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:  

World TB Day 2005: Spotlight on Frontline TB Workers

This year's World TB Day focus is on the fundamental role being played by frontline TB workers the world over to broaden the span of Directly Observed Treatment Short course (DOTS) services. If one were to describe their success so far, in a single word, it would be 'amazing'.

The phenomenal accomplishment of health care workers, who provide DOTS services at the cutting edge especially in resource poor settings in countries like India, is indeed incredible. The primary health care infrastructure in a number of states of the country is in a pitiable condition and needs fresh investment in physical, financial and human resources. Many states have been unable to fill the vacancies of physicians and other categories of health care providers resulting in an over-burdened health force. Mushrooming of shantytowns around metros and other large cities has compounded the problems of already depleted health services in urban areas.

High priority programmes like polio eradication (with some of the states going in for mass immunization campaigns up to six times a year) consume a substantial portion of the time of health care providers. Other health programmes including TB control are thus relegated to the backseat. The standards of training in schools for paramedical workers need to be streamlined across the country to bolster their clinical and interpersonal communication skills. The adverse effect of these roadblocks on Revised National Tuberculosis Control Programme is being reflected in low new smear positive tuberculosis case detection rates in states like Assam, Bihar, J&K, Jharkhand, Kerala, Madhya Pradesh, Nagaland, Punjab and Uttar Pradesh.

However, braving all these odds the frontline health care workers have been able to reach these patients, establish rapport with their communities and ensure that all the detected cases complete their treatment. This is reflected in satisfactory TB cure rates across the board in the country.

The communities both in rural and urban areas have also not lagged behind in supporting the endeavor of TB workers. A band of non-conventional DOTS providers comprising of private doctors, shop-owners, school teachers, retired employees, cured TB patients, NGO volunteers, peers and women activists have joined forces with the conventional work force to bridge the gaps in service delivery. The role of these non-conventional DOTS providers is going to be more crucial in coming days when the efforts to integrate TB and HIV programmes begin to surface.

DOTS programme is not simply about logistics, supplies and record keeping. It also encompasses establishment of a relationship of trust between the DOTS provider and TB patient. It is this personal bond, which sustains the programme's ties with the community.

Our frontline TB workers have very painstakingly cultivated this vital link and it holds out a ray of hope. A million thanks folks!

Get the HDI World TB Day Toolkit


 

Probe demanded into shortage of TB medicines, Indoor MDR patients suffering: Rights group

Tribune News Service, February 2005

Owing to the non-availability of essential medicines to TB patients, Social Jurists, a civil rights group, has petitioned the Lieutenant-Governor of Delhi to order a judicial inquiry into the deaths of indoor MDR (multiple drug resistance) TB patients in the past one year.

The Social Jurists have claimed that because of non-availability of essential medicines, MDR TB patients in Rajan Babu T.B. Hospital, Kingsway Camp (in Delhi), are in anguish.

"We visited the. Hospital, on 24th February and found that more than 50 indoor MDR TB patients, both in male and female wards, were not being given essential medicines, Kanamycin injection, Ofloxcin tablet, Ethionamide tablet, Pyarazinimide (PZA) etc. for the last 10 to 12 months," said Advocate Ashok Agarwal of the Social Jurists.

The hospital being run by the Municipal Corporation Delhi (MCD) is the Asia's biggest T.B. Hospital with 1,200 beds, but the present scenario has resulted in many deaths and some patients have also left the hospital midway, claimed Agarwal.

Read the complete story
 

India to launch effort to tackle drug-resistant TB

T. V. Padma, February 2005, Source: SciDev.Net

India plans to test a new tuberculosis strategy to treat people who are resistant to existing drugs. The DOTS-Plus project will begin at the L. R. S. Institute of Tuberculosis and Respiratory Diseases in Delhi next month. The country will also launch a surveillance programme this year to measure resistance to tuberculosis drugs in four states, Lakhbir Singh Chauhan, a deputy director at India's Ministry of Health and Family welfare, told a national conference on the disease held in Delhi last week.

The aim of the DOTS-Plus strategy, a revised version of the World Health Organization's tuberculosis detection and treatment programme, is to provide a standardized and affordable treatment to those infected with drug-resistant tuberculosis bacteria - about 3.4 per cent of cases in the country.

