New Delhi: Of the 29 lakh people in India suffering from tuberculosis, 6.19 percent have contracted multi-drug resistant form of the disease (MDR-TB), showed the results of India's first survey on it.
India's number of MDR-TB cases, currently estimated at 1, 47, 000, account for 25 percent of the world's disease burden.
This high prevalence has long been known but the epidemiology of DR-TB had never before been studied.
The results of the first National Anti-TB Drug Resistance Survey (2014-16) were released on Saturday, March 24, World TB Day by the Union Health Ministry. It is the largest such survey in the world.
A total of 5, 280 sputum smear-positive pulmonary TB patients, with 3240 new and 2040 previously treated patients, diagnosed at the designated microscopy centres of India's Revised National TB Control Programme (RNTCP) were enrolled in the survey. However, the study did not take into account patients treated in the private sector, where a large chunk of patients get treated.
The results showed that 2.84 percent of all new TB cases are drug resistant and, worryingly, 11.6 percent of the cases are found among previously treated patients. These numbers indicate gaps in India’s treatment protocol. Patient come back with MDR-TB possibly because of incomplete treatment and failure to adhere to the medicine routine. Government protocol states that any known TB patient should receive counselling and support to complete the six month treatment.
The treatment success rate among MDR-TB patients in India is consistently about 46 percent and the death rate is around 20 percent, against the global level of treatment success rate of 52 percent and death rate of 17 percent, said the report. To improve treatment for MDR-TB, the ministry also announced a shorter treatment of nine to 11 months, as News18 had reportedly recently. The treatment is for certain drug resistant patients who will qualify according to existing WHO guidelines.
Resistance to TB means resistance to first line drugs rifampicin and/or isoniazid. It goes on to include resistance to second line fluoroquinolones and injectables. A quarter of TB patients in India have drug resistance to one or the other anti-TB drug.
Among MDR-TB patients, there was additional resistance of 21.82 percent to any fluoroquinolones, and 3.58 percent to any second-line injectable drugs, said the report.
The report added that the high rates of treatment failure and deaths are associated with fluoroquinolone resistance in the Indian cohort of MDR-TB patients. Not surprisingly, the resistance to first- or second line drug resistance among all TB patients is 28 percent, with 22.54 percent among new and 36.82 percent among previously treated TB patients.
India has been tracking down and treating MDR-TB patients since 2007. By 2016, 1413331 TB patients were tested for drug resistance and 139369 MDR/rifampicin-resistant (RR)-TB cases detected in India. Among them, 126136 MDR/RR-TB and 6377 extensively drug-resistant (XDR)-TB patients were put on treatment. In 2016 alone, 580438 TB patients were tested, 37358 MDR/RR-TB diagnosed and 32914 MDR/RR-TB and 2475 XDR-TB patients put on treatment.
The survey clearly shows that drug resistance is present in all settings, said the report. A wide range of resistance patterns from any isoniazid resistance to XDR-TB needs to be addressed with strengthening of drug resistance surveillance, universal drug susceptibility testing (DST) and appropriate DST guided treatment strategies.
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