TB
News from India: November-December 2006
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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.
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Editorial
Note: TB anywhere is TB every where
At
the inauguration of the 37th Union World Conference on Lung Health
in Paris, UN Secretary-General's Special Envoy to Stop TB, former
Portuguese President Jorge Sampaio announced theme for World TB Day
2007. The chosen theme is "TB anywhere is TB Every where". The next
year's theme is a timely reminder for people living in all the continents
about dangers posed by TB epidemic to global health. Let us not forget
that:
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Each
year nearly two million die and nine million people get sick with
TB.
-
Someone
in the world is newly infected with TB bacilli every second.
-
Overall,
one-third of the world's population is currently infected with
the TB bacillus.
-
5-10%
of people who are infected with TB bacilli (but who are not infected
with HIV) become sick or infectious at some time during their
life.
-
People
with HIV and TB infection are much more likely to develop TB.
In
2004, estimated per capita TB incidence was stable or falling in five
out of six WHO regions, but growing at 0.6% per year globally. While
Southeast Asian region continues to be a priority for TB control programme,
TB pandemic in Africa and European regions has assumed emergent proportions.
The industrialized nations account for only 5% of global tuberculosis
cases. How ever most of the state-of-the-art research laboratories
for development of newer anti-TB molecules, vaccines and diagnostic
tests are located in the developed world. Thus public health professionals,
scientists and institutions in the north have the onerous responsibility
to come forward and help the people in south. On their part national
governments and civil society in poor countries have to match the
efforts of their peers in rich countries. TB control is a shared responsibility
of human race, because TB anywhere is TB everywhere.
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India gets a pat for
TB control
Sanchita Sharma New Delhi, October 17, 2006
The
hundreds of homeless who sleep on the pavements of Chandni Chowk and
the platforms of Old Delhi Railway Station do not have a home address,
but they receive house calls from doctors. A doctor, a senior treatment
supervisor and a laboratory technician visit them every Monday, Wednesday
and Friday mornings to screen them for tuberculosis and give them
free TB medicine under medical supervision under the government's
Revised National TB Control Programme (RNTCP). Prem Neelkanth's food
stall in a Mumbai slum also doubles as a TB clinic. Every day, Neelkanth
dispenses free TB pills from the neat row of medicine boxes marked
with the patients' names. The Ramakrishna Mission at Belur Math in
Howrah district of West Bengal is also an active partner in the Government's
RNTCP since November 2003. It doubles as a microscopy and treatment
centre in partnership with the TL Jaiswal Hospital TB Unit in Howrah.
Two
people die of TB every three minutes in India, but these statistics
are headed to change for the better. Public-private partnerships between
the government and individuals, private doctors, NGOs, industry and
corporate houses have made India's RNTCP among the most successful
public health programme in the world. "The RNTCP has saved over one
million lives and now India is exporting many of the lessons learned
here on how to deal with underprivileged populations and how to help
those who cannot help themselves," says Salim J Habayeb, India Representative-World
Health Organization, at the end of a joint monitoring of the RNTCP
by a panel of international experts. During October this year, international
experts visited 20 randomly selected districts in six states — Gujarat,
Haryana, Karnataka, Madhya Pradesh, Punjab and West Bengal — to review
patient records and interview patients at government-run TB clinics.
They all had good things to say.
"The
overall progress in TB control is exceptional. The private sector
has a shared role in giving the government's free drugs to patients
and reporting their progress to the RNTCP," said Dr J Narain, a WHO
expert.
Source: http://www.hindustantimes.com/news/181_1823255,000600010001.htm
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Experts
point towards rising number of Multi-drug resistant tuberculosis
Statesman News Service New Delhi, Oct. 17, 2006
With
less than three per cent of new TB patients and as high as 10-12 per
cent of old TB patients (in whom treatment protocol was not followed
and TB re-emerged) being resistant to commonly used anti-TB drugs,
international experts have said India must show "sustained commitment"
for controlling the disease and focus on consistent quality as poor
treatment practices will make the disease causing bacteria resistant
to drugs. While treatment costs for TB is about Rs 400-600 per patient,
it costs 300 times more, for treating a case of multi-drug resistant
(MDR) TB. Besides, the treatment period is 24-27 months and needs
monitoring by expert clinicians in case of MDR TB. MDR TB develops
when tuberculosis bacteria become resistant to the two most potent
anti-TB drugs (isoniazid and rifampicin).
Praising
India's success in TB control under the Revised National TB Control
Programme (RNTCP), the Joint Monitoring Mission of the Tuberculosis
Control Programme in India, said financial sustainability was the
most crucial issue at this juncture. "Currently, the programme is
being financed by both by the government and external assistance,
but since not many countries support TB control, the Indian government
must develop a strategy where programme could be supported without
external assistance," Dr Fabio Luelmo, a senior mission member, said.
There was also a need for improving managerial capabilities and quality.
