KOLLAM: Multi-Drug Resistant Tuberculosis (MDR -TB) patients in the state continue to depend on just two facilities, as the decentralised treatment service model pioneered by the state in 2012 is yet to take off.
Drug resistant TB develops when people with TB halt their antibiotics before the disease has been fully cured or when the TB drug regimen is improperly administered. Only the TB care facilities under the Medical Colleges of Thiruvananthapuram and Kozhikode are the two options where patients have to undergo initial treatment.
Under the decentralised treatment model, there are only three TB centres where MDR-TB patients can continue their 2.5 year-long treatment which is considered extremely expensive, toxic, arduous and often unsuccessful.
Interestingly, all the three are in the northern districts of Malappuram, Kannur and Kasargod. While the facilities at Palakkad and Thrissur were discontinued, there are no beds allotted for treating TB patients at government hospitals in the southern part of the state.
According to the TB Association of Kerala, the model adopted by the state has been replicated in other parts of the country such as Andhra Pradesh and Maharashtra.
TB being an airborne disease requires isolated and specialised wards. Health experts point out that government hospitals are reluctant to extend these two. Lobbying by a few in Medical Colleges to keep TB management under control also failed to yield the desired results.
Patients from Pathanamthitta and Idukki would definitely give a second thought before approaching the facilities at Pulayanarkotta TB Sanatorium under the MCH.The need for better facilities is very evident as eradication depends on better TB management considering the alarming tendency of patients to discontinue the treatment. India and China are the two countries with the highest MDR-TB burdens.
Out of the 25,000 new TB patients in the state more than 250 are MDR-TB patients. Experts say that most of MDR-TB deaths occur in the 15-40 age group.
Once a drug resistant strain develops, it can be transmitted directly to others just like normal TB. Though kerala has a better curable rate of 61% considering the national rate of 52%, director of State TB Training and Demonstration Centre, Dr Sunil Kumar M feels that containing drug resistant TB strains is a challenge with the limited access to healthcare.
Though the government included TB in the national list of notifiable diseases since 2012, a large number of TB cases often go undetected as early diagnosis of the disease is not being carried out effectively. Dr Kumar who is also the secretary of TB Association of Kerala said that two out of five patients do not follow the drug regimen, while those covered by the DOTS treatment have better compliance. Failure to follow the drug regime results in formation of deadlier drug resistant strains.
Extensively Drug Resistant TB (XDR TB)
Extensively Drug Resistant TB (XDR TB) is a rare type of MDR TB that is resistant to the most potent TB drugs. There are 12 confirmed cases in the state. It gets transferred from MDR TB patients. What makes it life threatening is the lack of availability of quality medicine. As XDR is not covered in the government sponsored TB management programme (Revised National Tuberculosis Control Programme), the TB officers have to use part of the government fund for TB programme to procure the required medicines. At present, the government spends ` 1.5 lakh for treating a MDR TB patient. Dr Kumar said that the medicines used are highly toxic and the same combination of drugs cannot be used for treating any other disease. For the entire TB management, the state gets a Central budgetary allocation of ` 12 crore which gets reduced to ` 9 crore in reality. The drugs are procured by the Central Government through Global Drug Procurement Mechanism through international bidding. It is generously funded by the World Bank.
PPP model for MDR TB care
PPP model for MDR TB care: Private Medical Colleges are making a foray into TB care. The first among these is Azeezia Medical college in Kollam which started a 3-bed-ward facility this month, while the Revised National Tuberculosis Control Programme (RNTCP) by the Health Department will provide the medicines. Sree Gokulam Medical College in Thiruvananthapuram is also said to have signed a similar agreement. Earlier, private hospitals shied away from TB treatment as doctors and paramedics were not keen. But experts point out that patients in the upper middle class category would prefer going to a private set up than a government facility. Besides a TB treatment facility is an added advantage for private Medical Colleges to get approval from the Medical Council for postgraduate courses in respiratory medicine.