Relief for TB patients

Aparna Banerji

Tribune News Service

Jalandhar, January 31

Bringing relief to thousands of tuberculosis patients or Multi Drug Resistant (MDR) TB suspects, the Jalandhar Civil Hospital is all set to install a CB Net (Cartridge Based Nucleic Acid Amplification Testing for TB diagnosis) machine which will ensure the testing of their samples in the city itself. The patients had earlier wait to get their samples tested from Patiala or PGI.

With a steady rise in MDR TB cases over the years and a growing TB affected population as well, in 2015 Indian became a country with 23 per cent of the world share of the TB patients. With Punjab and the region also among one of the sensitive zones, given the pattern of TB patients, the insallation of the machine is a much required move.

While in 2014 as many as 527 samples of MDR suspects had been sent for testing, in 2015 as many as 551 and this year so far 53 samples of MDR suspect sputum have been sent for testing. After the machine is installed in Jalandhar, these shall all be tested locally. Additionally, while the procedure if pursued privately costs Rs 2,500 per test, now it will be done for free at the civil hospital.

MDR TB defined

While category 1 TB patients are those which get regular TB patients and get healed, category two are the drop outs of the first TB procedure or those requiring second line or intensified TB treatment. Those patients who drop out of the second treatment as well or suffer from a more aggressive strain of TB in which at least two TB drugs stop working on them, are referred to as the MDR TB patients. And further when patients get immune to at least four TB drugs, hence an even more intense version of TB – are called XDR TB or modified TB patients.

MDR TB cases get immuned to drugs like Refampicil and Isnonex while XDR TB ones also develop an immunity to additional drugs like Kanamycin and Ofloxocin (or Livofloxocin).

While these MDR and XDR samples were previously being sent to PGI Chandigarh for testing now their sputum shall be tested in Jalandhar and the process which probably took weeks or more shall be made more prompt.

MDR stats

Steadily on the rise for the past few years, in the past five years the district has had 118 MDR plus XDR TB cases. Of these four are XDR TB cases. As many as 15 of these patients have died; 39 of these were female and three HIV positive. The district had 19 MDR TB patients in 2012, in 2013 there were 30 MDR TB patients under treatment, in 2014 these rose to 33 (plus 1 XDR TB) patients, in 2015 29 (plus two XDR TB) patients and in 2016 so far 3 MDR and one XDR TB patient has been received at the local civil hospital. Notably, these are just the patients on treatment and the total number of TB patients lying undetected by the health authorities could be many more.

MDR incidence

MDR incidence is 3 per cent in new TB patients and as high as 15 to 17 percent in previously treated patients. Prolonged cough, decreased immunity, lack of a proper diet and a bad environment could be the chief contributing factors for TB incidence. The incidence of death among TB patients is four per cent.

TB and HIV

While health sources termed TB as one of the primary killers, among HIV positive patients, because it is opportunistic ailment, the higher monitoring of TB in Jalandhar is also essential in terms of surveillance of both these diseases which are clearly interconnected and both have a high incidence in Jalandhar.

While 3 with MDR TB have been HIV positive in past five years the number of common HIV positive and TB cases is much higher.

Staff shortage

The additional infrastructure also warrants more TB control staff for Jalandhar which it is currently short of. There are only 6 lab technicians against 13 posts in the district, two supervisors against 12 posts, two persons on five lab supervisors posts and the one post of computer operator also lies vacant. The TB unit also needs additional doctors, which it currently is short of.

Officialspeak

While speaking about MDR incidence in the district, Dr Rajiv Sharma, District TB Officer, said, “There was phase some years ago when TB suspects and patients had risen to an alarming level but presently things are under control and with path breaking work on RNTCP (Revised National TB Control Programme) on both the local and national levels by the governments, more and more people are being identified and being brought under DOTs treatment.”

While the putting up of the machine would also bring a spurt in cases, due to prompt diagnosis, Dr. Sharma said in the long run it will help better identification and healthier populace.