The latest global report on tuberculosis has criticised India’s control plans, even as the Union Health Minister JP Nadda has said that TB will be eliminated from the country by 2025.
The Out of Step 2017 report published by Stop TB Partnership reviewed TB policies and practices in 29 countries which account for 82 per cent of the TB burden – India being the highest contributor. India was rated on the following parameters: TB diagnosis, TB Treatment, Models of Care, Medicines Regulatory Environment, and was mostly found to be ‘inadequate’ in fulfilling global level expectations.
The report states that while 15 countries have introduced the World Health Organisation (WHO) recommended test, Xpert MTB/RIF, as the initial test, India has not. “It is selectively available for high-risk patients,” it says. The test is crucial in detecting drug-resistance in patients. Once resistance is detected, better treatment is available, and patients will not be put on drugs which could anyway prove to be futile.
“Currently, India has 735 planned installations (of Xpert MTB/RIF), and a committed increase to take the number up to 1,019,” it states. “India still relies on smear microscopy which can miss half of all TB cases and not detect drug-resistance,” said Dr Madhukar Pai, associate director, McGill International TB Centre of Canada.
The report says that patients are diagnosed after a delay of nearly two months, after having seen at least three care providers. India is lagging behind on the treatment front as well. Two life-saving drugs, delamanid and bedaquiline, have been approved by WHO and India isn’t among the 11 countries that have approved these options. Also, India is not among the 13 countries that have approved shortened treatment for multi-drug resistance TB.
India is one of the 21 countries that allow accelerated regulatory approvals. However, 100 per cent quality assurance is not guaranteed as unregistered medicine is legally available.
“Sub-optimal quality of medicines will break the treatment drive. In a study, it was found that 10 per cent of TB medicines dispensed through pharmacies were spurious,” it says.
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