How Mumbai has declared a war on drug-resistant TB

March 14, 2016 - In an unusual marriage of resources, over 1,000 chest physicians from 320 hospitals have joined hands with the BMC to eradicate the scourge of tuberculosis from the city. The initiative has already yielded the desired results with 1,500 patients - of the 20,000 that had been notified as part of the plan -- having been identified as having developed resistance to drugs. Early detection will help doctors take measures and ensure that these 1,500 patients do not slip into the next stage - extensively drug-resistant (XDR) TB.

Under the initiative, private practitioners who come across cases of TB notify the BMC and follow a standard treatment regimen that has been approved by the World Health Organisation (WHO). Doctors in BMC hospitals also follow the same regimen, thus ensuring that the patient doesn't develop resistance to drugs. Earlier, the multiplicity of drugs prescribed by private and government doctors was leading to multi-drug resistant (MDR) and XDR TB, in some cases leading to a more serious condition called XXDR TB.

In fact, the programme has been such a resounding success that the WHO has lauded the efforts of the doctors in the city and asked other countries to replicate it. Last week, WHO officials from various countries and WHO TB Director Mario Raviglione were present in Mumbai to see first-hand the successful public-private partnership programme. Officials from all the high burden countries -- Indonesia, Bangladesh, Pakistan, Myanmar, Turkey, Tanzania, Ukraine, South Africa, Nigeria and Sri Lanka --were present and appreciated the PPP model in fighting TB. They also visited a few private hospitals like Saifee, Saboo Siddique, Vikas Nursing Home in Govandi and Sai Nursing Home in Dharavi.

"Every year the city gets around 30000 new cases in addition to that around 10000 visits to private practitioner, often private doctors don't keep track on TB patients. But under PPP programme BMC will keep track on private patients as well," said, Dr. Daksha Shah, TB cell head, BMC.

"We have 16 gene expert machines to diagnose drug resistance cases; and two hospitals --JJ and Hinduja Hospital -- to do culture test for drug sensitivity. TB medicines, treatment, tests etc are all free under the government's revised national tuberculosis control programme. However, many private practitioners are not aware of this," added Dr Shah.

The world took notice of spread of drug resistance TB in Mumbai in 2012 study by Hinduja Hospital's Dr Zarir Udwadia who revealed that 12 TB patients in Mumbai had developed resistance to all TB drugs. The fact that they were the first such cases in the country served as a frightening reality check for city health officials, who have since then been fine-tuning and expanding the TB control programme.

The efforts are supported in large parts by central and state governments, and the Bill and Melinda Gates Foundation. The main challenge was to enrol private practitioners for the TB control mission.

In the past one year, the BMC has started imparting monthly continuous medical education (CME) to doctors on updates in the fight against TB. On Sunday, the BMC organized a CME at Nanavati Hospital and enrolled over 124 physicians and chest physicians.

Dr Salil Bendre, senior chest specialist, Nanavati, who took the initiative to enrol private chest physicians in the programme, said: "It is not just the responsibility of the BMC to fight drug-resistant TB; city's chest physicians should also support it."

Dr. Vikas Oswal, chest physician, Vikas nursing home, Govandi," Many private doctors in Govandi area are responsible for drug resistance TB cases, majority of them unnecessarily prescribe potent antibiotics to patients even for minor illness like respiratory infections or common cough and colds.


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By Lata Mishra

Published: March 17, 2016, 8:14 a.m.

Last updated: March 17, 2016, 9:17 a.m.

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