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| Edited By: Disha Shetty |Source: DNA |Updated: Oct 25, 2016, 07:43 AM IST
We have to have a system where we are able to take diagnosis closer to the patient, either by using ASHAs or other kinds of community involvement. Those in rural areas also have the additional challenges of distance, poverty and under-nutrition. Some kind of social support or incentive mechanism would also help, at least for the poor in these areas.
It could be conditional incentive for completing your treatment or getting your sputum tested. Even that can help improve compliance. The problem is of the initial diagnosis. The quality of smear microscopy at our primary health care centres is very variable so we are going to miss a lot of TB cases.
Better diagnostics, bringing it closer to the patient and more community involvement is needed.
It is one of the standardised regimens but now with the new guidelines where daily regimen will be introduced there will be four weight bands with a different dose of medicine for each band. Right now for those between 30 and 60 kgs, the dose of the medicine is the same.
But the main problem of side effects is the problem of lack of food and that is the biggest hurdle which the TB programme is not addressing at the moment. They have their own set of problems. The health ministry does not deal with food at all. It will need some ministerial coordination to do that but I think it is important in many parts.
Chhattisgarh has started a programme where they are giving extra ration to all TB patients, places like Mumbai have done it for MDR-TB patients.
Doctors are allowed to change dose in the current regime and the health worker should be able to get the doctor on the phone if distance is a problem. They are not things that are so difficult to do. The district TB officer must take feedback from the health workers. This must be addressed as it is the reason why so many patients are dropping out.
The TB patients in rural areas need nutritional support and it should become a part of the programme. They should not be asked to buy the supplements as they are really expensive and don't provide any nutrition. It is much better for them to buy rice and a little extra dal rather than spending a couple of hundred rupees on nutritients which gives nothing. Vitamin supplements are available through the government system and small drugs for treating side-effects. The patients shouldn't really be buying them.
A lot of things are there on the paper but they don't happen. As far as these people not tolerating medicines, I think across rural India this is an issue that we have to address.
The policy changes have been made, they have to now be implemented. In the next few months we will see the roll out of the daily regimen and molecular diagnostics. We also want to ensure that everybody (TB patients) is tested for diabetes and HIV.
The one thing we are missing is the counselling and the nutrition support. The government is trying to rope in counsellors, MDR-TB counsellors are being appointed in some places.
We need to raise the profile of the TB programme like we did with the Maternal and Child Health Programme (MCH). Every pregnant woman, child and every death needed to be tracked. It made a huge difference and we need something like that in TB.
Also improving diagnostics will help picking up MDR-TB cases early and ensuring better treatment.
