Multi-drug-resistant tuberculosis treatment in India is plagued by delayed diagnostics and inaccurate treatment procedures. An initiative in Manipur breathes some relief
Iof appetite, pain in joints and FEEL LOSS suffer from a sleep disorder. There are times when I don’t feel like taking medicines,”says 41-year-old Nemvung,a resident of Churachandpur town in Manipur, who is suffering from multi-drug-resistant tuberculosis (mdr-tb), which is a more deadly form of TB and the intensive treatment process is accompanied with severe side-effects. In 2013, Nemvung was detected with mdr-tb. She began treatment in Imphal, but dropped out because of the distance—the hospital was 65 km away.When her condition worsened later that year, she went to a private clinic in Churachandpur, but dropped out once again as she could not afford the medicines.An understanding doctor directed her to a clinic of Médecins Sans Frontières (msf ).
The TB division of the Churachandpur District Hospital and msf have come together to create a model to treat patients afflicted with mdr-tb.The hospital has opened a specialised ward to admit patients,while msf gives individualised treatment to patients at home.This arrangement solves two problems that afflictTB patients in India—non-compliance of patients for medication and generic treatment for mdr-tb.
The initiative comes at a time when mdr-tb cases are on the rise across India. The number of mdr-tb cases increased five times from 4,297 cases in 2011 to 23,325 cases in 2013, said the then Union Health Minister Harsh Vardhan, while replying to a question in Parliament in 2014. Data compiled by msf, however, says there were about 35,000 mdr-tb cases in 2014,but only 20,000 were being treated. Yet, the Revised National Tuberculosis Control Programme (rntcp) “claims” to have covered the country through its Directly Observed Treatment, Short-course (dots),an international standard for TB control.
One way to check for drug resistance is the 350 Gene Xpert machine, which conducts Cartridge-based Nucleic Acid Amplification Testing (cb-naat).It is believed that this latest technology has better sensitivity than the traditional smear microscopy test and produces results within hours. Most hospitals, including the one in Churachandpur do not have this facility.The existing technology,which uses culture as methodology,takes many days to deliver results.
In the msf-district hospital initiative, patients can either approach the msf clinic or the district hospital. If they have failed