Tuberculosis has been and still is a menace worldwide. With nearly one-third of the population infected with Mycobacterium Tuberculosis, TB is the second most reason of death from infectious disease after HIV with Asia and Africa contributing to the maximum number of fatalities.
Though there is good news with WHO coming up with the recommendations this year aiming to speed up detection and improve treatment outcomes for multidrug resistant tuberculosis (MDR-TB) through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen, India has a long way to go to acquire the benefit of this new regimen.
India, one of the Asian countries and is a land of many cultures with people following different ways of living. The country has made a mark in the globe with rapid progress in the area of science and technology. New innovations and advancement in the health sector is another factor that it can boast of. But the irony is that even in this culturally wealthy and techno-rich country nearly 24 percent of the people live below the poverty line today.
With more than 276 million people living from hand to mouth, the administration needs to gear up working towards a zero tuberculosis population aimed at fulfilling the Sustainable Development Goals by 2030.
The World Health Organization has reduced the treatment period for MDR –TB patients between 9 to 12 months, but still the cost of the treatment and availability of the diagnostic facility and medicines is still a major concern for many.
Amina Devi, a mother of 5 had no idea of what Multidrug Resistant Tuberculosis is; she only knows that she has fever from time to time and some glands in her arm pits for which she needs to take treatment from a medical practitioner in the area she stays. Her husband being an alcoholic hardly has time to fend for the family.
There are various conditions which add to cases like Amina Devi in the area she stays. Lack of registered Medical Practitioners in the fringes of the National Capital Region, a diagnostic laboratory which is 12 kilometres away and caters to some basic tests only, and with no hospitals nearby adds to the intensity of the problem.
The only laboratory which is the nearest to this area and does the MDR-TB test is about 25 kilometres away in Delhi, the capital of India.
The price for MDR-TB test is INR 2000, an amount quite luxurious for a family which lives on its day to day earnings.
Nasiruddin, a rickshaw puller who earns INR 200 a day says he cannot even think about such expenditure.
“I never go to the doctor, If I do, I will have to pay his fees which is more than my one day’s earnings and then he will give me medicines which are again costly. I send my three daughters to school, and I need to feed them too,” he says.
Though there are polyclinics and government hospitals, very few conduct such tests. Most of the population here has no idea of the disease and the tests and treatments available.
People like Amina Devi and Nasiruddin carry such disease which is then passed on to other members of the families thus increasing the number of population suffering from tuberculosis which is MDR in nature adding to that there are many a patient who have also been affected by Human Immunodeficiency Virus or HIV as the risk of developing Tuberculosis among HIV patients is said to 26 tp 31 times greater according to the World Health Organisation.
According to Dr Fuad Mirzayev of WHO Global TB Programme, the shorter MDR-TB regimen done among 1,205 patients in Bangladesh, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, DR Congo, Niger, Swaziland, and Uzbekistan reveals that :
• Treatment success versus all other outcomes was reported in 84 percent of these patients against 62 percent in a comparable selection of MDR-TB patients treated with a variety of individualized regimens of longer duration.
• In patients who did not complete treatment successfully, 7 percent died, 6 percent were lost to follow up, and 3 percent had a treatment failure.
• Relapse was incompletely assessed in the studies reviewed (in 2 countries it was assessed at 24 months after treatment; in 1 other at 12 months). Relapse was only observed in 3 patients
Now to achieve the results of this new regimen, and move aggressively towards the SDG 2030 India needs to give maximum priority to health from both the national and the state perspective, because only a healthy nation can come with healthy economy.
Each and every individual should have access to basic health services irrespective of the economic background the individual comes from.
Make MDR-TB tests affordable and accessible so that all suspected cases can get the benefit of this regimen.