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India has the world’s highest estimated burden of multi–drug–resistant tuberculosis patients and needs to substantially accelerate its capacity for diagnosis and treatment of these patients, a World Health Organisation report has indicated.

The WHO’s global tuberculosis report for 2013, released today, estimates that India accounts for 64,000 cases of multi–drug–resistant tuberculosis (MDR–TB) among notified patients with pulmonary (lung) tuberculosis. China and Russia follow with 59,000 and 46,000 cases.

The report, based on data provided by national tuberculosis programmes, shows that the number of MDR–TB patients notified in India nearly quadrupled from 4,237 in 2011 to 16,588 in 2012. In both years, hundreds of patients with MDR–TB were not enrolled for treatment.

"This fourfold increase in the number of notified MDR–TB cases actually reflects a growing national capacity to detect MDR," said Bobby John, physician and president of Global Health Advocates, a non–government organisation tracking tuberculosis trends in India.

"But the figures also reveal the huge challenge ahead –only 16,000–odd cases are detected (whereas) the estimated burden is 64,000. The capacity needs to expand quickly," said John, who was not associated with the WHO report.

While drug–sensitive tuberculosis is treated with a combination of four drugs through a regimen that lasts six to nine months, treatment for MDR–TB is more expensive, has greater risks of side effects, and lasts 18 months to two years.

Drug-Resistant TB Challenge for India

The WHO report, analysing a worldwide MDR–TB crisis, says the response – to test and treat all patients affected by MDR–TB – has been inadequate and attributes this to insufficient resources for battling tuberculosis.

Control programmes in many countries lack the resources to test, detect and provide appropriate drugs and medical care to all their MDR–TB patients. In India, during 2012, only 14,143 among the 16,588 notified MDR–TB patients with pulmonary tuberculosis were enrolled for treatment.

"It is unacceptable that the increased access to diagnosis is not being matched by increased access to MDR–TB care," said Mario Raviglione, director of the WHO’s tuberculosis programme. "We have patients diagnosed but not enough drug supplies or trained people to treat them."

The WHO said that while the number of people diagnosed with MDR–TB through rapid diagnostic tests had increased by 40 per cent to 94,000 worldwide during 2012, three out of four MDR–TB cases still remained undiagnosed.

Many countries, including India, have introduced drug–sensitivity testing, a laboratory process that allows doctors to tailor specific drug regimens to patients with MDR–TB, but such tests still have limited reach.

Among previously treated patients suspected to have MDR–TB, such tests are available to about 12 per cent patients in China and 16 per cent in South Africa. India has a higher number of MDR–TB cases but has not reported the proportion of patients who are offered such tests through the government programme.

Telegraph India
24 October 2013,
New Delhi, India
by - G.S. Mudur

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