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Time of India
09-07-2025
- Health
- Time of India
Puducherry adopts verbal autopsy model to identify TB treatment delay patterns
New Delhi: Puducherry has adopted the verbal autopsy model to assess reasons behind tuberculosis deaths, identify patterns for treatment delay, improve triaging process and referral mechanism. The Indira Gandhi Medical College and Research Institute (IGMC&RI) in Puducherry has undertaken the task of analysing 160 TB deaths that had been reported in the UT in 2024 and would be submitting its finding to the Centre's TB division," State TB Officer of Puducherry, Dr C Venkatesh told PTI. "Using this method, doctors at IGMC&RI, Puducherry, are investigating the causes behind deaths due to tuberculosis and identifying both patient-related and health system related factors," Dr Kavita Vasudevan from the Community Medicine Department at Medical college, who is leading the project, said. A verbal autopsy is an interview-based process where close relatives or caregivers of the deceased are asked questions about circumstances and factors leading to death. For example, they are asked about the deceased's symptoms, treatment history, hospital admission time, treatment received and the circumstances at the time of death. This information is collected in a structured format, after which doctors assess the probable cause of death. This technique involves mixing both quantitative and qualitative methods to arrive at factors that lead to mortality in TB patients. For quantitative method, clinical records of TB deaths are being reviewed, while for the qualitative component, stakeholder interviews are being conducted with National TB Elimination Programme (NTEP) staff as well as the kin of the deceased patients, Dr Vasudevan explained. Preliminary analysis has revealed that the majority of TB deaths are occurring within seven days of being diagnosed, implying there is a delay in patients accessing the health facility and reaching the hospital late, she said. "A significant number of patients who died belong to the neighbouring districts of Tamil Nadu. These patients have come to health facilities in Puducherry for availing treatment and often give false addresses or addresses of their relatives in Puducherry," she said. Social factors also play a role and in some cases, social stigma related to TB or family neglect prevented patients from seeking timely treatment, Dr Vasudevan explained. Verbal autopsy is an important tool for public health, especially when the cause of death and the factors leading to death cannot be clearly determined from medical records. Puducherry's health department is reportedly planning to make verbal autopsies mandatory for every TB death case, Dr Venkatesh informed. Identifying the reasons for TB mortality can provide critical insights into the factors leading to these deaths, he said. In addition, the differentiated TB care approach recommended by the Central TB division is also implemented in Puducherry. This approach involves the provision of comprehensive evaluation and supportive treatment services at various healthcare levels. By employing this risk stratification process, healthcare providers can tailor their approach to ensure appropriate care for individuals identified with specific risks, he said. The World Health Organisation (WHO) has also advised use of verbal autopsies as an important tool in the fight against TB to better understand early symptoms, symptom duration, treatment initiation and interruptions, and the diagnostic process. Verbal autopsy provides insights into patient as well as health system delays, social or financial challenges faced during illness, perceptions of healthcare services and barriers to accessing timely diagnosis and treatment. Tuberculosis is one of the top ten causes of death worldwide and the second leading cause of death from a single infectious agent after coronavirus disease, surpassing HIV. India's TB burden remains a major public health challenge, highlighted Dr Vasudevan. According to recent estimates, number of deaths due to TB in India was 23 per lakh population. In Puducherry, the total TB notifications for the year 2022 was 3,835 which translates to nearly 247 TB notifications per one lakh population with a death rate of eight per cent, she said. As part of the Nationals Strategic plan and WHO End TB Strategy , one of the milestones is to reduce global TB deaths by 90 per cent by 2025, using 2015 as the baseline, she stated. A comprehensive approach is essential to effectively tackle TB, which includes provision of quality TB care through access to quality diagnostics, effective drugs for therapy, prevention strategies and identifying the underlying causes of mortality associated with the disease.
