Health and Development Initiative-India, (www.healthinitiative.org ), publishes ‘TB News from India' once every two months. The objective of newsletter is to highlight issues related to Tuberculosis and HIV/AIDS control in India and enlist political, public, professional and administrative support for its cause. Health and Development Initiative-India is a not-for-profit organization and the news items have been quoted from various sources for fair use and in public interest. Reproduction of the material published is welcome provided a reference is made to the original source of the news item and TB News from India.

Editorial note:  

“Every Breath Counts- Stop TB Now”

The theme chosen for World TB Day-2004 (WTBD) is “ Every Breath Counts- Stop TB Now”. There is an inseparable link between the act of breathing, and life itself. Indeed, breath, and breathing, is central to every human act and expression. Breath, and the act of breathing, is also closely associated with Tuberculosis.

Tuberculosis, as we all know, is an infectious disease that spreads through the air. People catch it when they inhale TB bacilli that someone with TB has expelled by coughing, sneezing, or even talking. Left untreated, a person with active TB can infect between 10 and 15 people in one year.

TB is a major public health problem in India. The national effort to vanquish this serial killer has started to show promise. Our country has a fastest expanding DOTS programme. No country can afford to consider TB control merely as a health issue. TB affects each and every aspect of national life and thus the support for TB control programmes must also come from every quarter. What we need today is a greater public participation in the national crusade against TB.

A vigorous campaign needs to be built around the WTBD theme. The message is simple: TB is curable and everybody with cough for three weeks must take a free sputum TB test. TB treatment is free at DOTS centres.

WTBD offers a unique opportunity to launch an aggressive nationwide campaign against this deadly killer. Both, the print and electronic media must respond to the rousing call and contribute to this national mission. It needs to be done with a sense of urgency as TB continues to spread silently but surely. Let us not forget-

‘Every Breath Counts, join hands to Stop TB now’.

A.R Rahman becomes Stop TB Global Ambassador

India’s musical superstar and composer of the hit musical "Bombay Dreams", Mr. A.R. Rahman, has agreed to become the first Global Ambassador for the Stop TB Partnership. His appointment will be highlighted with a daylong series of public events in London on 10 March 2004, followed by his appearance at the Stop TB Partners' Forum on 24 March 2004 to mark World TB Day.

Source: StopTB Communiqué Issue No. 37, January 2004.

India's battle against the Tubrculosis-HIV dual epidemic

(Patralekha Chatterjee, The Lancet Journal of Infectious Diseases Volume 4, Number 2, 01 February 2004)

India has the distinction of being a country with one of the highest tuberculosis burdens (one-third of the global case load) and one of the fastest expanding DOTS programmes for the treatment of tuberculosis. Launched in 1993 as a pilot project, India's revised national tuberculosis control programme (RNTCP)—an application of the universally accepted DOTS strategy—covers more than 744 million of the country's 1•068 billion population.

But there is a new worry. Of mounting concern to the country's health establishment is the emerging challenge of a tuberculosis-HIV co-infection. Of the approximate 4•6 million HIV-positive people in the country—the second highest number in the world after South Africa—around 1•8 million are estimated to be co infected with tuberculosis.

Tuberculosis accounts for one-third of deaths due to AIDS worldwide. Treatment with DOTS not only prolongs and improves the quality of life of HIV-infected people with tuberculosis; it also quickly renders the person non-infectious, blunting the increasing tuberculosis caseload. “The coinfection is a very serious issue for us”, says L S Chauhan, Deputy Director General (TB) in India's Health Ministry.

Collaboration between the AIDS and the tuberculosis control apparatus in the country—the mantra in the corridors of Nirman Bhavan, which houses India's Health Ministry—is a daunting task.

The tuberculosis-HIV coordination mechanism has been in existence in the six states with the most HIV-infected people (Andhra Pradesh, Karnataka, Tamil Nadu Maharashtra, Manipur, and Nagaland) since November 2001. Hovever, even up to 3 months ago, says Chauhan, “monthly meetings between the chief medical officers of the voluntary counselling and testing centres (which come under NACP) and the chief medical officers of the sputum microscopy centres (which report to the Tuberculosis Division) were not regular in many states even when the two units functioned under the same roof”.

Today, as the tuberculosis and HIV/AIDS coordination mechanism is set to expand to eight more states and union territories in the country, including Delhi, feedback from the six states is becoming a critical component of future planning.

Full text of article available at: http://infection.thelancet.com/journal/journal.isa 

India's treatment programme for AIDS is premature

(Sanjay Kumar; BMJ 10.1.04)

The announcement by India's health minister-on the eve of world AIDS day in December-that from 1 April 2004 the government will provide free antiretroviral drugs to 100 000 HIV positive people in six states with high prevalence of the infection has left the bureaucracy and AIDS experts confused and in a state of shock. The poor infrastructure, few facilities, and lack of training have prompted serious apprehension among those working in the field.

