Drug-resistant TB a concern

  1. Context: World Tuberculosis (TB) Day
  2. About TB: Tuberculosis is a contagious infection caused by Mycobacterium tuberculosis and it usually attacks the lungs
  3. It can also spread to other parts of the body like the brain and spine
  4. Tuberculosis is contagious and spreads through the air, much like cold or flu
  5. National plan: Govt will soon be releasing the National Strategic Plan for TB Control (2017-2025), with an overarching framework to achieving the elimination goal
  6. Fact check: The tuberculosis epidemic affects 28 lakh Indians; another 79,000 people suffer from type of TB resistant to most antibiotics
  7. According to the Health Ministry, 17.5 lakh TB patients and 33,820 DR TB patients were notified in 2016 from public and private health
  8. Criticisms/challenges: Unrealistic target set in budget for TB elimination
  9. Lack of budgetary support and reduction in allocation for public health
  10. Weak support for DR/MDR/XDR TB patients
  11. The two new WHO recommended drugs for DR TB, Delaminid & Bedaquiline, are not currently available in Indian national TB programme
  12. While Delaminid is yet to be registered in India, Bedaquiline is available at only 6 States in the country, under compassionate use

Note4students:

Important for prelims as well as mains.

[op-ed snap] How not to treat TB

Context:

  1. Last month, the Delhi High Court acceded to the plea of an 18-year-old girl that she be given access to Bedaquiline
  2. Bedaquiline is an anti-TB drug found useful in treating multi-drug or extensively drug resistant disease (abbreviated as MDR/XDR TB)
  3. The girl had to move court because Bedaquiline was recently added in the armamentarium of the Revised National Tuberculosis Control Program of India (RNTC) with significant riders

Why the Restriction?

  1. Since Bedaquiline was the first major anti-TB drug discovered in the last 40 years, the government restricted its use for fear of TB mycobacterium developing resistance to the medicine
  2. The rampant use of anti-tubercular medicines has resulted in India having 4.80 lakh new cases of MDR TB in 2015
  3. Since February 2016, its availability is restricted to just six hospitals in five different cities (Delhi, Mumbai, Ahmedabad, Chennai and Guwahati)
  4. The complainant resided in Patna; her domicile status was held against her from being treated with Bedaquiline
  5. However, there should be a scientific rationale for rationing the drug, of putting it beyond the reach of the patient (and the health practitioner), to prevent the development of resistance against it

Antibiotic Revolution:

  1. Ever since Penicillin was discovered by Alexander Fleming in 1929, an “antibiotic revolution” has been ushered in medicine with new antibiotics flooding the market every year
  2. But there is hardly any antibiotic against which “no resistance” has been reported
  3. The only way in which antibiotic resistance can be prevented is not to use the antibiotic, which, of course, is not possible
  4. Preventing resistance against Bedaquiline is a must, but the manner in which this is being done is impractical and undemocratic

Lack of management by the Government:

  1. A Joint TB Monitoring Mission in its report in 2015 pointed out that the lacunae within the RNTC in the management of multi-drug-resistant cases
  2. The high power committee suggested that the prime reason for the rise in drug-resistant TB is the inherent weakness of state-run TB control programmes
  3. Lack of awareness among patients, who do not complete the recommended six-month medication is another issue in the treatment
  4. Besides, slashing the five-year budget of RNTC from Rs 6,500 crore to Rs 4,500 crore by the present government has only added to the problem of TB control in the country
  5. A community perspective on the use of Bedaquiline is a must in a resource-challenged country like India

Scientific point of view:

  1. Scientific evidence suggests that a delay in the treatment of MDR/XDR cases of tuberculosis only makes the community more susceptible to the spread of infection by the multi-drug resistant TB organism
  2. Studies on the use of drugs like Bedaquiline in the early stages of multi-drug resistant scenarios in South Africa showed better results both in terms of disease cure and in the restriction of community spread of the disease
  3. It is thus imperative that the use of Bedaquiline early in disease will have far better results than in denying its use through impractical statutes

Geographical isolation by the government:

  1. The issue of the geographical restriction of Bedaquiline may be one of its kind in this country
  2. If the priority is prevention of drug resistance, it could be attained by methods less draconian than controlling the availability of the drug
  3. Restriction of treatment based on the geographical location of patients is the worst form of federal arrogance which a state can unleash on its citizens
  4. Regional domiciles should not dilute the principles of equipoise in the eyes of the state. Some patients cannot be more equal than others

Way forward:

  1. Strict surveillance of MDR/XDR cases
  2. Better community outreach programmes to educate the patient and the healthcare provider against treatment dropout
  3. Quality assurance on available anti-TB drugs and educating physicians against the irresponsible, injudicious use of anti-tubercular therapy

Note4Students:

This is an important op-ed. When the government announces its ambitious policy of eliminating TB by 2025, it becomes imperative to know what policies the government is taking up.