The Print
07-07-2025
- Health
- The Print
Puducherry's medical colleges lead way in TB elimination
'These institutions are working with the State TB Cell to identify vulnerable populations and map them as moderate or high risk. The mapped individuals are tested using highly sensitive tests – AI-enabled handheld chest X-rays and NAAT – molecular diagnostics,' Dr Venkatesh said. All ten medical colleges — three government medical colleges and seven private ones — have constituted Medical College Core Committee to implement and monitor TB elimination activities at their level, which include provision of diagnostic and treatment services, drug sensitivity testing, provision of TB preventive services, active case-finding survey and verification of claims for sub-national certification of TB elimination, Puducherry's TB Officer Dr C Venkatesh said. New Delhi, July 7 (PTI) Puducherry's ten medical colleges are emerging as the driving force behind the Union Territory's TB elimination fight, contributing to more than 50 per cent of TB notifications and participating in active case-finding efforts. People with co-morbidities and other vulnerabilities, which predispose them to the disease, are identified in the database and are followed up with in the future case-finding drives as well, he said. In 2023 and 2024, Puducherry was recognised as the best performing Union Territory across the South Zone in terms of diagnosing TB notification at medical college level. Puducherry has 10 medical colleges for a population of 14,00,000 with an annual intake of more than 1500 medical students. Medical colleges do not have a limited geographical area to cater to and being tertiary referral units, provide services to patients within the districts and from outside the district and state too, Dr S Govindarajan, Mission Director of National Health Mission (NHM), Puducherry, told PTI. The State TB Office has been actively engaged with the medical colleges to ensure effective implementation of the medical college Task Force mechanism, he said. 'Medical colleges in Puducherry contribute to over 50 per cent of the all diagnosed TB cases in the UT mostly offering NAAT technology for diagnosis. They contribute to the majority of the extra-pulmonary TB cases diagnosed. They have implemented the differentiated TB care model by providing inpatient care to those who need it,' Dr Venkatesh said. In association with the department of community medicine in all the medical colleges, Puducherry had conducted an active case-finding survey for tuberculosis, wherein about 5.2 lakh individuals were screened at their door steps, around 42096 chest X-rays were taken and a 1432 sputum samples were collected, of which 25 individuals were identified to be suffering from tuberculosis. Standardised paperless data capturing, public-private collaboration, AI-based screening by handheld X-ray device, deployment of upfront nucleic acid amplification testing (NAAT) for sputum, line list of vulnerable individuals available for periodic follow up and targeted interventions in reducing their risk, were novel practices that helped in successful implementation of this activity, said Dr Govindarajan. As per the competency-based medical education curriculum for undergraduate students, the National Medical Council (NMC) had mandated all medical colleges to follow Family Adoption Programme (FAP), wherein a medical student adopts three to five families, once he joins the course and periodically follows them up till the completion of the course for holistic care. 'Medical colleges of Puducherry had utilised this opportunity to tap these medical students as a resource to screen the adopted family members for tuberculosis. The state supports this initiative by provision of sputum transport and diagnostic services. This first-of-the-kind model had been well received in scientific forums for its scalable nature and utilising of medical students as a manpower for screening for tuberculosis, given the backdrop of areas where there is scarcity of resources,' Dr Govindarajan said. Puducherry has been the first runner to complete both State-level NTEP Operational Research workshop as well as the State-level Training every year for Medical Colleges Task Force Mechanism to accelerate ending TB. Following these, medical colleges in the Union Territory have been conducting periodic cascade training for various cadres of health care workers such as faculties, junior residents, interns and staff nurses. Puducherry State Task Force had also released a Standard Operating Procedure (SOP) for submission of operational research proposals to NTEP in the operational research workshop. Medical colleges of Puducherry had also supported the 100 days' TB campaign of central TB division by conducting awareness sessions in the form of street plays, flash mob dance, face painting, health talks in the community as well as health facility. NMC also advises for elective postings for medical students, wherein students opt for elective modules of their choice in their desired subject. Students who had opted for tuberculosis elimination activities supported the campaign by devising unique models for sensitising the community on respiratory hygiene and flipcharts regarding importance of nutrition in tuberculosis, Dr Govindarajan said. The IGMCRI, the government medical college, in association with the State TB office and NTEP State Task Force, had conducted 'Run for a cause' – a five-km marathon for doctors, medical paramedical students, 'TB Tales' – a reels competition for college students, and 'Brush Away TB' – a mega painting competition for school students. The support of medical colleges in elimination of tuberculosis in Puducherry has been well appreciated in various forums for which the Puducherry State Task Force had twice consecutively been awarded as the best performing State Task Force at the Zonal level review meeting by the central TB division, Dr Govindrajan said. PTI PLB MNK MNK This report is auto-generated from PTI news service. ThePrint holds no responsibility for its content.
