India moves forward in the fight against MDR-TB

According to the World Health Organization’s Global Tuberculosis Report 2013, India has the highest incidence of TB in the world, with 2.2 million new TB cases annually which amount to 18% of the global TB burden and 66% of that in South East Asia. India also has 31% of the global total of missed cases of 3 million. In addition, out of the 22 high-burden countries, India saw the greatest increase in multidrug-resistant (MDR-TB) between 2011 and 2012. There were an estimated 64000 cases of MDR-TB in 2012, over 25% (16588) of which were diagnosed with the disease and 14143 were put on treatment.

But Mr Chandra Kishore Mishra, Additional Secretary, Ministry of Health and Family Welfare, Government of India, while speaking in a plenary session at the on-going 44th World Union Conference on Lung Health was upbeat about India’s efforts to tackle the menace of TB. He remained undaunted by the slogan shouting of some protestors who marched on the podium, ahead of him blaming the Indian government for allowing people to die of TB.

He said that, “The Indian story is reasonably good one which needs to be taken forward. What is wrong must be accepted, what is good must be complimented upon. If there are issues, let us face them together. These are issues for humanity. If we cannot face them together that is the real shame.”

One must not forget that India is a vast country with a population of over 1.2 billion. The health delivery systems have shown improvements especially through the National Rural Health Mission aiming to provide basic healthcare services to all. With 13,000 designated microscopy centres, 90 MDR-TB centres, and over 50 testing laboratories in its 692 districts under the Revised National TB Control Programme (RNTCP), the country has achieved 100% nationwide coverage of Programmatic Management of Drug Resistant TB (PMDT) services since March 2013. TB case detection rates and treatment success rate are in line with the global targets. Since the implementation of the RNTCP, over 15.9 million patients have been placed on treatment and 2.9 million lives have been saved.

The National Strategy Plan (NSP) for TB Control 2012-2017 envisions a TB free India through achieving Universal access by provision of quality diagnosis and treatment for all TB patients in the community. The goal of NSP is to: decrease the morbidity and mortality by early diagnosis and early treatment of all TB cases in the community; achieve 90% notification rate for all TB cases; establish and strengthen 120 Cartridge-based DST (C-DST) laboratories and establish GeneXpert MTB/RIF in 950 cities by 2017; and strategize MDR-TB prevention through sustained high quality DOTS implementation and treat at least 40,000 MDR TB cases annually by 2017.

Of course there are challenges to be met. There has to be more political commitment and ownership of the programme. Engaging the large private sector–from informal private clinics to state of the art private hospitals—in TB care and control is crucial to the success of the TB control programme as a vast majority of Indians still seek treatment in the private sector. Over the counter sale of drugs and irrational use of 2nd line drugs will have to be curbed. So the way forward to scaling up TB control in India (and perhaps elsewhere too) according to Mr Mishra is-- “Having rapid point of care test; shorter and effective regimens for treatment of MDR/XDR-TB; more effective and affordable drugs; collaboration with all stakeholders; and innovative mechanism for involvement of the private sector.”

ENDS

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