When 40-year-old Sana Bano went to get her sputum tested at civic-run centre in Dharavi, she was told that she is multi-drug resistant (MDR-TB) patient and she will have to take up to 14,600 pills and up to 240 injections in two years to get her rid of her disease. Even then there was no guarantee that she would get cured of TB.
When 40-year-old Sana Bano went to get her sputum tested at civic-run centre in Dharavi, she was told that she is multi-drug resistant (MDR-TB) patient and she will have to take up to 14,600 pills and up to 240 injections in two years to get her rid of her disease. Even then there was no guarantee that she would get cured of TB.
How many TB-resistant cases are reported in the city?
The burden of drug-resistant tuberculosis (DR-TB) in Mumbai is higher than the global average. The city is a breeding spot for TB bacteria, with the disease affecting young and old, rich and poor alike. While globally, five percent of all TB cases do not get cured by basic TB drugs, in Mumbai over 15 percent of cases are resistant to the most powerful first-line treatment of anti-TB drugs – Isoniazid, Rifampacin, Pyrazidamine and Ethambutol. They are termed as multi-drug resistant (MDR-TB) patients.
What does it mean when the sputum test is positive?
Over the past two years, 33,890 persons showing TB symptoms such as persistent hollow cough, weight loss and fever were tested on Genexpert machine. Their sputum samples were analyzed to test them for resistance to Rifampacin drug. "If the sputum test is positive, it means that the person will not respond to first-line drug treatment for TB," said a Brihanmumbai Municipal Corporation (BMC) official. Of the 33,890 symptomatic persons tested, up to 5120 persons were tested to be MDR-TB patients. MDR-TB patients are then put on a severe drug regimen of two years.
Moreover, in what are abysmal cure rates, only 371 of the 5,120 patients been declared free of MDR-TB, till date.
For a population of 1.2 billion and a burden of over 46,000 notified TB cases every year in Mumbai, there are only 18 Genexpert machines in the city, which conduct MDR-TB diagnostic tests. "While eight machines are in BMC hospitals of high burden pockets like Dharavi, Kurla among others, other 10 machines are in private hospitals," said Dr Minni Khetarpal, city's TB officer.
In 2012, former additional commissioner (health) for BMC, Manisha Mhaiskar had promised that by 2014, each of 24 wards in Mumbai will have Genexpert.
When should a person undergo Genexpert test?
Currently, BMC conducts Genexpert tests on only those patients who have failed an initial two-month regimen of basic TB treatment. The World Health Organisation (WHO) in its latest TB strategy has categorically mentioned that every patient who walks in with TB symptoms should be made to undergo Genexpert test upfront. "We have recommended in our latest strategy that Genexpert tests should be made mandatory for all patients in high burden TB countries, for example India," Mario Raviglione, head, Global TB Programme, WHO told dna.
A senior BMC official said, "We do not have requisite infrastructure or funds to put all patients through Genexpert tests. Each cartridge used for a single person costs Rs 3000. This is too expensive and there are not enough funds to maintain existing infrastructure."
"We are writing and appealing to the central TB division to help us maintain our existing Genexpert diagnostic infrastructure. We hope the government listens to our plea," said Sanjay Deshmukh, additional municipal commissioner (health), BMC.
MDR-TB burden in Mumbai
2010 – 111
2011 – 410
2012 – 2195
2013 – 2903
2014 – 3522
Genexpert testing – 33,890 (positive for MDR-TB) – 5120
Number of patients cured - 371
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