Opinion Taming TB

One in four tuberculosis patients worldwide is an Indian. Epidemiologists regard the tuberculosis bacteria as the Indian public health system’s greatest bugbear. If a study published in the latest edition of the Lancet Infectious Diseases Journal is anything to go by, the problem might be more daunting that it was earlier thought to be. The good news, however, is that we are closer, than ever before, to identifying the exact magnitude of the problem. The number of tuberculosis patients in the country was earlier reckoned to be 2.2 million. But there were always question marks on the accuracy of this figure because it was difficult to ascertain the exact number of patients who sought private treatment. It was believed that private clinics and hospitals treat about 8 million tuberculosis patients, while 1.4 million patients consult government-run medical centres. A joint study by the Indian government’s Central TB Division, the Imperial College of London and the Bill and Melinda Gates Foundation confirms what had long been suspected: Many more tuberculosis patients seek treatment from the private sector than government hospitals. The study estimates that more than 2 million patients consult private doctors — even pharmacists — and the country’s tuberculosis burden could be more than 3.5 million people.

India’s private healthcare system is largely unregulated, especially in matters related to treating tuberculosis. This means that patients are rarely educated about the disease and do not receive proper support. The authors of the Lancet paper argue that the absence of proper protocols in private hospitals and clinics often means that patients stop treatment as soon as they feel better. They do not complete the requisite six to nine months of therapy. A study published in March 2016 in the Transactions of the Royal Society of Tropical Medicine and Hygiene highlighted another problem that arises when patients consult private physicians. The private doctors interviewed in the study administered broad spectrum antibiotics to tuberculosis patients as the first course of treatment. They did not ask for a lab investigation and focused on treating the symptoms. A patient had to consult a doctor several times before being suspected of tuberculosis.

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Stopping therapy midway exposes a patient to a virulent strain of the tuberculosis bacteria: One resistant to the multi-drug therapy used to treat the disease. Delays in diagnosis compound the problem. According to the WHO, India accounts for 64,000 multi-drug resistant tuberculosis patients. The figure could be much more in the light of the Lancet study. In 2012, the Revised National TB Control Programme introduced protocols that made it mandatory for private healthcare providers to report the tuberculosis cases they treat. The figures thrown up by the Lancet study show that much more needs to be done to regulate treatment of tuberculosis outside the state healthcare system.