TB prevalence and interventions for reducing TB and LTBI in high-risk key population of rickshaw drivers and construction workers” is SHARE INDIA, Ramaiah Medical College and Indian CST’s – ICMR funded project which supports NTEP’s 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 and LTBI among rickshaw drivers and construction workers. We used a customized and cost-efficient approach to conduct prevalence surveys that could inform the extend of gaps and unmet needs of these group. These included.

• Model to use medical interns to conduct active case TB and LTBI interventions.
• Reduce barriers for early TB and LTBI case detection, including delay in presentation to NTEP facility, timely diagnosis and subsequent anti-TB treatment/TPT.
• Pursue advocacy, communication, social mobilization to address the needs of TB and LTBI care in high risk key population.
• Foster community participation in TB care, prevention and health promotion.

The rickshaw drivers and construction workers were educated about TB and after obtaining consent; the questionnaire was administered by the deployed trained project staff/medical interns/project assistant from SHARE INDIA, New Delhi and Ramaiah Medical College, Bangalore. The survey tool collected information on the demographic profile, past history of TB, family history of TB, close contact with patients with TB, nutrition and other habits like smoking, drinking etc. Diagnosis of LTBI was done by tuberculin skin test (TST) which was administered by trained project staff/postgraduates/ Public health Nurse/ interns. The TST results were interpreted after 48-72 hours by measuring the size of the induration (mm). The cut-off for TST was 10 mm induration. Based on TST results, individuals were identified as LTBI positive (infected with MTB) and LTBI negative. TST positive individuals and TB suspects were referred and linked to the nearest NTEP facility through project Staff. Active TB was treated by NTEP. TB preventive Treatment (TPT) (isoniazid for 6 months) was provided by NTEP. As TPT is a new intervention, all patients on INH were clinically monitored weekly and for liver function at 2 monthly by medical officers and District TB Officers (DTO) under NTEP. Counselling and health education was given to all the participants as a part of all interventions so as to increase awareness of the importance of detecting and treating LTBI. 

At Delhi Site, 4000 rickshaw drivers were surveyed. 424 (10.6%) rickshaw drivers were found TB symptomatic, out of these 172 (41%) were referred to NTEP facilities for TB testing and 03 (1.7%) positive TB cases were diagnosed. All 4000 rickshaw drivers were administered TST, however only 3385 TST readings could be done, out of which 640 (18%) were TST positives. Based on the individual study sites, the prevalence of LTBI ranged from 14-29% across the five study zones (Karol Bagh- 14%; Civil Lines- 14%, Pili Kothi- 17%; Hedgewar, Shahdara, Patparganj-18% and Central Delhi-29%). 323 (50%) participants who were LTBI positives were tested for TB at NTEP facilities and 04 (1.2%) TB cases were found. Out of the remaining 319, only 10 (3%) could be initiated on TB Preventive Treatment at NTEP Centres. Overall, 07 participants were diagnosed as TB positive cases out of these 06 were cycle rickshaw drivers while one was e-rickshaw driver. 

Study highlights the importance of tailored, community-focused strategies in tackling TB among India’s most vulnerable populations