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:  

Improving the private sector's ability to manage TB effectively

India has embarked upon an ambitious project to synthesize a public-private mix (PPM) to improve the delivery of DOTS services in select cities. The Central TB Division (CTD) conducted a workshop in Delhi in August '04 to review the surveillance data from the twelve pilot sites of the PPM project of the RNTCP in India. The analysis of data showed that the scaling up of PPM DOTS in the pilot sites had resulted in the detection of a substantial proportion of additional cases of TB through different categories of health care providers. It is encouraging to note that the trends for all the PPM sites put together show a steady and gradual increase in case detection.

Population Services International (PSI) Myanmar is also offering TB screening and branded Directly Observed Treatment (DOTS) services through its Sun Quality Health (SQH) network of private clinics. PSI/Myanmar's integrated approach includes training SQH franchise members in TB diagnosis and treatment, and branding DOTS services, drugs and communications and motivating those at risk to get tested and complete treatment.

Along the way, the program has taken numerous essential steps, including defining protocols, training and accrediting labs, conducting quality assurance, aggregating and sharing data.

Off to a solid start, SQH providers had registered and begun DOTS treatment for 1,311 confirmed TB cases by early October. The project has trained over 100 SQH general practitioners in TB/DOTS, and seven private labs have been trained and accredited.

The PSI initiative in Myanmar deserves to be studied in detail. One of the concerns expressed in initial results from PPM project in
India is relatively low yield of new TB cases from private partners despite their participation in large numbers. PSI initiative seems to
have overcome this through robust training for private providers in Myanmar.

Another notable aspect of PSI initiative is branding of DOTS services. India is also attempting it through a COMBI project in
Kerala. However we are still in dark about impact made by COMBI in Kerala so far.

PPM project in India can definitely learn a few lessons from PSI initiative in Myanmar.
 

Kalam launches TB seal campaign

Press Trust of India

President A P J Abdul Kalam inaugurated the '55th TB Seal Campaign' of the Tuberculosis Association of India (TBAI) on 2nd October. The theme of this year's campaign is "Incredible India". New TB seals were presented to the President on the occasion.

In his message Kalam said, "The TB Seal Campaign is a noble effort to raise awareness about the disease amongst the citizens. The awareness campaign should be broad-based, therefore, reaching out to rural areas and should include effective modes of communication such as drama and interactive methods".

TBAI an NGO working in the area of tuberculosis is complementing and supplementing the governmental efforts in the control of
tuberculosis. The Association launches TB Seal campaign every year to create awareness among the masses and collect funds for health education and other programmes.

The TB seal goes to the people with the message that the spread of TB should be checked.



Read the full text at:
http://www.123bharath.com/news/index.php?action=fullnews&id=24978

TB fast-cure hope with Indian drug

A new drug developed in India has emerged as the "most promising" candidate drug against tuberculosis in 40 years and might reduce treatment duration from eight to two months, industry and government officials claim.

The drug, developed under a research-industry partnership programme, has cleared animal trials and is now awaiting approval for clinical trials on humans, Indian science and technology minister Kapil Sibal said.

The drug was discovered by industry partner Lupin while several laboratories of the Council of Scientific and Industrial Research
(CSIR) helped establish that it is effective in animals and does not have adverse effects. "This will change the way the world looks at
India," Sibal said. "It establishes India's leadership in drug development."

TB is now treated with a combination of four drugs; the last one - Rifampicin - was discovered in the early 1960s. But though the
existing drugs can easily cure a patient, the treatment takes about six to eight months and scientists have long looked forward to a drug that can cure in a much shorter time.

Lupin officials said their studies on animals have shown that the new drug, called Sudoterb, can completely clear tubercular infection
within two months.

Lupin has sought permission from the Drugs Controller General of India to conduct clinical trials on humans. The first set of trials
will find out whether the drug is safe for humans, while subsequent trials will examine whether it is effective.

The human trials are expected to cost Rs 50 crore and will take about four years to complete.

The Rs 25-crore development effort has so far been funded by the New Millennium Indian Technology Leadership Initiative programme managed by the CSIR that seeks to synthesise ideas from industry and research centres and get them to work together.

Lupin has filed patents on the new drug in India and in the US. CSIR director-general R. Mashelkar said Lupin was an ideal partner because the company was the world's leading producer of standard TB drugs and had invested in research aimed at finding new drugs.

Industry sources estimate that the market for TB drugs today is about $600 million. Multinational drug companies have not invested
significantly in TB drug research because tuberculosis has not been a major concern in developed countries.

 

Read the full story at:
http://www.telegraphindia.com/1040907/asp/nation/story_3726922.asp

Checking MDR TB cases an uphill task
 
Jagmeet Ghuman, The Tribune, Chandigarh October 5, 2004

The growing tendency among multi-drug resistant (MDR) TB patients to discontinue treatment midway has proved a setback to the efforts to control the spread of the disease, in Himachal Pradesh (a hill state in northern part of India).

