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TB News from India: May-June 2002 Issue

(TB News from India is published by Health and Development Initiative-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

Global Plan to Stop TB released

' What a splendid gift TB elimination will be for humanity's Third millennium' writes Desmond M Tutu, Archbishop Emeritus of Cape Town, South Africa in his foreword to just released Global Plan to Stop TB. For the first time in human history, we have a truly global, comprehensive plan and budget that will be immensely helpful in bringing together the people and resources to effectively tackle tuberculosis. The plan has four objectives: To work for expansion of DOTS; To adapt this strategy to meet the challenges of HIV and TB drug resistance; To improve existing tools for TB control and strengthen Stop TB global partnership.

The plan clearly demonstrates that with an investment of $ 9.1 billion over the next five years, TB can be controlled, averting hundreds of deaths each year, says George Soros, Chairman Open Society Institute.

May this plan charter our path for a TB free world.

Progress toward TB control in India is critical to global TB control: Editorial note in MMWR Weekly (CDC)
Despite the availability of highly effective and inexpensive drugs, TB causes more deaths per year in India (421,000) than malaria, hepatitis, meningitis, nutritional deficiencies, sexually transmitted diseases, leprosy, and tropical diseases combined (258,000). Since 1993, India has implemented successfully a TB control program using the WHO-recommended DOTS strategy. Many of the principles for diagnosis and treatment of the DOTS strategy were derived from studies conducted in India that demonstrated the effectiveness of ambulatory treatment of TB, the necessity and feasibility of DOTS, the efficacy of intermittent treatment with anti-TB drugs (twice weekly rather than daily), and the feasibility of case detection through sputum smear microscopy in primary-care settings. However, only recently have these findings been applied widely to establish TB control in large areas of India. The 4% death rate recorded in RNTCP areas since implementation is substantially lower than previously documented death rates of up to 29% among treated smear-positive TB patients in non-RNTCP areas. 

Several obstacles impede the expansion of TB control under RNTCP.

  • Diagnosis and treatment of TB are uncoordinated and inconsistent because many patients initially receive TB care through the large private health-care sector, pharmacies often sell anti-TB drugs over the counter, and TB notification requirements are not enforced routinely.

  • Poverty impedes program performance. Many areas lack regular electric supply, limiting the effectiveness of binocular microscopy. Economic hardships and drought cause large-scale migration, reducing treatment completion and cure rates. 

  • Third, a patient-centered approach to care---one that actively helps patients by providing them with transportation to health facilities, food, and social support to overcome obstacles to completion of treatment---is not practiced widely in India. 

  • Anti-TB drug resistance, which reflects current or past poor program performance, is difficult to treat and might account for the noticeably higher treatment failure rate among retreated TB patients.

In several surveyed areas of India, 1.0%--3.3% of new TB patients have multi drug-resistant TB (MDR-TB), which is resistant to at least isoniazid and rifampin, the two most effective anti-TB drugs. Even if as few as 2% of new patients were to have MDR-TB, this would represent an estimated 20,000 new infectious cases of MDR-TB in India every year. In areas with relatively good performance, pilot projects of expanded programs to treat MDR-TB should therefore be considered. 

This report does not assess the level of human immunodeficiency virus (HIV) infection among TB patients; the increasing prevalence of HIV in India represents a serious threat to TB control efforts. 

The TB control program in India, already one of the largest public health programs in the world, continues to expand, with plans to cover 80% of the country by 2004 and 100% by 2005. The implementation of RNTCP has resulted in a net savings of more than $400 million in economic costs; effective nationwide implementation by 2005 would save more than $27 billion through 2020. Sustaining and expanding this program will require continued high-level commitment from the central and state governments of India, supplemented by continued and coordinated assistance from international and bilateral organizations. 

Progress toward TB control in India is critical to global TB control and has direct implications for TB elimination efforts in the United States because nearly half of all TB cases in the United States occur among foreign-born persons, a substantial proportion of whom (nearly 10%) are immigrants from India. With immigration from India to the United States rising, India's proportionate contribution to U.S. domestic TB will probably increase. 

This editorial note is in response to a report published in MMWR Weekly dated March 22,2002/51 (11); 229-232 entitle 'Progress Towards Tuberculosis Control---India 2001. 

You can read the full report at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5111a2.htm 

Tuberculosis control a major priority for Indian Government: Prime Minister
Tuberculosis control has been a major priority of my government said the Indian Prime Minister Mr. A B Vajpayee in his message to the nation on World TB Day this year. He said that Revised National Tuberculosis Control Program (RNTCP) had succeeded in its objectives. The programme has already covered 450 million people and his government had approved massive expansion of RNTCP so as to reach 800 million people by the end of 2004.

