MSF: Alarming rate of drug-resistant tuberculosis cases in India requires heightened response
New Delhi, 23 March 2012 – The growing number of drug-resistant tuberculosis (DR-TB) cases in India, lends greater urgency to solve major problems surrounding the treatment of TB and regulation of TB drugs in the country’s private market, the international medical humanitarian organization Médecins Sans Frontières / Doctors Without Borders (MSF) said today, alongside the Peoples’ Health Movement, Stop TB Partnership and Delhi Network of Positive People (DNP+).
India has the second highest DR-TB burden in the world with an estimated 99,000 new multi-drug-resistant (MDR) cases every year. Yet in 2010, only 2% of the estimated cases received second-line drug treatment under the national programme.
“It’s painfully clear that DR-TB infections are on the rise in India,” said Dr. Amit Sengupta from Jan Swasthya Abhiyan / The Peoples’ Health Movement. “The conditions for emergence of drug resistance are undeniably prevalent, in both the public programme and the private health sector.”
In India, the Revised National TB Control Program (RNTCP) provides treatment to TB patients on alternate days, instead of daily treatment. This poses a higher risk for patients to miss doses, which is another key factor that leads to the creation of drug-resistant strains of TB. Further, the programme does not invest in treatment counseling that strengthens adherence to treatment.
“The Direct Observed Treatment (DOT) model implemented by RNTCP is paternalistic, and fails to empower and support patients through TB treatment serving up a perfect recipe for treatment interruptions. This has implications not only for the patients treated but also on the development of drug resistance,” said Hari Shankar of DNP+. “With treatment counseling, patients like me can easily adhere daily to fixed dose combinations of HIV medicines without having to be observed by health authorities every day. The TB programme should make treatment protocols that are simple to adhere to and are supported by treatment counseling, just as has been done for AIDS treatment.”
At MSF’s HIV clinic in Mumbai, HIV+ patients who reach the clinic often arrive in very bad condition and even die before their DR TB treatment can be started. Usually these patients have already been treated in the private sector with inappropriate TB drug regimens.
“The proliferation of TB formulations in the private market coupled with the casual over-the-counter sale of antibiotics, of which some are used for DR TB treatment, is fuelling the development of drug resistance,” said Piero Gandini, MSF’s Head of Mission in India. “There is an urgent need for regulatory control of sale and administration of TB drugs in the private sector in order to address the growing incidence of severe forms of DR-TB in India.”
“The world is watching India’s growing DR-TB crisis. Now that we have new tests that can detect DR-TB in less than two hours, it’s a perfect time for the government to take immediate action to boost access to diagnosis and treatment of DR TB in the public programme so that more people are started on appropriate drug regimens and we can reduce transmission of this disease in India,” said Blessina Kumar TB Activist & Vice Chair of the Stop TB Partnership.
Notes to the editor:
TB: Despite existing since antiquity, TB is the second biggest killer globally today - and there are more and more cases of TB resistant to first-line drugs normally used to treat it. According to WHO, India has the highest burden of TB with two million cases every year and the second highest DR TB burden in the world with 99,000 cases every year.
DR TB: Drug-resistant tuberculosis is a form of TB that is resistant to standard first line TB drugs. A personcan be directly infected by this form of TB or can develop it if treatment taken was not appropriate in terms of drug regimen, dosage or duration. This problem in India is compounded by an unregulated private sector that prescribes TB drugs irrationally in improper drug doses or combinations leading to drug resistance (more DR-TB). The lack of regulatory control of TB formulations in the market fuels this practice. There are 48 different FDC dosage combinations and 22 different single drug formulations in India - of the 4 first line drugs itself (PLoS study).
DR-TB treatment: The treatment of DR-TB relies on old antibiotics—many of which have severe side effects, ranging from constant nausea, deafness and psychosis - they are the only drugs that exist today that can tackle DR-TB. Patients must receive 6 months of painful injections and take up to 17 pills every day for up to two years.
About MSF: Médecins Sans Frontières (MSF) is an international, medical, humanitarian organisation providing free, high-quality medical assistance to vulnerable populations in nearly 70 countries.
Internationally MSF treat DRTB in 29 different countries with more that 1000 new admissions every year.
Since 2006, MSF runs an anti-retroviral treatment (ART) centre in the Khar area of Mumbai. The clinic has a special focus on HIV+ patients who are co-infected with DR TB. Since the start of the project, 92 HIV+ patients have been diagnosed with DR-TB. Currently the clinic has 29 patients on DR-TB treatment in Mumbai. In India, MSF is also running other medical activities in Manipur, Chhattisgarh, Andhra Pradesh, Bihar, Jammu & Kashmir, and Nagaland.
In its medical projects for DR TB treatment, MSF has adopted an ambulatory approach i.e. a community based model. MSF patients are provided psycho-social support and treated in their communities, with the option to receive daily injections and pills at or near home—an approach that represents a major step forward in adapting care to patients' needs, while boosting their capacity and likelihood to adhere to their two year long treatment which, involve drugs with severe side effects.
