Health and Development Initiative-India, (www.healthinitiative.org), publishes `TB News from India' once every two months. The objective of newsletter is to highlight issues related to Tuberculosis and HIV/AIDS control in India and enlist political, public, professional and administrative support for its cause. Health and Development Initiative-India is a not-for-profit organization and the news items have been quoted from various sources for fair use and in public interest. Reproduction of the material published is welcome provided a reference is made to the original source of the news item and `TB News from India.'

Editorial note:  

TB is a workplace issue too!

One may wonder why should employers be interested in TB - and specifically interested in taking steps to contribute to TB control?

The answers are straightforward:

• TB interrupts workflow, lowers productivity and raises both
  direct cost related to treatment and care and indirect costs such as
  the replacement and retraining of workers.
   

• Without effective treatment, employees sick with TB will often
  spend three to four months off work.
   

• But given effective treatment, many employees can return to work
  within two to four weeks without the risk of infecting others.

TB is a workplace issue because health is essential not only to the well being of individuals but the functioning of economies. Employers can play a vital role in promoting and undertaking TB control
activities in the workplace and in the neighboring community. Workers' organizations can collaborate in these activities and advocate for the needs of employees, including health care.

The advantages of the workplace for TB control activities are that workers attend on a regular basis, communication systems are in place, and existing structures, services, and facilities can be used
for prevention, care, and support. Most employers can contribute towards the following key components of TB control, identifying TB suspects and referring them for diagnosis; helping TB patients to complete their treatment. Some large-scale employers with a significant number of TB cases among their workforce may wish to set up a workplace DOTS program.

World Economic Forum's Global Health Initiative has commenced its activities in India to enlist support of businesses for Revised National Tuberculosis Control Programme (RNTCP). This indeed is a  well-timed move because an isolated health sector cannot alone stop TB and new partnerships must be forged across sectoral boundaries.

After all TB is everyone's business.

New guidance for TB management in the workplace launched at the India Economic Summit

(A set of guidelines for managing TB in the workplace, published by Global Health Initiative of World Economic Forum were launched at India Economic Summit held at New Delhi during last week of November 2003.)

"TB Management in the Workplace: An Introduction for Businesses in India" provides guidance for managers to tackle TB in the workplace. The document lays down ten key principles that can guide a workplace TB policy and program. It identifies TB as a workplace issue. Case studies have shown that treating TB in high prevalence settings makes business sense, and workplace is often the ideal place to identify cases and administer treatment. The document cautions against discriminating with individuals because of their real or perceived TB status, as discrimination and stigmatization of people with TB causes delays in diagnosis and makes it more difficult to cure patients. It calls upon workplace managers to work together with Revised National TB Control Program [RNTCP] for providing DOTS services. Often daily contact with workers makes the workplace an ideal setting for
implementing DOTS program, it says.

Read the complete story at:
http://www.weforum.org/pdf/Initiatives/GHI_Guidelines_WHO_TB_India.pdf

Private sector participation crucial in fighting AIDS
(Bachi Karkaria, Times of India, December 16,2003)

Richard Feacham, executive director of Global Fund to Fight AIDS, TB and Malaria (GFTAM) believes strongly in the private sector offensive in global war on AIDS. He refers to the latest meeting of the Global Business Coalition (GBC) in Nairobi in early December 2003. Seven MNCs with operations in developing world announced the expansion of their own HIV/AIDS programmes into the larger community.

Tata Steel was the Indian major in this GBC initiative. The Tata Steel hoped to scale their 21 community clinics currently engaged in testing and treatment for 14000 people in Jamshedpur. Feacham said that Ratan Tata is a leading member of this coalition and has thrown his personal commitment behind the war against AIDS.

Feacham said we welcome private sector endeavors because it is our experience that they move faster and more successfully.

TB cases on the rise in Punjab
(Times of India, New Delhi/Chandigarh; December 13, 2003)

Even as Punjab government continues to pour in large sums of money to control tuberculosis in the state, the disease seems to have a life of its own. with hundreds of people losing their life to it every year. Statistics for the last many years show that the disease has not been tamed in the state, a situation similar to one prevailing in other states of the country where also disease is on the rise. This year disease is on the rise in border district of Gurdaspur and Jalandhar. During the two years between 2001-2003 some 13,460 cases were reported from Ludhiana, the hub of industry in the state, alone. This is in spite of the fact that health department is running a special campaign in nine of the seventeen districts of the state under the Revised National TB Control Programme [RNTCP]. Part of the problem, health officials say is that of the resistant strains of tuberculosis bacillus infecting people. These are not amenable to treatment by usual drugs prescribed for the disease. Another problem is that many people diagnosed with the disease do not complete the regime of medicines given to them leading to emergence of [drug] resistant strains

Evening OPDs for TB patients soon in Chandigarh
(Sourav Sanyal, Times Of India, November 29, 2003)

To cater to the needs of patients suffering from TB evening OPD is returning to hospitals in Union Territory of Chandigarh. Though the exact dates for launching the evening Out Patient Departments (OPDs) have not been finalized, these are expected to become functional by March 2004. Speaking of evening OPDs Dr. Pradeep Kapoor. WHO-RNTCP Consultant says," We thought of starting evening Directly Observed Treatment Short-course [DOTS] centres since patients undergoing treatment are often forced to forego their daily wages as they have to report to DOTS centres during morning hours and this might act as a deterrent.

