RESUMO
Background: Differentiated tuberculosis care (DTC) approach is the need of the hour to mitigate those risks and provide better treatment outcomes to reduce both mortality and morbidity. Before implementing such an approach, there should be adequate literature on healthcare facility assessment along with qualitative exploration on readiness and acceptability among various stakeholders that are currently needed to fill the gaps in National Tuberculosis Elimination Program. Objectives: Our study objectives were to assess the availability of equipment, treatment, and investigations for managing patients under the DTC approach, to explore the readiness, acceptability, and feasibility of the DTC approach among healthcare providers involved in TB care provision, and to determine the knowledge regarding DTC approach among healthcare providers delivering TB care for COVID-positive pulmonary TB patients. Materials and Methods: All Peripheral Health Institutes (PHIs) in two randomly chosen blocks within the Tiruchirappalli district's health units were selected for the healthcare facilities assessment. By the universal sampling method, all the stakeholders were included. The study population was assessed for their knowledge regarding DTC. Checklist-based assessment of the feasibility of healthcare services followed by a questionnaire-based knowledge assessment was done. An in-depth interview-based exploration of readiness and acceptability of the DTC approach was conducted. This study was conducted among various stakeholders involved in TB care in selected PHIs of Tiruchirappalli from July 2022 to October 2022. Results: The majority of healthcare workers (HCWs) are unaware of bidirectional screening (89.0%) and lack training in providing TB care to COVID-co-infected patients (87.8%), although the majority were aware of risk stratification for TB patients (90.2%) and are linking TB with other co-morbidities (82.9%). About 62.2% of HCWs claimed they are not using information communication technology-based services to receive lab findings from public scans and laboratory centers, and more than one-third were unaware of these facilities. Based on the qualitative assessment, most of them were willing to undergo periodic training to improvise their approach and treatment. Also, most of the HCWs felt manpower can be increased for the specific care of the patients. Conclusion: The research suggests that with sufficient training and upskilling of the HCWs, DTC is almost feasible and that HCWs will accept it if specific strategies are used. More studies like these in assessing the feasibility and acceptability of this DTC approach and exploring the challenges and solutions will help the policymakers in finding the lacunae before implementing this DTC model in various states across India.
RESUMO
Background: Transgender people experience widespread prejudice discrimination, violence and other harms of stigma and trans-phobia (dislike of or prejudice against trans-sexual or transgender people). To study various modes in which transgenders experience the stigma and discrimination and to understand situations and circumstances under which they are vulnerable toward stigma and discrimination. Materials and Methods: The present study was a mixed-method study which was conducted during the months of January to June 2019 among 43 study participants. Focus group discussion and in-depth interview was conducted with these participants with subsequent transcription. Interpretative phenomenological analysis (IPA) was used for analysis. Results: Transgenders face discrimination and stigma in various setting including education, employment, healthcare, and various public setting. Difficulties in getting government identity cards (ID), facing difficulties in changing ID cards after transition, discrimination in getting bank loan, homelessness, travelling rejections were considered as major obstacles and discrimination by the study participants. Conclusion: Multilevel interventions are needed for transgender populations, including legal protections, improvement of various settings. Inclusive measures should be taken to improve their status focusing on social stigma coupled with psychological pain and economic hardship.
RESUMO
Background: In case of a CBRNE catastrophe, junior doctors (first responders) will be the first to respond to the CBRNE disaster, so they should be fully equipped with the knowledge and skills of managing CBRNE casualties and preventing the endangerment of lives. Objectives: To assess the awareness and preparedness of first responders in medical institutions regarding CBRNE casualties' management and to explore the perceptions of first responders towards CBRNE disaster management. Materials and Methods: The present study was a mixed methods study which was conducted during the months of January to March 2020 among 153 study participants. Focus group discussions (FGDs) were conducted along with free listing and pile sorting till data saturation. Data entry was done in an Excel sheet and data analysis was be done using SPSS software v. 21. Results: Out of the 153 participants only 37 participants (24.1%) had ever heard about the term "CBRNE" (chemical, biological, radiological and nuclear disasters) or "hazmat" (hazardous material). At the end of FGDs, participants could answer affirmatively that they had heard the term "decontamination" of CBRNE casualties. Very few participants could ambiguously explain the meaning of the term "decontamination" in the context of CBRNE casualty. Conclusion: There is an imperative need for enhancing not only knowledge and awareness, but also proper training for first responders to utilizing simulation sessions. This is particularly important as health care professionals are the first line of defence when it comes to identifying and treating patients that have come into contact with CBRNE hazards.
