More virulent and drug-resistant forms of the ailment are emerging, but Maharashtra has no facilities to either detect cases or treat them.
There is a growing belief among experts that multi-drug resistant tuberculosis (MDR), and its deadlier cousin, the extensively-drug resistant tuberculosis (XDR), may soon become bigger threats than HIV-AIDS. Yet these new strains of TB do not find any mention in the national TB control programme. Worse, Mumbai has no accredited laboratory to confirm cases of MDR and XDR TB.
As the city gears up to celebrate the World TB Day on March 24, civic authorities are struggling to provide treatment to anyone who is diagnosed with MDR or XDR. The Revised National TB Control programme (RNTCP) has started taking baby steps towards tackling these extreme forms, even while the ailment grows by leaps and bounds.
In Mumbai, till 2008, about 30,606 patients were enrolled for the Direct Observation Treatment (DOTS) Plus project under the RNTCP. “Of these, approximately three per cent were suffering from multi-drug resistant tuberculosis,” said Arun Bamne, deputy executive health officer of the TB Control Programme, Mumbai. He admitted that Mumbai does not have any laboratories to confirm MDR or XDR. “We are in the process of verifying the proficiency of certain laboratories, like the ones at Metropolis, Hinduja Hospital, Nair, KEM and JJ hospital,” said Dr Bamne. “Once verified, they will be accredited by the Centre to confirm such cases.”
In all of Maharashtra, only the Tuberculosis Research and Training Centre at Nagpur has been accredited to confirm MDR cases. Patients diagnosed with MDR or XDR TB have to run from pillar to post to accumulate money for their treatment as the national programme has no provisions to treat this more virulent form of the ailment. This, when India carries the highest burden of TB, accounting for one-fifth of the global incidence.
“Patients unable to find treatment in the national programme have to resort to private hospitals,” said Dr Zarir Udwadia, chest physician, PD Hinduja Hospital. “About 10 per cent of MDR patients coming here suffer from extensively-drug resistant tuberculosis. And the incidence is rising. It is high time the national programme started acknowledging this and providing a second line of treatment.”
Dr Amita Athavale, head of the chest and TB department at KEM, said the RNTCP was making changes to make itself more efficient. “Diagnostic tools have been reworked to rule out ambiguity,” she said. “And newer therapies, that will affect only specific cells, are on the anvil.”
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