TB prevalence and interventions for reducing TB and LTBI in high-risk key population of rickshaw drivers and construction workers” is a SHARE INDIA project funded by Indian Council of Medical Research (ICMR). The project supports National TB Elimination Program's (NTEP) existing guidelines to treat TB in high risk groups (socially vulnerable and clinically high risk) and to reach the unreachable for the screening of TB among rickshaw drivers and construction workers.
5 zones of Delhi (as per MCD) and high and low pollution zones of Bangalore (as per Karnataka Pollution State Board)
(a). 5 Zones of Delhi Site - Central Delhi, Karol Bagh, Civil Lines, Sadar/ Paharganj and Shahdara/ Patparganj
(b). High and low Pollution zones of Bangalore
Key affected population especially rickshaw drivers and construction workers are disadvantaged group of people in comparison to the general population primarily on the account of their reduced access to medical services and the underlying detriments of health. Cycle rickshaw drivers do strenuous pedalling as compared to e-rickshaw drivers although both groups are exposed to environmental pollutants and workers at construction sites are exposed to silica containing dust at high and low pollution levels but may or may not be engaged in strenuous activities. This makes the rickshaw drivers and construction workers vulnerable, underserved and they are at risk of TB infection and illness constitute a challenge for TB control.Several studies have suggested that the TB burden in these groups is higher than the general population. Keeping this in mind SHARE INDIA enhanced outreach activities to detect TBand LTBI in these vulnerable groups.
We used a customised and cost efficient approach to conduct prevalence surveys that could inform the extend of gaps and unmet needs of these group. Through this project we intended to:
A project initiated the activity with the objective of detecting TB and LTBI as early as possible in the key population i.e. Rickshaw drivers and Construction workers to initiate the treatment/TB preventative therapy promptly.
The project's objectives are as under:
Identifying the prevalence of TB and LTBI in rickshaw drivers and workers at construction sites exposed to silica containing dust at high and low pollution levels compared with those that are engaged in strenuous activities within these groups
1. Preventing development of active TB in infected individuals by chemoprophylaxis
2. Test and treat school children ferried to and from school by TB affected rickshaw drivers and the household contacts of children with active TB
Meeting with Rickshaw Drivers Owners/ Thekedars and Construction workers
One to one “pre-sensitization meetings were conducted at project sites with Fleet operators for e- rickshaws, rickshaw owners / thekedar and construction contractor or site engineer before the initiation of the study. These stakeholders were sensitized on the ICMR funded project, TB and LTBI, Goals of TB Elimination by 2025, planned survey to find TB and LTBI cases and data collection on tablets including cough sound, outcomes and expectation from the study.
Mapping of Rickshaw stands and Construction sites
The project study covered 5 zones of MCD for Delhi site and for Bangalore site study zones were selected based on Air Quality Index values from the 12 ambient air quality monitored sites from the Karnataka State Pollution Control Board (KSPCB)
Delhi-Zones (Rickshaw Drivers)
• Karol Bagh
• Central Delhi
• Sadar/ Paharganj
• Civil Lines
• East Delhi
Bangalore-Zones (Construction Workers)
• BTM Layout
• Hombegowda Nagar
• Jayanagar 5th block
• City Railway Station
To study the prevalence of TB and LTBI in high-risk key population for Delhi and Bangalore zone, google maps were created and marked with location of study sites and presence of rickshaw stands and construction sites. The key work sites of cycle and e-rickshaw drivers like metro station, market, schools were mapped and routes of operation of rickshaw drivers have been mapped with key charging points for e- rickshaws.
Training of project staff to recognize the increased risk of TB and screening in these high riskpopulation for signs and symptoms suggestive of TB and LTBI and give special attention to syndromic disease surveillance.
Enrolment of Rickshaw drivers and construction workers
The project team engaged in one-to-one discussions and group meetings with Rickshaw drivers and construction workers and they were provided TB education material in local language about importance of screening and testing for TB and LTBI. The rickshaw drivers and construction workers were explained to provide sputum sample if required for TB testing at NTEP facility in case they have signs and symptoms suggestive of TB or TST and X-ray diagnosis for LTBI diagnosis at NTEP facilities. All participants were well informed and consent was taken before enrolment.
Conducted field surveys as per developed questionnaires
The project team equipped with pre-loaded questionnaires on tablets and printed consent forms and approached rickshaw drivers and construction workers. Survey questionnaires were designed in a manner to collect information based on all detriments of health including social determinants. The information that was collected was uploaded on the cloud in real time through a GPMS Tranportal supported by Indian CST–our project partner.
Linkage of TB affected participants to NTEP facilities
All study participants are linked to nearest NTEP facilities which will ensure confirmation of diagnosis thereby ensuring early detection of TB. The diagnosis of participant is done as per NTEP algorithm utilizing NTEP TB diagnostics available at the linked NTEP facilities.
Linkage of TB affected participants to Social Welfare schemes
The project is also linking all eligible TB affected participants to social welfare schemes including nutritional support as per NTEP guidelines.
Strengthening NTEP & Project staff for Detect – Treat – Prevent – Build approach with TST Training
The NTEP and the project staff is trained for Tuberculin Skin Test (TST) administration and Reading for LTBI at New Delhi Tuberculosis Centre (NDTB), New Delhi and STDC Karnataka. The training not only helps in building the capacity for TB elimination programs but also opens a new way for understanding LTBI burden that can contribute to new TB cases.