New Delhi: As per the study under the knowledge of RNTCP, modelling was done and forecasted the percentage of MDR tuberculosis among incident cases of tuberculosis to increase, reaching 12·4% (95% prediction interval 9·4–16·2) in India by 2040. However, based on data from the National Drug Resistance Survey 2015-16, among all TB, MDR-TB is 6.2% which is in line with global average.This was stated by the Minister of State (Health and Family Welfare), Mr Ashwini Kumar Choubey while speaking in the Parliament (Rajya Sabha) recently.
The Minister listed the steps taken by the government to tackle the problem of TB by 2025. “Early diagnosis of all the TB patients, prompt treatment with quality assured daily treatment regimen along with suitable patient support systems to promote adherence to prevent the development of drug resistance among any patient. To identify the drug resistance at early stage, all TB patient are being screened for detection of resistance under Universal Drug Susceptible Testing (U-DST),” said Mr Choubey.
“Revised guidelines for Programmatic Management of Drug Resistant TB (PMDT) are being implemented since December 2017,” he said adding “Increase in diagnostic and management capacity for early detection and consequent earlier initiation of treatment. This will aid in decreasing mortality and cutting down transmission of the infection.”
“The country has 1180 functional CBNAAT sites, 89 Culture and Drug Susceptibility Testing (C-DST) laboratories certified in various technologies for drug resistance-TB detection,” Mr Choubey said.
The MoS Health listed the newer evidence-based regimens that have been introduced to improve the treatment outcomes of drug resistance TB patients:
The Shorter MDR Regimen for MDR/RR TB patients (9-11 months of regimen instead of 24 months of conventional regimen)
Newer drugs (Bedaquiline) containing regimen has also been introduced country-wide under the program and made accessible to all districts during 2018.
Newer drugs (Delamanid) containing regimen has been introduced in 7 states.
Various interventions like Integrated mechanism for management of Adverse Drug Reactions (ADRs), provision of patients and family counselling at the time of diagnosis and during the course of treatment, airborne infection control as well as grievance redressal mechanism have been introduced to improve patient compliance, the Minister informed.
“The Nikshay Poshan Yojana provides 500 INR monthly to all TB notified TB patients in order to provide nutritional support and aid in the treatment of TB,” he said.
Mr Choubey pointed out that the private sector engagement is being promoted to reach out to all patients who are seeking treatment in the private sector and efforts are being made to provide them all diagnostic, treatment and care facilities, including public health action such as counselling, nutritional support, contact tracing etc.
Achievements during 2018
In 2018 year, 5, 36,752 TB patients have been notified from private sector. There has been 40% increase in TB notification from private sector as compared to 2017. 44,517 (8%) TB patients were given anti-TB drugs from the programme.
As per State reports till 25.01.2019, 40% notified TB patients, 35% treatment supporters and 8% private practitioners have been paid incentives through DBT.
The shortfall in stated targets, reasons thereof and strategies are as follows:
A massive partnership with the private sector has been initiated as Joint Effort for Elimination of Tuberculosis (JEET) for the elimination of TB by 2025, five years ahead of the global schedule. Though the MoU was signed in March 2018, the project was launched in May 2018 and has picked up from October 2018.
To increase in notification from private sector, public private support agency approach has been initiated in 85 districts from May 2018 onwards; Indian Medial Association has been engaged for large scale sensitization and advocacy with private practitioners with standardized digital material.
States have been supplied anti-TB drugs to covering TB patients notified from private sector based on demand. States have been guided to keep programme provided anti-TB drugs at private practitioner’s clinic or pharmacy
Invalid or dormant bank accounts or holding of account in a branch which is yet to be integrated with PFMS (Public Finance Management System) are a few challenges being faced in scheme implementation. To overcome these issues and to ensure that beneficiaries of the schemes are not denied of DBT benefit, flexibility of providing the benefit through existing bank account of a blood relative has been given. States have also been advised to facilitate opening of zero balance accounts for TB patients, if necessary, under the PradhanMantri Jan DhanYojana (PMJDY) and Indian Postal Bank.