The government is set to roll out the daily drug treatment for tuberculosis in Mumbai from September this year, replacing the three-times-a-week treatment schedule. The new treatment protocol for drug-sensitive cases — the regular TB cases that react to first line drugs — will be rolled out in five states including Maharashtra. The new protocol will eventually help bring down relapse rates, and in turn the number of drug-resistant TB cases.
Also, the daily drug treatment for HIV/TB patients will be rolled out across the country in July.
In the new treatment regimen, which complies with WHO guidelines, patients will be given a Fixed Dose Combination (a combination of two or more active drugs in a fixed dose), Dr. Sunil Khaparde, deputy director general, Central TB division said on Friday.
He said that while drug-resistant TB cases were already following the daily drug dose protocol, it will now be implemented for drug-sensitive cases as well. Patients will be given dosage for an entire month, he said.
The new protocol is likely to push up compliance because the earlier treatment stretched for up to two years, and people often dropped out of it, that was leading to relapse and building up of resistance to TB drugs. Dr. Khaparde said the drugs have been procured, and for now only adult patients will be given the daily dose treatment.
Speaking on the revised national TB programme, Dr. Soumya Swaminathan, director general, Indian Council of Medical Research, said the first alert for multi-drug (MDR) and extensively drug (XDR) tuberculosis had come from Maharashtra, and more specifically, Mumbai. Although she said that there has been a dramatic turnaround in how TB was being handled in Mumbai, as well the State and across India, the numbers of drug-resistant TB are not coming down, but have stabilised.
She said TB intervention needs to be locally contextualised. “Though it is fine to have a national revised national TB control programme, but what will work in Mumbai will not work in a tribal area. State TB officers and district TB officers should be given flexibility to modify the intervention,” Dr. Swaminathan said, adding that in Mumbai, a more aggressive campaign is needed given the transmission of MDR TB.
Dr. Swaminathan said that the treatment outcome of drug-resistant TB has less than 50 % cure rate across India.
Maharashtra’s load of tuberculosis cases is among the highest in the country. Last year, the State recorded 1.3 lakh fresh cases of tuberculosis, of which 28,000 were recorded in Mumbai. Of these, 5,500 were cases of multi-drug resistant tuberculosis, with Mumbai’s share at a worrisome 3,600, said Dr. Sujata Saunik, principal secretary (health), Maharashtra government.
Describing TB as a public health emergency, Dr. Saunik said there was a need for a better analysis of data of drug-resistant cases. She said this was because 50 per cent of the TB patients seek treatment in the private sector. She said there was a need to work closely with the private sector to bridge this gap.
Dr. Swaminathan said that a research secretariat will be set up at the ICMR, and that it will be operational in about three months.
Among other things, it will encourage research in TB medication, and promote trials in short-term regimens. A national TB prevalence survey is also likely to begin across the country in the beginning of next year. “This will be the first time after 1956 that such a survey will be undertaken,” she said.