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Tuberculosis patients across India will now be put on daily treatment instead of the previously practiced intermittent treatment regimen. The government has finally made the path-breaking shift from the old system of administering alternate day therapy to TB patients to a system where a new drug dose combination would be administered to affected people daily. The intermittent therapy was started in 1992 when India rolled out DOTS therapy.
Tuberculosis: Tuberculosis (TB) is an infectious disease usually caused by the bacterium Mycobacterium tuberculosis (MTB). Tuberculosis generally affects the lungs, but can also affect other parts of the body. Tuberculosis is spread through the air when people who have active TB in their lungs cough, spit, speak, or sneeze
TB in India: At the end of 50 years of tuberculosis control activities, the disease remains a major health challenge in India. As per new estimates, the number of new cases every year has risen to 2.8 million and mortality is put at 4,80,000 each year. These figures may go up when the national TB prevalence survey is undertaken in 2017-18. Against this backdrop, the Ministry of Health and Family Welfare, in its national strategic plan for tuberculosis elimination (2017-2025), has set a highly ambitious goal of “achieving a rapid decline in burden of TB, morbidity and mortality while working towards elimination of TB by 2025.”
Global TB Report 2017: India continues to have the highest number of tuberculosis (TB) cases in the world, the Global TB Report 2017 released by World Health Organization (WHO). In 2016, there were an estimated 10.4 million new TB cases worldwide. Seven countries accounted for 64% of the total burden, with India having the maximum number of TB patients, followed by Indonesia, China, Philippines, Pakistan, Nigeria and South Africa.
DOTS: DOTS or Directly Observed Treatment Short course is the internationally recommended strategy for TB control that has been recognized as a highly efficient and cost-effective strategy. DOTS comprises five components. 1. Sustained political and financial committment. TB can be cured and the epidemic reversed if adequate resources and administrative support for TB control are provided 2.Diagnosis by quality ensured sputum-smear microscopy. Chest symptomatics examined this way helps to reliably find infectious patients 3.Standardized short-course anti-TB treatment (SCC) given under direct and supportive observation (DOT).Helps to ensure the right drugs are taken at the right time for the full duration of treatment. 4. A regular, uninterrupted supply of high quality anti-TB drugs. Ensures that a credible national TB programme does not have to turn anyone away. 5. Standardized recording and reporting. Helps to keep track of each individual patient and to monitor overall programme performance
Need for switch: The daily dose regimen was much needed to prevent India’s rising multi-drug resistant burden, a fast emerging challenge. Even today, one in every four TB patients in the world is from India, which accounts for the highest TB burden in the world. India was also the only country in the world still practicing the intermittent (alternate day) TB therapy, and the WHO had been nudging the country for years to make the critical transition.
Reason for high relapse rate: There is an estimated relapse rate of 12 per cent in the Indian anti-TB programme. This is primarily because of problems associated with taking anti-TB pills every second day. Patients often forgot when they had taken the medicine and would tend to relapse and develop resistance to drugs. The daily regime will end this problem.
The shift in the existing DOTS (directly observed treatment short course) therapy is expected to reduce India’s multi drug resistance and extreme drug resistance cases. With resistance issues being addressed, another challenge is that 75 per cent TB cases are in the hands of private doctors with treatment compliance poor. The government has also decided to offer free drugs and free diagnostics to TB patients visiting private sector. The idea is to encourage private sector doctors to notify TB.
By: Dr. Vivek Rana ProfileResourcesReport error
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