On this World TB Day, India must pull up its socks and tackle the challenge with the seriousness it deserves. More than 1,000 persons die of tuberculosis every day in the country. The medical fraternity and drug manufacturers need to script a new plan, writes MADHUKAR PAI
Tuberculosis is an ancient disease that has plagued humans for centuries. India accounts for a quarter of all TB cases in the world. Approximately 2.3 million new TB cases occur every year and TB kills nearly 1,000 people every day in India. The emergence of severe forms of drug-resistant TB has worsened the situation, especially in cities like Mumbai.
TB is caused by a bacteria that spreads from person to person through the air. long-term cough and fever are the most important symptoms of TB. When a person with TB coughs, TB bacteria get expelled into the air. The bacteria can then get inhaled by another person who can become easily infected. TB usually affects the lungs, but it can also affect other parts of the body. TB can affect adults and children, and can impact people from all strata of society. Persons with HIV infection and AIDS are particularly prone to getting TB.
The positive news is that TB is treatable and curable. However, unlike most common infectious diseases (such as malaria or pneumonia) that require a few days of anti-biotic treatment, TB requires several antibiotics and six months of treatment. If the full course of treatment is not followed, TB bacteria can become resistant to antibiotics. Multi-drug-resistant refers to TB that is resistant to rifampicin and isoniazid, two of the most critical first-line antibiotics used to treat TB.
All individuals with cough for more than two weeks must seek care early and get their sputum tested for TB. Sadly, many persons with chronic cough do not seek medical care, and this results in long delays before a diagnosis is made. Sputum testing can involve microscopic examination for the TB bacteria, culture to grow the bacteria in a tube, or newer molecular tests that multiply TB DNA.
GeneXpert is the latest advance in TB detection. It is a highly accurate, molecular test that has been endorsed by the World Health Organization. This technology is completely automated and can rapidly detect TB as well as drug-resistant TB within two hours
Owing to the Initiative for Promoting Affordable and Quality TB Tests, led by the Clinton Foundation, it is now widely available in over 60 laboratories across India at prices that are 50 per cent less than the market price. Through the IPAQT initiative other WHO-approved TB tests such as liquid culture are also available at subsidised rates.
Sputum microscopy testing is available free via thousands of designated microscopy centres run by India’s Revised National TB Control Programme. If patients seek care in the private sector, they must demand sputum testing over blood tests for TB. Private doctors in India prefer blood tests for TB. Unfortunately, these are inaccurate and can provide misleading results. The WHO has discouraged these tests, and, in June 2012, the Government of India banned the use of blood-based antibody tests for TB.
laboratories in India should not replace anti-body TB tests with equally bad or worse alternatives such as ‘TB Gold’ or ‘TB Platinum’ (which are meant for latent TB infection). TB disease cannot be diagnosed by any currently available blood test. Testing the sputum for TB bacteria using microscopy, GeneXpert or culture are the only valid approaches for accurately detecting pulmonary TB.
Doctors have an important role to play in ensuring that their TB patients are treated correctly. Doctors must follow recommended treatment guidelines, monitor patients’ response to treatment, and make sure therapy is completed. Doctors should also avoid starting anti-TB drug treatment without doing any laboratory testing to confirm the disease. If TB is confirmed, they should start treatment promptly.
For regular, drug-sensitive TB, a standard four-drug treatment must be started, and the total duration of treatment must not be less than six months. Drug-resistance usually occurs when patients do not complete their full course of treatment; when doctors prescribe the wrong treatment, the wrong dose, or length of time for taking the drugs.
If drug-resistance is suspected, it should be confirmed using laboratory tests, such as GeneXpert, and liquid culture. For drug-resistant TB, second-line drug treatment must be started, and the total duration of treatment must be at least two years.
Pharmacies and chemists have a big role to play in preventing drug-resistance. They must not dispense TB drugs without a valid allopathic doctor’s prescription, and TB drugs must not be sold over-the-counter. With correct diagnosis and complete treatment, TB can be cured and loss of life averted. Most importantly, this will also help control the spread of this deadly infection.
(The author is associate director, McGill International TB Centre, Montreal, Canada)