Worried Over TB Spike, India May Launch Door-to-Door Monitoring Mechanism
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New Delhi: India's tuberculosis monitoring machinery is putting on the riot gear after a latest WHO report blamed the country for under reporting the number of patients.
A national level meeting of experts will now take a call on a new methodology to assess prevalence by aggressively doing door-to-door campaign instead of counting patients who approach the doctor.
TB or tuberculosis has been the second largest infectious disease killer in India. The country now has 27 percent of the world’s TB cases and deaths, and the number of deaths doubled in 2015 – 480,000 from 220,000 in 2014.
The all-India meeting to be held in New Delhi on October 18-19 will discuss and put in place a more aggressive strategy to deal with the disease.
Dr Sunil Khaparde, programme officer of the Revised National Tuberculosis Control Programme (RNTCP), told News18 that the meeting will decide on active case finding to replace the current practice of letting patients come to doctors.
Already implemented in parts of Mumbai, the strategy will involve going door to door in cities to spot instances of TB infection.
The ministry also approved a National Prevalence Study, which will get underway from the beginning of 2017. It will take two to three years to complete the study and will give a more accurate picture of the country’s disease burden. The last and only such study was done in 1956. International health communities have repeatedly told India it needs such a study, Dr. Khaparde said.
He pointed out that till the study is complete, even the results given to WHO are interim. “The results don’t mean an increase in the number of cases or disease burden, but a more accurate picture of it,” he said.
“With better surveillance we noticed this trend in 2014, when the there was a 38 percent jump in notification of the disease,” he added.
The meeting comes on the heels of the latest WHO report that estimated India had 28 lakh cases of TB in 2015, and 700,000 cases went unreported in 2014.
The 2014 estimate, found erroneous, was revised to 29 lakh from 22 lakh. Estimated cases of the deadly multidrug resistant (MDR) TB stand at 79,000.
Although the TB report has made medical circles sit up and take note, the health ministry’s defense is that it is the government’s increased surveillance that has thrown up the number of 28 lakh incidents of tuberculosis in the country, which was then submitted to the WHO.
As the ministry’s annual TB report for 2016 says these new measures have been appreciated by the global health body in its 2015 report.
However, what really caught WHO’s eye, that led it to pose questions to India, was an August 2016 study in the medical journal The Lancet that tracked the high sales of TB drugs in the private sector, indicating 50 percent more patients than previously calculated.
Dr. Khaparde admits they had to be honest with themselves when the study came out and relook their data.
The surveillance of TB markedly improved by making the disease notifiable in 2012, and an online notification system was implemented. The private sector, till then a void of information, had to now submit records of their cases.
“Private sector notifications went up to three times,” said Khaparde. This didn’t reflect in WHO’s 2015 report as that was calculated on “assumptions” made in 2011, he said.
Khaparde felt that that cooperation with the private sector for proper reporting of data fell in place only over the past year, thus more patients finally showed up in the latest numbers.
Before The Lancet however, a sub-national study on Gujarat, 2011, raised red flags, giving an incident rate of 450 cases per one lakh population, higher than the national average.
For now, Khaparde said the 500 new cartridge-based nucleic acid amplification test (CB-NAAT) machines for gene therapy purchased earlier this year, to supplement the existing 121 machines, were installed in three months, and are now in every district.
These machines provide the most advanced and accurate diagnosis, and will be used to test patients for whom the standard sputum test does not work -- HIV-TB cases, extrapulmonary TB, pediatric cases, suspected multi-drug resistant cases. The daily regime of medicines will also start by December.