According to a survey, the state has around 200 TB patients diagnosed as multi-drug resistant (MDR). These cases do not respond to
conventional medical treatment prescribed either under the Revised National Tuberculosis Control Programme (RNTCP) or the National Tuberculosis Control Programme (NTCP). These cases require multi-drug medical treatment involving huge expenditure.

The MDR TB Treatment Society, which was formed in 2001 at TB Sanatorium, Dharampur, to provide free of cost medical treatment to
MDR cases has registered 70 patients till date. Out of these, 12 patients have been fully cured, while 33 were under observation. Rest
of them have no link with the society since they left sanatorium after getting indoor medical treatment.

This act of MDR patients caused great harm as the disease was contagious. Registered MDR patients were discharged soon after their sputum tests changed from positive to negative. It generally took four to six months, said Dr H.C. Gupta, Solan district TB officer.

The patients are advised to take future treatment as outdoor patients and go for sputum tests. "But in most cases, the patients do not turn up and thus become defaulters," Dr Gupta maintained.

The society was helpless to monitor such cases, pointed Mr Kuldeep Kanwar, senior lab technician and member of the society. There was an urgent need to forge coordination between respective district TB centres (DTCs) and the society to keep track of MDR patients, suggested Dr Gupta.

At present, 33 MDR cases were under treatment and they need around $ 45000 approximately for treatment. The construction work on a culture sensitivity lab was underway at sanatorium. The lab was being constructed by the society using funds donated by Mr Ravi Sood, an NRI, who gave funds to the tune of $ 30,000.

 

Read the full story at:
http://www.tribuneindia.com/2004/20041005/himachal.htm#13

Corner Groceries and Tea Stalls Double as TB Clinics in India

Rama Lakshmi, Special to The Washington Post, September 12, 2004

For a long time, customers have come to shop at Prem Neelkanth's corner grocery store in a sprawling Bombay [Mumbai] slum, buying eggs, bread, tea and sugar. But in the last two years, sickly men and women, some coughing painfully, have also lined up to obtain their tuberculosis medicine.

Neelkanth, 36, is a volunteer in the government's effort to supervise tuberculosis patients as they take their medication. He is one of an army of health workers and neighborhood participants in a federal program known as DOTS, Directly Observed Treatment -- Short Course, funded by a $142 million World Bank loan.

He hands tuberculosis medicine to a patient at his grocery store in New Bombay. Neelkanth keeps a neat row of medicine boxes marked with patient names and visits the homes of those who fail to show up. His grocery stands near a row of overcrowded shacks, with narrow alleys of open sewers and piles of putrid garbage -- a veritable breeding ground for the infectious, airborne disease.

The TB patients he sees are daily laborers who live nearby and do not have time to make three trips a week to the hospital for six months to receive their required dosages. So on their way to work, they just make a quick stop at the grocer's.

"My grocery shop is now like a TB clinic," said Neelkanth, pointing to a neat row of medicine boxes marked with patient names, given to him by the city's health officers.

"I know everyone in this neighborhood. So if someone does not turn up for their dosage, I go and knock on their door in the night with the medicines. It is my duty to ensure they don't miss a single dose," he said, watching a 50-year-old cart-puller gulp six pills.

Many of those suffering from the disease are rejected by their families and relatives every year, according to the Health Ministry.
Health workers said that some patients meet them stealthily by street corners to swallow the medicines, and ask the workers not to visit their homes. Ishwar Jogdand, 50, a frail man, said he lost his job as a laborer at a construction site after missing many days of work because of his TB. Then his family of six, living in a one-room hut in a slum, turned him away.

For the past six months, he has been sleeping under a highway overpass. "My family said I could return only when I am fully cured,"
Jogdand said. A health worker from Alert India, a group that works among TB patients in New Bombay slums, visits him every other day to hand over his medication.

Alert India officials said another challenge in administering medicine involves keeping up with workers who change job sites.

"It is quite common for the villagers to come to the city during dry summer months in search of work and return to their village during
the rains for the sowing crops," said Geetha Balasubramanian of Alert India. "Some even give false addresses of their village homes to
avoid the stigma. So we try to convince the patients not to leave until they complete the six-month treatment and are cured."

"There are rules about who you register under DOTS. Only after showing the proof of a stable residence and commitment to complete
the treatment is a patient taken on DOTS," said Ritu Priya Mehrotra, professor of social medicine and community health at New Delhi's Jawaharlal Nehru University.

"This means the migrant worker, the poorest of the poor who shifts every month from one place to another, is not put on DOTS at
all. . . . And they are the ones who need treatment the most."

Read the full story at:
http://www.washingtonpost.com/wp-dyn/articles/A14636-2004Sep11.html

Early trends from Public-Private Mix (PPM) pilot sites encouraging

The Public-Private Mix (PPM) project launched by Revised National Tuberculosis Control Programme (RNTCP) at twelve pilot sites across the country has helped in detection of substantial proportion of additional cases of TB through different categories of health care providers.