Source: http://www.thestatesman.net/page.news.php?clid=2&theme=&usrsess=1&id=133524
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WHO
Reports Progress in Fight against Tuberculosis in Worst-affected Asian
Countries
By Anjana Pasricha New Delhi 22 October 2006
The
World Health Organization says there has been considerable progress
in the fight against tuberculosis in South Asia and Indonesia, where
the worst TB problems exist. India has the highest number of tuberculosis
cases in the world. For decades, tuberculosis has extracted a heavy
toll in India, although the disease is usually easily cured with an
inexpensive, six-month treatment of drugs. Nearly two million new
patients are stricken with the disease every year in impoverished
Indian communities, and one thousand die every day. But an international
panel of health experts that traveled through six Indian states this
month to review the world's largest tuberculosis control program says
the tide may finally be turning. World Health Organization officials
say the program has prevented at least one million deaths in India
from the disease in recent years, and the cure rate has increased
dramatically, to more than 80 percent.
But a top international tuberculosis expert and senior member of the
mission that reviewed the program, Fabio Luelmo, cautions that combating
tuberculosis is a long-term battle. "You have to maintain this for
about 50 years minimum to reduce tuberculosis so it is not a major
problem, because no matter what you do, tuberculosis reduces slowly,
because a large part of the population is already infected. So it
[the program] needs sustainability," said Luelmo.
WHO officials say the main battle against tuberculosis is being waged
in the five countries of South and Southeast Asia that account for
the bulk of the worldwide cases. The five are India, Bangladesh, the
Maldives, Burma and Indonesia. Jay Narain, the director for communicable
diseases at the WHO's Southeast Asia office in New Delhi, says all
these countries are making progress against the disease, and two -
India and Indonesia - are showing particular success. "Most of the
countries are making extremely good progress, said Narain."I can say
categorically that the global progress in TB control is being driven
by the progress that is being made in this region, led by India, followed
by Indonesia."
Source: http://www.voanews.com/english/2006-10-22-voa5.cfm
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Rs. 1,156 crore cleared for TB control programme
Anbumani Special Correspondent, The Hindu Oct 18, 2006
Union
Health and Family Welfare Minister Anbumani Ramadoss on Tuesday said
the Government had cleared Rs. 1,156 crore for the Revised National
Tuberculosis Control Programme (RNTCP) for the next five years. Of
this, Rs. 950 crore would be provided by the Government and the World
Bank as loan. "The loan amount is also our money as we have to repay
it. The remaining Rs. 200 crore will come from the Global Fund," Dr.
Ramadoss said at a function held here to present the report of the
Tuberculosis Joint Monitoring Mission to the Ministry. The mission
asked the Government to ensure the sustainability of the RNTCP by
regular funding against external aid. It also recommended the integration
of the World Health Organisation-funded RNTCP with the National Rural
Health Mission (NRHM) to protect and sustain its key elements.
Combating
TB was a long-term battle, particularly in the wake of the Multi-Drug
Resistant (MDR) variant and the rising incidence of TB in HIV patients.
Hence, the Government must continue to give priority to the disease.
The NRHM, through its cadres, could also improve access and convenience
of services at the community level, the mission said in its findings.
Dr. Ramadoss said: "We are now trying to consolidate the programme
at the Central and State levels and would be integrated with the NRHM
at the district level." With the percentage of MDR-TB incidence still
a little less than 3 per cent, the Ministry has developed a national
plan for implementing an advanced TB control programme. It plans to
establish a RNTCP network in a phased manner by setting up accredited
quality assured Intermediate Reference Laboratories for culture and
drug sensitivity testing services. Concurrently, a network of Directly
Observed Treatment Sites as per the international guidelines will
be identified for enrolling and providing treatment to MDR-TB cases.
The treatment of MDR-TB is over 300 times more expensive than for
non-resistant TB and uses drugs that have many side effects. The treatment
takes more than three years.
Source: http://www.hindu.com/2006/10/18/stories/2006101801981700.htm
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Four
loan agreements worth us $ 792 million signed with World Bank
Four
loan agreements, three for health sector projects and one for rural
water sector project, were signed with the World Bank on 16th October,
2006 for a total assistance of US $ 792 million. Health sector projects
are designed to improve reproductive and child health services, reduce
mortality and morbidity due to tuberculosis in the country, and to
increase utilization of essential health services in the State of
Karnataka. These projects will go a long way in achieving the objectives
of the National Rural Health Mission. The total cost of Second National
Tuberculosis Control Program, from FY 2006 to FY 2011, is US $ 342
million. Besides World Bank assistance of US $ 170 million, Government
of India is providing domestic budgetary support of US $ 42.5 million
for the said project. The balance requirement is expected to be provided
by other development partners. The project aims at treating and reducing
the incidence of tuberculosis through sustaining the quality of public
TB services across the country and by maximizing inclusion of TB patients
under Directly Observed Treatment, Short course (DOTS).
