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LATEST NEWS UPDATES | TB fight, via email

TB fight, via email

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published Published on Sep 7, 2014   modified Modified on Sep 7, 2014
-The Telegraph


New Delhi: The Union health ministry is considering a plan to build an email repository of doctors across the country to directly reach out to them with information relating to healthcare, including standard guidelines to treat tuberculosis.

The Medical Council of India estimates that India has over 600,000 practising doctors.

"I expect most doctors today will have email (addresses)," health minister Harsh Vardhan today said. "Such an email repository would help in our fight against TB."

Vardhan's announcement came as he launched the country's first and the world's largest survey of multi-drug-resistant TB or MDR-TB.

The survey will seek to revise the estimate of the number of patients in India infected with MDR-TB, which earlier and smaller studies had indicated to be 64,000, or the world's largest burden.

Studies have suggested that a section of private practitioners in India have often prescribed inappropriate therapy to TB patients. A wrong combination of drugs or wrong duration of the therapy can increase the risk of patients developing MDR-TB and transmitting it to others.

Health officials conducting the survey on MDR-TB plan to study TB bacilli from 3,223 patients diagnosed with the infection for the first time and 1,991 patients diagnosed earlier too and being treated again for the disease. These patients were selected from 120 government TB clinics nationwide.

The study will examine how the bacilli respond to each of 13 anti-TB drugs - four first-line and most effective drugs and nine second-line drugs, used only when the first-line treatment fails.

"This will be a path-breaking survey - not just for India," said Nata Menabde, the World Health Organisation (WHO) representative in India. "It could also have a significant impact on global efforts to develop new tools to fight MDR-TB."

While ordinary TB is easily cured through six to nine months of multi-drug treatment with the four first-line drugs, MDR-TB needs to be treated with second-line or even third-line drugs that are less effective, more expensive, and carry the risk of severe side effects.

The WHO's global TB report last year had estimated that India had about 64,000 patients of MDR-TB, followed by 59,000 in China, and 46,000 in Russia. But India's figure is based only on patients who seek free treatment from the health ministry's TB control programme.

Health officials estimate that about half of TB patients in India seek treatment from private doctors. Also, India's TB control programme still does not have the infrastructure to offer drug-resistance testing to every patient with TB - the ideal way to decide appropriate therapy.

The survey will also examine the genetic profile of MDR-TB bacilli isolated from patients in India, Kuldip Sachdeva, the head of the TB control programme, said.

"We want to pinpoint the genetic mutations associated with MDR-TB in India," Sachdeva said.

Medical experts believe that information about genetic mutations in MDR-TB bacilli could be used to develop new diagnostic tests and to design new drugs to treat MDR-TB.

While gene-based tests developed abroad are currently available to screen MDR-TB, many believe they are still expensive to be rolled out rapidly across the country.

"The best way to reduce costs is to develop locally designed diagnostic tests," said Bobby John, a physician and adviser to Global Health Advocates, a non-government organisation involved in public health issues.

"Biomedical experts in our engineering institutions should use any genetic data that comes out to design new diagnostic tests."

While Bangladesh, Brazil and China have carried out similar MDR-TB surveys, no survey has covered over 5,000 patients and tested how bacilli respond to 13 drugs.

Earlier studies in India indicated that up to 25 per cent of the MDR-TB cases in the country may also be resistant to a set of third-line drugs called fluoroquinolones, often considered the drugs of last resort when TB bacilli are resistant to both first-line and second-line drugs.

"This is worrisome," said Sachdeva. "There has been rampant use of fluoroquinolones not for TB but for other infections - this could explain the resistance. We may be wasting resources if we don't test patients for response to drugs upfront."

The TB control programme now offers drug sensitivity tests to only a specific set of patients --- children below 14 years, TB patients who do not respond to treatment in two months, patients infected with the human immunodeficiency virus, family members of patients diagnosed with MDR-TB, and patients being re-treated for TB.

Sachdeva said: "In about three to five years, we hope to offer drug sensitivity tests to every patient diagnosed with TB."


The Telegraph, 7 September, 2014, http://www.telegraphindia.com/1140907/jsp/nation/story_18808773.jsp#.VAvV9clwxng


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