Only 39 per cent TB patients complete therapy through govt programme, says study
Out of the 2.7 million individuals with tuberculosis (TB) in India in 2013, estimates show that only about 1.05 million or 39 per cent completed therapy through the government TB programme and survived for one year after treatment without experiencing a relapse. In a new study, published Tuesday in a medical journal, PLOS Medicine, an international team of researchers, including TB experts from major institutes in India, analysed the problem of “missing” TB patients in India using an approach called the “cascade of care which allows policymakers to visualise the largest gaps in care delivery by India’s public sector TB programme”. Watch what else is making news: India accounts for the highest burden of tuberculosis globally, which is 23 per cent of the global burden of incidence of active TB patients and 27 per cent of the world’s “missing” TB patients. The “missing” patients represent about 1 million patients each year who have not been notified to the Government of India’s Revised National TB Control Programme (RNTCP). The study involved Ramnath Subbaraman from Harvard Medical School, Boston, along with Dr Madhukar Pai from the McGill International TB centre, Canada, Dr Soumya Swaminathan , Director General Indian Council of Medical Research and researchers from TB research institutes in Bengaluru and Chennai. The researchers tried to estimate how many patients in India’s TB programme are not being detected, not enrolling for treatment, not completing treatment and not surviving without TB recurrence for one year after finishing treatment. Pai told The Indian Express that this study was probably the first published, national TB care cascade. It provides an end-to-end view of what happens to patients when they navigate the public healthcare system, and shows the biggest gaps that RNTCP needs to address. Diagnosis remains the biggest weakness in the system, and this will not change until India upgrades from smear microscopy to more sensitive, rapid, molecular testing for diagnosis as well as drug-susceptibility, he added. The researchers reviewed 39 studies published between 2000 and 2015 that describe patient loss to follow up, and collected data from multiple studies published by WHO and India’s national TB programme. Researchers estimated that about 7,60,000 TB patients in India never reached government TB diagnostic clinics and either remained untreated or received what is often poor quality care in India’s private sector. More than 5,00,000 TB patients in India were evaluated at government TB clinics, but were not successfully diagnosed with TB at those clinics or did not start TB treatment despite getting diagnosed, Subbaraman said. According to Subbaraman, this problem might be addressed by large-scale implementation of electronic patient In addition, direct SMS to patients of their diagnosis might ensure that patients immediately know of their TB diagnosis.
records in the RNTCP so that there is less missing patient information, which can be linked across sites through a patient’s unique ID, like an Aadhaar card number.
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