India needs to work aggressively to combat MDR-TB

Pritha Roy Choudhury, CNS Correspondent, India
TB has been, and still is, a global menace. With nearly one-third of the population infected with Mycobacterium Tuberculosis, TB is now killing more people each year than HIV, with Asia and Africa contributing to the maximum number of fatalities. As per the latest treatment regimen available, the treatment period for MDR-TB has been halved from the current 24 months to 9-12 months, thus not only reducing the cost of treatment but also improving adherence and hence upping the cure rate.

In a webinar organised by CNS, Dr Fuad Mirzayev of the WHO Global TB Programme, said that the shorter MDR-TB regimen done among 1,205 patients in Bangladesh, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, DR Congo, Niger, Swaziland, and Uzbekistan revealed a 84% treatment success rate as compared to the 62% in a comparable selection of MDR-TB patients treated with a variety of individualized regimens of longer duration. Also, relapse was observed only in 3 patients. The World Health Organization (WHO) has come up with very clear recommendations for conditional use of this shortened MDR-TB treatment regimen, aimed at speeding up detection and improving treatment outcomes. India is not only a high TB burden country, nearly 24% of its population lives below the poverty line today. With more than 276 million people living from hand to mouth, the administration needs to gear up working towards a zero TB population aimed at fulfilling the Sustainable Development Goals by 2030. India indeed has a long way to go to acquire the benefits of the new innovations. It is still in the process of making the new regimen a reality for MDR-TB patients who stand eligible for the new regimen.

Amina Devi
, a mother of 5, has no idea of what MDR-TB is. She only knows that she has fever from time to time and some glands in her arm pits for which she needs to take treatment from a local medical practitioner. Her alcoholic husband has no time to fend for the family. There are various conditions which add to cases like Amina Devi in the area where she lives—fringes of the National Capital Region (NCR). Lack of registered medical practitioners in the vicinity, the nearest diagnostic laboratory for diagnosis of MDR-TB being 25 km away, and no hospitals nearby, all add to the intensity of the problem. The price for MDR-TB  test in the private sector is INR 2000, an unaffordable amount for families which live on their meager day to day earnings. Nasiruddin, a rickshaw puller who earns INR 200 a day, says he cannot even think about such expenditure. “I never go to the doctor, If I do, I will have to pay his fees which is more than my one day’s earnings and then he will give me medicines which are costly. I send my three daughters to school, and I need to feed them too,” he says.

Most of the population here has no idea of the disease and neither are they aware that the test and treatment for TB is available free of cost in the government health facilities. People like Amina Devi and Nasiruddin live with untreated TB, which is then passed on to other members of the families, thus increasing the number of population suffering from MDR-TB. To reap the benefits of this new shorter treatment regimen, and move aggressively towards the target of ending TB by 2030, India needs to give maximum priority to health, at both the national and the state levels. Each and every individual should have access to basic health services, irrespective of their economic status. Free and timely evidence based diagnosis and treatment of all forms of TB should be made accessible to all, so that not only all TB patients get cured, but they also do not spread the disease to others.

Pritha Roy Choudhury, Citizen News Service - CNS
August 1, 2016