The state-run tuberculosis control programme caters to just about half of the total patient load and those infected are not completely cured, a study has found.
Out of the 27 lakh estimated TB patients in 2013, a mere 53% (about 14 lakh) were registered for treatment at the government-run clinics; 45% (above 12 lakh) finished the treatment and 39% (10 lakh) experienced recurrence-free survival after one year.
About 760,000 (in 2013) TB patients never reached government diagnostic clinics and either remained untreated or received poor quality care in India’s private sector, said a six-nation study involving nine researchers (including the Indian council of Medical Research director general Soumya Swaminathan).
Researchers dug into the Indian healthcare system to demonstrate how thousands of patients are missed out despite government’s tall claims that at least one TB centre exists in each district.
A cascading effect was observed at each stage, causing the loss of thousands of patients who fail to complete the treatment.
“The very first gap in the overall cascade (out of an estimated 2.7 million TB patients in India) is about 760,000 patients or about 25% of all TB patients in India. They are probably getting treated in the private sector, though some of them may remain untreated without any TB care,” said Ramnath Subbaraman, a professor at Harvard Medical School, Boston who led the team.
“For patients diagnosed in government TB centres but do not get enrolled for treatment, a few studies suggest that only a small percentage of these patients end up in private sector care, so it is likely that many of these patients remain untreated,” Subbaraman told DH.
Quality of healthcare
Though more than 500,000 patients were evaluated at the government TB clinics, they were not diagnosed or treated there.
The quality of diagnosis, however, is suspect in the absence of modern tools.
“Out of 61,000 multi-drug-resistant TB patients who reached government TB clinics, only 6,413, or 11%, completed appropriate treatment and survived for one year after treatment without experiencing disease relapse.
A key conclusion is that the government needs to address the leaks in the care cascade in the public sector,” said co-author Madhukar Pai, from McGill University in Canada.
The findings have been published in the October 25 issue of the journal PLOS Medicine.