The troubling factor: Extra drug resistant tuberculosis

By Syed Akbar
Hyderabad: The renewed fight against tuberculosis in the country
has paid rich dividends with the incidence of the killer disease coming down
by appreciable levels.
But what is worrying health experts and planners is the explosion of drug-
resistant tuberculosis fuelled by HIV/AIDS. Andhra Pradesh, with the largest
number of HIV/AIDS cases in the country, is now more vulnerable to drug-
resistant TB. Incidentally, the State too has a large number of TB patients.
India has one of the largest number of TB patients accounting for
one-fifth of
all the TB cases in the world and the emergence of drug-resistant TB strains
has become a major challenge to medical doctors and scientists alike.
Strains of extremely drug-resistant tuberculosis or XDR-TB have now been
found in 28 countries including India. The death rate for people co-infected
with HIV and XDR-TB is around 85 per cent while for normal TB patients is
less than 10 per cent.
According to World Health Organisation, India continues to be a global TB
hot spot, despite reduction in the incidence in the country. In India
every one
minute a person afflicted by TB dies. The WHO observes that HIV and drug-
resistant TB are threatening to reverse the gains made in TB control over the
last few years. A majority of newly diagnosed TB
patients have developed resistance to first-line anti-TB drugs.
The Central government launched last year a new strategy to stop TB and
achieve reversal of the epidemic by 2015. "The new strategy while building
on the previous DOTS strategy to control TB, includes additional
interventions to meet evolving challenges such as HIV associated TB,
emerging drug resistance and enhance the uptake of services by the
community at large," a senior health official pointed out.
The death rates due to tuberculosis have come down to just four per cent
because of strict implementation of DOTS in different parts of India
including Andhra Pradesh where TB is largely prevalent. While the death rate
in patients who do not undergo DOTS is a whopping 29 per cent, those who
are treated by DOTS are less susceptible with just four per cent mortality.
Where DOTS is not used, infectious patients are seven times more likely to
die from the disease.
Union Ministry of Health and Family Welfare records point out that more
than three lakh children are forced to leave school every year because their
parents are TB patients. More than a lakh women with TB are rejected by
their families due to social stigma attached to the disease. The economic
cost
of tuberculosis in the country is about Rs 8,000 crore a year, i.e. had the
disease been controlled, India would have saved that much amount.