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AXSHYA means no TB. So the name of the project AXSHYA INDIA means India without TB, which is what our vision is.

Background

India bears 21% of the global burden of incident TB cases and has the highest estimated incidence of Multi Drug Resistant-TB cases (MDR-TB) (131,000 out of global incidence of about 500,000 in 2007). Extensively Drug Resistant TB (XDR-TB) has also been reported from India. HIV prevalence among TB patients is reported to be 4.85%. India’s Revised National Tuberculosis Control Programme (RNTCP), based on DOTS strategy, is being implemented through general health system of the states under the umbrella of National Rural Health mission (NRHM). The Programme is implementing all components of WHO Stop TB Strategy 2006 and has made great strides in achieving global targets for new smear positive case detection (NSP CDR) (70%) and treatment success (85%), as per the Millennium Development Goals (MDGs) and the related Stop TB Partnership’s Global Plan (2006-2015). The programme needs to now consolidate and sustain current achievements uniformly across all states and districts in the country, and to increase access to quality TB care for all, including DR-TB. However to achieve these goals, the programme faces certain challenges.

Project Axshya India

intends to address the identified challenges like insufficient laboratory capacity for detecting and follow up of requisite drug resistance cases in the country and funding gaps for procurement of second line drugs for all MDR-TB cases planned to be initiated on treatment. Though the programme is achieving targets of NSP CDR and treatment success at national level, wide variation in performance is observed across districts in form of low case notification rates, high treatment default rates, and areas with vulnerable populations or health systems access challenges. Further, the programme has a well defined ACSM strategy and continuous efforts are being made in building the capacity of the states for need based planning of ACSM activities. There are also approved schemes for the involvement of NGOs and Private Practitioners. However there is sub-optimal capacity in state and districts to execute and monitor such activities leading to poor community involvement and limited engagement of all health care providers including NGOs, corporate sector and private practitioners in the TB programme. Addressing these challenges requires a concerted response from the government and civil society, this being the overall strategy of the GF Rd 9 project having three Principal Recipients viz Central TB Division (CTD) (Government of India - GoI), and a partnership of 16 NGOs organised under 2 civil society PRs (the International Union Against Tuberculosis and Lung Disease, or ‘the Union’, and World Vision India). In addition to being aligned with the national strategy and the WHO Stop TB Strategy, the Axshya India project will address several recommendations from the Joint Monitoring Mission (JMM) 2009, review by World Bank experts, and other stakeholders in TB Care and Control in India. Axshya India intends to scale-up DR-TB diagnosis and management capacity under programme conditions and prevent emergence of drug resistance through improved access to quality TB care through strengthened civil society engagement.

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