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2 Drug-Resistant TB in India
2 Drug-Resistant TB in India
Pages 17-36
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From page 17... ...
• ndia's RNTCP has an overall goal of providing universal access I to quality diagnosis and treatment for all TB patients, with an inter mediate goal of successfully treating at least 90 percent of all new and at least 85 percent of all previously treated patients. continued 1 This chapter is based on the presentations of Ashok Kumar, Deputy Director General and Head, Central TB Division, and Project Director, RNTCP; Kuldeep Singh Sachdeva, Chief Medical Officer, Central TB Division; S
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From page 18... ...
However, the increasing burden of drug-resistant TB introduces new challenges to TB control and treatment. Ashok Kumar, Deputy Director General and Head, Central TB Division, and Project Director, RNTCP; Kuldeep Singh Sachdeva, Chief Medical Officer, Central TB Division; S
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From page 19... ...
. Sachdeva noted that the RNTCP carried out a drug resistance surveillance survey in accordance with global guidelines in the states of Gujarat and Maharashtra in 2007 and in Andhra Pradesh in 2009 (Table 2-1)
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From page 20... ...
According to drug resistance surveillance data from Gujarat, fluoroquinolone resistance occurred in 24 percent and kanamycin resistance in 3 percent of 219 MDR TB cases detected. XDR TB was observed in about 3 percent of MDR TB isolates, and all 7 of these cases were in previously treated patients.
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From page 21... ...
With regard to prevention, the plan calls for improving and sustaining high-quality DOTS implementation, promoting the rational use of anti-TB drugs, and implementing infection control measures. The RNTCP is also seeking to improve laboratory capacity, effectively treat MDR TB patients, initiate and rapidly scale up MDR TB services, and evaluate the extent of second-line anti-TB management strategies.
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From page 22... ...
In a small number of cases the treatment history was not recorded, and 0.4 million had already been diagnosed with TB but had their treatment changed to a retreatment regimen after treatment failure or interruption. In 2010, an estimated 3.4 percent of new TB cases globally were MDR TB and an estimated 20 percent of retreatment TB cases were MDR TB (WHO, 2011a)
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From page 23... ...
The standardized treatment regimen for MDR TB in India is a 6-drug regimen, with an intensive phase of 6–9 months and a continuation phase of 18 months; the total duration of treatment is about 24–27 months. The six drugs are kanamycin, levofloxacin, cycloserine, ethionamide, pyrazinamide, and ethambutol.
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From page 24... ...
Human resource capacity will be strengthened by having a DOTS-Plus coordinator in every district and additional staff at laboratories and DOTS-Plus sites. By 2012, the number of DOTS-Plus sites is slated to increase from about 24 currently to 200 sites covering all states across the country -- the equivalent of 1 site per 10 million people (RNTCP Status Report, 2011)
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From page 25... ...
TAMIL NADU laboratories to obtain accreditation KERALA Medical college/NGO/private laboratory (preparatory) (i.e., "preparatory" status in the leg Thiruvananthapuram National reference laboratory end above)
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From page 26... ...
Cegielski suggested that the high level and diversity of drug resistance found at baseline suggests that standardized treatment approaches for MDR TB are not advisable. The 2010 IOM workshop in South Africa (IOM, 2011a)
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From page 27... ...
A Kumar noted that meetings organized by the GDF, WHO, and the RNTCP have brought Indian drug manufacturers together to educate them and encourage them to adhere to established standards.
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From page 28... ...
The partnerships are designed to achieve community awareness, improve access to TB care, reduce patient costs and inconvenience, detect cases early, promote the rational use of anti-TB drugs, and ensure sustained funding. For example, the Indian Medical Association and other private-sector professional societies, particularly those for chest physicians, have endorsed the application of international standards of TB care.
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From page 29... ...
Improving the efficiency with which suspected MDR TB cases are referred and tracing patients who are lost to follow-up are both critical, since the best treatment for MDR TB is to prevent it from developing. The irrational use of first- and second-line drugs needs to be discouraged, including in education and training provided at medical colleges.
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From page 30... ...
WHO (2008) also has established basic guiding principles for designing a treatment regimen for drug-resistant TB: 13This section is based on the presentation of Rohit Sarin, Senior Consultant, LRS Institute of Tuberculosis and Respiratory Diseases.
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From page 31... ...
One is an empirical treatment strategy, in which a DST report is not available, but a course of treatment is devised on the basis of a patient's history of drug intake and other factors. In an individualized treatment strategy, a DST report is available for a patient for all 14 A recent WHO (2011c)
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From page 32... ...
The disadvantages of a standardized treatment strategy are that it is not as effective as an individualized strategy in all cases; it can amplify resistance; the drug susceptibility pattern within a community needs to be well documented; and organisms may be resistant to some of the drugs in the regimen, resulting in an avoidable increase in both cost and toxicity. Countries can adopt MDR TB treatment strategies on the basis of the laboratory method used to confirm MDR TB.
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From page 33... ...
In resource-limited settings, standardized treatment regimens may be necessary instead of individualized regimens. Different options for standardized regimens are available, depending on drug resistance patterns in the country.
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From page 34... ...
Specialized training should focus on operations research, drug management, treatment of drug-resistant TB, TB and HIV coinfection, and infection control, said Thomas. Training should be followed by in-service monitoring and supervision to detect performance deficiencies, identify new staff in need of training, and identify additional staff needed for current and new interventions.
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From page 35... ...
• Because diagnoses were taking such a long time, in part because of a lack of laboratory capacity, private laboratories are now being accredited and utilized for more rapid diagnoses. • All types of health care providers, including private-sector labora tories, NGOs, medical colleges, other private institutions, and pro fessional societies, are now being incorporated into TB treatment.
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