Multi Drug Resistant (MDR) TB has reared its ugly head throughout the world including in India, where MDR TB is three per cent of the total new Tuberculosis cases reported every year. According to latest WHO estimates, in 2008 4.4 lakh people were infected with MDR TB across the world.
With 1.8 million new cases annually, India carries the largest TB burden in the world, which is one-fifth of the world's new cases. In fact, India along with China is home to 50 per cent of the world's MDR TB, the WHO says.
Drug resistant TB occurs when patients are not treated with standard treatment protocols or when patients enrolled on standard treatment protocols discontinue their treatments for various reasons.
"Each treatment default and failure needs to be seen as adding to the drug-resistance pool, and aggressive strategies need to be applied to minimise treatment defaults, and better diagnostic screening should be put in place for prevention of treatment failures, especially among those seeking re-treatments," Dr Bobby John, President, Global Heath Advocates said.
According to him, this can be achieved by increasing the number of microscopy-based diagnostic centres, which currently are established at a penetration level of one for every 100,000 population so that there is improved case detection.
People who default on their treatment and those who don't have cure as an outcome of their treatment form the major portion of potential pool for drug resistance in any community. Primary resistant infection is the remaining part.
The other important need is to increase the number of Drug Sensitivity testing labs, to better screen re-treatment seekers for drug resistance, he said.
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People presenting themselves with relapse of TB, or after previously defaulting their treatment, or having had treatment failure earlier, need to be screened before being initiated on treatment again.
In order to test for MDR TB, drug sensitivity tests (DSTs) need to be conducted on cultures samples, for which India is setting up intermediate referral labs (IRLs).
India's TB Control Programme has established nine accredited IRLs at Andhra Pradesh, Delhi, Gujarat, Kerala, Maharashtra, Orissa, Rajasthan, Tamil Nadu and West Bengal.