High Alert
Blessina Kumar,Vice-Chair of Stop TB Partnership,Geneva,and HIV/TB patient rights activist,says TB control programme in India faces challenges in ensuring adherence to treatment
3 min read
The television clip of a popular Bollywood star assuring that tuberculosis (TB) is a curable disease if diagnosed early and treated in time,raised many a hope in the country and helped propagate the TB control programme. While timely and accurate diagnosis is the first step towards curing TB,the more difficult part and challenge for Indias TB control programme is in the completion of a treatment course within the prescribed period.
Under Direct Observed Treatment Strategy (DOTS),a TB patient is put on intermittent drug regimen to be administered directly under the supervision of a provider. This is to ensure adherence and consistent recording of the event. Yet such a strategy,effective as it may be,ignores circumstances where it is hard for the patient to adhere to and finish the treatment to avoid the risk of becoming drug resistant. Adherence is even more important for patients who are already drug resistant. Missing even a single dose can worsen the condition.
The patient is required to visit the DOTS centre thrice a week in the morning to receive medication. This is challenging for anyone,more so for those who are daily wagers and live in rural areas. Long distances,coupled with a lack of transport facilities,act as a barrier in addition to stigma. In the private sector,incentive-driven practitioners exploit patients by prescribing expensive drugs,which they rarely monitor. As a result,patients stop treatment due to high costs and a lack of understanding over how this can impact health.
India faced a severe shortage of anti-TB drugs. The shortages reflect fundamental problems including governments poor procurement systems,weak supply chains and inadequate methods of gauging demand. When DOTS providers in Delhi went on a strike in August,patients had little control over their treatment. For example,co-infected TB patients from the HIV rehabilitation home,Sahara,were sent to a prominent TB hospital to continue their treatment. When they reached there,they were shunted out and not given any treatment unless they produced various documents.
Exacerbating their misery and pain,a whole day of waiting was spent in vain. Some of them were very ill and decided to go back to their homes to die than wait endlessly for a cocktail of drugs that was already taxing their bodies and mind with side effects.
To help improve the situation,public sector,doctors and other health care providers (HCPs) need to interact with patients in a way that is not discriminatory. In the private sector,doing away with the use of unnecessary and irrational drugs along with continued patient supervision and support could strengthen adherence. Counseling in both sectors remains a critical but neglected need that needs to be urgently filled.
As told Anuradha Mascarenhas
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