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:  

TB still on the rise!

Tuberculosis still kills almost two million people a year worldwide and, despite the availability of curative treatment for three decades; the incidence is on the rise in many countries. The international target is to detect 70% of pulmonary sputum positive cases and treat 85% of these successfully.

In the DOTS era what is urgently needed is clear and unambiguous advice for people running tuberculosis control programmes along with practical advice for fieldworkers. Case detection, treatment, and monitoring have to be redefined in terms of newer developments such as molecular epidemiology and DNA amplification. The emphasis should still be in support of affordable evidence-based investigations and treatment considering the fact that poorer and less developed economies are involved. National and International initiatives should aim at preventing drug resistance, weeding out irrational prescribing practices and forming guidelines for standardizing treatment in order to curb HIV infection and multi drug-resistance (MDR), the two most important reasons for the persistent TB epidemic.


 

Authorities in Andhra Pradesh grapple with deadly duo as District sees rise in HIV-TB co-infection cases

P. Sujatha Varma, May 2005

Krishna district in Andhra Pradesh is facing fresh challenge on the health front. A new trend of HIV-TB co-infection cases pouring in from various pockets has forced the district tuberculosis control wing and the district leprosy department to sit up and take notice of the emerging danger.

Interestingly, the district administration was unaware of the new threat until a group of local voluntary organisations, jointly working on Krishna Community Health Intervention Programme (KRISCHIP) - funded by the UK-based Community Fund - brought the matter to the notice of the authorities. The objective of KRISCHIP is to reduce the vulnerability of poor rural and urban communities in Krishna district to the spread of communicable diseases like tuberculosis, HIV/AIDS, malaria and leprosy.

"While preparing separate statistics for HIV/AIDS and tuberculosis, we found the `co-infection' factor creeping into several cases, thus creating a lot of confusion. A large number of persons affected by HIV-AIDS were found to be suffering from tuberculosis too," explained a volunteer from Lepra India, the lead partner in the KRISCHIP.

The district has eight Voluntary Counselling and Testing Centers (VCTCs) and 43 Revised National TB Control Programme (RNTCP) centers. "This is the first time the VCTCs and RNTCPs have been asked to work in coordination to detect the exact number of HIV-TB co-infection cases existing in the district," says the District Tuberculosis Control Officer, Sashidhar Reddy. He admitted that the rise in number of `co-infection' cases has prompted the two departments to focus on making joint efforts to effectively curb the ailment.

In a survey conducted in 42 of the 135 slum habitations that comprise Vijayawada urban zone, a total number of 498 TB cases were reported, of which, 212 were confirmed. And, 31 of the 72 cases referred were found to be HIV positive. The KRISCHIP volunteers are studying the incidence of `co-infection' to establish the exact number of people victimised by the twin diseases.

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100 more AIDS centres to come up in Andhra Pradesh

The State Government has directed the Andhra Pradesh State AIDS Control Society (APSACS) to set up 100 more Voluntary Counselling and Testing Centres (VCTCs) across the State. As many as 107 VCTC centres are already functioning in the State.

APSACS will open 70 centres by next month and the remaining 30 centres will be set up at TB hospitals where microscopic testing facility is available.

On an average each district will get three additional VCTCs in addition to the existing number.

While the available government infrastructure would be used at the new centers, volunteers from Lepra India would also be roped in.

 

Chandigarh improves TB cure rate

Tribune News Service, Chandigarh, June 2005

Union Territory (UT) of Chandigarh ranks among the top three states of the country in case detection and cure rate of tuberculosis and also effectively implementing the revised National Tuberculosis Programme. This was disclosed at a meeting of the governing body of the State TB Control Society, held under the chairmanship of the Home Secretary, UT, Mr Krishna Mohan. Chandigarh.

He said strenuous efforts had been made by the Administration to break the chain of transmission of tuberculosis. Over 5,500 cases had been treated in three years. The city had also achieved the target of putting smear positive patient on DOTS at 96 per cent whereas it was 86 per cent in 2003. The cure rate of the new smear positive patients was 79 per cent in 2003 whereas it had gone up to 86 per cent in 2004.

Mr Mohan further added that the expansion of microscopy facilities and inter-personal communication through the counselling cell had reduced the defaulter rate to less than 4 per cent in 2003. He informed that the infrastructure had been strengthened and two treatments units and 13 microscopy centres established in the city. These units and centres provide free sputum examination, diagnosis and treatment of tuberculosis. There are 104 DOT centres in Chandigarh, where treatment of tuberculosis is provided under direct supervision.

He further said that the problem of migratory population living in slum areas and affected by tuberculosis was being looked into seriously. Municipal Councillors, NGOs and panchayat members had been involved to persuade chest symptomatic persons to get themselves diagnosed and treated so that they did not further spread the disease


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Labourer on hunger strike dies of TB in Mumbai

By: A Mid Day Correspondent, May 2005

Nitin Kirtawade caught TB at the protest, which was taking place on a filthy pavement in Kalina. After a 50-day ordeal, Nitin Kirtawade, a former casual labourer with Air India (AI) breathed his last on Tuesday evening.

Kirtawade was among the 300-odd casual labourers of AI who have been on a hunger strike outside the airline's Kalina office since March this year.

"Doctors said Kirtawade had died due to pulmonary tuberculosis, which he caught because he was on an open road protesting for the past two months," said D Warekar, one of his fellow protesters. Kirtawade had been hospitalised for a week before he died.
 

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When the waiting proves fatal

By R. PRASAD, The Hindu

A clinical trial is slated to study the possibility of treating HIV patients with TB and use DOTS for better compliance to HIV medication.

