& Treatment

DIAGNOSIS & Treatment

TB is a curable disease. Yet lakhs of patients die of TB in India. This is most often because they are either diagnosed inaccurately or treated inappropriately. Since TB is airborne, an incorrectly diagnosed person can infect others. Further, inappropriate treatment perpetuates drug-resistance. Most often the challenges associated with TB diagnosis and treatment are attributed to economic, social and physical limitations in accessing diagnostics, continuing and completing treatment. We cannot address India’s TB crisis until we improve TB diagnosis and treatment to ensure all Indians with TB get detected and treated early!

Challenges of TB diagnosis and Treatment

Delayed diagnosis: TB remains undiagnosed and hence untreated for several reasons. These include, use of outdated tools for TB diagnosis; misuse of existing TB tests for the detection of active TB as well as inadequate uptake of World Health Organisation (WHO) endorsed rapid diagnostic TB tests. However, often a key reason for delayed diagnosis is poor awareness and inability to access health services. Often by the time TB is diagnosed it is either in advanced stages or drug resistant.

Inappropriate Treatment and poor compliance: Even when someone is diagnosed with TB, patients often receive inappropriate treatment especially in the private sector. This can lead to increased suffering, illness, drug resistance, and sometimes death. Further, completing treatment is the responsibility of the physician as well as the patient. However, patients are virtually offered little or no counselling to help them understand the repercussions of not completing TB treatment. Moreover doctors fail to do adequate follow ups for treatment and patients who stop treatment aren’t tracked on a regular basis.

Poor Understanding and Awareness: Most TB affected lack adequate information on effective TB diagnosis and treatment. This combined with reduced monitoring often leads to delayed diagnosis and treatment interruptions which in turn fuel the transmission of TB. Also patient literacy on treatment specifically remains extremely poor and limited. This combined with deep seated stigma and discrimination is a critical challenge for TB treatment.

What needs to be done?

Create public awareness on TB ensuring prevention and reduction of stigma:

India needs to urgently address issues of public awareness, prevention, community engagement and stigma reduction. Survivors and TB affected communities remain passive recipients of care often fearful of accessing treatment or speaking out about TB due to wide spread discrimination. Our fight to combat TB must begin with empowering individuals and communities with information and reducing stigma.

  • Create a comprehensive multi-media awareness campaign to ensure awareness of all kinds of TB, their symptoms and the need for early diagnosis and treatment.

  • Focus on creating awareness of Extra Pulmonary TB which remains neglected and those affected by it suffer from delayed diagnosis and treatment.

  • Strengthen community and institutional infection control measures to act as a strong preventive tool especially within high-burden settings.

  • Ensure mandatory counseling for TB affected individuals and families to ensure prevention and family support for TB affected.

Early and accurate diagnosis for every Indian:

Extensive research has shown that delayed and inaccurate diagnosis is one for the primary drivers of India’s TB epidemic and its growing menace of drug resistance. In order to ensure accurate diagnosis the following measures can be taken up:

  • Substitute sputum smear microscopy with WHO-endorsed, highly sensitive molecular diagnostics by 2017, while simultaneously scaling up capacity for liquid cultures and DST.

  • Scale-up implementation of new diagnostic tests, and offers universal drug-susceptibility testing (DST) to all TB patients to ensure rapid detection of all forms of TB.

  • Create mechanisms to ensure every Indian seeking care in both the public and private sectors can easily access accurate TB tests for free whenever needed. 

  • Prevents the use or entry of sub-optimal tests by making sure that all new diagnostics for TB undergo rigorous validation before approval.

Prioritize changes in treatment of TB: 

Treatment practices for TB in India continue to be disjointed. There needs to be alignment between international practices and the public and private sectors. Some key changes in this regard can be:

  • Create partnership with the private sector to ensure alignment between the public and private sector guidelines on treatment and diagnosis.

  • Provide quality assured drugs for entire treatment period for each patient through accredited public and private outlets/pharmacies.        

  • Ensure access to free drugs to all patients irrespective of whether they seek care in the public or private sector.

  • Ensure quick access to new transformative drugs such as Bedaquiline and Delaminid through the government system to patients who need them the most.

  • Shift from the intermittent regimen to the daily regimen under direct observation to have uniformity of care across all healthcare sectors. This will help ensure universal access and also prevent further drug resistance.

  • Provide drug susceptibility testing guided treatment as a norm to all suspected drug resistant TB cases to ensure appropriate treatment and prevent MDR TB cases from becoming XDR TB.

Most often the challenges associated with TB diagnosis and treatment are attributed to economic, social and physical limitations in accessing diagnostics, continuing and completing treatment"

India cannot defeat its TB epidemic until we provide the millions of affected people quick, accurate diagnosis, including access to drug resistance tests as well as appropriate TB treatment. The regulation of diagnostics, introduction of new technologies as well as increased public awareness on both TB diagnosis and treatment is an essential step in India’s fight against TB. Until we do so, TB will continue to make Indians suffer and die, placing an enormous social and economic burden on India. It is essential that the people of India, especially its most disadvantaged, be protected from TB. 

the petition