Near Real Time Supervision of Home Visits Under Public Health Action

Background

India accounts for more than a quarter of the global tuberculosis (TB) burden. TB patients are notified under Revised National Tuberculosis Control Programme (RNTCP) using a case-based notification system called as Nikshay, an application in a mobile tablet. One tablet is provided to every Senior Treatment Supervisor (STS) responsible for supportive supervision, recording and reporting TB treatment for a population of 0.5 million.

After notification (both from public and private), patients receive “public health action support” (PHAS) which includes home visit, counselling of TB patients and family members, monitoring treatment adherence and follow-up, contact investigation and isoniazid chemoprophylaxis to eligible contacts, HIV counselling and testing, and drug susceptibility testing and finally linking to receive cash incentives under the direct benefit transfer for TB patients. In rural areas, the home visit must be performed by the STS preferably within a week.

Shahdol is a tribal district in east Madhya Pradesh where home visits by the STS were not happening. To address this, RNTCP Shahdol developed a raterbased web-form (using Open Data Kit (ODK) software synced to online ONA platform) to track the ‘home visits’ on real time basis. After receiving hands on training; since August 2018, the STS carries this mobile tablet during home visit and captures the following information: Nikshay identifier, date of home visit, geolocation of patient’s home, number of household members, number of children <6 years, number of house-hold child contacts screened & received Isoniazide preventive therapy and any other adult house-hold symptomatic contact.

Benefits

Up to 500 records can be captured per month, questionnaire can be developed in local language (hindi), works offline, near-real time and objective assessment of home visits along with feedback and identification of hot spots for targeting active case finding.

Scalability

Since STS have a mobile tablet, this strategy has the potential to objectively assess home visits under PHAS and can be scaled up.

Source : We Care Coffee Table Book - Good, Replicable and Innovative Practices 2019