This was certainly a landmark because seldom does such interfaces take place in an open manner. Also this is a landmark because Dr Ashok Kumar agreed to support and participate in a proposed national consultation on TB-HIV collaborative activities in India.
This meeting is a big step forward for government to come forward and meet the civil society in an open meeting. I commend the government to meet the community, said Anand Grover, UN Special Rapporteur on Right to Health and head of HIV/AIDS Unit of Lawyers' Collective. Anand is a senior Supreme Court lawyer. Most of us come from HIV activism background so will like to quote 'Living with HIV with dignity but dying of TB.' PLHIV are often not able to deal with TB because of lack of community empowerment. In HIV world we have learnt a lot that community empowerment and rights-based approaches are very important. Incidence of HIV is declining because of involvement with communities. Community empowerment is a key. HIV world has understood vulnerabilities – because we recognize vulnerabilities the programmes and policies are developed accordingly for most at risk populations like sex workers, men who have sex with men (MSM) or injecting drug users (IDUs). Can this be done in TB world? HIV positive have become active on TB advocacy too so that gives hope. Collaborative approaches can achieve a lot more and let's hope government and civil society can bring in this change, said Anand Grover.
Dr Ashok Kumar from RNTCP said he was grateful for this incredible opportunity to interact with the civil society. Entire solution lies with the people themselves, said Dr Kumar. Dr Kumar shared learning from his own lifetime experience of how community engagement had a positive impact on programme outcome in addressing health challenges posed by smallpox, leprosy, guinea worm, reproductive and child health, filarial diseases among others. TB is one of the major opportunistic infections for PLHIV. We along with everyone need to join forces in fighting TB successfully. Globally and also in India the programme has definitely controlled TB, challenges do emerge and we need to manage them because it is not the bacillus that has to be blamed but the human behaviour, said Dr Kumar. There are health system related issues too that challenge us. We have a curative tool but if we insult our tool, then bacillus will become stronger. How can we modify human behaviour so that bacillus doesn't become stronger, we need to find solutions together to improve TB programmes. We are here to support the civil society, it is not the government and people but we are one. People make the government and there is no barrier said Dr Kumar.
Dr KS Sachdeva, CMO, RNTCP said that the RNTCP needs civil society more than the civil society needs the programme. According to a study, only 2% of MDR-TB knowledge was there in the community. TB-HIV awareness was there and so was the knowledge that TB is the most common opportunistic infection (OI) for PLHIV. Advocacy, Communication and Social Mobilization (ACSM) needs to change and become more effective for MDR-TB and TB-HIV collaborative services' roll out. Progress in TB-HIV collaborative services' roll out is faster than MDR-TB also because lot of money is required for scaling up MDR-TB programmes. TB-HIV is low cost activity with high impact. Increasingly PLHIV having TB are getting due services at ART clinics and TB patients who are HIV positive are served at TB clinics. This is not enough as intensified TB-HIV collaborative service package has rolled out in 29 states and by end of next year entire country will be covered by it.
Dr Sachdeva also raised another key issue that there is a disparity in infrastructure of TB and HIV programmes – there are 400,000 DOTS centres and 350 ART centres. Service of the National AIDS Control Organization (NACO) has to be commensurate with the scale to which RNTCP is functioning. 400-500 link ART centres are also there but even then it is not comparable to RNTCP centres. We have to narrow this mismatch to improve TB-HIV collaborative services for the people. More is the time difference between onset of anti-TB treatment and ART more is the mortality, said Dr Sachdeva.
The Stop TB Partnership, International Treatment Preparedness Coalition (ITPC) India and Medicins Sans Frontieres (MSF) Access Campaign had organized this meeting in New Delhi, India.
Anand Grover (UN Special Rapporteur on Right to Health), Dr Mira Shiva, Shivangi Rai, Karthik Subramaniam, Hari Singh, Mudrika (Dilli Mahila Samiti - DMS), Jagdish, Pramila (DMS), Pankaj Anand (International HIV/AIDS Alliance – India), Anandi Yuvaraj, Christo Mathews (Global Health Advocates), Sapra (TB Alert), Kajal Bhardwaj, Loon Gangte (DNP+/ ITPC), Operation Asha representative, Joanna (MSF), Dr Chinkholal, Bobby (Indian Harm Reduction Network – IHRN), Luke Samson (SHARAN/ IHRN), Dr Charles Gilks (UNAIDS India), WHO representative, Shalini, Jagriti representative, Pradeep Datta, Leena Menghaney (MSF Access Campaign), Blessina Kumar (Stop TB Partnership), Manoj Pardesi (ITPC), Bobby Ramakant (CNS/ Stop-TB eForum) were some of the participants.
Note: Issues raised by the civil society during this interface are available online here
Bobby Ramakant - CNS
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