Out of about 2.7 million people that suffered tuberculosis (TB) in India in 2013, only 1.05 million completed treatment in the government-run TB programme.
Out of about 2.7 million people that suffered tuberculosis (TB) in India in 2013, only 1.05 million completed treatment in the government-run TB programme. The new estimates, which will be released in the prestigious medical journal PLOS Medicine on Wednesday, reveals that about 7,60,000 TB patients in India never reached government TB diagnostic clinics.
“Patients either remained untreated or received what is often poor quality care in India’s private sector,” claimed the study.
Speaking to this newspaper in Liverpool on the sidelines of the 47th Union World Conference on lung health, the lead author of the study, Dr Ramnath Subbaraman, said, “Our study highlights major opportunities to improve care by strengthening diagnostic services and implementing new interventions to improve tracking and retention of TB patients in India’s TB programme to make a dent in this leading infectious cause of death.”
As per the study, more than 500,000 TB patients in India got evaluated at government TB clinics, but were not successfully diagnosed with the disease at those clinics or not started on TB treatment despite getting diagnosed.
Significantly, for patients with multidrug-resistant TB (a form of the disease that is more difficult to treat), out of 61,000 who reached government TB clinics, only about 6,413, or 11 per cent, completed the treatment.
The analysis — “cascade of care” which is being used by the HIV community — has been done for the first time in India for TB estimates. The experts found that out of 2.7 million TB patients estimated by the WHO, only about 1.9 million reached the government TB centre. “The first gap is patient who never reached the centres. Our study found that out of 2.7 million patients, 1.9 million made to government and 1.6 got successfully treated,” added Dr Subbaraman.
Experts said that the gap is falling from two groups of patients — one is smear negative TB patients and second is MDR TB patients. “Those who are smear negative do not get diagnosed by sputum smear and have to follow a long process. They are not easily diagnosed. 60-80 per cent of these patients don’t make it through and hence the gap”.
Experts call for better diagnostics to track these patients.
“Rapid molecular diagnostic test, which include gene experts need to be scaled up. Use of electronic patients records so that patients can be linked using a unique ID like Aadhaar card number may help in tracking missing patients. Scaling up counselling like in HIV can also beneficial in achieving better results,” added Dr Subbaraman.
The study gains significance as India has 23% of the global burden of active tuberculosis (TB) patients and 27% of the world’s “missing” patients, which includes those who may not have received effective TB care and could potentially spread TB to others.
