By Ananya Singh
In a highly ambitious move, The Central Tuberculosis Division has set 2025 as the goal of eliminating tuberculosis. To further their treatment strategy, the Ministry of Health and Family Welfare launched the daily drug regimen for tuberculosis patients on 17 November 2017.
Reducing the pill burden
The recent switch to a daily treatment using fixed-dose combinations (FDC) has been introduced throughout the country under The Revised National TB Control Programme (RNTCP). As per Health Ministry guidelines, the daily doses for treatment will use Fixed Drug Combinations (FDC). FDC combines four to five essential drugs for combating TB in one pill. These will be made available to private practitioners and pharmacies. They may dispense the same to TB patients who seek treatment in the private sector, free of cost. The aim is to improve ease of accessibility for TB patients. Another feature of the strategy for daily treatment includes introducing child-friendly formulas such as dispersible pills.
Further, the dosage is to be administered in a more efficient manner, based on scientific principles according to the weight of the patient. The daily drug regimen encompasses dispensing FDC pills that reduce the burden of a large number of medicines on the patient. “The biggest advantage for the patient under the new regimen will be reduced pill burden, as instead of seven tablets, patients need consume only 2 or 3 tablets, according to his weight band,” R. Raghunandan, State Joint Director (TB) told The Hindu.
Making headways
The government of India’s Revised National TB Control Program (RNTCP) was initiated in 1997 and expanded to all parts of India by 2006. Its primary responsibility is to carry out India’s five-year TB National Strategic Plans (NSPs). Under RNTCP, diagnosis and treatment of tuberculosis are free of cost. The objectives of the program are to achieve and maintain detection of TB of at least 70% and TB treatment success rate of at least 85%.
Tuberculosis claims around 4.2 lakh lives in India on an annual basis. The country has long been battling the disease and its repercussions. Earlier, the Health Ministry was providing a treatment three times a week. The Government of India envisioned a TB-free country at the end of the five-year National Strategic Plan 2012-17, by successfully implementing Universal Access. The achievement of the above would be possible only through ensuring high-quality diagnosis and treatment for TB patients across the economic and social spectrum.
Adoption of the regimen
As such, the government extended the RNTCP to include the private sector and patients with drug-resistant TB. Government hospitals were following the thrice-weekly treatment. However, the private sector had been treating their large number of TB patients using tailor-made drug combinations.
The switch has been made as per the recommendations of World Health Organisation (WHO). Analysing the results of the intermittent treatment, it was found that patients under the thrice-weekly regimen were more prone to developing resistance to drugs used for combating TB. Further, there was also a higher chance of relapses. WHO revised their TB management guidelines in 2010 and advised the adoption of the daily drug regimen under the RNTCP in India.
India: A Tuberculosis ‘High Burden’ Country
India has a long way to go if elimination of TB by 2025 is to be achieved. India falls under the 22 TB ‘High Burden Countries‘ as determined by WHO. In 2016 alone, approximately 28 lakh cases of TB and 4.5 lakh deaths due to the disease were recorded in the country. India stands at the top with the highest number of TB and multi-drug resistant (MDR) TB cases in the world. It ranks second across the globe behind South Africa in terms of the estimated HIV associated TB cases.
Calculating the number of TB cases in the country has not been easy. While the government hospitals provide free of cost treatment, many cases go unregistered as the patients seek care in the private sector. In order to improve the efficiency of estimates, the government now requires every diagnosed TB case to be reported by the private sector. One of the primary reasons patients spend large amounts of money on private sector treatment is the lack of awareness about TB related services available through public programs. The government’s major hurdle in extending TB care to all remains a lack of knowledge on behalf of the public.
Benefits of new treatment strategy
As stated by Jennifer Furin, an infectious diseases expert at Harvard Medical School, “India’s TB programme has made a lot of progress in the past few years. But compared to what they need to do if they are serious about eliminating TB in eight short years, they have barely scratched the surface.” Accounting for nearly 25% of tuberculosis cases worldwide, India’s journey to eradicate TB is far from complete.
The switch to daily treatment is considered a positive step toward achieving the goal by 2025. Daily treatment is believed to have more favourable results as a combination of essential drugs is administered in one dose. With the thrice-weekly treatment, patients would often end up skipping medicines. Continuous missed doses can retard progress.
“With daily regimen, the advantages are better patient compliance and less drug toxicity. We can also prevent drug resistance. Moreover, patients cannot miss any drug as all drugs are combined in a single pill,” said Sunil Kharpade, Health Ministry’s TB Division chief. Further, daily treatment reduces chances of relapse. While benefits of the new treatment strategy seem promising, the actual results remain to be seen.
The way forward
In order to ensure that people make use of the advantages available under the public health system, awareness is of extreme importance. The government must work in tandem with the private sector for the success of the daily drug regimen. Under the NSP 2017-2025, the government aims to ensure maximum outreach and access, by extending aid to the private sector in providing quality treatment and care. This will allow a holistic approach to handling the fatal effects of TB.
All TB patients, whether in public or private sector must be awarded high-quality care and treatment to ensure no relapses. It is crucial that the government make use of information technology to achieve maximum outreach. Education drives must be undertaken to make public aware of early signs of TB, ensuring 100% detection and treatment.
The goal of eradicating tuberculosis in India by 2025 leaves the country with only eight years for achieving this ambitious project. TB remains one of India’s major health hurdles. The government needs to be quick about implementation and revisions in its policy. Also, there is a need to invest in education mechanisms to ensure that the burden of TB reduces in the coming eight years.
Featured Image Source: Visual Hunt
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