The free Anti Retroviral Therapy (ART) given by the Indian Government to some infected with HIV is a step in the right direction, to reduce the number of people succumbing to the disease every year.

The free treatment comes with some riders though � only those people with CD4 counts less than 200 are eligible for free medicines and those suffering from tuberculosis need to first get it treated before becoming eligible for free ART medicines. This latter condition applies even if the patient has a CD4 count an indicator used to understand the condition of a person's immune system � less than 200.

Ironically, many HIV infected persons who also have tuberculosis die before TB can be treated. "The mortality rate is high among HIV patients with TB," said Dr. Soumya Swaminathan, Deputy Director (Division of HIV/AIDS), Tuberculosis Research Centre, Chennai. "Nearly 20 per cent of them die in the first year and another 20 per cent in the subsequent year in the absence of ART."

Hence the need of the hour is to offer ART at the earliest to those suffering from TB. "With a median survival rate of 18 months, it is a serious problem for those with HIV and TB," said Dr. Swaminathan.

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Neelesh Misra, Associated Press

A 95 percent drop in new HIV infections between 2003 and 2004 in India reported last week by the government's National AIDS Control Organization (NACO) stemmed from a change in surveillance methodologies, according to a statistician who worked on the project. Using figures compiled by two independent research organizations, NACO reported that India had only 28,000 new HIV infections in 2004, compared with 520,000 new infections in 2003.

In 2003, a change in data collection methods included an increase in sentinel surveillance sites and an expansion of testing from mostly high-risk populations to include low-risk populations, said M. Thomas, an independent statistician who worked on the survey.

New HIV infection figures for 2003 also included many cases that erroneously had not been recorded in previous years, making the number of new HIV infections between 2002 and 2003 appear very large, said Denis Broun, the Indian coordinator for UNAIDS. So, while "the overall estimate was realistic" for 2004, the figures are incomparable with 2003 numbers, said Broun.

Despite the methodological changes, both the World Health Organization and UNAIDS said that HIV's spread in India appears to be stabilizing. "The growth in HIV infections is flattening out" in high-prevalence states, said Broun. WHO and UNAIDS officials also embraced India's surveillance methodology.

India's government did little to explain the methodological changes, infuriating activists who doubted that new HIV infections had truly plunged so radically. India has long rejected reports that its infection rate could dramatically rise in coming years. Source: CDC HIV/STD/TB Prevention News Update 05/31/2005

 

IEC Resources

Tuberculosis can be properly treated and cured with the help of modern medication.

By: Anuradha Mascarenhas, Indian Express, June 2005

Tuberculosis has been a constant problem in India for centuries. Though previously considered a dreaded disease, mostly causing the death of the infected, modern medical science promises a better future through its blessed touch. Nowadays, Tuberculosis, popularly known as TB can be diagnosed, treated and cured through proper medication. Quite against the popular notion, TB does not only affect the poor or the elderly. It can affect anybody at any time of life. Consult a doctor with the very first symptoms of TB and get a proper treatment.

"Our goal today is to try and diagnose TB early and correctly. For lung TB the simplest method of diagnosing is to collect three consecutive samples of sputum and test them for `Acid Fast Bacilli (AFB)," Abhyankar mentions. He further adds, "Though chest x- ray is suggestive but always does not diagnose TB."

Visit the following URL to read this article which provides basic information about TB and DOTS implementation in India:
http://cities.expressindia.com/fullstory.php?newsid=5681

TB India 2005: RNTCP Status Report

The Central TB Division of Ministry of Health and Family Welfare has published a status report on Revised National Tuberculosis Control Programme (RNTCP). The report provides an overview of its progress up to the year 2004, burden of tuberculosis disease in the country and research activities undertaken under the programme.

The document also includes a number of success stories that emerged during implementation of RNTCP in the country. These stories highlight the crucial role played by frontline TB workers in provision of DOTS in this vast country.

The document is an excellent resource for all those who are closely following the progress of TB control in India.

This publication can be obtained from:-
Central TB Division, Directorate General of Health Services,
Ministry of Health and Family Welfare,
Nirman Bhawan, New Delhi 110011
 

Website: http://www.tbcindia.org

TBNI International: Bangladesh

Undetected TB patients pose threat to others

Rafiqul Islam Azad, The Nation May 2005

More than half of the undetected tuberculosis-infected people are moving around us without hesitation posing a serious threat to public health, according to an official report. Under the National Tuberculosis Control Programme (NTP), the government could identify only 46 per cent of TB patients in the country till last year and the rest remained unidentified.

The NTP sources, however, said that more than three to four per cent of the people carrying TB might be identified at the private level hospitals, which remained out of official records. Official documents show that of the identified patients 85 per cent were given treatments in 2003, which the NTP sources said fulfilled the global target for 2005.

However, the officials concerned admitted that Bangladesh was still far from detecting 70 per cent of the TB carriers in line with the global target due to lack of awareness among the people.

According to doctors and TB specialists, there are more than seven lakh TB patients across the country. Nearly 300,000 people were being infected by the TB and 70,000 people died every year in Bangladesh, sources said.

"A new TB patient is detected every two minutes, while one patient dies every 10 minutes," said Dr Vikarunnessa Begum, Programme Manager (TB) of the Tuberculosis and Leprosy Control Programme. She said the government is supplying TB medicine at the Upazila level free of cost. But due to lack of awareness, the people cannot utilise the existing treatment facilities.

Referring to the government efforts, Dr Vikarunnessa said side by side the government hospitals, a total of 120 DOTS (Directly Observed Treatment Short course) centres have been established in the capital to provide free diagnosis and treatment.

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TBNI Editorial Team

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