India’s case with TB is like that of “blind men and an elephant”

Dr Zarir Udwadia, Consultant Chest Physician, a speaker at the recently held TEDx Gateway, shares his views on the gaps in India’s TB strategy with Viveka Roychowdhury

As a chest physician, what is the most frustrating part of treating TB patients in India?

As a physician treating TB patients, there are issues pertaining to healthcare sector inefficiency and patient behaviour that are seen as impediments

1. Public sector or the national programme that caters to the under-served population has a dogmatic but obsolete approach rendering it not just inefficient but amplifier of our TB epidemic. Private healthcare sector is amorphous, or at the best unorganised, leading to inappropriate management of the patients. Also poor resource allocation and frequent drug shortages in the market causes treatment disruption of the drug in the regimen further amplifying the resistance profile of the bacteria. For example at this very point in time two pivotal second line drugs clofazamine and kanamycin are not available in any pharmacy in Mumbai. This is irresponsible in the extreme of the pharma industry who should recognise the importance of regular treatment in this one disease.
2. It is very disturbing when patients don’t follow the prescribed regimen. Those with resources at hand, go on a doctor’s shopping spree usually consulting two to three doctors and failing to follow even one. Whereas those lesser fortunate have meager resources to even afford the prescribed treatment. Such inconsistent behavior compounded with low literacy levels lead to poor follow up and treatment drop-outs, which further breeds the disease in the community.

Are you hopeful that global plans like WHO’s End TB Strategy will achieve their goals?

Currently goals set by WHO End TB strategy appears to be far fetched. The current measures taken by various high burden countries fall short to break the transmission cycle. Most of the resources allocated are to treat the prevalent TB population with poor emphasis on prevention.

India’s performance to be specific has been abysmal with more than one quarter of the one million missing TB patients moving freely in India. India’s case with TB is like that of “blind men and an elephant” where we are trying to curb the epidemic without knowing its actual scale. India’s plan to study National TB prevalence, which is slated to start in 2017, will pave way for further action.

Are you satisfied with the implementation of India’s TB Mission 2020 plan? Any gaps and suggestions to plug them?

India’s report card on TB management is dismal in all quarters. The cascade of care for TB which evaluates the performance of healthcare delivery system recommends radical measures to ramp up the fight against TB. According to the latest reports 40 per cent of TB symptomatics in India never seek healthcare. Of those who seek healthcare in the public sector only 40 per cent of treated TB patients have a recurrence free survival at one year whereas only 11 per cent of treated MDR-TB patients have recurrence free survival.

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