India’s TB burden- statistics

  1. According to the WHO, India shoulders 71,000 multi-drug resistant tuberculosis patients
  2. Nearly 10 per cent of all MDR-TB patients have extensive or XDR-TB
  3. XDR-TB: Resistant to any fluoroquinolone, and at least one of three second-line injectable drugs (capreomycin, kanamycin and amikacin), in addition to multidrug resistance
  4. India has about 2,300 XDR-TB patients & only 36 are currently on the Govt’s access programme

Let’s know more about Bedaquiline

  1. Considered to be the most effective treatment for multi-drug resistant tuberculosis
  2. Used exclusively to treat patients who have failed to respond to second-line anti-TB medicines
  3. India had received a donation of 300 doses from the United States Agency for International Development (USAID), with another batch of 300 doses to be donated next year
  4. The drug was to be introduced in six hospitals in Delhi, Mumbai, Chennai, Ahmedabad and Guwahati and later be introduced in 104 districts in five States

‘Miracle’ TB drug hit by low enrolment

  1. Six months after the launch of ‘miracle’ drug bedaquiline, the Govt has enrolled a mere 36 patients
  2. Other countries like South Africa, Swaziland or even Belarus have put nearly 5% of their MDR TB patients on bedaquiline within a year

India sets an example in subsidised TB diagnosis

A study, published recently in the journal Lancet Global Health, has indicated that India is the best country in the world to offer subsidized TB diagnosis.

  1. Of the 12 high-burden countries where the private sector is a major player in providing health care.
  2. The Indian private sector offers the cheapest price for the WHO-approved Xpert MTB/RIF, a molecular test for diagnosing TB.
  3. Access to accurate tests at subsidised price is very important in India as nearly 80% of the population in India first seek the private sector.
  4. If one out of every four TB patients in the world is an Indian, one in eight TB patients in the world is a privately treated Indian patient.
  5. Hence, to further reduce the costs, the study asks the Indian government to waive off customs duty of 31% levied on Xpert machine and reagents.

Child-friendly TB drugs launched

  1. Child-friendly TB drugs for first-line medication in a fixed-dose combination were launched for the first time.
  2. The availability of child-friendly TB drugs of correct dosages will increase drug adherence and thereby reduce acquired drug resistance.
  3. Earlier,  the adult drugs had to be crushed  to achieve an appropriate dose for a child making it all the more difficult to administer to young children.
  4. Since the fixed-dose combinations come in a dissolvable form, tablets no longer need to be crushed.

Chennai’s new strategy to eliminate TB

To help communities move to zero deaths from tuberculosis in their own way, and create “islands of elimination”, which will reverse the overall tuberculosis epidemic.

  1. With this project, Chennai may drastically reduce TB mortality, shrink the number of new cases annually and impact TB prevalence in the city in a matter of 3-5 years.
  2. The Zero TB Cities project earnestly embraced the Zero TB Declaration in 2012, that calls for a “new global attitude” in the fight against TB.
  3. The project envisages a comprehensive tuberculosis elimination strategy at the community level by using all the currently available arsenals.
  4. The “island of elimination” strategy does not call for any breakthroughs but requires a change of mindset.

Chennai has been chosen as one of two cities in the world where the Zero TB Cities project will try to create an “island of elimination”. Lima in Peru is the other city.

TB ranks alongside HIV as leading killer worldwide: WHO report

Ending the TB epidemic is part of the Sustainable Development Goal agenda.

  1. In 2014, tuberculosis (TB) killed 1.5 million people, 400,000 of whom were HIV-positive.
  2. Fight against TB is paying off, however, with this year’s death rate nearly half of what it was in 1990.
  3. WHO’s Global Tuberculosis Report 2015, most of the improvement came since 2000, the year the Millennium Development Goals (MDG) established.
  4. Need to close detection and treatment gaps, fill funding shortfalls, and develop new diagnostics, drugs and vaccines.

Fund crunch hampers TB fight

  1. Government has failed to meet annual targets to control spread of the nation’s most fatal infectious illness.
  2. India records more than 300,000 TB related deaths and 2.2 million new cases of TB each year.
  3. The draft report is not in the public domain but was leaked on the Internet by health activists

Hi-tech facility that detects TB in two hours

  1. Mysuru to get a state-of-the-art facility under the Revised National Tuberculosis Control Programme (RNTCP).
  2. The cartridge-based Nucleic Acid Amplification Testing (CBNAAT) equipment.
  3. Support from the World Health Organisation (WHO), National AIDS Control Organisation (NACO) & USAID.
  4. Once TB is detected, the patient is supposed to take meds under the Directly Observed Treatment (DOT), recommended by WHO.

Not everyone with TB infection may suffer from the disease: IMA

  1. As such human immune system can stop the contagious TB bacteria from multiplying.
  2. Such people are called “TB infected” but, they don’t feel sick or show symptoms or spread TB.
  3. But if person suffering HIV, diabetes mellitus, malnutrition, then it can’t fight against TB infection.
  4. Such people are called “TB diseased patients”, each of them capable of infecting 10 more.

IMA says – Patients with TB should be tested for HIV

  1. If a person has HIV and TB co-infection it means that they have both HIV infection and either latent TB or active TB disease.
  2. HIV infection and infection with TB bacteria are though completely different infections.
  3. But people living with HIV are at greater risk of developing TB owing to the weakened immunity.
  4. Progression to TB disease is often rapid among people infected with HIV and can be deadly.

Indian Medical Association on TB & Swine Flu

  1. Swine flu is a droplet infection, while TB is droplet nuclei infection. What’s that?
  2. Droplet infection = Infected particles of size > 5 microns & Droplet nuclei infection = < 5 microns.
  3. This essentially makes TB more easily transmittable – hospital can be a place where TB is transmitted to other patients and healthcare staff.
  4. While prevention of flu requires simple three layered mask, the one for TB prevention requires N95 mask.

    Discuss: An estimate – In India, 2.1 MM new TB cases occur annually and 2,40,000 TB deaths occur every year. The article speaks about an ethical liability with the patient to disclose his/ her illness



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