"We have burnt our fingers with tuberculosis, and now we will burn our fingers with HIV," warned Alaka Deshpande, head of medicine at the JJ Hospital in Mumbai, where more than 15 000 people who are HIV positive have been enrolled for treatment. "If we don't give the drugs properly and monitor the patients, they are going to develop drug resistant HIV very rapidly, and that situation would be catastrophic," she added.

Adherence to antiretroviral treatment is a constant problem, and many patients stop mid-course as they cannot afford it any longer, cannot sustain its toxic effects, or just feel better, said Dr Deshpande.

We need to learn from the experience of directly observed therapy short course (DOTS) for tackling tuberculosis," said Dr Jai Prakash Narain, coordinator of HIV/AIDS and tuberculosis at the South East Asia Regional Office of the World Health Organization. "Mechanisms have to be developed to ensure that at least 90% patients take the pills, as in tuberculosis," he added.

Dr Narain identifies critical elements as uninterrupted drug supplies; laboratory capacity for CD4 monitoring; expansion of voluntary counselling and testing; training of healthcare workers; monitoring of resistance to antiretroviral drugs; and strengthening of the health system's capacity to deliver the drugs.

“Unless these critical elements are in place one should not even start the programme," he warned, adding that a bad programme could be worse than no programme at all.

Read the complete story at: http://bmj.bmjjournals.com/cgi/content/full/328/7431/70-f

Source: SEA-AIDS eForum 2003: sea-aids@healthdev.net

World Health Organisation issues Interim Policy on collabroative TB/HIV activities

The Human Immunodeficiency Virus (HIV) pandemic presents a massive challenge to the control of tuberculosis (TB) at all levels. Tuberculosis is also one of the most common causes of morbidity and one of the leading causes of mortality in people living with HIV/AIDS (PLWHA).

The ‘Interim Policy’ issued by WHO responds to a demand from countries for immediate guidance on which collaborative TB/HIV activities to implement and under what circumstances. It does not call for the institution of a new specialist or independent disease control programme. It rather promotes enhanced collaboration between tuberculosis and HIV/AIDS programmes in the provision of a continuum of quality care at service-delivery level for people with, or at risk of tuberculosis and people living with HIV/AIDS.

The policy goal is to decrease the burden of tuberculosis and HIV in populations affected by both diseases. It notes that so far even in settings where HIV prevalence is high, tuberculosis and HIV/AIDS programmes have largely pursued separate courses. The policy proposes establishment of mechanisms for collaboration between tuberculosis and HIV/AIDS programmes at all levels so as to decrease the burden of tuberculosis in people living with HIV/AIDS and vice-versa.

The policy also advises nations to conduct surveillance of HIV prevalence among tuberculosis patients. It also recommends that Tuberculosis control programmes should mainstream provision of HIV testing and counselling in their operations or establish a referral linkage with the HIV/AIDS programmes to do so.

The global targets for collaborative TB/HIV activities are that all countries shall establish at least a national TB/HIV coordinating body to create the mechanism for collaboration between tuberculosis and HIV programmes by 2005. Joint TB/HIV implementation plans and a system for HIV surveillance among tuberculosis patients shall be established by 2007.

Stress on managerial aspects of TB Control

(The Hindu, New Delhi, February 3, 2004)

The Indian Institute of Health Management Research [IIHMR] and Paris-based International Union Against Tuberculosis and Lung Diseases [IUATLD] jointly organized an international course on " management, finance and logistics of tuberculosis control" in February. The participants from a number of developing countries including Afghanistan, Bangladesh, Indonesia, China, Pakistan, Nepal, Nigeria, Ethopia, Sudan and Uganda attended the two-week course held at Jaipur.

Participants were provided an overview of key issues in strategic leadership and skills needed for TB control. The participants were also imparted skills for striking collaboration and partnership with various stakeholders in TB control.

Experts who spoke at the opening session of the course laid stress on efficient management of resources currently available for TB programmes.

COMBI campaign gets underway in Kerela

A statewide Communications for Behavioural Change (COMBI) campaign, developed by the Stop TB Partnership Secretariat and Social Mobilization and Training (SMT) team of WHO, was launched in January in Kerala, India. The campaign will mobilize millions of school children and thousands of health workers, supported with media spots, around the slogan "Coughing, coughing, coughing... take the free TB sputum test," with the aim of sharply increasing the detection rate for infectious TB cases. Kerala signed on to the campaign because while it has achieved 100% DOTS coverage, case detection has been lagging behind the national average. A similar but nationwide COMBI campaign is due for launch in February in Kenya.

Source: StopTB Communiqué Issue No. 37, January 2004.

Also Read our earlier story:
http://www.healthinitiative.org/html/tbnews/archives/marapril2k3.htm 

ESIC finally wake up to RNTCP

Employees State Insurance Corporation (ESIC), which runs 141 hospitals and 1453 Dispensaries in 25 states of the country, has finally decided to participate in the RNTCP, seven years after it was launched in India. The OPD attendances at these ESI institutions are more than 80 million each year. The hospitals run by the corporation would now function as microscopy centres and all dispensaries would work as DOTS centres under RNTCP.

