The Health Department is moving to integrate the Revised National TB Control Programme (RNTCP) with the State’s Non-Communicable Diseases (NCD) control programme as the number of patients with both diabetes and tuberculosis (TB) has been going up in the State.
Diabetes interferes with the treatment of TB and increases the case fatality and relapse of TB. Given the high prevalence of diabetes in the community, it is believed to be primarily responsible for the increasing incidence of drug-resistant TB in the State.
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Kerala has been reporting high levels of failure of standard TB treatment using first-line drugs (6 per cent) owing to the prevalence of diabetes among TB patients. Experts suspect that the different drug regimens taken by the patient for diabetes and other co-morbidities are affecting the therapeutic levels of TB drugs in the bloodstream, thus affecting the treatment outcome for TB.
Public health experts have been suggesting for some time now that a collaborative framework be evolved between the two vertical disease control programmes so that there is a better understanding of drug interactions or synergistic effects, which may result in improved drug adherence and better treatment outcomes.
The first of the meetings to work out a common framework for TB-diabetes control will take place here in the first week of May when top officials from the national and State NCD control cells, Confederation of Indian Industry, and pharma major Eli Lily are expected to get together.
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The estimated prevalence of diabetes in Kerala is around 20 per cent, and in the rural areas, this is 22 per cent. There have not been any previous estimates of the prevalence of diabetes among TB patients.
Survey
In a survey led by the International Union Against Tuberculosis and Lung Diseases and the State TB Cell in October 2011 among 22 rural and eight urban reporting units under the RNTCP in Kerala, in a sample of 552 TB patients the prevalence of diabetes was found to be 44 per cent. Among the diabetic TB patients, 84 per cent had inadequate control of diabetes. RNTCP officials said that for the past three or four years, all TB patients were being screened for diabetes and the diabetes status was noted in the RNTCP treatment card too. However, the RNTCP was unable to follow up the patient, ensure that the blood sugar monitoring was done regularly, and medications were taken properly.
“There is a lot of attention in the international scenario on the dangerous combination of diabetes and TB. Till now, the only co-morbidity that was being focussed on was HIV. But blood sugar monitoring and treatment will have to be taken up within the general health system. Though there had been some attempts to link the TB programme with the NCD control programme, we could not take it forward as we could not streamline the logistics involved,” a senior RNTCP official said.
Free diabetes medication, including insulin, is provided to patients now under the State’s NCD control programme. After the initial hiccups, the distribution of medicines has become more or less streamlined. A proper framework will have to be drawn up to ensure that the logistics of both TB and NCD control programmes are well-coordinated.