Controlling the spread of tuberculosis (TB) has been a significant challenge for India, which accounts for more than a quarter of TB cases worldwide. This situation is further exacerbated with the emergence of drug resistance in TB bacteria. Until 2017, India recorded about 147,000 multidrug-resistant TB cases. Although government initiatives like the Revised National TB Control Programme are aimed at controlling this advance, the outcome is not too satisfactory. Understanding the hurdles faced by individuals with drug-resistant TB could provide insights into tackling the spread of this disease.
In a recent study, researchers from the Foundation for Medical Research, Mumbai have tried to understand the various challenges faced by individuals with tuberculosis during their treatment procedures. They interviewed 46 patients suffering from drug-resistant TB from 15 municipal wards in Mumbai specialised with tuberculosis care. The study was funded by the Bill & Melinda Gates Foundation, and its findings were published in the journal PLoS ONE.
The researchers found that most often, individuals with multi-drug resistant TB switched between private and public health providers and the journey of each patient was different. For many of them, TB was not an unknown disease. However, instead of getting treated, they ignored the symptoms and waited until their condition got worse. Surprisingly, those who had a history of tuberculosis also followed the same.
Many patients approached a clinic nearby or a familiar medical practitioner as it was the most convenient approach for them, the study found. However, most of these neighbourhood doctors are not trained enough to handle complicated cases of drug resistance and end up delaying the treatment procedure. Eventually, these patients end up visiting several health facilities and laboratories to get proper care, further delaying the treatment.
The researchers also found that lack of time and patience, work pressure, cost of treatment in the private sector and the lack of proper guidance from the doctors force such individuals to seek help from different places, which might delay the diagnosis and treatment further. With no clue about the recent developments in medicine and proper understanding of why they are made to undergo the same tests repeatedly, the patients remained confused during the treatment procedure.
The study found that although the treatment for drug-resistant TB is free in government hospitals, most patients were not comfortable with the treatment procedure. The reason is that they were not explained about the complexities associated with the diagnosis and the treatment of drug-resistant TB, including the side effects of the drugs.
The authors suggest that programmes like the Revised National TB Control Programme should be implemented such that the patient understands the treatment options available in their neighbourhood and the associated cost, irrespective of him/her being treated in a private or government hospital, or by a general practitioner or specialist.
“We need a robust health system in which the public and private sectors function as equal partners supporting and complementing each other,” they say, advocating engagement and education in the communities about the treatment options.
The findings of the study play a key role in helping the government’s goal of eliminating TB from India by 2025.
“Recommendations from this study have the potential to help bring improvements in TB control not just in the city of Mumbai, or the state of Maharashtra, but in the entire nation at large”, conclude the authors.
Editor's Note: The article is updated for minor edits. The error is regretted.