‘True scale’ of India’s TB problem: 2.8 million new cases
NEW DELHI — Finally coming to terms with the enormity of its tuberculosis problem,
is preparing a radical overhaul and expansion of its national treatment program to fight an affliction that kills more adults worldwide than any other infectious disease.The severity of the matter was underscored on Thursday when the increased its estimate of the number of new patients with in India, to 2.8 million in 2015, compared with 2.2 million in 2014 — more than in any other country in the world and more than a quarter of the world total.
substantiallyThe organization’s estimate of new global TB patients rose to 10.4 million, from 9.6 million a year earlier, in large part because of the revised numbers in India. But increases were noted in Indonesia and several other countries.
The revision in India follows a study published in August in the journal Lancet Infectious Diseases that estimated the number of Indians afflicted with TB at 3.6 million, about 50 percent higher than previous Indian government and W.H.O. figures for 2014.
The increase confirms numerous Indian district and state studies from recent years.
Tuberculosis, an ancient and deadly bacterial disease that most commonly affects the lungs, has been curable for decades using a cocktail of
taken for six months.India brought this cure to the masses in the 1990s and had early success in reducing the number of cases. But that faded, in part because it failed to reach patients in the private sector, where the vast majority of Indians get medical care.
The disease killed 480,000 people in India last year, accounting for about a quarter of the 1.8 million deaths worldwide, the W.H.O. report said.
When not treated properly, tuberculosis not only spreads but also mutates into more drug-resistant forms, which are far more difficult to treat. Multidrug-resistant TB, in which the two most powerful drugs are ineffective, is contagious and curable only about 60 percent of the time.
A Mumbai pulmonologist, Dr. Zarir Udwadia, warned in a paper in 2011 that he had found four TB patients who were totally drug resistant.
Experts say the severe underestimation of TB patients in the country was the result of undercounting of patients in the private sector. The government and international experts simply tallied the patients in government programs and added to those a guess at the number being treated privately.
It turns out the world “had little idea of the true scale of the problem in India — the worst-affected country,” said Dr. Nimalan Arinaminpathy, the lead author of the Lancet paper and a senior lecturer at Imperial College London.
The Lancet authors calculated the amount of TB medicine sold in the private sector and then worked backward to estimate how many people were taking the drugs.
Dr. Sunil Khaparde, the manager of India’s TB program and a co-author of the study, agreed in an interview that it had given India a better estimate of its TB problem. But he added that the country plans to conduct a prevalence study over the next three years to determine with more certainty the actual number of cases.
To reach more patients, Dr. Khaparde said, the government planned to provide free TB drugs and diagnostic tools to patients being cared for by private medical practitioners, as it does now for patients in government programs.
To do so, Dr. Khaparde said, the government will expand several pilot programs that have proved successful in involving private medical practitioners. The goal is to ensure their patients are adequately treated and monitored so they finish the six-month regimen to be cured of regular tuberculosis, or a longer course of nine months to two years to have the best chance of overcoming drug-resistant disease.
The World Health Organization’s representative to India, Dr. Henk Bekedam, credited the administration of Prime Minister Narendra Modi with not only acknowledging the evidence of greater prevalence of the disease but also being ready to carry out significant changes to the government’s longstanding TB program. India plans to increase spending to $300 million from $96 million, Dr. Khaparde said.
Mr. Modi personally led a one-and-a-half-hour review of the country’s TB programs with top health officials and state officials this year, demanding improvements.
“It’s good he’s interested and wants to see things changed,” Dr. Bekedam said, adding that the main question now was how quickly and effectively the country could put the changes in place. A new five-year plan scheduled to take effect in 2017 is still being drafted.
Dr. Udwadia, in an interview, called the revised estimates of tuberculosis in India “long overdue” but expressed skepticism that the government would successfully expand the pilot programs.
“I don’t see them rolling out on a countrywide basis,” he said. “They will remain small pockets in isolation.”
Jagat Prakash Nadda, India’s minister of health and family welfare, was not available for an interview.
To succeed, the program will have to persuade private practitioners and their patients to use the free diagnostics and medicines provided by the government, said Dr. Sreenivas A. Nair, the W.H.O.’s tuberculosis officer in India.
In the past, the government failed to persuade private practitioners to send their patients to the government programs.
The new program does not try to persuade private practitioners to give up their patients, but instead allows them to continue treating the patients while they register for the government’s free diagnostics and drugs.
Once registered, the patients are monitored by the government, which offers home visits, counseling and screening of household members. The greatest dangers are an interruption in treatment or a cocktail of medicines too weak to kill the bacteria, which can help breed drug-resistant forms of the disease.
To improve the monitoring, the government plans to instruct patients to call after taking their daily doses. If no call is made, reminders will be sent to patients, their family members and, finally, health workers.
“For TB, what’s required is proper surveillance,” Dr. Sreenivas said. “Why we eradicated
is we know where the cases are and take action.”India already derives more than half of its funding for fighting TB from international aid groups. Dr. Sreenivas said India would need more assistance to expand its programs.
The Global Fund to Fight AIDS, Tuberculosis and Malaria, which expects to spend $119 million on tuberculosis programs in India in 2016, “will definitely consider any proposal that supports a major expansion of India’s programs on TB,” said Seth Faison, a spokesman.
Source: The New York Times