Even as the Centre refused to acknowledge the emergence of totally drug resistant (TDR) TB cases, the Maharashtra government has decided to introduce mandatory notification of all multi drug resistant (MDR) and extensively drug resistant (XDR) tuberculosis cases. Non-compliance of this notification will attract punishment. The Maharashtra government will also adopt these cases and offer them free treatment.
All public and private sector laboratories will have to report any such suspected drug resistant cases, re-test them from a Revised National Tuberculosis Control Programme (RNTCP) accredited laboratory and treat all such confirmed drug resistant TB cases as per the RNTCP guidelines.
A statement issued by the Central team that visited Mumbai following reporting of 12 TDR TB cases — three of whom have since died — said that the cases has been “erroneously” labelled as TDR-TB and cases reported by Hinduja Hospital fall only within the category of Extensively Drug Resistant TB (XDR TB) based on standard WHO definitions.
Diagnosis of XDR TB must be based on microbiological confirmation from the accredited national reference laboratories namely National Institute of Research in TB in Chennai, National TB Institute in Bangalore and LRS Institute of TB and Respiratory Diseases in New Delhi.
The Municipal Corporation of Greater Mumbai (MCGM) will also strengthen the TB service delivery systems in Mumbai by immediately converting all the 24 wards of MCGM to 24 RNTCP districts, with placement of requisite infrastructure and human resource for 24 district TB drug stores and one additional State level TB drug store at Mumbai.
The MCGM will also decentralize basic Tuberculosis Unit (TU) from the current population level of 1 TU per 5 lakh to 1 TU per 2 lakh population for enhanced outreach and services delivery. Additional 35 TUs with Medical Officer TB Control and 20 Microscopic centres with lab technicians will be immediately created.
Three additional DOTS-Plus sites, along with additional culture & DST laboratories, will be established at GTB Hospital under MCGM at Mumbai. There will be immediate up-scaling of DR TB services to universal access criteria to test patients for MDR TB in Mumbai, including those from the private sector.
