Citizen News Service (CNS), with support from the Lilly MDR-TB Partnership, recently released a report examining how drug-resistant tuberculosis (TB) in India is managed. The report covers lessons learned from selected sites in six cities across the country, and makes recommendations for improvements.
CNS embarked on a mission to document the best conventions and lessons learnt from select sites of Programmatic Management of Drug-resistant Tuberculosis (PMDT). The survey included nearly 200 key informant interviews, cured patients of multi-drug-resistant TB (MDR-TB), MDR-TB patients currently on treatment and their family members, extensively drug-resistant TB (XDR-TB) patients, nurses, doctors, laboratory technicians, microbiologists, PMDT site nodal officers, state and district TB officers to analyse and conclude the major factors in practice that could bring about a universal access to quality diagnostics and treatment programmes for PMDT across India.
This report was generated to address MDR-TB’s disease burden in India. The report is based on a survey and detailed research undertaken to find the major practices involved in educating, treating, managing and improving the overall situation of PMDT in various regions of India. The various practices and methodologies, practiced by several medical institutions were observed, highlighted and questioned by CNS during January-June 2013.
CNS visited key 14 sites in six cities and reviewed PMDT guidelines of India in terms of four key parameters: counseling, infection control, diagnostics and laboratory services, and treatment and care services.
Some of the major recommendations on key specific areas are:
Infection control: Counselling should be done for infection control at all levels. Cough hygiene should be integrated in general health education. Supplies (of products that help in infection control such as N95 masks) should be uninterrupted and adequate.
Counseling: Quality counselling and training (and re-training) of counsellors on a broad range of issues affecting lives of patients (and attendants and their family members where possible) on TB should be integrated and financed. Counsellors should also include cured patients of TB (and drug-resistant TB). Post of counsellors has already been sanctioned; recruitments should be made at the earliest.
Diagnostics and laboratory services: Quality sputum (and sample) collection and transport system are some areas that need more attention in most states. Uninterrupted laboratory supplies, trainings and re-trainings of team members involved in diagnosis, and strict implementation of laws that ban substandard or inaccurate diagnostic tests such as TB serological tests should get a priority.
Treatment and care services: Law on TB notification should be strictly enforced. Innovative ways such as engaging pharmacies should be opted for. Drug supplies, training and re-training of care providers, and strengthening of social support systems for patients on treatment and cured patients need attention.
Bobby Ramakant, Director – Policy and Programme, CNS said, “India has been scaling PMDT across the country alongside improving DOTS with nearly every state having quality assured standard intermediate reference laboratory (IRLs) for early and confirmed diagnosis of drug-resistant TB with modern WHO and RNTCP approved technologies and standard treatment and care facilities integrated in existing healthcare facilities.”
Edgard Olaizola, Managing Director, Lilly India said, “Today, TB/MDR-TB is a major health challenge for India and there is a pressing need to address its rising burden. That said, the Lilly MDR-TB Partnership has been working in India with various stakeholders to combat this daunting disease. Launch of this report on best practices in Programmatic Management of Drug-resistant Tuberculosis marks an important milestone for Lilly MDR-TB Partnership, we will continue to focus on fighting this deadly disease.”
Despite challenges of health systems and the highest TB disease burden globally, India has certainly come a long way in its response to providing access to standard WHO recommended anti-TB treatment through Directly Observed Treatment Short course (DOTS) to more than 14.2 million (1.42 crores) people across the country. However, TB continues to remain one of the key public health priorities in India. Drug-resistant TB is one of the major concerns and India envisions providing universal access to quality diagnostics and treatment services for all patients with drug-resistant TB in next five years.
EP News Bureau – Mumbai