The Hindu : National : Engage the local community in TB treatment, says U.K. expert

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Engage the local community in TB treatment, says U.K. expert

Ramya Kannan

A third of population with active TB not known to access treatment services

— Photo : N Sridharan

Paul Sommerfeld.

CHENNAI: While India’s basic model to treat Tuberculosis is good, the country will do well to engage local communities and improve referral diagnostic centres to make the programme work better, Paul Sommerfeld, chair of trustees, TB Alert, U.K.’s National and International Tuberculosis charity, has said.

India has the dubious distinction of having more TB cases than other countries, because of its population, though it did not have the highest rate of TB. It is estimated that a third of the Indian population who contract active TB are not known to access proper treatment services.

Human face to DOTS

The basic model, based on a Directly Observed Treatment, Short Course (DOTS) approach, is well organised to provide services across India. DOTS is at least nominally available in every part of India for effective treatment and the national TB programme staff have been well trained to detect and deliver drugs. It was a major achievement by the Indian government, Mr. Sommerfeld added.

However, reaching out to the community and involving them in the treatment process would help overcome some of the shortcomings of a strictly medical solution. “There are bound to be all sorts of little glitches — willingness and co-operation of the patient as well as the administrative effectiveness of the programme. All of that can be helped by community action,” Mr. Sommerfeld told journalists at The Hindu on Wednesday.

“Long disease”

“TB is a long disease to deal with. It is a disease that is curable… For 50 years we have had effective drugs. But it involves a 6-month treatment course,” he said. To hold on to the patient during the full course of treatment was difficult.

In his opinion, the world would need new tools which would help deal with the disease more efficiently. “We have been playing around with diagnostic tools that go back to the 1980’s, we are dealing with a not-so-effective vaccine that dates back to 1920’s and haven’t had a new drug for the basic regimen since Rifampicin in the 1970’s,” he said.

However, there was good news too. There was a lot of research; new diagnostic tools are now available; three new drugs are in the last stage of trials and there is optimism that within five years, at least one new drug will be part of the normal medication for TB that will bring treatment time down to three months, Mr. Sommerfeld explained.

Referral diagnostics

He also raised the point of strengthening laboratory facilities in the country. While India was one of the leaders in having basic microscopy centres (to run basic tests) for every lakh population, going beyond that basic tool, for instance, to test drug resistance was a greater task. There were insufficient referral centres for that, he added.

MDR TB

Multi drug resistant TB, where patients develop resistance to the main drugs, is becoming increasingly an issue in India.

While there was no clear picture on how large a problem it is, it is believed that a number of cases of MDR TB go undetected in India, Mr. Sommerfeld said.

The Revised National Tuberculosis Control Programme was trying to address that through its DOTS Plus campaign.

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