Study finds one-fourth of world’s multi drug-resistant TB in India

Published in Hindustan Times | By Rhythma Kaul | On March 25, 2018

On World Tuberculosis Day on Saturday, the health ministry released some ominous survey findings. More than one in four (28%) TB patients in India are resistant to at least one anti-TB drug, and one in 16 (6.19%) is ailing with difficult-to-treat, multi drug-resistant TB (MDR).

Alarmingly, the estimated number of MDR/rifampicin resistant (RR)-TB in India is 1,47,000, accounting for one fourth of the global burden of MDR/RR-TB, the survey report says.

Rifampicin is a key anti-TB drug, widely in use across the world.

What’s also worrying is that among MDR TB patients, 1.3% were detected with extensively drug-resistant TB (XDR-TB) that doesn’t respond to many of the most effective anti-TB drugs, according to the findings of the National Anti-TB Drug Resistance Survey (2014-16).

The focus of the survey was MDR-TB, in treatment of which India has a success rate of about 46% and death rate of 20%, against a global average of 52% and 17%, respectively.

“MDR TB is a menace and only about 50% patients can be cured even with best treatment available so focus should be on preventing drug-resistant TB from developing as far as possible by reporting cases, adhering to drug regimen and not dropping out of treatment mid-way among other things,” said GC Khilnani, head of the pulmonary medicine department at the All India Institute of Medical Sciences (AIIMS) in New Delhi.

The estimated number of MDR TB patients in India is 147,000, accounting for one-fourth of the global burden, showing how difficult it is to meet India’s goal of eliminating it by 2025.

Elimination, defined as bringing down new infections to less than one case per 100,000 population, is possible only when patients get diagnosed and cured without stopping treatment. Stopping medication without completing treatment exponentially raises the risk of developing drug resistance.

India still adds more new patients annually than any other country, contributing to 27% of the world’s disease burden, shows the TB India Report 2018 that was released alongside the survey report.

About 2.79 million TB patients are estimated to be added annually in India alone, of the total 104 million globally. Of the 1.3 million TB deaths globally, 423,000 are reported in India.

To be sure, the survey has its limitations. Data collected from private sector health facilities, where close to 60% of TB patients are treated, is inadequate.

“Private sector is an issue but we are hopeful that with our new gazette notification, wherein not reporting TB cases could lead to jail, should help in tracking cases. Our primary focus at the moment is to track and treat every TB patient,” said Sanjeeva Kumar, additional secretary (health).