, ASHAs, and TB Health Visitors among others.  For instance - -in community mobilization and sensitization activities - Chhattisgarh, Assam and Telangana employ cured TB patients as "Axshya Saathis", encouraging them to share their experiences and challenges with other TB patients.


A number of states implementing several forms of PSS are targeting towards economically weaker patients or patients with DR-TB. With, strengthened patient support systems across the country all TB patients, who need most support can be targeted with adequate socioeconomic assistance.

Moreover, monitoring and evaluation mechanism should be put in place to track progress and understand the success of PSS, as only few states have a mature monitoring and evaluation system in place to track outcomes and impact.




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