DNA speaks to Mumbai’s TB officer Dr Daksha Shah on the measures being undertaken by the Revised National Tuberculosis Control Program (RNTCP), a state-run TB control initiative of the Government of India.
At present in Mumbai 56 patients are receiving bedaquiline. The drug is used to treat multidrug-resistant tuberculosis when other treatment cannot be used. It is provided under a ‘Conditional Access Programme’ managed by government’s TB programme. The nationwide figure of patients receiving the drug is 164. As per reports that’s a small fraction of India’s estimated 78,000 drug resistant TB patients. DNA speaks to Mumbai’s TB officer Dr Daksha Shah on the measures being undertaken by the Revised National Tuberculosis Control Program (RNTCP), a state-run TB control initiative of the Government of India.
How has the approach to the care of TB patients changed?
Several patients are receiving bedaquiline at the Sewri TB hospital. The GeneXpert test to check if a patient has a drug resistant strain of TB is also now available to more people. The focus is on counselling, which the NGO Doctors Without Borders, is taking care of at the Sewri TB hospital jointly through the RNTCP and the Tata Institute of Social Sciences. This has helped bring in a sense of positivism among patients, and also raised their trust in the system.
At the moment patients are given medicines every alternate day, instead of a daily regimen...
The daily regimen, where patients are given medicines daily should start as soon as we get enough drug supplies, which could be as early as February. The patient will have to come to the DOTS (Directly Observed Treatment Shortcourse) centre only once in 15 days, and we will encourage family members to be DOTS providers. We also have plans to use technology. We will give out a number on which a patient can give a missed call once he she has taken the drug. The data will be recorded and patients will be tracked. Reminder calls will be made to patients to ensure they don’t drop out of the treatment.
What challenges does a city like Mumbai present?
TB bacteria tends to spread fast in wards with high population density. We have taken up community engagement by trying to reach out to schools and places of worship. About 70 per cent of drug resistant patients are seeking care in the private sector. Engagement with the private sector has helped with notifications. We cannot force patients to come to the government sector but by reaching out to the private practitioners we are trying to standardise the quality of care provided. Private doctors are being given access to the GeneXpert. We are working with GPs, and Ayush practitioners too, on infection control. However it will take at least five years for the number of cases to stabilise in Mumbai and for the results to show.
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