Dr Vishal Sehgal, President, Portea Medical emphasises that home-based care for TB has multiple benefits from ameliorating the understanding of the condition to better compliance, and reducing stigma. On a larger level, home-based care enables to unburden the load on the overstretched and under-resources healthcare institutions, as was evident during the pandemic
It was in 2018 that the United Nations committed to end the epidemic called tuberculosis (TB) worldwide by 2030. The campaign called “End TB” aimed at reducing the incidence of the condition by 80 per cent, mortality by 90 per cent and eliminating the associated costs. However, even in 2021, in India alone, about 504,000 people died of TB (which comes to almost 1 per minute!) What is alarming is that over a quarter of the estimated TB cases around the world are in India. Any gains that were made in reducing the number of cases were dipped by the pandemic as healthcare resources got diverted to combat COVID.
The pandemic brought down the rate of detection for TB by 25 per cent in India in 2020 alone, as per an analysis by the health ministry. In May 2021, even the National Institute of Tuberculosis and Respiratory Diseases (NITRD) became a designated COVID Care Centre. However, this is also where an alternative system of care emerged. The focus shifted to home-based care with caregivers emerging as the front line of hope for patients with conditions like TB who could not be managed in the hospitals due to the pandemic. On World Tuberculosis Day, there is a need to raise awareness on the impact of home-based care for the condition and how caregivers have an integral role in its management.
Home-based TB treatment and care
Home-based care for TB has multiple benefits from ameliorating the understanding of the condition to better compliance, and reducing stigma. On a larger level, home-based care enables to unburden the load on the overstretched and under-resources healthcare institutions, as was evident during the pandemic. For instance, in a study, it was found that when home care was offered to MDR TB patients with the participation of their family, there was a significant difference in the treatment outcomes. It helps in the integrated management of the condition and in improving the lives of patients and their families. On a larger level, the role of public-private partnerships becomes important here since it can enable active delivery of rehabilitation, counselling, as well as psychosocial support for both the patients and their families.
One of the biggest advantages of home care is that it reduces the burden on hospitals and limits chances of hospital-acquired infection (HAI). It can also be much cheaper than hospitals since service providers use available capacity in patients’ homes. It has potential to address the long-standing challenges of shifting disease profiles, changing population pyramid, transitioning family structures, and the rising costs of care.
The role of caregivers
While home care covers the physical aspects, treatment is also about psycho-social support and caregivers form the backbone of this process. They not only help in monitoring TB patients in terms of medications, fulfilling nutritional needs, and improving the immune system but also offer the much-needed motivation and support to recover.
Impact on patient outcomes
With lifestyle and chronic diseases like TB on the rise in India, out of hospital services are becoming important in the care continuum in terms of bridging access gap and ensuring availability of beds. There are encouraging results with home care by improving adherence to treatment, providing patient education, reducing hospitalization rates, and improving quality of life. Home healthcare can help patients recover from TB and prevent the spread of infection. In the Indian context, the home care sector is evolving rapidly and bridging the healthcare supply-demand gap. The savings from reduced hospitalization in control of the condition can be reinvested within national TB programmes.
The need of the hour is to shift the management of TB from a hospital-dominated model to care that is embedded within communities and led by the primary care system. This will make access to care nearer and more accessible to those who need it the most, and therefore improve health outcomes in TB patients. Towards this, all segments including the preventive, ambulatory, community, and home care sectors must enhance their capacity which will in turn enable in planning, implementation, and monitoring integrated models of care.