(TB News from India is published by Health and Development Initiative-India ( www.healthinitiative.org ) 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:

A Satellite Symposium on TB and Poverty which built on the World TB day 2002 theme: "Stop TB, fight poverty" took place immediately after the 33rd IUATLB World Conference on Lung Health at Montreal. It was organized jointly by the Stop TB Initiative and EQUI-TB Knowledge Programme, Liverpool School of Tropical Medicine.

One of the key objectives of the Symposium was to initiate the formulation of new strategies, supported by solid evidence for greater equity in DOTS Expansion, for greater access and better quality care for the poor. 

In his concluding remarks Dr. S B Squire of EQUI-TB Knowledge Programme said that DOTS accessibility continues to be a major challenge despite a remarkable progress made in past ten years. The focus has now shifted to 22 high burden countries. There is an urgent challenge to improve case detection and over come the barriers to access to DOTS. One such barrier is poverty. Tuberculosis particularly affects the poor and contributes to poverty.

Both the care seeking pathways and diagnostic processes consume resources. Although the treatment is free but diagnosis of tuberculosis is still costly. Both the diagnosis and treatment can be adopted to make them more accessible to people.

While building an evidence base to support the TB-Poverty linkages doctrine, a few questions need to be answered. What is the evidence that increasing DOTS accessibility to poor will make a difference? What is the best balance of investment-Quality DOTS or additional measures? Will a pro-poor approach improve case detection and cure rates? How can the voice of poor be heard at impact assessment sessions?

There was a consensus at the Symposium that the TB and Poverty linkages needed to be explored further and documented. An evidence base so generated could be used to bring tuberculosis control on the poverty alleviation agenda of both the international organizations like World Bank and national governments. 

(A report on the presentations made at Satellite Symposium on TB and Poverty will shortly be available on HDI website at www.healthinitiative.org ) 

Theme and Slogan for World TB day 2003 announced

The theme for World TB Day 2003 is "People with TB" and the slogan is "DOTS cured me-It will cure you too". Dr. Jacob Kumaresan, Executive Secretary of Stop TB Partnership in a message sent to all Stop TB partners, announced this. The theme stresses the need to address the People with TB by involving them as advocates for Global TB control. It also tends to highlight Case Detection and DOTS expansion, which is one of the key objectives of the Global Plan to Stop TB launched in 2001. 

Documentary on the oldest killer disease

(A story contributed by Kannan K. in The Hindu Thursday, Aug 01, 2002.)
It kills more people than AIDS, but no one talks about it. Yes, tuberculosis is the world's oldest killer. And just when everyone thought it had gone away, the disease has returned to haunt us. 

Focusing attention on this problem is a four-part documentary series, "The Story of Tuberculosis in India'', that tells the tale of this resilient bacteria from earliest times and looks into the future to ask, "Can it ever be controlled''. Made by Hester Brown for the Mass Communication Research Centre, two parts of the series - "Tuberculosis: The Wasteland in Our Midst'' and "Solutions'' -- were screened at India Habitat Centre in New Delhi.

"While researching potential subjects for making films, one kept cropping up -- tuberculosis. So many people have had a brush with it. One person had mistakenly been put on anti-tuberculosis drugs and had to keep taking them even though they were so strong they made him vomit. This I discovered later was very common," says Ms. Brown, who has been living in India since 1997. 

Based on interviews of patients and their families on the streets of Delhi, the documentary series highlights many other issues like wrong diagnosis by X-ray in 70 per cent cases. A woman expressed shock at the stigma TB carries when her husband got it. "Though he got better. When he died later, his wife believed the stigma contributed to his death.'' 

Watching the documentary series what strikes one is the ironical fact that in India, the story of TB is "one of terrible waste''. Clinically speaking, the cure for TB is easy and cheap and yet when the documentary explored people's experience with it, their challenges seemed enormous and daunting. 

Read the full story at:
http://www.hinduonnet.com/thehindu/thscrip/print.pl?file=2002080104360200.htm&date=2002/08/01/&prd=thlf&  

Kalam for Financial Aid to TB Patients
(A PTI story in The Hindu October 2, 2002)

Indian President Abdul Kalam announced that the nation's anti-tuberculosis campaign should also provide for some financial assistance for patients. Kalam, who inaugurated the 53rd TB Seal Campaign of the Tuberculosis Association of India, said the community should have compassion for TB patients and work for their cause. Stating that appropriate technology and health care have to be developed for both full diagnosis and complete cure of the disease, he explained that the Tuberculosis Association of India has an important role in this regard. The President hopes that the TB Seal Campaign will mobilize the public to serve those who are suffering. 

Goa Set to Introduce New Treatment for TB
(The Times of India, October 3, 2002)

Goa is a tiny state in Western India known for its scenic beaches and its Portugese heritage. Goa's Health Minister, Dr. Suresh Amonkar, stressed the importance of having complete knowledge of tuberculosis as well as learning from the experiences of health professionals to control the disease and eventually eradicate it from the state. He was speaking at the opening of 53rd TB Seal Sale Campaign organized by the Tuberculosis Association of Goa (TAG). The seals have no postal value and are purchased as a altruistic gesture. The proceeds are used for various anti-TB activities. Amonkar said that the problem with fighting TB is that every person involved in the management of the disease should know every aspect of it, including issues such as transmission and the identification of vulnerable groups. He advocated holding seminars involving various medical staff and health workers who are involved in TB control in order to share in their experiences and difficulties.

