Expressing concern over the slow pace of adding diagnostic facilities, gap in funding, low awareness about the disease taking its toll on diagnosis, treatment and prevention of tuberculosis, experts have called for change in policy and more financial commitment to eradicate TB by 2025.
The government is committed to the eradication of TB by 2025 which is a major public health challenge in India. It's noteworthy that it has now become a notifiable disease. Resistance to primary drugs is the commonest form of TB.
According to World Health Organisation Global TB Report 2016, India accounts for 2.8 million of the 10.4 million new TB cases globally. XDR TB constitutes 10 per cent of total MDR TB cases.
The country needs more GeneXpert machines which detect the DNA in TB bacteria, resistance to the drug Rifampicin by using a sputum or blood sample and provides faster diagnosis of MDR and XDR TB. It helps control the epidemic. There are 0.4 GeneXpert machines per million population in India. In the country, the mean of the time between the patients' first notice of the symptom and the time starting treatment is six months. An average TB patient infects 10-15 people a year. If delay in treatment is curbed, the growth of infectious disease will be reined in, said Dr. Zarir F. Udwadia, consultant chest physician at Hinduja Hospital, Mumbai.
There are 67 reference laboratories doing reliable drug susceptibility testing (DST) of second line anti TB drugs. This means there is 0.2 reference labs per million population.
The number of reference labs needs to be enhanced to bring a uniformity to DST. Currently there is hardly any similarity in lab reports from different geographical locations, he said.
In India which is home to one third of global drug resistant TB cases, 1000 patients are in dire need of combination of two novel drugs-- Bedaquiline and Delamine. Theoretically it is possible to cure TB if you have whole new regime because all the traditional drugs have failed to invoke response, said Dr Udwadia.
The need of the hour is to come out with six-month long new drug regime capable of treating MDR, XDR TB without injectables. All this will not be possible without strong political and financial commitment, he opined.
Though the RNTCP programme has done really good thing from changing intermittent doses to daily doses as intermittent doses often lead to chances of drug resistant TB, a lot is still needed to achieve elimination of TB by 2025. RNTCP also needs to focus on latent TB, a source of new TB cases.
Prescribing practice by different groups of people needs to be changed to contain TB. As per a report, 13 per cent, out of 100 patients having TB symptoms approached chemists seeking medications, are referred to doctors by chemists. 38 per cent people with TB symptoms are recommended antibiotics and steroids by chemists. This is a ground reality of prescribing practices which need to be changed, he added.
Dr. Sameer Khan, chief of business, CallHealth, a healthcare services startup, said “India adds 2.8 million new cases of tuberculosis, annually. The centre has raged a positive war against TB to eradicate it by 2025, however, the path has many challenges. In order to holistically approach and actualise the 2025 goal, and at same time incorporate preventive cure among all, it is imperative to change the mindset of the people.”
Traditionally, the society has not been quick to accept TB afflicted patients and survivors; discrimination against them persists till today. Hence, we need to first alter the societal connotations against TB and help raise awareness about the disease and life after it, he opined.
“In order to meet the stated deadline we need some serious political and financial commitment for developing new vaccines, diagnostics and treatments that is fit for the purpose (like the successful fight against polio and smallpox in the past). The biggest hindrance in the way of eliminating TB is lack of awareness despite a dedicated national programme and high medical cost associated with the treatment,” said Gautam Khanna, vice president, Association of Hospitals.