The Print
05-07-2025
- Health
- The Print
Puducherry first to screen TB patients under Family Adoption Programme
'During their routine visits to adopted families, students screen the members for symptoms suggestive of tuberculosis and help them with both diagnosis of the disease and treatment,' said Dr C Venkatesh, State TB Officer of Puducherry. The National Medical Commission had in 2022 mandated the FAP as a part of the Competency Based Medical Education curriculum, requiring each medical student to adopt three to five families, once he or she joins the MBBS course. New Delhi, Jul 5 (PTI) Puducherry has become the first in the country to screen tuberculosis (TB) patients under the Family Adoption Programme, or FAP, which entails MBBS students adopting families to monitor their health conditions and give them consultation. The student follows up with the patient till the successful completion of a full course of anti-tubercular therapy, he said, adding that Puducherry, a Union Territory, has become the first in the country to include screening for TB patients under the programme. The FAP's objectives include understanding community dynamics, assessing health needs of its members, and generating data to inform and support evidence-based practices. Case finding in TB control programmes has been passive for decades, and this being a patient-initiated activity, has its own limitation, Dr Venkatesh said. Contrarily, experts now recommend active case finding which is a provider-initiated activity. Here risk groups are approached and identified, thus early diagnosis and treatment initiation are possible, he said. 'Medical colleges of Puducherry have utilised the opportunity of Family Adoption Programme, to tap these medical students as a resource to screen the adopted family members for tuberculosis,' he said. During their routine visits to allotted families, students screen the members for symptoms suggestive of TB and use a novel tool to assess the vulnerability status of the members for TB. The approach allows even the asymptomatic individuals, who are identified as moderate to high risk of developing TB, to become eligible for investigations, Dr Venkatesh said. 'Once diagnosed as positive for TB, the student accompanies the patient to the hospital and helps in linking the patient to the TB programme,' he said. The medical student provides counselling to the patient, as well as the family members, regarding respiratory hygiene, sputum disposal methods, role of nutrition, clearing myths regarding stigma and discrimination against TB patients. In addition, the student conducts contact tracing among the other family members and helps start the TB preventive therapy to eligible family members, Dr Venkatesh said. The student periodically screens the members of the allotted families for three years and ensures those with high risk are identified earlier for diagnosis. All these would not have been possible without the support of the state by provision of consumables, logistics, sputum transport, diagnostic and treatment services, Dr Venkatesh said. The first-of-a-kind low cost model has been well received in scientific forums for its scalable nature and use of medical students as a manpower for screening for tuberculosis, in regions where there is scarcity of resources, Dr Venkatesh. PTI PLB VN VN This report is auto-generated from PTI news service. ThePrint holds no responsibility for its content.
The Print
04-07-2025
- Health
- The Print
Puducherry's shift to 100 pc rapid molecular test improves TB diagnosis
One untreated TB individual can infect a minimum of 10-15 persons per year. If these patients had gone undetected, they would have transmitted the disease in the community, Dr C Venkatesh, State TB Officer of Puducherry, said. Puducherry, Jul 4 (PTI) A complete shift from traditional microscopy testing to rapid molecular testing over the past five years has enabled early detection of tuberculosis cases, improving the diagnosis of microbiologically confirmed TB cases by around 30 per cent in Puducherry, officials said. In 2018, only 13 per cent of patients could undergo molecular/NAAT test as an initial diagnostic test. However, with the concerted efforts of the Puducherry State TB Cell, 100 per cent of TB suspects are now being tested using Nucleic Acid Amplification Testing (NAAT), Dr Venkatesh said. This means patients are now receiving quicker and more accurate tests and signifies the precious treatment time that is saved by the health department in saving lives, he said. Under the Presumptive TB Examination Rate (PTEBR) framework, Puducherry has aggressively implemented programmatic reforms aimed at early detection, efficient diagnostics, community engagement, and nutritional support. 'A key pillar has been the shift to 100 per cent upfront NAAT for all presumptive TB cases, thanks to the 100 days campaign- Nikshay Shivir initiative where this could be more widely advocated for and helped sustained in practice within the UT, respectively,' Dr Venkatesh said. This has led to a 30 per cent increase in microbiologically confirmed TB cases and faster treatment initiation, especially in drug-resistant cases, he said. Complementing this is the performance of the Intermediate Reference Laboratory (IRL) at the Government Chest Hospital, which ranked first nationally in 2024. It processes over 1.2 lakh samples annually and caters to both Puducherry and seven districts of Tamil Nadu compounding to around two crore population, District Magistrate, Puducherry A Kulothungan said. As a result, the UT saw testing rates increase from 2,233/lakh in 2015 to 5,268/lakh in first quarter of 2025, a 136 per cent improvement. 'TB incidence has dropped by 59 per cent since 2015, earning Puducherry a silver medal in India's Sub-National TB Certification in 2022,' Kulothungan said. The shift to NAAT testing has improved two aspects– firstly in microscopy testing heavy bacterial load (10000 bacteria per ml) in a given sample is needed, whereas in the genetic molecular testing (NAAT test) even less than thousand bacteria in a given sample can be detected, explained Dr S Govindarajan, Mission Director of National Health Mission (NHM), Puducherry. Secondly, through the microscopic testing we can confirm the presence of TB bacteria alone, Dr Govindarajan explained. In the NAAT test, apart from diagnosis of TB bacteria simultaneously the resistance pattern of the key TB drug— Rifampicin–can be detected, he stated. Puducherry was recognised by the Union Minister of Health for its sustained efforts during the 100-day campaign which ended on March 17. During the 100-day campaign, over 3.8 lakh vulnerable individuals were screened using door-to-door Active Case Finding( ACF) and AI-based hand held X-ray devices, Dr Govindarajan said. Modern tools like AI-enabled chest X-rays and NAAT are deployed at scale, supporting even distant places such as Mahe, Yanam and Karaikal. In 2025, eight villages were declared TB-Free – Sivaranthagam, Ariyur(N), Vathanur, Soriyankuppam, Kudiyiruppalaya, Pooranankuppam, Sembipalayam and Korkadu, Dr Venkatesh added. PTI PLB DV DV This report is auto-generated from PTI news service. ThePrint holds no responsibility for its content.
