India: TB declared a notifiable disease - what does this mean for people living with HIV, diagnosed with TB

According to the news reports - with immediate effect - all private doctors, caregivers and clinics treating a patient with TB will have to report every single case to the government. See "Finally, tuberculosis declared a notifiable disease", Times of India, 9 May 2012 which is available at http://timesofindia.indiatimes.com/india/Finally-TB-declared-a-notifiable-disease/articleshow/13060051.cms

According to the Times of India, the notification was sent to all states on May 7. The Times of India news report also quoted from the notification - "In order to ensure proper TB diagnosis and case management, reduce TB transmission and fight emergence of drug resistant TB, it is essential to have complete information of all TB cases. Therefore the healthcare providers shall notify every TB case to local authorities - district health officer/chief medical officer of a district and municipal health officer of a municipal corporation, every month. Those who come under the ambit of healthcare providers include "clinical establishments run or managed by the government, private or NGO sectors, and individual practitioners".

Dr. Ashok Kumar, DG, TB Division, Ministry of Health in IBN Live: "It is essential to have compete information of all TB cases. Therefore, the healthcare providers shall notify every TB case to local authorities, that is, district health officers or CMOs of the district and Municipal health officers of a municipal corporation, every month in a given format."

According to an earlier note of the TB control division, "With improved notification, RNTCP could improve case management and reduce TB transmission and the spread of drug-resistant TB."

Dr Nata Menabde (WHO Representative to India) in an email to WHO HQ and Stop TB on May 8 claimed that WHO India should be credited for the development - Quoting from the email - "This is to share with you an important achievement we have accomplished yesterday for TB. As you know TB is not yet a notifiable disease.  Through a series of advocacy efforts backed up by gathering of evidence in support for notification, WHO-India was able to take up this matter with GOI successfully and an executive order has been released by GOI yesterday making TB a notifiable disease in the country. We have helped the programme to develop necessary formats for notification and are now developing plans for the implementation, which include use of ICT including mobile technology. This along with the introduction of case based web based notification system; the first phase  is expected to start next week and is expected to bring a necessary boost for the country's TB burden estimation and PPM initiatives."

BUT THIS RAISES LEGAL-ETHICAL ISSUES FOR PEOPLE LIVING WITH HIV DIAGNOSED WITH TB -

WHAT does notification of TB diagnosis to TB authorities mean for patients and their families?

HAS the community which is most vulnerable (e.g. HIV+), health groups in India been consulted on what this means for patient confidentiality?

HAS this notification been coupled with the guarantee of treatment?

CIVIL SOCIETY SHOULD CALL FOR an open discussion and debate with RNTCP on the benefits of the policy of compulsory notification of TB cases to the TB authorities. WHAT happens if patients face stigma and discrimination if the policy is implemented wrongly. Will this drive patients to seek care much later or even disappear?

At a minimum the government should have had a dialogue on how to ensure that the policy will be implemented with a  guarantee of medical confidentiality, psychosocial support and access to the most appropriate treatment as per WHO guidelines.