New Delhi: Ahead of World Tuberculosis Day, health experts rued the government's delay in implementing the daily fixed-dose treatment of tuberculosis despite making policy changes in this regard, and urged it to swiftly implement revised TB treatment regimes.
Although experts welcomed reports that the Central TB Division will soon switch from intermittent (three times in a week) to daily treatment for drug sensitive TB as part of 'Directly Observed Treatment (DOTS)', they said that more concrete steps needed to be taken towards implementing the recommended policy changes.
"India has taken the first steps towards adopting daily FDC regimen for drug-sensitive TB treatment or DOTS. The Revised National TB Control Programme (RNTCP) recently released new policy, which recommends implementation of a daily DOTS regimen using FDCs.
"In addition, the government is planning to conduct a pilot project of the daily regimen in 100 districts and is contemplating bringing in 4-FDC formulations. While these are positive signs, more concrete steps need to be taken towards implementing the recommended policy changes," experts said in a joint statement.
It said that while currently India uses single drug formulations for each of the drugs that are part of the recommended drug sensitive TB (DS-TB) treatment regime, it was likely that the TB programme will also introduce daily fixed-dose combinations (FDCs) as an additional step to ensuring proper treatment.
The experts include officials of Asia Pacific Network, International Treatment Preparedness Coalition - South Asia, Delhi Network of Positive People, Community Network for Empowerment (Manipur), Sankalp Rehabilitation Trust and MSF Access Campaign.
Experts said that while the last round of tenders for TB drugs did not include FDC formulations, the government should ensure that TB drug tenders in 2015 include FDCs.
"There has been no public announcement of the selected
districts in which the pilot is being planned nor of any training or preparation being offered by RNTCP to facilitate the process.
"With India bearing such a huge burden of tuberculosis and drug-resistance, immediate actions need to be taken by the government to roll out daily FDCs in the DOTs program," experts said.
TB, a communicable disease is one of the leading causes of mortality and morbidity in India. Every year in India nearly 20,00,000 people develop TB and more than 3,00,000 people die of the disease.
Rates of drug-resistant TB (DR-TB) in India are particularly high, with 35,385 cases diagnosed with DR-TB, but only 20,753 people started on MDR-TB treatment in 2013, a document titled "Treating Drug-Sensitive TB in India: Implementation of Daily Therapy with Fixed Dose Combinations" released by the experts said.
FDCs simplify treatment, reduce pill burden, the management of drug supply, and may also limit the risk of drug-resistant tuberculosis arising as a result of monotherapy.
Apart from recommending swift implementation of policy changes, experts said necessary training and orientation to prepare RNTCP staff and health personnel to switch to daily DOTS with FDCs should begin immediately.
They also recommended that proper streamlining of the existing stock of single drug formulations to non-pilot districts must be implemented while a plan must be developed for the eventual rollout of daily DOTS using FDCs in the whole country.