TB DOTS implementation hits HIV roadblock

[Guest guest]

DOTS implementation hits HIV roadblock

Anuradha Mascarenhas

PUNE, MARCH 20 : Although the DOTS (Directly Observed Treatment,

Short course) strategy to treat tuberculosis in the country started

14 years back, the programme faces several stumbling blocks. It seems

the coming together of the TB and the HIV programmes is a huge

challenge to the effective implementation of DOTS.

Since 60 per cent of HIV positive patients develop TB, centres that

treat HIV positive patients have started administering TB drugs. In

the past six months, around 11,842 patients with HIV have been

infected with TB across the country and immediately put on DOTS.

On March 24, which is observed as anti-TB Day, the government will

not only launch a disease prevalence survey to understand the exact

burden of tuberculosis across the country, but also aim at

strengthening cross-referral linkages — HIV to TB and vice versa. " TB

patients coming to the HIV department and vice versa will be

strengthened, " said Dr L S Chauhan, Deputy Director General

(Tuberculosis) and programme manager of the National TB Control

Programme.

At present, around 6.8 million cases of TB have been treated under

DOTS since the inception of the national programme in 1993. As many

as 1.4 million cases of TB were brought under the DOTS programme in

2006. " TB patients getting infected with HIV is a huge challenge to

the effective implementation of the DOTS programme, " Chauhan said,

adding that the Central TB Division has started documenting data on

this issue in the past six months.

" We are collaborating with the HIV prevention and control programme

officials and referring TB patients to their department. The identity

of the patient is not disclosed, " Chauhan said, adding that a

training module has been developed for officials in both TB and HIV

departments.

The HIV-TB coordination programme is being implemented in the six

highly-affected states of Maharashtra, Karnataka, Andhra Pradesh,

Tamil Nadu, Nagaland and Manipur with HIV prevalence of over one per

cent.

If HIV is a posing a challenge to the DOTS programme, then multi-drug

resistance to anti-TB drugs is another cause of concern. According to

the latest survey conducted by the Central TB Division, there are

less than three per cent of multi-drug resistance MDR-TB patients

among the new cases. And there are around 1.8 million new cases of TB

every year.

The DOTS programme has been expanded to DOTS-PLUS to handle emerging

cases of MDR-TB across the country. However, Chauhan admits that the

treatment is expensive and around 15 laboratories will be set up in

the country by 2008.

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