India: Drug sensitivity test on every new TB patient in Maharashtra

State health officials said the test will push up detection rate of drug-resistant TB by three times and will also do away with consumption of drugs that are futile in treating the disease.

Currently, TB patients in Maharashtra undergo the drug susceptibility test when even after two months of treatment their sputum tests positive for the disease, indicating resistance to prescribed drugs. The test is also carried out on patients reporting relapse of TB, and the HIV-infected who test positive for the disease, as they are considered highly vulnerable for drug-resistant TB.

Subjecting newly diagnosed TB patients to the test will significantly improve early detection and treatment of drug resistant TB. "The objective is to pick up cases of drug resistance in newly diagnosed TB patients at the earliest possible so that the patient is provided with effective treatment right after being diagnosed with TB," state tuberculosis officer Sanjeev Kamble told TOI on Monday.

"This will increase detection of drug-resistant TB three times against the prevailing rate. Currently, we detect 4,000 cases of drug resistant TB every year. But when we start putting every newly diagnosed patient on drug susceptibility test, the number of drug resistance TB may go up to 8,000 or even 12,000 per year," said a senior state health official.

Maharashtra reports 1.3 lakh new tuberculosis patients every year.

To initiate a mammoth diagnostic activity that involves testing such a large number of patients' sputum to detect drug resistance is no mean task. Besides, it needs high-end diagnostic machines to detect drug resistance.

"To detect drug resistance, the patient's sputum will be tested on Gene Xpert. Currently, we have 22 Gene Xpert machines and the Union health ministry has agreed to give us 27 additional Gene Xpert machines, which will reach us within two months. We have decided to start testing every new case of TB for drug resistance after we get these machines," Kamble said.

These machines will be deployed at every district hospital and TB hospital. In Pune, state government run B J Medical College attached Sassoon hospital will also get the Gene Xpert.

"Currently, Sassoon hospital has Gene Xpert machine for its research work. We will give them a Gene Xpert machine to enhance detection work of drug resistant TB, which will benefit patients from Pune and adjoining areas," said another state health official.

Gene Xpert is a new diagnostic device that detects drug-resistant tuberculosis in less than two hours. The test is called Cartridge Based Nucleic Acid Amplification Testing (CBNAAT).Gene Xpert has been approved and recommended by the World Health Organisation (WHO).

The device can be installed at any place and can be used by the paramedical staff. A health worker takes the sputum of the suspected TB patient and mixes it with a reagent and then tests it.

Resistant strains of tuberculosis bacteria (Mycobacterium tuberculosis) develop when the medications used to treat the disease are not used or managed correctly.

About MDR-TB:

* Tuberculosis can become resistant if a patient is not treated long enough, doesn't take the prescribed medication properly or is not prescribed the right drugs.

* Multidrug-resistant tuberculosis (MDR-TB) is caused by bacteria that do not respond to, at least, isoniazid and rifampicin, the two most powerful, first-line anti-TB drugs.

* It results from either primary infection or may develop in the course of a patient's treatment.

* Inappropriate or incorrect use of anti-TB drugs, or use of poor quality medicines, can all cause drug resistance, says World Health Organisation.

Tuberculosis: Maharashtra

* The state started detecting MDR-TB cases in Maharashtra from September 2007.

* Since then, we have reported over 40,000 MDR TB cases in the state so far.
 
* Mumbai accounted for the highest number of cases, followed by Nagpur and Pune.

* MDR constitutes 2-3 per cent of the newly diagnosed cases and 17 per cent among patients put on re-treatment after a gap in taking anti-TB medicines.

Source: The Times of India