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ISTC is key to containing tuberculosis, says expert

C. Maya

Dr. Philip Hopewell, Professor of Pulmonary Medicine, University of California.

Thiruvananthapuram: Increasing levels of drug resistance to tuberculosis is an emerging problem worldwide. However, drug resistance is a problem created by poor treatment practices, says Philip Hopewell, Professor of Pulmonary Medicine and Associate Dean of the University of California, San Francisco.

The former president of the American Thoracic Society, Dr. Hopewell was the co-chair of the international committee which drafted the International Standards for Tuberculosis Care (ISTC), a document that has been endorsed by the WHO and the Centres for Disease Control and Prevention (U.S.) as the standard for delivering high-quality care for TB patients.

Global tuberculosis control efforts are hampered because of the deviation from standard and internationally recommended treatment practices by medical practitioners, which not only result in in-correct treatment, but also leads to the emergence of drug-resistant strains, he says. Dr. Hopewell who was in the city recently to review the pilot studies on the acceptance of ISTC among medical practitioners, was talking to The Hindu.

"Globally, it is estimated that about three per cent of the total TB cases can become multi-drug resistant TB (MDR-TB) or the new strain, extensively drug resistant TB (XDR -TB) cases. But we should not lose sight of the fact that we still have a lot of drug-susceptible cases of TB in the community and proper management of these cases is very important from the public health point of view," Dr. Hopewell says.

The increasing data on drug resistance makes it all the more important that TB control strategies followed by public sector and private sector health providers are guided by international recommendations so that the services in both sectors are of acceptable quality, with standardised treatment regimens.

"A large number of TB cases in India are managed by private medical practitioners and they should be encouraged to conform to the standards set by the ISTC. Physicians will like to treat their patients individually but the DOTS strategy of the WHO has the sound backing of extensive research and data on the drug regimens and the side effects of chemotherapy. When every patient is treated differently, it becomes difficult to tackle TB as a public health problem," he says. The MDR TB has ceased to be a major problem in the U.S. now because for the past 50 years now, all our recommendations and strategies for TB control have been drawn up jointly by the Centres for Disease Control and the American Thoracic Society.

This public-private collaboration has been helpful in enforcing a standard approach towards TB care and in keeping the caseload down, he adds. "The use of the ISTC could be one way in which the private and public sector doctors in India can come together to improve TB care," he says.

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