Cough re­sis­tance

Multi-drug-re­sis­tant tu­ber­cu­lo­sis treat­ment in In­dia is plagued by de­layed di­ag­nos­tics and in­ac­cu­rate treat­ment pro­ce­dures. An ini­tia­tive in Ma­nipur breathes some re­lief

Down to Earth - - HEALTH - JY­OT­SNA SINGH |

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.

Treat­ment break­down

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

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