A study released by Medecins Sans Frontiers (MSF) or Doctors Without Borders has revealed a shocking trend: More people in the city are falling prey to multi-drug resistant tuberculosis (MDR-TB) in the first instance itself, and not after a relapse. The study mapped co-infection patterns in HIV patients with tuberculosis.
Where was the study conducted?
The study was conducted in Mumbai's HIV/AIDS therapy centres. Seven anti-retroviral centres (ART) in the city were studied between February 2013 and January 2014, where patients were screened during 14,000 visits. The sputum of 1,724 patients with symptoms of TB were collected. "Twenty-five per cent of these patients had MDR-TB with no previous record of having TB. They must have been exposed to drug resistant bacterium in their communities or during their visits to healthcare facilities in their neighbourhood," said the study.
What did it find?
The study found that 25% of all cases of HIV/TB co-infection were drug-resistant in the first instance, and that 44% of relapse cases of tuberculosis were presented with drug resistance.
Which are the MDR-TB hotspots?
"In 'hot-spots' such as the slums of Mumbai, and among vulnerable groups such as people living with HIV, the DR-TB epidemic may be driven by primary transmission, rather than simply by a lack of adherence to TB treatment," said Dr Petros Isaakidis, principal investigator of the MSF study.
What can the govt do?
"The government needs to pay more attention to primary transmission of DR-TB, particularly in settings of high HIV prevalence and rapid TB spread. Promptly diagnosing and treating DR-TB is the solution to curb primary transmission," said Dr Isaakidis.
The data highlights the urgent need to address DR-TB among people living with HIV by systematically offering screening, drug susceptibility testing (DST) and access to treatment based on actual resistance patterns. "We need to urgently prevent transmission of DR-TB to others. With DR-TB, treatment is prevention, and these findings should lead to a stronger focus on diagnostics and treatment, particularly in high HIV-prevalent settings," says Eldred Tellis of the Mumbai AIDS Forum. "This is in addition to the fact that health authorities cannot afford to neglect TB infection control in overcrowded healthcare facilities like ART centres."
Health officer speaks
In September, health minister Dr Harsh Vardhan formally launched the first-ever nationwide TB drug-resistance survey to get a better understanding of the disease in the country. "This study comes at the right time. Studies like this are complementary to the national survey and are essential to get a close-up picture of the DR-TB epidemic in 'hot-spots' and marginalised populations," says Dr Arun Bamne, co-author of the study and former executive health officer of Mumbai's Public Health Department. "Such studies will help shape the national response with specific interventions for those populations most at risk of getting DR-TB."
Red alert
In last 5 years, BMC detected 6,701 multi-drug resistant TB patients in city
Study found that 25% of all cases of HIV/TB co-infection were drug-resistant in the first instance
People are being exposed to drug resistant bacterium in their communities or during their visits to healthcare centres
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
)
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}
)
){kind=small}
){kind=small}
)
)
)
)
)
){kind=small}
){kind=small}
){kind=small}
){kind=small}
){kind=small}