About 8 million workers employed in approximately 0.25 million factories are covered by ESIC. Out of these 8 million insured persons nearly 1.44 million are female factory workers. The total number of ESI Beneficiaries is 31 million, which includes all the dependent family members. The ESIC receives monthly contributions both from employees and their employers and in return provides health services and various types of sickness benefits to its members.

This decision of ESIC comes as a big boost to expansion of DOTS services in the country. However the members of parliament, representatives of the industry and labor unions associated with the corporation need to keep a close vigil on the pace of integration between ESIC and RNTCP. Once the DOTS is firmly placed in ESI institutions the avenues to set up referral mechanisms or workplace DOTS programmes can be explored.

Strengthening TB management in India

(Express Healthcare Management, October 2003)

This essay by Dr Ashok Sahni Professor and honorary Executive Director, Indian Society of Health Administrators (ISHA), Bangalore in which he discusses critical issues and recommendations for strengthening TB management makes an important reading. The article is based on discussions made during two national level meetings organized by ISHA in July 2002 and June 2003 focusing on TB Management in India-diagnosis, treatment, and rehabilitation, attended by 51 experts.

An important recommendation made in the essay is that in order to prevent denial of the diagnostic test (sputum examination) to chest symptomatic (CS) patients taking early action, “which has resulted in unpopularity of service providers”, and for improving case finding under RNTCP, sputum should be examined for all CS with symptoms for at least two weeks, to start with.

The essay makes a number of recommendations related to policy, treatment, drug availability and inter-sectoral coordination and community involvement issues.

You can read the full article at:
http://www.expresshealthcaremgmt.com/20031015/editorial02.shtml

Dyeing units emit slow death: 10,000 TB cases in Ludhiana’s Budha Nullah area

(Manoj Kumar, The Tribune, Chandigarh. February 5, 2004)

Foul smell of chemicals, clouds of black smoke and blackish water of Budha Nullah — the drain passing through city — welcome you as you enter Ludhiana, the industrial hub of Punjab.

According to a recent WHO study conducted here, about 3,000 industrial workers were afflicted with tuberculosis, most of them working in dyeing units. Dr Satish Nauriah, President, Ludhiana TB Eradication Society, associated with the project, said: “The actual number of TB patients in the dyeing units alone must be over 10,000 since the industrialists do not allow proper diagnosis of the workers. Once their health deteriorates, their services are terminated and the sick workers leave for their homes in UP or Bihar.

Read full text of the story at:
http://www.tribuneindia.com/2004/20040205/main7.htm 

Global fund signs major new AIDS and TB grants for India

On February 10, 2004 India signed two new grant agreements with the Global Fund to Fight AIDS, Tuberculosis and Malaria, paving the way for the disbursal of US$ 33 million over the next two years, and totaling US$ 129 million over five years. These vital new grants will help scale up the national HIV/AIDS prevention and control program and expand the national TB control program.

The first phase of the approved US$ 29 million dollar TB program, amounting to US$ 7 million, will be for the national TB control program. TB control activities will be expanded and consolidated in 56 districts of UP and Bihar, covering a population of 110 million people with DOTS (Directly Observed Therapy, Short Course) services. Part of this activity will be applied through the non-governmental TB Association of India extending DOTS services in the urban slums of Bangalore, Delhi, Hyderabad and Kolkata.
The global battle against HIV/AIDS hinges on India keeping its burden low. This grant is intended to support India in its crucial phase of tackling the epidemic,” said Professor Richard Feachem, Executive Director of the Global Fund. He continued, “Quick action can prevent HIV from derailing the Indian economy.” On support for the TB control program, Prof Feachem said: “With this support, the India TB control program will be able to cover most of the uncovered population with DOTS services, and emerge as a global success story in the scale up of TB control programs.”

Read the complete story at:
http://www.theglobalfund.org/en/media_center/press/pr_040210.asp

TN has 86 per cent TB cure rate
(PTI, JANUARY 08, 2004)

The South Indian State, Tamil Nadu witnessed an 86 per cent recovery rate from tuberculosis since the launch of TB eradication programme in 1999, a top government official said.

Speaking at the launch of a newsletter of REACH (Resource Group for Education and Advocacy for Community Health), Tamil Nadu Joint Health Secretary Supriya Sahu claimed a direct link between tuberculosis and poverty and asked the state authorities to employ persons suffering from TB in development programmes so as to provide them a means of earning. She said TB patients should be integrated with the mainstream and not be isolated.

Read the complete story:
http://timesofindia.indiatimes.com/articleshow/412633.cms

Conference Announcement

International Symposium on Emerging Trends in Tuberculosis Research
November 15-17, 2004, New Delhi, India

Information regarding abstract submission and registration for the symposium should be directed to Dr. Pawan Sharma, pawans@icgeb.res.in or pawan_37@hotmail.com

 

TBNI Editorial Team

Dr. Dinesh Kumar,
dinesh_kumar@vsnl.com 

Dr. Jatinder Singh,
jatindersingh@vsnl.com