Hindustan times interview - Battling through MDR and XDR TB 2016

Public hospitals are major pitfalls for country’s efforts to curb rising cases

Hindustan Times (Gurgaon) 22 Mar 2016 Sanchita Sharma sanchita.sharma@gmail.com

India’s revised national tuberculosis control programme (RNTCP) is thriving, but only on paper.Only those who cannot afford treatment in the private sector use it. With the government unable to monitor India’s unregulated private sector, which is the first point of diagnosis and care for the majority of the 2.2 million people diagnosed with TB each year, extensively drug resistant TB is spreading (XDR TB) rapidly.

Meena Dhadke, 30, is one such person who was diagnosed with “sensitive” TB — the kind that can be easily treated — in March but is getting treated at a private hospital in Mumbai. Her husband Ambaji Dhadke, 31, has been fighting XDR TB for two years and he weighs only 30 kg for his 5’ 6” frame.

“Her husband is a serial defaulter who stopped treatment five times in the past two years, which has made his infection impossible to treat,” says Dr Gaurav Ghatawat, the chest specialist at the charitable Fauziya Hospital in Kurla West, Mumbai, who is treating the couple.

Treating XDR TB involves having a cocktail of 12-15 drugs and injections that cause side effects such as appetite loss, stomach cramps, vomiting, diarrhoea, fever and depression. “He stops having medicines when he feels too sick to take them,” says Dhadke.

In the private sector, treating sensitive TB costs less than ` 1,500 a month, multidrug resistant TB costs around ` 5,000, and XDR TB costs close to ` 20,000 a month, yet Dhadke — who works in homes for a living — refuses to take her husband to be treated free at the government’s TB Hospital in Sewri East.

“Everyone who goes there dies, I want him to live,” she said. Sewri Hospital is known for poor infection control, which has led to several doctors and nurses working there developing XDR TB.

She struck gold by choosing Fauziya Hospital, where TB diagnostic and treatment protocols are followed, unlike at many other unregulated clinics and hospitals where irrational drug combinations are prescribed in wrong doses.

“Irrational fixed drug combinations containing important anti-TB drugs such as quinolones and linezolid are rampantly available in the market, which has worsened the prevalence of XDR in India,” said Dr Grania Brigden, TB and AMR ( antimicrobial resistance) advisor, access campaign, Medecins Sans Frontieres (MSF).

Keeping patients on course is the other challenge. For many, the compliance that the RNTCP’s directly observed treatment short-course (DOTS) regimen hopes to achieve by giving drugs under observation is threatened when they are too sick to go to a government centre.

“The biggest indicator of a good programme is whether people are choosing to use it... People go to DOTS centres as a last resort,” says a doctor in the government sector who does not want be named.

THE AVAILABILITY OF IRRATIONAL FIXED DRUG COMBOS CONTAINING IMPORTANT ANTI-TB DRUGS WORSENED THE PREVALENCE OF XDR