A recent study on the volume and pattern of sale of anti-tuberculosis drugs in the open market in the State has shown that there are as many cases of tuberculosis (TB) being treated in the State’s private sector as are being registered under the official Revised National TB Control Programme (RNTCP) every year.
However, not all these cases get notified in the official web-based, case-based notification network, NIKSHAY, set up by the Union Health Ministry.
TB has been considered a notifiable disease in the country since May 2012, and though most private practitioners are aware of the system, thousands of cases go “missing” from official records every year.
The anti-tuberculosis drug sales data of 2014-15 in the State shows that every year, at least 4,000 to 9,000 cases of TB diagnosed in the private sector in the State do not get notified in NIKSHAY at all.
“This does not mean that these patients are not getting treated. They receive treatment outside the national programme. Our only concern is that in the private sector, these cases may not always be followed up regularly, and there is no way to ensure that a patient has completed the drug course. Irrational prescriptions are another concern,” a senior Health official said. The data on the sale of anti-tuberculosis drugs in the State for 2014-15 was collected from all districts with the help of the State Drugs Control Department, pharmacists’ association, and drug distributors to make an assessment of patients outside RNTCP and to identify the gap in the notification of TB cases in the private sector.
Over-diagnosis
“A major concern is that there is an ‘over-diagnosis’ of TB in the private sector, wherein patients are started on anti-tuberculin treatment (ATT) empirically. This means that a significant number of cases being started on ATT are without any laboratory or scientific evidence and may not be TB at all,” he pointed out.
Physicians in the private sector are of the view that the reluctance to notify TB cases is owing to the fact that confidentiality is a major issue for patients, for whom a diagnosis of TB still carries a lot of stigma.
RNTCP is now in the process of promoting public-private mix (PPM) models of TB care, so that there is better involvement and compliance by the private sector as far as the Standards of TB Care in India are concerned. RNTCP staff will directly contact the patient only if the doctor requests, so that a patient’s confidentiality is not breached.
RNTCP also needs to develop some good PPM models for the follow-up of cases in the private sector because incomplete treatment can lead to the development of drug resistant TB.
“Going by the fact that the proportion of drug-resistant TB cases in the State is quite low, one can reasonably assume that fairly good standards of TB management are being practised by majority of private practitioners here,” P.S. Rakesh, epidemiologist and a former RNTCP consultant, said.
