Description of the Project: India alone accounts 26% (2.3 million) of the global TB burden. Delayed or inappropriate TB management contributes to increased losses and risk of drug resistance in India. Significant number of patients are receiving TB treatment or treatment for their TB symptoms in the private sector. Many patients with tuberculosis, those on private treatment as well as beneficiaries of DOTS, receive inadequate or inappropriate treatment support resulting in treatment non-compliance, sub-optimal treatment outcomes, cause spread of infection and increased risk of drug resistance. Even the program noted the need for counselling and reports expressed the paucity of trained, skilled counsellors for the specific need. KHPT offered TB Careline services, a telephonic facility during USAID funded SHOPS-TB Project in Karnataka. A significant number of TB patients were registered and received support services. The service was continued despite closure of the SHOPS TB Project in December 2014. Private providers expressed the need for treatment support services to their TB patients and strongly recommended continuation of the TB Careline service. The objective of the research is to assess the effectiveness of a telephonic support services to patients with TB for favourable treatment outcomes in selected districts in Karnataka state in India. The research study is conceptualized as a multi-arm Interventional study amongst patients with confirmed diagnosis of TB in the public or private health care system presumed to have drug sensitive TB. This systematic evaluation of the effectiveness of a telephonic intervention for TB care and support will help provide evidence for scale up and adoption.

Description of the Project: Health-related quality of life (HRQoL) is an assessment of how the individual's well-being may be affected over time by a disease, disability, or disorder. It is multidimensional and covers physical, social, emotional, cognitive, work related, spiritual as well as a wide variety of disease related symptoms, therapy induced side effects and financial impact of medical conditions. There are wide range of tools and metrics available for assessment of QoL in various settings. I am particularly interested in exploring dimensions of QoL in two different settings in India. One is in the context of a rural northern Karnataka that lags behind the rest of the state in many of the maternal and child health indicators. Here, my study will follow up on a cohort of low birth weight babies for a period of 18 months and assess the impact of health and nutritional interventions on indicators such as morbidity and mortality, anthropometric measurements, developmental milestones including cognitive development of infants. The project will also explore relationships with existing socio-economic, gender and cultural norms thus outlining multidimensional facets of quality of life which need to be taken cognizance of while designing health and development initiatives. The other study is in an urban setting, particularly in the geriatric age group affected with dementia due to Alzheimer’s or other causes. Here the family level correlates of QoL and particularly care givers’ role in intervention programs toward improving memory, cognition, coordination and other aspects of dementia affecting elderly will be explored. The study can add new evidence into existing literature in relation to cognitive stimulation and training as a complement to existing therapies. Through these studies, my postdoctoral research will aim at establishing definitions, determinants, indicators, intervention methods and tools for improving quality of life in different settings.