Twenty-year-old Manikala Vasantha is a resident of Ambedkar Nagar Attaguda slum, Hyderabad. She lives with her father. HPPI’s field officer found out about the possibility of Vasantha having TB through another TB patient from the same locality called M Ramesh. He is Vasantha’s cousin.

When HPPI’s City Field Officer (CFO) reached Vasantha’s home in September 2023, she was hesitant to talk. Vasantha was alone at her home as her father was away at work. But having observed her talking slowly, presumably due to fatigue, and thin frame compared to her height, the CFO gently persisted asking questions conversationally. The officer learnt that Vasantha was originally from Andhra Pradesh, and that almost three years ago she had a surgical procedure of her Cervical Lymph node in Guntur Government Hospital, Andhra Pradesh in 2020-2021. When questioned about her persistent cough Vasantha believed her old surgery was the cause. During the time of the surgery, she also learnt that she is HIV+. Consequently, Vasantha started with the Antiretroviral Therapy (ART) from Integrated Counselling and Testing Centre (ICTC) in Guntur. The field officer found the condition of Vasantha’s house to be in neglect. She and her father had migrated to Hyderabad from their village in Andhra Pradesh for earning better means of living. They live in a small hut in a deeply congested slum. The neglect appeared not only in physical aspects as evident from the poor living conditions, but also the neglect in care seemed to be mental, social and parental.

Vasantha, now twenty years old, could hardly read or write and seldom stepped out of the home. Her mother had passed away when she was fifteen. Since then, she would stay at home while her father went away to work to earn a living. With lack of education and awareness she was unable to comprehend how HIV makes her more susceptible to diseases, the symptoms and seriousness of TB and fact that the it can be treated. What increased the complication was the lack medical reports of the previous surgery which were left behind in their village in Guntur.

The officer counselled Vansantha to get tested for TB. Vasantha understood and agreed to get an X-ray and her sputum tested for TB, but asked the officer to request her father first. Convincing her father was a tough task. With the multiple visits the father relented and Vasantha finally got tested. The field officer also put Vasantha in touch with a field officer experienced in counselling HIV patients. Vasantha was counselled about living with HIV and how she can get stronger with diet among other relevant things.

Getting the right diagnosis was not without its challenges. The sputum test result cleared her from TB but the X-ray showed her to have TB. To seek clarity, the field officer took Vasantha to a specialist doctor. The doctor recommended a Fine Needle Aspiration Cytology (FNAC) test. However, the test results were not conclusive this time too. Both the doctor and a Senior Tuberculosis Laboratory Supervisor (STLS) advised her to get tested again. Vasantha had started losing will and patience. And what exacerbated her reluctance more was her fear of needles. With a lot motivation and moral support, she got tested again; the test conclusively showed her to have non-pulmonary TB. The doctor and STLS gave the confirmation for her to start the medication for TB in October 2023.

After three months since the TB detection, Vasantha has started her treatment and is recovering well. The field officer visits her regularly to ensure she stays on course of her treatment. Vasantha’s health has improved, cough has gone and she is physically active. She has started working and earning a living too for the first in her life. With her job as a housekeeping staff in a nearby hostel, Vasantha’s worldview is changing. She has agency for the first time in her life and is confident. With the suggestion of the field office, Vasantha has agreed to study more and take 10^th class exams through an open school. Vasantha summarises it best as, “My life has a direction with the new vigour I feel. I am looking forward to a new chapter in my life.”