Dr Pai shared another study outcome to underline public sector DOTS (Directly Observed Treatment Shortcourse) is not the first choice for lot of people with presumptive TB. "This is a study done in Delhi when researchers went to DOTS clinics and asked patients how did they end up in DOTS centres. The study found that public DOTS system is not the first choice for lot of TB patients in India. Patients usually go to public DOTS system only when they are broke and/ or not able to afford private care any longer. Most TB patients went first to local pharmacists, chemists, 'vaid' (traditional healers), non-qualified practitioners, AYUSH practitioners, these are the people who first see people with cough."
"This means that we are constantly missing patients with presumptive TB when instead they get broad-spectrum antibiotics, steroids, broncho-dilators, etc. We need to end this delay of few weeks or months so that every patient with presumptive TB gets tested and receives standard care without delay. In reality, by the time 'TB cascade' begins it is weeks and months down the line. By the time MDR-TB gets detected it is several months down the line. MDR in this country is not detected at the start of the TB treatment routinely but it is detected only if the patient fails one round of anti-TB therapy."
Should not we treat with drugs that work?
Obviously yes! TB is curable and therefore we need to treat every patient with confirmed accurate diagnosis of TB, with standard combination of drugs that work for a particular patient. Giving drug or drugs that do not work for a patient (because patient may be resistant to one or more drugs already) will not have desired treatment outcomes, rather can have alarming public health and social justice consequences!
So ideally, every presumptive case of TB should get accurate confirmatory diagnosis for TB, and also get a DST so that doctors know which drugs are sensitive for a given patient (and which are the drugs patient is already resistant to). But it is seldom happening right now in reality.
Dr Mario Raviglione, Director of Global TB Programme of the World Health Organization (WHO) had said earlier last week when "Call To Action For A TB-Free India" was launched that it is a "clinical malpractice" if DST is not done on day-1 when a patient contacts a health system (public or private).
Dr Pai shared with Citizen News Service (CNS): "Usually a patient has to take six months of standard anti-TB therapy before DST is even done for a patient. Most people never know if they have drug resistance early on - they only get to know when they fail one round of anti-TB therapy or have recurrence or relapse."
TB is a bacteriological diagnosis