Engagement and Preparedness of Urban Accredited Social Health Activists (U-ASHAs) for Delivery of Tuberculosis (TB) Care: Findings From two Cities in Maharashtra, India.

Finding missing tuberculosis (TB) cases from the "under-reached" population of urban slums and connecting them with TB services is a priority and ongoing challenge for India. It requires the effective engagement of community health workers including urban Accredited Social Health Activists (U-ASHAs). The study aimed to understand the current engagement of U-ASHAs in TB care and their commensurate preparedness in terms of TB knowledge and training. An exploratory study was conducted in Mumbai and Pune cities of Maharashtra during 2022-23. The study used a mixed-methods approach, including a semi-structured survey of U-ASHAs (n = 222) and in-depth interviews with relevant stakeholders (n = 33). The statistical analysis used was descriptive statistics using MS Excel. The average age and work experience of U-ASHAs were 35.4 (21-50) years and 2.7 (0.5-6) years, respectively. They considered maternal child health services as their main portfolio and TB as an ancillary program. They were mainly involved in a biannual active case finding (ACF) and were recently envisioned as TB treatment supporters with poor clarity about other roles in TB care. Just half-day training for TB as part of 8-day general induction training, brief updates before ACFs, and the absence of an on-the-job supervisory structure resulted in TB knowledge gaps particularly for the latest diagnostic tests, adverse drug reactions, government schemes for TB patients, and contact tracing. Conclusions: Intermittent TB activities coupled with insufficient training impede U-ASHAs' functionality in TB care. Clarity of TB-related roles, integration of TB activities in daily tasks, comprehensive training, and on-the-job supervisory structures have merit in strengthening U-ASHAs' engagement in urban TB care.