Dr. Kapoor also spoke about a pilot project aimed at fostering public-private partnership in controlling TB, WHO is running at 15 sites across the country including Delhi, Bangalore, Pune, Lucknow, Chennai and Chandigarh. An all-round approach is being followed in Chandigarh to achieve participation of NGOs, Private Practitioners (PPs) and Corporate sector. Fifty-five PPs have already signed a memorandum of understanding with Chandigarh District TB Control Society. The success of evening OPD plan will depend on active participation of PPs, feels Dr. Kapoor.

A "task force" comprising of local area representatives, ex-servicemen and cured patients is also proposed to be setup to spread the message that treatment for TB is now available free of cost and
that any person having cough for three weeks or more needs sputum examination at a DOTS centre.

Read the complete story at:
http://timesofindia.indiatimes.com/articleshow/329136.cms

Non-Compliance, A Crucial Obstacle in Tuberculosis In Control: A Gujrat Study

Non-compliance of treatment by patients continues to be one of the major hurdles in control of tuberculosis, according to a study conducted in Anand district of Gujarat. Anand is one of the 25 districts of Gujarat implementing Revised national Tuberculosis Control Programme (RNTCP). It is a major tobacco cultivating district of Gujarat. The RNTCP was launched in Anand district in April 2000.
The district has been divided into four Tuberculosis Units (TU). All the TB patients registered under RNTCP during last quarter of year 2002 from two randomly selected TU were interviewed. Some DOTS providers were also interviewed.

The study found a default rate of 7.3%. One principal reason for defaulting was side effects of anti-TB drugs. The default rate was also found to be higher amongst patients who were observed by Government staff as compared to those observed by volunteers. This could be due to the reason that cash incentives given to volunteers are not admissible to Government staff. These important findings
point to the difficulties in practice of DOTS at the cutting edge.

(Contributed by Dr Niraj Pandit Assistant Professor, Department of community medicine, P. S. Medical College Karamsad Gujarat).

India's AIDS epidemic could grow to African levels: activists
(Agence France Presse, Thursday, November 13, 2003)

India could see an AIDS epidemic similar to that in some African countries where the disease is the leading cause of death, according to a study funded by Microsoft head Bill Gates. The study cited figures from the Indian National AIDS Control Organisation (NACO), which said 4.58 million Indians, were living with HIV/AIDS at the end of 2002, a significant leap from the figure of 3.97 million given the previous year.

"HIV/AIDS is now spreading to the general populace in India and if knowledge of the disease, preventive measures and counseling is not made universal then India could see an epidemic similar to that of some of the African countries," said a release by the Washington- based Population Reference Bureau (PRB) which co-authored the study with the Population Foundation of India (PFI).

India, with a population of more than one billion, has the second largest number of people living with HIV/AIDS after South Africa. The total increase in HIV/AIDS cases worldwide in 2002 was five million of which India accounted for about 12 percent.

Study co-author A.R. Nanda, who heads the PFI, said the "problem would have been worse" if the Indian government had not addressed the issue as soon as the first AIDS case was detected in the southern city of Madras [Chennai] in 1986.

"But the trends still indicate the need to remove the social stigma currently associated with HIV/AIDS and ramp up efforts to fight the disease," said Nanda.

He pointed out that general awareness levels of HIV/AIDS in India were skewed with villagers displaying "colossal ignorance" about the disease." Three out of four rural women living in the populated states of Bihar, Gujarat and Uttar Pradesh said they had never heard of HIV/AIDS. And three out of 10 men were not aware of the condom's protective value," said Nanda. The study said that while 90 percent people living in urban areas had heard of HIV/AIDS only 72 percent of people in the rural areas had done so.

Read the complete story at:
http://massiveeffort.org/showstory.asp?id=653

Country's first TB hospital to be shut down
(Kolkata, Times News Network, November 03, 2003)

Ignoring the rising number of TB cases in state as well as throughout the country, the West Bengal government has decided to sell off and close down South Asia's first and the state's only specialized TB hospital - the K.S Ray TB Hospital adjacent to Jadavpur University.

Set up in 1923 by pioneering thoracic surgeon Kumud Sankar Ray as a four-bed sanatorium, it became a 750-bed centre with money donated by a landed aristocrat called Provash Ghosh, who died from the disease and willed his entire fortune to Ray to acquire the 65-acre location and set up the hospital.

According to health secretary Asim Burman, the decision was taken on two counts. "The hospital is located in a congested area, where treating a contagious disease may become a problem. Moreover, TB is no longer such a big threat in this region."

Read the full text of the story at:
http://timesofindia.indiatimes.com/articleshow/264160.cms

Web Call: A visit to Global Health Initiative's Best Practice Guidelines page

The World Economic Forum's Global Health Initiative (GHI) is designed to foster greater business engagement in the global battle against HIV/AIDS, tuberculosis (TB) and malaria. It works in partnership with various international organizations to develop and communicate corporate best practices in these areas. The documents available on this page are part of the GHI's efforts to improve the quality as well as the quantity of the private sector's efforts to combat these diseases. A number of useful documents are available on this page, which include:

	Guidelines for Workplace TB Control Activities prepared by the World Health Organization (WHO) and the International Labour Organization with the goal of harnessing the contribution of employers and workers towards the control of tuberculosis (TB)
	TB Management in the Workplace: An Introduction for Businesses in India and Africa provide guidance for managers to tackle TB in the workplace.
	Statement on the Role of the Corporate Sector in Global TB Control, prepared by Programme in Infectious Disease and Social Change, Harvard Medical School.

This page is a useful reference point for those working to engage businesses to support National Tuberculosis Programmes (NTPs) or interested in developing workplace programmes and policies for
tuberculosis control.
 

Visit the Home Page at :
http://www.weforum.org