Street women empowered and engaged to stop TB: A 'mixed method' study

The Census of India 2011 defines 'houseless household' as, "households who do not live in buildings or census houses but live in the open on roadside, pavements, under flyovers and staircases, or in the open in places of worship, mandaps, railway platforms, etc." India had 17.73 lakh unhoused people, with over 700,000 of them being women. Tuberculosis (TB) affected an estimated 8.7 million people ….globally in 2011, including 0.5 million women. The WHO has set targets to end the global TB epidemic by 2035. In India Revised National Tuberculosis Control Program [called National TB Elimination Program (NTEP) since 2020] set out National Strategic Plan for Tuberculosis: 2017-25 for Elimination By 2025. Humana People to People India (HPPI) newer projects -TASA (TB Affected Street Activist) and SWEET (Street Women Empowered and Engaged to Stop TB)-specifically focus on homeless and street-dwelling women. The objectives of study on two projects: 1. To understand the determinants of Tuberculosis and assess barriers to TB care faced by homeless people, poor migrant workers and people living in unauthorized slums of Delhi. 2. To assess the effectiveness of community-based interventions-specifically the TASA and SWEET projects-in empowering homeless and other vulnerable and marginalised people in Delhi to increase TB awareness, enhanced community-level engagement, improved participation of women, better access to social entitlements, and reduction in TB-related stigma. 3. To demonstrate that trained homeless women can function as effective health advocates by identifying presumptive TB cases, facilitating testing, supporting treatment adherence, and addressing TB-related stigma and discrimination in their communities.

This community-based interventional study analyzed retrospectively by both quantitative and qualitative methods i.e. mixed method, was conducted on above mentioned projects. These projects were implemented between May 2023 and April 2024 and December 2023 to January 2025 respectively. The study was conducted between 30.11.24 and March 30, 2025. The study included 7994 homeless people of 2 districts and 5142 Homeless Women, from 5 districts of Delhi who were staying either on streets, Ran Basera (Night Shelters), under the fly-overs, slums etc. For qualitative part a Focus Group Discussion (FGD) of 12 TASAs and 20 In-Depth Interviews (IDI) were conducted. HPPI trained 20 TASAs on TB, National Tuberculosis Elimination Program, violation of human rights, stigma and discrimination of TB patient and how to address these issues. Each TASA made 10 Sahelies/friends in the homeless communities, and passed on this knowledge to Sahelies.

TASAs organized 8 TB rallies, 10 meetings to solve issues of homeless PwTB under TASA project. Twenty-six and 46 advocacy meetings were held and 93 and 51 PwTB helped with treatment under TASA and SWEET projects respectively. TASAs and Sahelies held 54 Communities, Rights and Gender Meetings, helped 772 homeless by linking to Social Welfare Schemes. The FGD and IDIs showed that about 50 % TB has been controlled and about 68 % Sahelies will surely take care of TB patients in their community, in future.

Solutions to barriers to TB care, enhanced community-level engagement, and better access to social entitlements can be achieved through empowered homeless women's i.e. TASAs and Sahelies.