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World TB Day: TB remains a challenge despite advanced remedies
Despite various modifications and advancements in the diagnosis and treatment of Tuberculosis (TB), such as a daily regimen of medications and high sensitivity tests in Tamil Nadu, eradication of TB remains a challenge.
By
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Chennai
“Though adherence to treatment has been enhanced by newer innovations like using basic mobile phones and augmented packaging for medication, drug compliance continues to be a big challenge as patients may take treatment just until they feel well. This can foster the development of resistance and lead to the spread of the disease. In addition, in many comorbid conditions other than TB — like HIV, Diabetes, renal and liver disorders — transplant recipients can complicate treatment regimens,” Dr Subramanian Swaminathan, senior consultant, Infectious Disease, Gleneagles Global Health City said.
Diagnostics in tuberculosis has advanced with the invention of Nucleic acid amplification tests (NAA). Compared to the routine cultures, NAA tests can detect the presence of M tuberculosis bacteria in a specimen weeks before culture. However, the NAA tests are not available point-of-care (POC) in remote areas of Tamil Nadu.
A descriptive study that evaluated the pre-diagnostic cost and health-seeking behaviour of new adult pulmonary TB patients registered at Primary Health Centres (PHCs) in Vellore district in 2018 revealed that most rural TB patients registering at PHCs visited private health facilities first and incurred substantial direct out-of-pocket medical costs and delays prior to diagnosis and anti-tuberculosis treatment initiation. The study highlights the need for PHCs to be made as the preferred choice for first point of contact to combat TB more efficiently.
The diagnosis of extrapulmonary tuberculosis (EPTB) remains a problem due to the difficulty to obtain appropriate clinical sample, especially from the remote places and secondly due to the poor sensitivity of diagnostic tests for these conditions in Tamil Nadu.
“Many EPTB patients experience a long delay in the initiation of treatment. Timely treatment can improve health and reduce morbidity. However, late detection is one of the obstacles in the complete eradication of TB. The compliance of daily regimen treatment is likely to reduce the burden of TB in the State. There is a need to promote TB vaccine also,” Dr Ranjith Veeramani Thangavelu, senior pulmonologist at Government TB hospital, said.
NGO holds campaign to fight stigma
On account of World Tuberculosis Day, REACH, a city-based NGO organised a campaign titled ‘Speak Up to Fight Stigma. Stop TB’ to encourage the people affected by TB, their family members, survivors and healthcare workers to speak about their experience with TB in Egmore. The campaign focused on eliminating the discrimination faced by patients and stigma associated with it. Actor and social activist Suhasini Maniratnam launched the campaign and recalled how she dealt with TB, which affected her twice. Referring to herself as a living example of how one could move on with their lives after being cured of TB, Suhasini recalled, “I would monitor my weight daily and make a note of it as I had drastically lost weight. My family took good care of me and ensured that I ate well”.
Smoking and pollution affect patients
Though the effects of polluted air and smoking on TB patients have been considered a risk, they are often overlooked among the patients.
Pulmonologists said that smoking may increase the difficulty of treating TB and prolong the drug cycle.
“Environmental pollution causes inflammation of the airway and worsens the infection. Though the natural defence mechanism of the body fights the pollutants in the airway, poor condition of the air causes difficulty in breathing and irritation.
It has also been found that the risk of mortality from TB is higher in smokers. Long-term exposure to ambient polluted air from vehicles increases the risk of TB,” said Dr Raj Kumar, pulmonologist, Fortis Malar.
Though State Health Department has undertaken various steps to reduce the incidence of TB, the programme needs to address pollution and smoking, especially in the urban areas.
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