• Axshya SAMVAD

  • Technical support to RNTCP

  • Urban Intervention

  • Axshya Villages

  • Sputum Collection and Transportation (SCT)

  • Rural Health Care provider engagement

  • NGO Engagement with RNTCP schemes

  • Strengthening District TB Forums

  • DR TB Counselling

  • Maintenance of Binocular Microscopes

In all 300 target districts, the community volunteers “Axshya Mitras” through NGOs, and implementing partners, the project has mapped marginalized and vulnerable areas of districts. In these target areas, house-to-house visits are made by “Axshya Mitras” to educate community about TB care and control, identify TB symptomatics – referrals and or sputum collection and transportation. In the process, 1000 vulnerable households (including, slums, in Urban areas) are visited by Axshya Mitras every month in 300 target districts. Over the past 9 months, 1,447,702 households were reached through Axshya Samvad, which together led to 288,193 symptomatic persons being referred for testing, of which 15,931 were confirmed to have TB. This activity is also conducted among prison inmates, Occupational Hazard (Lung disease), Tribal population, etc.


Technical support to RNTCP
Project Axshya continued its commitment and technical support to the Revised National TB Control Programme of India and in expanding its reach, visibility, and effectiveness. Through several of its initiatives, the project strengthened the Advocacy, Communication, and Social Mobilisation (ACSM) at the national, state and district levels across India. The project also provided expertise and technical support in other key areas such as public-private partnerships and monitoring and evaluation. Some initiatives and outcomes over 2014-15 include:

CTD consultants at the national level
Three consultants from The Union provided expert support to the Central TB Division (CTD), Ministry of Health, Govt. of India. They assisted and provided technical support in key areas of the programme such as Public Private Mix (PPM), Advocacy, Communication and Social Mobilisation (ACSM), Monitoring and Evaluation (M&E) and training. The consultants also contributed to Central Internal Evaluations, Zonal and State Task Force meetings of medical colleges, and a National Core Group meeting to discuss involvement of community pharmacies in the programme.
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ACSM consultants at the state level
The Union continued to provide technical assistance to nine states of India – Karnataka, Madhya Pradesh, Maharashtra, Punjab, Uttar Pradesh and Uttarakhand, Bihar, Jharkhand and Chhattisgarh– through its ACSM consultants. The consultants in each of these states:

  • Supported the State and District TB cells to enhance the quality of decentralized ACSM strategic planning, activities and materials through capacity development activities and field supervision.
  • Provided technical support to develop and implement a plan for greater integration of the RNTCP’s ACSM activities with NRHM; and liaise with other relevant government departments.
  • Facilitated coordination of RNTCPs ACSM activities with initiatives of other partners and stakeholders.
  • Provided technical support to Axshya Sub-Recipient partners in the respective State and districts, on planning, implementation and supervision of the project activities.

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Urban Intervention Project is implementing a high-yield package of interventions for urban TB control for improving timely detection and effective management of TB cases in 40 select cities across the country (60% of total effort)

  • At least 80% of the households in urban slums reached annually in each target site with the objective of enhancing awareness about TB, identifying TB symptomatics and linking them with TB services.
  • 6,000 Qualified Private Practitioners sensitized on Standards for TB Care in India (STCI) and empaneled for providing TB services and notifying confirmed TB cases
  • Facilitating provision of quality assured X-ray services through empanelled private laboratories to ~200,000 smear negative TB symptomatics.
  • Facilitating provision of Xpert test through public and empanelled private laboratories to ~30,000 HIV + and pediatric TB symptomatics. 250 private hospitals oriented on STCI and linked to Nikshay (a web based RNTCP TB case notifying system) and regularly notify confirmed cases

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  • 2,000 private laboratories sensitized on ban on serologic tests and engaged in providing reliable TB diagnostic services and also linked with Nikshay to regularly notify TB cases.
  • Establish a system for providing TB patients treated in private sector in the identified 60 urban sites with treatment adherence support through effective use of ICT (Information communication technology) and counselling services.
  • At least 1,200 Axshya Wards established
  • 1,200 district level networks of PLHIVs, targeted interventions, care and support centers, and ART centres engaged to provide early identification, rapid diagnosis, early treatment initiation and treatment adherence to HIV + patients.
  • 300 Axshya Kiosks set up which will offer extended hours for DOT, information on TB, counselling services, sputum collection and transportation services and retrieval of treatment interrupters.
  • Establishing and strengthening ~180 TB support groups in slum clusters.
  • At least 6 sensitization events completed for corporate houses

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Axshya Villages
Axshya Village are currently being formed under Project Axshya where the community is aware of Tuberculosis care and control. A total of 15,000 such villages will be formed across the 300 districts during the project period. Form these villages; we are expecting to achieve “Zero-TB” deaths.


Sputum Collection and Transportation (SCT)
SCT is proposed and the yield from the established network is encouraging. The network involves, Axshya Mitras, NGO/CBO representatives, RHCPs, and in few target districts, local transport like taxi drivers, are acting as transporters of sputum. The network would be expanded to more MARP regions in the districts and linked with the proposed Urban TB intervention. A target of 100 Sputum collection and transportation is proposed for each district and an expected 3000 samples would be collected from 300 districts.


Rural Health Care provider engagement
Through this intervention over 20,000 Rural Healthcare providers have been sensitized and nearly 25% have been successfully engaged in TB services.

NGO Engagement with RNTCP schemes
Project Axshya has continuously engaged, monitored, and conducted supportive supervision to increase the capacity of NGOs engaged in the project. Through this exercise, the NGOs have submitted proposals for RNTCP schemes under NGO-PP schemes. This sustained activity has “value-for money” also has an advantage over the proposed National Urban Health Mission. Nearly 700 NGOs have been sensitised and over 200 of them have submitted proposals for signing RNTCP schemes.

Strengthening District TB Forums
The experience of advocacy for supporting TB patients through District Tuberculosis Form members at district level across 300 districts has shown progress in terms of support to patients, health systems, nutritional support and advocacy for pension schemes. One such experience is that DTF advocated for support for TB patients in food security bill. The support to TB forum will continue in light of support to TB patients.

DR TB Counselling
To address the high loss to follow up amongst the drug resistant TB (DR-TB) patients project Axshya has initiated a pilot offering counselling services to facilitate treatment adherence of DR-TB patients (MDR and XDR-TB) across 30 districts in the country. The counselling which is provided at the DOTS Plus site, DTC and patients residence focuses on treatment adherence, psychosocial support, nutrition and care. Till March 2015, over 5,300 DR-TB patients were counselled. National review meeting and National Committee meeting on DR TB Counselling was organised in November 2014 to review the status of counselling services provided to DRTB patients and their family members. During the review meeting, DR TB Counselling proved to be effective in improving treatment adherence and reducing defaulters.


Maintenance of Binocular Microscopes
Project Axshya is providing support for maintenance of over 5000 Binocular Microscopes in Bihar, Chhattisgarh, Rajasthan, Uttar Pradesh, Uttarakhand, Karnataka, Haryana, Punjab and Chandigarh to ensure uninterrupted diagnostic services. The AMC includes quarterly preventive maintenance and onsite emergency breakdown service within 72 hrs. This service has been highly appreciated by respective states and programme officers. There is now a growing demand for similar services from many states and districts that were previously un-covered.