A joint initiative of the government, independent experts and civil society has found that multidrug-resistant tuberculosis (MDR-TB) is emerging as a major health problem in India. Moreover, delay in treatment of MD-RTB is the main reason behind increasing antibiotic resistance, especially towards drug Rifampicin.
The findings have been established by Joint Monitoring Mission (JMM) 2015 of the Revised National Tuberculosis Control Programme (RNTCP). JMM is an annual exercise that brings together national and international experts, Union Ministry of Health and Family Welfare, civil society members, implementation partners and developmental agencies to review the progress of TB control efforts in India. The exercise is being conducted for the last five years.
JMM 2015 was carried out in seven states across India to get a sense of challenges being faced in elimination of the communicable disease.
JMM noted that the cost of providing MDR services is reaching 40 per cent of the government’s total expenditure on TB since 2011 when it first started treating MDR TB cases also. This threatens the future of TB control in India and underscores the necessity to prevent drug resistance.
The revised tuberculosis programme currently treats patients without knowing their resistance profile. The present method of diagnosis through microscopy of sputum cannot diagnose drug resistance. Only after a patient stops responding to the regular treatment of thrice weekly doses, tests for MDR are conducted.
What aggravates the problem is that regular treatment of patients with prior resistance has often led to failure and amplification of resistance to drug Rifampicin. The medicine forms first line of treatment for TB. Once a patient gets resistant to it, he or she can transmit MDR-TB to others who come in contact. Hence, it is important to stop a patient gain stronger resistance and diagnose early so that contamination can be reduced.
Private hospitals adding to problem
Another reason for spread of multidrug-resistant TB is lack of regulation in private sector. Over 70 per cent people with TB first go to private practitioners. JMM says that there too, substantial diagnostic delays occur. Diagnosis and treatment are of variable quality. This, combined with the absence of drug distribution controls, leads to drug resistance.
In spite of mandatory notification, patients are not notified to the RNTCP. The existing TB surveillance system lacks the capacity to count the large pool of privately-diagnosed and treated TB cases hampering timely interventions.
JMM 2015 noted that the ambitious National Strategic Plan (NSP) for 2012-17 lacks the much needed funds. While RNTCP expenditure has increased 27 per cent since 2012, the gap between allocated funds and minimum required investment to fulfill NSP 2012-17 is growing. If this trend continues, final expenditure on the plan would be Rs 3,000 crore—two thirds of the minimum required. Thus, while bold policies are in place, they cannot be implemented.
JMM has recommended that adequate funds should be ensured for RNTCP and standards for TB care should be enforced throughout the country.