The new strategy is to be extended across State by September

With the number of suspected multidrug resistant TB (MDR-TB) cases on the rise in the State, the State Health Department has plans to introduce Directly Observed Treatment Short Course (DOTS)-Plus, a comprehensive management strategy for control of MDR-TB across the State by September.

According to doctors, the best first-line anti-TB drugs (rifampicin and isoniazid) are not effective against MDR-TB cases. Nearly three per cent of the newly diagnosed sputum positive cases in the country are found to develop MDR-TB. One patient can directly spread the disease to at least 10 others if it is not checked at the initial stage.

Although MDR-TB poses a great challenge to the government as well as those involved in checking the disease, the introduction of DOTS-Plus was delayed by at least two years in Karnataka. It was introduced only six months ago in Bangalore Urban, Bangalore Rural, Kolar and Tumkur.

Sources in the State TB cell said the introduction of DOTS-Plus in the State was delayed because of problems in procurement of drugs.

Cases

State Health Commissioner B.S. Ramaprasad told The Hindu that as many as 4,000 suspected cases of MDR-TB had been detected in the State in the last six months. Of these, 72 were diagnosed positive cases from the four districts where DOTS-Plus had been introduced.

Mr. Ramaprasad, who along with Health Secretary E.V. Ramana Reddy reviewed the functioning of the State TB Cell two days ago, said DOTS-Plus strategy worked as a supplement to the standard DOTS strategy which Karnataka has been following for some years now.

What's DOTS?

The DOTS strategy involves making a volunteer responsible for ensuring that a TB patient adheres to the treatment regime. If a volunteer registers with the State TB Centre or the district TB unit as a DOTS provider, authorities will give the volunteer a two-day training and send patients to him/her for monitoring.

It is the volunteer's responsibility to ensure that the patient takes the medicine regularly.

“Although the pilot DOTS-Plus programme is still on in the five districts, there is a need to cover the entire State,” he said.

Success rate

Shashidhar Buggi, Director of SDS TB and Rajiv Gandhi Institute of Chest Diseases (RGICD), said 500 cases of MDR-TB had been diagnosed at the institute since 2006. “Of these, 300 have been treated successfully,” he said.

He stressed the need for concerted efforts from doctors, patients and the public to check its spread. This is all the more important with one person dying of tuberculosis (TB) every 90 seconds in India, he said.

Pointing out that DOTS-Plus would be more rigorous than the standard DOTS strategy, Dr. Buggi said it would mean taking medicines and injections daily for the first 6 to 9 months.

This strategy takes into account specific issues (such as the use of second-line anti-TB drugs) that need to be addressed in areas where there is high prevalence of MDR-TB, he said.

Awareness

In Karnataka, the infection rate is compounded by lack of awareness and patients discontinuing treatment. “Although TB patients are provided free medicines, people in rural areas do not have food to eat as they are poor. They discontinue (medication) because taking the medicine without proper food causes acidity,” Dr. Buggi added.