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Tuberculosis:
A large, untapped global market exists for improved TB tests
A
significant and largely untapped global market exists for more effective
and affordable tests to diagnose tuberculosis in low and middle income
countries, where most TB cases today occur. This is the major finding
of a new report, Diagnostics for Tuberculosis: Global Demand and Market
Potential, released today by the Special Programme for Tropical Disease
Research and Training (WHO/ TDR) and the Foundation for Innovative
New Diagnostics (FIND). Most people in the world who have tuberculosis
(TB), or live in TB risk areas, do not have good access to rapid and
accurate testing, states the report, the most comprehensive review
of the TB diagnostics market to date.
Improved tests could bolster international TB control efforts and
respond to a significant market demand, adds the report, calling for
industry investment in new diagnostic tools targeted to low and middle
income countries. In middle and low income countries alone, over 66
million sputum microscopy examinations, 39 million chest x-rays, and
8.5 million cultures are performed each year on suspected TB patients
– using technologies developed 50-100 years ago.
The report found striking regional variations in testing, with Russia,
India and South Africa together accounting for 91% of TB cultures
performed in TB-endemic countries, and Asia making up 68% of the global
chest x-ray market. "The technology exists to make better TB tools,
and this report leaves no doubt that there is a large global market,"
said Dr Giorgio Roscigno, Chief Executive Officer of FIND.
"There
is a huge opportunity for diagnostics developers to expand their investments
to meet this very real need. We need to use this market analysis to
encourage the development of accurate, affordable and easy-to-use
diagnostics for developing countries." The report represents the first
time an international network of researchers and policy experts has
examined the full range of tests available on the market for: active
disease; latent infection; drug resistance; and treatment response.
The report was financed by the Bill and Melinda Gates Foundation,
and involved more than 100 public health and industry experts as well
as several international agencies. Despite increased global funding
for TB control, and the emergence of public-private partnerships to
support product development, commercial interest in TB diagnostics
has been limited by a dearth of information on the size and character
of the TB diagnostics market, especially in the developing world,
the report states. The majority of recently developed tests serve
sophisticated laboratories in industrialized countries, where less
than 5% of global tuberculosis cases are found. "The world urgently
needs new, safe and affordable diagnostics to simplify case detection,"
said Dr Mario Raviglione, Director of WHO's Stop TB Department. "Despite
scientific progress that is rapidly changing other fields, most of
the world's TB patients have access only to conventional microscopy
which requires repeated testing, may miss half the cases, and which
works especially poorly for HIV co-infected patients".
Source: http://www.spiritindia.com/health-care-news-article-3015.html
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Pioneers
in TB Control in Africa, India Win New UN-Backed Health Prize
A
tireless advocate for people infected with both tuberculosis and HIV
in Zambia and the manager of the national TB control programme in
India have won a prestigious new United Nations-backed health prize
for their efforts to transform control of the debilitating but curable
disease that kills some 5,000 people every day.
Winstone
Zulu from Zambia and L.S. Chauhan from India became the first winners
of the The Stop TB Partnership Kochon Prize, inaugurated this year
by the Partnership, a network of more than 500 organizations whose
secretariat is housed at the UN World Health Organization (WHO) headquarters
in Geneva. The Kochon Foundation was created in 1973 by the late Chong-Kun
Lee, Chairman of the Chong Kun Dang Pharmaceutical Corp., one of the
first TB drug manufacturers in Korea. Mr. Zulu himself was cured of
tuberculosis, although all of his four brothers died of the disease.
He is a co-founder of Kara-Kabwe Programmes for Kara Counselling,
a provider of HIV/AIDS counselling in Zambia, and was Co-President
of TBTV.org, one of the first global organizations of people with
TB and HIV/AIDS.
Dr. Chauhan is Deputy Director-General (Tuberculosis) and Programme
Manager of the National TB Control Programme in India. Since 2002
he has overseen the rapid expansion of the DOTS TB-control program
in India, a remarkable accomplishment in the country that bears the
world's highest TB burden.
Source: http://allafrica.com/stories/200611010703.html
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Resource:
New TB/HIV Infection Control Publication now available
"Tuberculosis Infection Control in the Era of Expanding HIV Care and
Treatment"
In
this era of increasing access to HIV counseling and testing, care,
and treatment for people living with HIV, more people living with
HIV-associated immunosuppression are attending health care and community
facilities than ever. This new publication includes recommendations
to help minimize the risk of TB transmission to staff and patients
at facilities in resource-limited settings in which HIV care is provided.
This document is an addendum to the 1999 WHO Guidelines for the Prevention
of Tuberculosis In Health Care Facilities in Resource-limited Settings.
This document is available for downloading at: http://www.cdc.gov/gap
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Editorial
Team: Dr. Dinesh Kumar dineshkumarsharma@gmail.com
; Dr.
Jatinder Singh jatindersingh@vsnl.com
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