The first-ever survey of drug-resistant (DR) tuberculosis (TB) has found that over a quarter of patients in India could be resistant to one or more drugs that can cure them. India is home to 2.8 million TB patients, the largest in the world.
On Saturday, the Union Health Ministry released the National Anti-TB Drug Resistance Survey report where it shows that India is home to 2,666 cases of extensively drug resistant (XDR) TB, which is being infected by the deadliest strain of the airborne disease and resistant to all known medicines. Among the 4,958 patients on whom drug susceptibility testing (DST) was conducted (necessary to find out if a person has drug resistant TB), 28% had resistance to one or the other anti-TB drug, while 6.19% had multi-drug resistant (MDR) TB.
“The bad news is that resistance to any TB drug (i.e. any first- or second-line) among all TB patients was 28%. In other words, over a quarter of Indian patients carry TB bacteria that are resistant to at least one anti-TB medication. This puts them at high risk of acquiring resistance to additional TB drugs if quality of TB treatment is not good,” says Dr. Madhukar Pai, Associate Director at the McGill International TB Centre, Montreal, Canada.
In 2017, India re-estimated its national TB burden to reflect 2.8 million cases out of total 10 million global cases; of these 1,47,00 are MDR. According to the new data, last year alone, 1.8 million TB cases were reported in India, out of which 38,605 cases were MDR-TB and a further 2,666 were XDR. The country reported 423,000 TB deaths in 2017.
The new data also confirm what experts have long suspected: India’s crowded mega-cities provide a perfect breeding ground for the airborne infection to spread. With 879 XDR patients, Maharashtra has the highest number of such patients. Uttar Pradesh has the highest number of cases of drug-resistant TB (9,138); 619 of these are XDR. In addition, the new data show that nearly 3% of new patients and nearly 12% of previously treated patients have MDR-TB.
No private sector data
While this is the largest study of its kind, the survey does not reveal the national burden of DR-TB as it does not include data from patients being treated in the private sector. The survey was done at designated microscopy centres (DMCs) within the laboratory network of the Revised National Tuberculosis Control Programme (RNTCP), and provides a conservative estimate of India’s actual disease burden. “It is important to note that patients in the Indian survey were sampled only from RNTCP centres, and not the private sector. Since over half of all TB patients are managed in the private sector, we are still not getting a ‘national’ perspective. We know [that the] quality of TB care is quite poor in the private sector, and I suspect DR-TB rates are probably higher in the private and informal sectors. Hopefully, the next DRS can sample patients in the private sector,” Dr. Pai says.
For better cooperation from the private sector, the government, on Thursday, announced that doctors and pharmacists could be jailed for up to two years for failing to report new cases. The report comes as the government has prioritised identification of new cases. Dr. B.D. Athani, Director General Health Services says, “Currently, TB incidence is declining by 1.2% per year and to achieve the TB elimination goal by 2025, we need to have a decline in TB incidence by 15-20% annually.”
India has set itself the target of eliminating TB by 2025, five years ahead of the global target set under the Sustainable Development Goals. To reach the ‘elimination’ target, the country will have to restrict new infections to less than one case per 100,000 people as against the current rate of 211 new infections per 100,000 people.
vidya.krishnan@thehindu.co.in