Nani Nair, from the World Health Organization's regional office for South East Asia, told last week's conference that the international focus on tuberculosis India is tremendous. Nair said previous Indian initiatives to ensure that patients keep to their treatment courses paved the way for a global DOTS strategy. "What happens in India with the DOTS Plus strategy may guide the [rest of the] world," she said.

Although India is well on course to meet this target, several challenges remain. A major concern is the country's high annual risk of tuberculosis infections. Vineet Kumar Chadha, a senior epidemiologist with the Bangalore-based Tuberculosis Research Institute, has estimated that 1.5 percent of the population is at risk of infection each year.

Despite national averages meeting the 2005 targets, there remain areas in India where the detection and treatment rates are far too low. Similarly, warned Chauhan, the growing numbers of people infected simultaneously with tuberculosis and HIV could neutralize the nation's efforts to control tuberculosis.

Read the complete story

TB angle in immigration tangle

RASHMEE Z AHMED, Times News Network, FEBRUARY 2005

In an extraordinary political, pre-election attempt to link foreign, non-European workers in Britain with dreaded infectious diseases of all sorts, the UK's main opposition Conservative party has said that people travelling to live and work in Britain should undergo checks for tuberculosis and HIV/AIDS.

The demand, by Conservative leader Michael Howard on Tuesday, to close Britain's doors to non-EU visa applicants who test positive for TB, is seen to take the UK's ongoing, bitterly political immigration debate into dangerously right-wing territory.

Commentators said the Conservative call for a TB check, especially for doctors and nurses from countries like India, where there is a high incidence of TB, would effectively link Asian immigrants in the public mind with disease.

The checks would be required for all workers in healthcare, childcare or teaching. The Conservative Party's plan is that any non-European Union worker intending to come to Britain for more than 12 months, or to settle permanently, would have to undergo full medical tests, paid for by themselves in their home country. The prospective immigrant would need an overall check-up, chest X-rays for tuberculosis and tests for hepatitis and HIV.

The Tories defended their plan by pointing to the rising incidence of TB in Britain. Government figures suggest that TB in England has increased by 25 per cent over the past 10 years. "Nearly two thirds of people with TB are born abroad," said Howard, "I don't think a responsible government can stand aside and do nothing in the face of this problem."

Britain's medical establishment has already indicated that TB is spreading rapidly within sections of the British Asian community, which retains strong links with the sub-continent and frequently travels there.

Read the complete story

Bread, Blankets and Biscuits for TB patients

The Hindu, January 2005

The Delhi Mayor, A. R. Verma distributed kits that contained blankets, towels, socks, bread and biscuits to 100 TB patients who had successfully completed Directly Observed Treatment Short course (DOTS) programme. Mr. Verma was participating in a function organized Staff Welfare Association of Chest Clinic of Municipal Corporation of Delhi to honor these TB patients.

The Chief Medical Officer of Chest Clinic, R K Mehra said that the Chest Clinic has so far cured 1,50,000 TB patients, out of which 50,000 were sputum positive.

Poor kids get free dud TB capsules Johnson T A

'AIDS control mission' launched
Tribune News Service, Chandigarh, January 2005

The Chandigarh Union Territory Administrator, Gen S.F. Rodrigues (Retd.) today announced the launch of an "AIDS control mission'' in Chandigarh with its focus on research, cure, awareness and support strategies, to effectively tackle the spread of this epidemic.

Assuring full backup support by the Chandigarh administration to the Mission, General Rodrigues announced that Prof K.K. Talwar, Director, Post Graduate Institute of Medical Education & Research (PGI), would lead the Mission.

Addressing the delegates after inaugurating the Indo-US symposium, on "Recent Advances in AIDS Research" organized at the PGI on 10th January, General Rodrigues said the magnitude of this grave problem could be gauged from the fact that there are 39.4 million people infected with HIV, out of which 2.2 million are children. During 2004, 4.9 million people got infected (with HIV) which included 0.64 million children.

Earlier briefing the media persons before the launch of two-day event, Dr Ajay Wanchu of the Department of Internal Medicine at the PGI said that more than 60 per cent of the HIV positive persons in India suffer from tuberculosis (TB) in the initial stages of the disease. This correlation between the two diseases becomes crucial as the HIV/AIDS infection does not have any clear symptoms and the TB can be an important pointer for a patient to get his HIV status checked.

"Contrary to the pattern of infection in western countries, we have seen a large number of HIV positive persons in India falling sick due to TB initially. We can safely say that TB can be an important pointer towards HIV and TB patients should get their HIV status checked,'' he said.

