The Provincial TB Control Program in collaboration with the Primary & Secondary Healthcare Department Punjab has ensured uninterrupted supply of TB medicine to all districts. The District Health Authorities have delivered medicine at all health facilities in the district. It is being ensured that the TB patients coming to follow up must receive adequate medicine from the hospital pharmacies.
Instead of one month, medicine of two months is being issued keeping in view the lockdown situation. The Tehsil TB Assistants are being utilized to deliver medicine to TB patients at their door steps. In the previous one week, medicine has been delivered to more than 20,000 Drug Sensitive TB Patients.
The medicine of Drug Resistant TB patients is being delivered through Treatment Coordinators of the Program. In the previous one week, medicine has been delivered to more than 1000 out of 1524 “on treatment” Drug Resistant TB patients.
In the OPDs, a minimum distance of one meter should be ensured between the visiting patients. That may be done by drawing lines on the floor where the people may stand to avoid overcrowding. It is also possible that only the registered patients may be allowed to enter the OPDs for example the TB patients who have TB-02 cards with them (in case the OPD services are halted) and they may be FAST Tracked. The functionality of OPDs in some health facilities are compromised due to fear of COVID-19 but the Program has ensured, through letters to Chief Executive Officers and Medical Superintendents, that all TB patients coming to the health facility are catered.
Microscopy is very important to keep diagnosing TB cases and to monitor their treatment on follow ups. The microscopy services have not being discontinued. The Program has provided adequate reagents and logistics to all districts and requested all CEOs to ensure that microscopy services do not get withdrawn.
Complementary COVID-19 and TB response may be ensured. This will assist in curbing both epidemics to save lives. The capacity building efforts, surveillance and monitoring system are being utilized for both the diseases simultaneously. The National emergency requires assigning the BSL-III Provincial Reference Laboratories for COVID-19 response. The BSL-III Laboratories of the TB Control Program have been upgraded for COVID-19 testing. The staff has also been provided by the Program and the lab will be testing around 2000 tests per day. These labs will be performing tests for both COVID-19 and TB diagnostics.
Contact tracing efforts for both the diseases may be same. Since COVID-19 response is urgent and quick, it may facilitate the TB Program in screening of TB contacts in the same area. The health center practices which include FAST Tracking and cough etiquettes may be the same for both diseases. This way, with less resources, more work can be done.
Currently, stigma has been created for both the diseases. Communication strategy which entails both the diseases may prove highly fruitful and extra resources may not be required for awareness raising campaigns. The Program has already started advocacy through newspapers which include advocacy for both the diseases simultaneously.
The Provincial TB Control Program Punjab has developed a documentary video for TB awareness. These videos have been shared on social media, electronic media and will run on the LEDs attached in hospital OPDs. In addition, in collaboration with the PPM Partners, branding of all DHQ hospitals has been done. The Program has also started awareness campaign through SMS messages which are mainly focusing the rural population.
Hopefully, all these efforts may lead to a combined TB/COVID-19 management and no one will be left behind.
The Provincial TB Control Program Punjab (PTPP) is integrated with the Primary & Secondary Healthcare Department and working under direct supervision of Directorate General Health Services Punjab Currently the Program is providing free of cost TB diagnostic and treatment facilities though 649 Basic Management Units (both Public and private) with 12 Specialized sites for Drug Resistant TB, 168 Gene Xpert sites, five TB Culture Laboratories and two TB Provincial Reference Laboratories. The Public Private Mix (PPM) Partners support through case notification from the General Practitioners.