title: Social inclusion: An effort to end loss-to-treatment follow-up in tuberculosis.
abstract: Pathanamthitta district is implementing Revised National Tuberculosis Control Program as a pilot district since 1993. The district programme was reporting approximately 5% of their diagnosed smear positive patients as never put on treatment (Initial lost to follow up - ILFU) and 5% of the new smear positive [NSP] Pulmonary TB patients as lost to follow up [LFU] during treatment. Attempts based on reengineering of DOTS were not largely successful in bringing down these proportions.
  
  
  METHODS
  A treatment support group [TSG] is a non-statutory body of socially responsible citizens and volunteers to provide social support to each needy TB patient safeguarding his dignity and confidentiality by ensuring access to information, free and quality services and social welfare programs, empowering the patient for making decision to complete treatment successfully. It is a complete fulfilment of social inclusion standards enumerated by Standards for TB Care in India. Pathanamthitta district started implementing this strategy since 2013.
  
  
  RESULTS
  After intervention, proportion of LFU among NSPTB cases dropped markedly and no LFU were reported among the latest treatment cohorts. Proportion of ILFU keeps similar trend and none were reported among the latest diagnostic cohorts.
  
  
  CONCLUSIONS
  Social support for TB care is feasible under routine program conditions. Addition of standards for social inclusion in STCI is meaningful. Its meaning is translated well by a society empowered with literacy and political sense.
authors.affiliation: Medical Consultant, WHO Country Office for India, New Delhi, India. Electronic address: balakrishnans@rntcp.org.
authors.forename: S
authors.initials: S
authors.lastname: Balakrishnan
authors.affiliation: District TB Officer, Pathanamthitta, Kerala, India.
authors.forename: J
authors.initials: J
authors.lastname: Manikantan
authors.affiliation: National Professional Officer, WHO Country Office for India, New Delhi, India.
authors.forename: A
authors.initials: A
authors.lastname: Sreenivas
authors.affiliation: Director of Health Services, Thiruvananthapuram, Kerala, India.
authors.forename: S
authors.initials: S
authors.lastname: Jayasankar
authors.affiliation: Director, State TB Training and Demonstration Centre, Thiruvananthapuram, Kerala, India.
authors.forename: M
authors.initials: M
authors.lastname: Sunilkumar
authors.affiliation: Department of Community Medicine, Travencore Medical College, Kollam, Kerala, India.
authors.forename: P S
authors.initials: PS
authors.lastname: Rakesh
authors.affiliation: Medical Consultant, WHO Country Office for India, New Delhi, India.
authors.forename: D S A
authors.initials: DS
authors.lastname: Karthickeyan
authors.affiliation: Medical Consultant, WHO Country Office for India, New Delhi, India.
authors.forename: C R
authors.initials: CR
authors.lastname: Mohandas
mesh_terms: D000995:Antitubercular Agents / Q000627:therapeutic use; D023801:Directly Observed Therapy; D006801:Humans; D007194:India / Q000453:epidemiology; D059012:Lost to Follow-Up; D055118:Medication Adherence; D012657:Self-Help Groups; D012944:Social Support; D014376:Tuberculosis / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents
keywords: Initial default; Lost to follow-up; Social inclusion; Treatment support group