The President of Republic of India Mr. K.R. Narayanan in his message to nation on World TB Day said that Tuberculosis has emerged as a major killer in our country with its devastating consequences for human, and social and economic development. There is an urgent need to expand these facilities all over the country so that affected citizens can take advantage of this Programme, he said.

Read the full text of Messages of The President and Prime Minister of republic of India at: http://www.healthinitiative.org/html/tb/president.htm  & http://www.healthinitiative.org/html/tb/primeminister.htm  respectively. 

World vision to co-ordinate national attack on TB
Pune will be the nerve centre in an elaborate nation-wide attack being launched on tuberculosis. Meghna Parsad of Times News Network reports in Times of India dated 15th March 2002 that Ministry of Health Government of India would launch a three-year long national project with the help of World Vision, to treat and combat the influence of Tuberculosis in the country. The project is called 'Shifa' ('healing' in Urdu) and is sponsored by the Canadian International Development Agency (CIDA). The cost of the project is $4 million.

The three major components of the present TB programme in India, which World Vision will pioneer, are technical, developmental and quality. Jebaraj D G, national coordinator, World Vision explains that technical component envisages reaching out to more patients and increasing cure rate by ensuring completion of treatment.

Development involves ensuring an active participation of other NGOs, government agencies and local developmental agencies in spreading the message, while quality pertains to the management, documentation, free drugs and over-all treatment of tuberculosis-infected patients.

The project will start with eight locations, including Mumbai, Himachal Pradesh and Hyderabad in the first year," Jebaraj says, adding that the number will be extended to 17 locations, including Pune, in the second phase of the project

Read the full text of story at:
http://timesofindia.indiatimes.com/articleshow.asp?art_id=3894850&sType=1  

Central funds for health under-used in Kerala
A Press Trust of India report published in The Times of India dated March 18,2002 says that Comptroller and Auditor General of India in its latest report has noted that out of the Rs 5.90 crore (approximately $ 1,200000) from the Centre for the state/district tuberculosis control societies during 1996-2001, 53 per cent remained unspent as of March 2001. Other national programmes on AIDS and leprosy also failed to achieve the targets. The shortage of microscopy centres and non-functioning of existing centres denied the benefit of laboratory testing facilities to TB patients in four districts, the report said and added that in seven out of 12 district TB centres, there were no facilities for X-ray examination for diagnosis of TB cases.

The heavy shortfall in detection of TB cases was noticed in five test-checked districts mainly due to failure to refer patients for sputum smear tests. Similarly, detection of new sputum positive cases was also low during 1999-2001 due to non-participation of medical college/ESI/private hospitals and NGOs, it added.

Read the full story at:
http://timesofindia.indiatimes.com/articleshow.asp?art_id=4091338&sType=1  

One dies of TB every 15 minutes in Andhra Pradesh
In Andhra Pradesh, every 15 minutes, one person dies of tuberculosis, says state TB officer T V Venkateshwarulu. He was speaking at a World TB Day function organized by Mahavir Hospital and Research Centre in Hyderabad. This is because of poverty. When one member gets TB it can throw the entire family into poverty," he said.

State Health and Family Welfare Minister N Janardhan Reddy said 2. 25 crore people are covered under the disease observation programme in Andhra Pradesh. 

"The problem lies in the villages where the treatment is discontinued after three to four months instead of the complete six-month course because patients feel they have recovered," he said adding the bacteria which are manifested in the bodies come to the fore in two or three years.

Read the full story at:
http://timesofindia.indiatimes.com/articleshow.asp?art_id=4807979&sType=1  


Web Call: A visit to TRC Chennai
The Tuberculosis Research Centre(TRC), is a research institute of the Indian Council of Medical Research (ICMR), an autonomous organization under the Ministry of Health and Family Welfare, Government of India. TRC, through its now famous" Madras Study" concluded that domiciliary treatment of TB was possible. This laid the foundation of DOTS, the globally recommended strategy for tuberculosis control that is now being used in more than 120 countries. 

The website of the organisation, www.trc-chennai.org  showcases the core concepts associated with TB control. Current research being conducted at TRC in the form of Controlled Clinical trials, Operational research, Epidemiological studies and laboratory studies is available. Older trials and studies are also accessible and form a highlight of the website. Preliminary concepts about diagnosis and categorization of patients, DOTS, and its place in the Standardised treatment of tuberculosis are presented on the "Tuberculosis and DOTS" page. A number of technical documents on TB and DOTS, important publications of TRC are available for downloading. The findings of the path-breaking Chingleput BCG Vaccination trial and other important research findings can also be retrieved. The website is an excellent resource to access if one is interested in the origin of DOTS and its place in present day TB treatment strategies especially in terms of the developing countries.