Read the full text of story at:
http://timesofindia.indiatimes.com/cms.dll/articleshow?artid=24089728&sType=1  

India, 21 Others Urgently Need Funds to Fight TB : WHO
(A story by IndiaExpress Bureau 7th Oct 2002)

The World Health Organization (WHO) said India and 21 other countries, which are worst hit by tuberculosis, were badly in need of extra financial aid to realize the global targets of detecting and successfully curing a large percentage of TB patients by 2005. 

Financial experts in WHO have put the total cost of TB control at 12 billion dollars a year. World Health Assembly has set a target to detect 70 per cent of TB patients and cure 85 per cent of these patients by 2005. 

"This is a race against time," said Dr J W Lee, Director of WHO's STOP TB Department. "Poor control practices in many countries and the TB/HIV co-epidemic mean that urgent action needs to be taken to control TB." 

"This funding gap is clearly identified and affordable," Lee said. "If we are to meet these targets, we must act now." 

Other worst affected countries are Pakistan, Bangladesh, China, Russia, Afghanistan, Brazil, Cambodia, Congo, Ethiopia, Indonesia, Kenya, Myanmar, Nigeria, Peru, Philippines, South Africa, Tanzania, Thailand, Uganda, Vietnam and Zimbabwe. 

Figures show that on average, the cure rate in the high burden countries has touched 84 per cent, which represents a big increase from previous years.

Read the full story at:

http://www.indiaexpress.com/news/health/20021007-0.html  

Intelligence Study Raises Estimate of AIDS Spread: Sparks a New Debate

(A story by Washington Post Staff Writer in Washington Post dated Tuesday, October 1, 2002; [Source: AIDS-INDIA eFORUM ])

A United States government intelligence panel estimates that by the end of this decade the growth of AIDS infections in five populous countries, including India and China, may dwarf the current epidemic in sub-Saharan Africa and outstrip current worst-case scenarios for the global burden of the disease.

The National Intelligence Council predicts that by 2010 there will be between 50 million and 75 million cases of human immunodeficiency virus (HIV) infection in India, China, Ethiopia, Nigeria and Russia. Which is double or triple the estimate of 25 million cases that an international team of experts projected for those countries as part of a study published last summer.

The five nations together contain about 40 percent of the world's population. In each, the AIDS epidemic has barely begun or has not yet peaked. Most experts believe, that the experience in these nations -- and the response of the five governments -- holds the key to the next phase of the pandemic.

These unusually bleak estimates were reached by experts inside and outside the US government who agreed that the current projections are overly low. Epidemiologists at UNAIDS and the World Health Organization questioned the validity of the council's projections, while acknowledging that most demographers in the past underestimated the scope of the epidemic.

"India is certainly going to experience a massive epidemic, and so will China. India is on an African trajectory, only 15 years behind. In both countries, the national responses are grossly inadequate to begin to confront the wave of devastation and death that is breaking over them."

The National Intelligence Council is a panel of experts that performs strategic analysis for the US President, the CIA, the Defense and State departments, the National Security Council and other government agencies.

The head of the AIDS program for WHO, Bernhard Schwartlander, said he doubts the Indian projections in the new report, which are for 20 million to 25 million cases, up from about 4 million now. That would mean that 4 percent to 5 percent of adults would have the virus.

"India has almost twice the population of what there is in sub-Saharan
Africa. I can see such a scenario happening in certain cities and perhaps even in states. But it would be difficult to see it happening on a nationwide basis, at least with the data we have," said Schwartlander, an epidemiologist who has been responsible for much of the WHO and UNAIDS estimates.

David F. Gordon, formerly the head of economics and global issues on the National Intelligence Council and now with the CIA, said 10 to 20 experts on each country were consulted and came up with the estimates, using data gathered by other agencies as a starting point.

"We do not have a model that we are comfortable with to generate these kinds of numbers," he said. "The main methodology was to seek the consensus of experts. These should not be seen as destiny."

Full text of the story at:
http://www.washingtonpost.com/wp-dyn/articles/A24869-2002Sep30.html  

Pimpri Chinchwad Municipal Corporation Shows the Way in TB Control
(Contributed by Dr. Vikas Inamdar, Pune)

Pimpri is an Industrial town near Pune in Maharashtra with a population of over one million. A 'City Tuberculosis Control Society' (CTCS) was set up in 1998 to implement the Revised National TB Control Programme (RNTCP). The first task that faced CTCS was to provide training to doctors and Para-medical workers. Till date, 35 doctors; 16 Laboratory Technicians; 25 Multi-purpose Health Workers & 16 other health workers have been trained as per RNTCP guidelines. The CTCS set up nine Microscopy Centers and 21 Corporation run Dispensaries and Hospitals as treatment observation points. A unique feature of the programme is that DOTS centers have also been set up in clinics of 30 Private Practitioners. In a period of three years from 1999 to 2001 the program has registered and treated 3769 patients and achieved a cure rate of 90%.

Web Call -a visit to 'My Story' page of Stop TB initiative website

http://www.stoptb.org/mystory.html 

The site which forms a part of the Stop TB initiative website accomplishes the singular goal of highlighting everyday stories on tuberculosis. The accounts are those of individuals who have suffered on account of their own disease or because it was contracted by a loved one. The diagnostic and treatment tracks emerge lucidly when they are seen in the perspective of common everyday experiences. The website could form an excellent tool for dispelling myths about tuberculosis.