Burdened by the load of TB and HIV

After campaigning against polio, Bollywood icon Amitabh Bachchan is now creating awareness about tuberculosis. World Tuberculosis Day was observed this Tuesday and to mark the event the Ministry of Health and Family Welfare introduced its nationwide campaign ‘TB Harega, Desh Jeetega’ featuring Big B.

Though the campaign will run in right earnest, a herculean task lies ahead for the health authorities to trace undetected cases of TB, lower the number of patients suffering from Multi Drug Resistance (MDR) and to bring down the mortality rate.

Ironically, tuberculosis is the leading cause of death among People Living with HIV/AIDS (PLHA). As per the World Health Organisation (WHO) Global TB Report 2014, an estimated 1,20,000 HIV-associated TB patients emerge annually. This accounts for the second highest global burden of HIV associated TB after South Africa.

In a conference by the Ministry of Health and Family Welfare on World Tuberculosis Day, it was highlighted that against the estimate of 1,20,000 HIV-associated TB cases only 44027 were notified to Revised National Tuberculosis Control Programme (RNTCP) in 2013. Though they continued to take treatment, the mortality rate and lower treatment success rates are still a major problem. The major reasons for such a high mortality rate is the late diagnosis of TB or HIV, non-initiation of TB Preventive Therapy (IPT), inadequate TB treatment regimen, poor patient support systems, and lack of infection control measures in the community and HIV care settings.

But Jagat Prakash Nadda, Minister for Health and Family Welfare focused on the newer challenges. “Resistance to anti TB drugs is of great concern. It is due to irregular and incomplete treatment with irrational regimens.

We have to deal with it effectively by expansion of diagnostic and treatment services for managing Drug Resistant TB across the country,” Nadda said.

To tackle the problem, the government has started its first nationwide Anti-Tuberculosis Drug Resistance Survey India 2014-15. Conducted by the National TB Institute, Bangalore and WHO, the survey will provide statistical estimates of the prevalence of anti-tuberculosis drug resistance among new and previously treated patients.

Presently, treatment of drug resistant TB is much more complex and lengthy in comparison to treatment of drug sensitive TB and special care during treatment. It gets more difficult due to adverse drug reactions. Under RNTCP, drug resistant TB patients are treated primarily on ambulatory basis after a brief period of in-patient care at the initiation of treatment. There is special facility for such patients which is one per 10 million population across the country. A patient when stabilised on this treatment, is then referred to a decentralised identified DOT centre. Currently, there are 127 centres for MDR TB patients.

Many TB patients who are drug sensitive and drug resistant suffer from HIV. The major factors for poor treatment outcome are resistance to medicine, lower Body Mass Index (BMI) and previous treatment episodes.

Though there may be massive campaigns, the problem can be eradicated by improving health care services at primary and community level.