Read related stories No.1 and No.2

Indo-French tie up on TB likely
 
Times of India January 2005

Institutes in India and France may carry out a joint study of a newly developed diagnostic strategy for tuberculosis (TB), which kills an estimated, half a million people every year in India alone.

"An immunological 'tool box' for diagnosis and management of TB is possible. In order to recommend this 'tool box', numerous confirmatory and medico-economic studies need to be done," said Prof P.H. Langrange, Head of the Medical Microbiology department of Hospital Saint-Louis of Paris. He was on the sidelines of the 92nd session of the Indian Science Congress.

"The idea is to improve the existing (diagnostic) tools by developing affordable new tools for low-income, high-burden settings," he said in his special address at the Congress.

The multicentric study would help in making early diagnosis of various types of TB, said the Director of the Chennai-based TB Research Centre (TRC) P.R. Narayanan. He said there were two types of TB that were difficult to diagnose - smear-negative and extra-pulmonary TB. The patient had to be given a 10-day antibiotic course when symptoms initially appeared. If the symptoms persisted, then an X-ray was recommended and the patient treated for the disease.

"The problem is that the patient may not report back after the 10 days. Moreover, there is no confirmation of TB in these two instances," Narayanan said.

Read the complete story
 

Delhi lines up AIDS review

The Telegraph, January 2005

Nearly 20 years after the AIDS control programme was launched in the country, the government believes the time has come to make an independent assessment of the various schemes promoted by health authorities to fight the disease.

The National AIDS Control Organisation (NACO), the nodal body for the campaign, has already advertised for the stocktaking exercise and a number of agencies have expressed their willingness. Some five to six agencies have also been short-listed. A committee will decide which of them will get the contract.

Union health minister Anbumani Ramdoss is keen that a detailed review be done to gauge the effectiveness of the current programmes. He also wants to know how NACO is utilizing the huge funding from abroad.

The AIDS control body received a $100-million grant from the Global Fund for AIDS, Tuberculosis and Malaria (GFATM) to prevent parent-child transmission. Another $14.8 million was granted for fighting HIV/TB co-infection. NACO had also secured additional money from the Bill and Melinda Gates Foundation that made an initial commitment of $200 million to upscale activities for AIDS prevention. India is second only to South Africa, which has the highest cases of AIDS in the world.

Read the complete story
 

ACTION begins its activities in India

Advocacy to Control TB Internationally (ACTION), an international advocacy initiative developed by a consortium of organizations comprising of American Thoracic Society, Massive Effort Campaign, PATH, RESULTS Educational Fund, Stop TB and WHO has decided to launch its activities in India. Initially ACTION aims to develop an understanding of current policy framework and spread of activities against TB through consultations with cross-section of stakeholders and NGOs working on TB control issues in the country. The first such consultation is being held in New Delhi on 2nd March 2005.

For further information please contact Mr. John Mathai, Country Director at johnmathai@tbaction.org or Mr. Pranay Lal, Policy Advisor at pranay@tbaction.org.

World TB Day Structured Online Discussion Announcement: "Hidden Heroes"

The Health and Development Networks (HDN, a Chiang Mai, Thailand based international NGO) in association with Stop TB Partnership is coordinating a structured, time-limited, online discussion around the theme of the 2005 World TB Day (WTBD), "the key roles and needs of frontline health workers in stopping tuberculosis." The online discussion starts in the first week of March 2005.

The overall aim of the discussion is to share information about the critical role that frontline workers fill in turning back the tide of TB. Contributions and comments on various sub-themes and questions are encouraged, including vital contributions that frontline workers make to TB case detection and implementation of the DOTS strategy. Issues pertaining to local obstacles, needs in finding and curing cases of TB; how hidden heroes access hard-to-reach communities and go beyond the conventional health system; laboratory, diagnostic, or treatment facilities/services that would help to provide DOTS services to more TB patients at a local level are addressed.

If you are already a member of the Stop-TB eForum, information about the discussion will be sent to you automatically.

If you are not a member, and would like to participate in the discussion, join the HDN eForum by sending an email to join-stop-tb@eforums.healthdev.org.

Questions about the discussion can be directed to the HDN eForum
Resource Team Email: info@hdnet.org.

News from India's neighbours

No News items in this category for this edition.

TBNI Editorial Team

Dr. Dinesh Kumar,
dinesh_kumar@vsnl.com 

Dr. Jatinder Singh,
jatindersingh@vsnl.com