India: TB patients protest outside health ministry, promised proper drug regimes from July
May 20, 2016 - A group of tuberculosis patients, protesting outside the Union health ministry in Delhi's searing mid-May heat, brought attention to the problem of India's outdated tuberculosis treatment, and forced the ministry officials to give assurance to provide patients with the fixed-dose combination (FDCs) medicines they urgently need.
In a letter addressed to Union health minister JP Nadda, TB patients, patients living with HIV who are at the risk of contracting TB, and civil society groups such as the Delhi Network for Positive People (DNP+), asked the minister to keep his commitment of rolling out FDCs for patients on a daily basis. India's Revised National Tuberculosis Control Programme had announced in December 2014 that daily FDCs would be provided in 104 districts across five states. Earlier than that, the National Technical Working Groups on TB/HIV had recommended that daily FDCs be made available to treat drug-sensitive TB, i.e bacteria that has not developed any resistance yet to drugs, for people living with HIV. Neither of these promises can be seen on the ground, said Paul Lhungdim, president DNP+.
However, the waiting group was, said Lhungdim, accosted by the security and only after two hours were they met by an official from the RNTCP, who promised daily FDC will be rolled out for HIV-positive people nationwide by July, and will be made available to pediatric patients as well.
Antiretroviral therapy (ART) centres for HIV-patients are without the daily FDCs and the five selected states have not yet seen the rollout "due to delays in procurement of the medicines needed for treatment". The FDC regimen, says the letter, is only available in 30 ART centres, leaving 516 centres still waiting for medicines.
Fixed-dose combination drugs, that mix two or more active pharmaceutical ingredients (APIs) into a single dose, cut down on the multiple pills TB patients have to pop. Recommended by the World Health Organisation for countries to use in their first line of TB treatment, they simplify treatment, "reduce pill burden", improve "treatment adherence" as it's easier for people to keep track of and have on time fewer number of pills, and reduce the risk of drug-resistant tuberculosis, a growing threat in India. Brazil and South Africa have made use of FDCs in their treatment programmes.
However, the RNTCP has since 1996 used the intermittent regimes -- single-drug formulations for each of the drugs administered three times a week as part of 'Directly Observed Treatment Short-course' (DOTS). Patients end up taking seven or eight anti-TB medicines every other day, leading to many not finishing their treatment course, or not adhering to it properly, which can lead to a bout of drug-resistant TB.
Source: DNA India
