India to treat multi-drug resistant tuberculosis nation-wide by 2010

[Guest guest]

India to treat multi-drug resistant tuberculosis nation-wide by 2010

Amit Dwivedi

India is gearing up to strengthen tuberculosis (TB) control so as to

provide TB prevention, diagnostics and treatment, particularly for

multi-drug resistant tuberculosis (MDR-TB), nation-wide by 2010.

MDR-TB is TB that is resistant to at least two of the best anti-TB

drugs, isoniazid and rifampicin. These drugs are considered first-line drugs and

are used to treat all persons with TB disease.

" The 4th Global Survey on anti-TB drug resistance does not indicate that the

rates of MDR-TB are increasing sharply in India or in Indonesia, or in the

South-East Asian Region as a whole. The overall rates for MDR-TB among new

smear-positive cases in the Region is 2.8% among new cases and 18.8% among

people receiving prior treatment for TB for one month or more.

However given population sizes in our larger countries, the

numbers of cases are indeed large " said Dr Jai P Narain, Director,

Communicable Diseases Department, South East Asian Regional Office

(SEARO) of the World Health Organization (WHO).

MDR-TB is a result of inadequate programme performance of Directly

Observed Treatment Short-Course (DOTS). DOTS is the WHO-recommended

treatment strategy for detection and cure of TB which combines five

elements: political commitment, microscopy services, drug supplies,

surveillance and monitoring systems and use of highly efficacious

regimes with direct observation of treatment.

" National TB control programmes in our Region have moved steadily to

achieving the case detection and treatment success targets under DOTS.

Treatment success rates in excess of 85% have been consistently achieved since

2002 " further explains Dr Narain.

However due to a broad range of reasons, some people with

drug-susceptible TB (which is not resistant to any anti-TB drug) develop

resistance to anti-TB drugs, or may contract the drug-resistant strain of TB,

which is also a possibility. People living with HIV (PLHIV) or those with

compromised immunity are at particularly alarming TB risk (both drug susceptible

and drug-resistant TB strains).

" MDR-TB cases arise among patients failing Category 1 and 2 regimens,

contacts of MDR-TB cases, congregate settings and in other at risk

populations such as PLHIV " adds Dr Narain.

Testing or diagnosing these drug-resistant strains of TB and providing effective

medication (which is many times more expensive, and treatment duration is much

longer) and improving DOTS programme performance for successfully diagnosing and

curing drug-susceptible TB (and preventing development of any further anti-TB

drug-resistance) can certainly make TB control more effective.

" We see this as an opportunity to strengthen our efforts to focus on

prevention of MDR-TB so that we do not have to make the larger

investments in treating additional cases of MDR-TB " says Dr Narain.

" India has adopted policy and is now rapidly building laboratory

capacity through a network of 24 reference laboratories qualified to

undertake culture and drug susceptibility testing (DST) to offer testing to all

those who may have drug-resistant forms of TB. There is also an expansion plan

to treat MDR-TB cases country-wide by the end of 2010 " informs Dr Narain.

Dr Narain points out two specific areas that require attention: To

determine how/ where MDR-TB is being generated, and to prevent further emergence

of MDR-TB.

While achieving good cure rates under DOTS, we need to focus also on

reasons for default and other unfavourable outcomes " says Dr Narain.

" Given good cure rates under DOTS, are most MDR-TB cases arising from

unsupervised treatment, through unsustainable out-of-pocket expenditure, outside

of DOTS programmes? " asks he.

Dr Narain suggests some ways to prevent further emergence of MDR-TB. " By

addressing all causes of adverse TB treatment outcomes, enhancing involvement of

private sector and unlinked public health facilities, and promoting wider

acceptance and application of the International Standards of TB Care " can

possibly improve TB programmes in the region.

Amit Dwivedi

(The author is a Special Correspondent to Citizen News Service (CNS). He can be

contacted at: amit@...

<mailto:amit@...> )

______________________

Published in:

Thai Indian News

<http://www.thaindian.com/newsportal/health/india-to-treat-multi-drug-re\

sistant-tuberculosis-nation-wide-by-2010_10098022.html> , Bangkok,

Thailand

Assam Times <http://www.assamtimes.org/Editorial/2080.html> , Guwahati,

Assam

Bihar and Jharkhand News Service

<http://www.biharandjharkhand.com/news/articles/amitdwivedi210908.htm>

Drug and Policy Control

<http://www.drugpolicycentral.com/bot/article/thaindian11690.htm> ,

Delhi

The Seoul Times <http://www.theseoultimes.com/ST/db/read.php?idx=7282> ,

Seoul, South Korea

News Track India <http://www.newstrackindia.com/newsdetails/18171> ,

Delhi

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warm wishes across

Amit

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