The proportion of cases detected by health providers outside the public health sector was 43.8% at the pilot sites.

All the PPM sites put together have witnessed a gradual and steady rise in detection of TB cases. Though fewer in number, Medical Colleges contributed a substantial number of new TB cases. NGOs have come up as key resources for providing care to these patients.

However an area of concern was the relatively low yield of new TB cases from private partners despite their participation in large
numbers. Thus indicating that partners from private sector need to be selected carefully.

Source: Public-Private Mix (PPM) Workshop organized by The Central TB Division (CTD), Ministry of Health and Family Welfare, Government of India, August 2004, New Delhi

US funds TB vaccine trials in India

Indo-Asian News Service

A US agency will fund studies worth nearly $1 million in India ahead of clinical trials of new tuberculosis vaccines. The US Centres for Disease Control and Prevention (CDC) will provide $925,000 to the Aeras Global TB Vaccine Foundation for the studies under a programme renewable up to three years, according to a US embassy release.

"The cooperative agreement with the CDC is the first US government contribution to Aeras, a leading organisation working to develop new vaccines against TB, a bacterial disease that kills two million people worldwide each year. The fund is renewable for up to three years," it said.

US-based Aeras had performed the pre-clinical evaluation and regulatory activities for a new recombinant BCG vaccine candidate and started the first phase of the trial in February 2004.

Dedicated to developing TB vaccines, Aeras has worked for several years with the University of Cape Town to establish a clinical research site in Cape Town, South Africa, where the vaccine's fourth phase trial has got enrolled around 10,000 individuals.

This site along with two others locations in India and Peru will be used for second and third phase trials of candidate vaccines.

Aeras will be working with CDC and collaborators at the St. John's National Academy of Health Sciences in Bangalore to develop and expand sites for second and third phase clinical trials in Palamaner in Andhra Pradesh.

"The cooperative agreement will help Aeras create a professional development programme for staff in India, develop laboratory capacity for TB diagnosis and referral systems to treat and cure patients," the statement said.

The study would examine TB incidence and prevalence, particularly among newborns and adolescents in Andhra Pradesh.



Read the full story at:
http://www.123bharath.com/health-india-news/index.php?action=fullnews&id=22132

News from India's neighbours

Myanmar: Pioneering TB Testing and Treatment

Cheryl Barnds, PSI/Washington

Population Services International (PSI) Myanmar has significantly improved detection, diagnosis and treatment of tuberculosis (TB) in pilot regions since launching PSI's first such program in March 2004. By adding TB screening and branded Directly Observed Treatment (DOTS) to the services and products offered through PSI/Myanmar's Sun Quality Health (SQH) network of private clinics, and motivating those at risk to get tested and treated, Myanmar is blazing a path not only for PSI but for other TB implementers and donors.

Improving the private sector's ability to manage TB effectively, PSI/Myanmar's integrated approach includes training SQH franchise members in TB diagnosis and treatment, and branding DOTS services, drugs and communications and motivating those at risk to get tested and complete treatment. Along the way, the program has taken numerous essential steps, including defining protocols, training and accrediting labs, conducting quality assurance, aggregating and sharing data and enlisting the help of Myanmar's biggest star - actor, singer and dancer Yazar Ne Win - in the production of a television spot.

Off to a solid start, SQH providers had registered and begun DOTS treatment for 1,311 confirmed TB cases by early October. Only ten clients have defaulted. PSI/Myanmar has trained over 100 SQH general practitioners in TB/DOTS, and seven private labs have been trained and accredited.

Mass communications are designed to increase care-seeking behavior and reduce stigma. Robust training for providers covers disease basics, high-risk groups, diagnosis, treatment, monitoring and patient education, with an emphasis on the quality of client interaction. Providers are given printed materials for counseling and client information. PSI also maintains a telephone hotline for providers; the questions and responses are summarized in a monthly bulletin distributed to all providers.

Read the full story at:
http://www.psi.org/news/1004g.html

Pakistan Has 6th Highest Incidence of TB in the World

Daily Times (Lahore, Pakistan), October 25, 2004

The government of Pakistan informed the National Assembly that the World Health Organization ranked the country sixth among the 22 countries with the highest tuberculosis prevalence rate in the world. In a written reply, Health Minister Muhammad Naseer Khan said that the Health Ministry had declared TB a national emergency on March 24, 2001. Eight months of free treatment was being provided under the TB control program in 98 of 120 districts. From 2001 to 2004, the Health Ministry registered 49 anti-tuberculosis drugs. During the last three years, 63 drug-manufacturing licenses have been issued to various manufacturers

Source:
CDC TB-Related News and Journal Items Weekly Update (October 24-30, 2004)
 

TBNI Editorial Team

Dr. Dinesh Kumar,
dinesh_kumar@vsnl.com 

Dr. Jatinder Singh,
jatindersingh@vsnl.com