‘Market drugs proliferation to blame for TB burden'

Aarti Dhar

The growing number of drug-resistant tuberculosis (DR-TB) cases in India calls for greater urgency in solving major problems surrounding treatment and regulation of drugs in the private market, the international medical humanitarian organisation, Médecins Sans Frontières/Doctors Without Borders (MSF), said here on Friday. It has called for revisiting the treatment protocols to make them simple so that patients adhere to them.

India has the second highest DR-TB burden in the world with an estimated 99,000 new multidrug-resistant (MDR) cases every year. Yet in 2010, only two per cent of the estimated cases received second-line drug treatment under the national programme, the MSF said at a press conference on the eve of World TB Day. The MSF's views were shared by the People's Health Movement, Stop TB Partnership and the Delhi Network of Positive People (DNP+).

“It is painfully clear that DR-TB infections are on the rise in India,” said Dr. Amit Sengupta from the Jan Swasthya Abhiyan/The People's Health Movement. “The conditions for emergence of drug resistance are undeniably prevalent, in both the public programme and the private health sector.”

A key factor

In India, the Revised National TB Control Programme (RNTCP) provides treatment to patients on alternate days, instead of daily. This poses a higher risk of their missing doses, which is another key factor in the creation of drug-resistant strains of TB. Further, the programme does not invest in treatment counselling that strengthens adherence to treatment, he said.

‘Paternalistic model'

“The Directly Observed Treatment (DOT) model implemented by RNTCP is paternalistic, and fails to empower and support patients through TB treatment serving up a perfect recipe for treatment interruptions. This has implications for not only the patients treated but also the development of drug resistance,” said Hari Shankar of DNP+. “With treatment counselling, patients like me can easily adhere daily to fixed dose combinations of HIV medicines without having to be observed by health authorities every day. The TB programme should make treatment protocols that are simple to adhere to and are supported by treatment counselling, just as has been done for AIDS treatment.”

Late arrival

HIV+ patients who reach the MSF's HIV clinic in Mumbai often arrive in a very bad condition and even die before their DR-TB treatment can be started. Usually these patients have already been treated in the private sector with inappropriate TB drug regimens.

“The proliferation of TB formulations in the private market coupled with the casual over-the-counter sale of antibiotics, of which some are used for DR-TB treatment, is fuelling the development of drug resistance,” said Piero Gandini, MSF Head of Mission in India. “There is an urgent need for regulatory control of sale and administration of TB drugs in the private sector in order to address the growing incidence of severe forms of DR-TB in India.”

Blessina Kumar of Stop TB Partnership said: “The world is watching India's growing DR-TB crisis. Now that we have new tests that can detect DR-TB in less than two hours, it's a perfect time for the government to take immediate action to boost access to diagnosis and treatment in the public programme so that more people are started on appropriate drug regimens and we can reduce transmission of this disease.”

http://www.thehindu.com/todays-paper/tp-national/article3207968.ece