TB treatment: India lagging in global standards for tuberculosis, says report

The most recent world-wide report on tuberculosis has censured India’s control plans, even as the Union Health Minister JP Nadda was quoted as saying that TB will be eradicated from the country by 2025.

The Out of Step 2017 report published by Stop TB Partnership evaluated TB policies and procedures in 29 countries which are responsible for 82 per cent of the TB epidemic –with India having the highest number of cases. India was evaluated on the following parameters: TB diagnosis, TB Treatment, Models of Care, Medicines Regulatory Environment, and was chiefly revealed to be ‘inadequate’ and below global levels.

The report affirms that while 15 countries have introduced the World Health Organisation (WHO) advocated test, Xpert MTB/RIF, as the preliminary test, India has still not done that. “It is selectively available for high-risk patients,” it says. The test is crucial in ascertaining drug-resistance in patients. Once resistance is found, better treatment is offered, and patients will not be put on drugs which could anyway prove to be useless.

“Currently, India has 735 planned installations (of Xpert MTB/RIF), and a committed increase to take the number up to 1,019,” it states. “India still relies on smear microscopy which can miss half of all TB cases and not detect drug-resistance,” said Dr Madhukar Pai, associate director, McGill International TB Centre of Canada.

The report states that patients are identified after a postponement of nearly two months, after having gone to at least three care providers. India is trailing on the treatment options as well. Two life-saving drugs, Delamanid and Bedaquiline, have been accepted by WHO and India has not done that so far being among the 11 countries that have failed to do so.  Also, India is also not among the 13 countries that have permitted shortened treatment for multi-drug resistance TB.

Even though India is one of the 21 countries that allow accelerated regulatory approval, however 100 per cent quality assurance is not assured as unregistered medicine is also available legally. 

“Sub-optimal quality of medicines will break the treatment drive. In a study, it was found that 10 per cent of TB medicines dispensed through pharmacies were spurious,” it says.