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Regulating sale of anti-tuberculosis drugs

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Rahul Kumar Dwivedi, Citizen News Service -- CNS

The government of India's notification, which came into effect on 1st March 2014, aims to arrest irrational sale and use of anti-tuberculosis drugs (and other 45 third- and fourth-generation antibiotics). "The Union Health Ministry has notified amendments to the Drugs and Cosmetic Act, 1940, in which a Schedule H1 has been included. 1st March 2014 onwards these 46 antibiotics that include anti-TB medicines too will only be sold upon presenting a valid prescription from a medical professional. Government needs to be congratulated for this long overdue measure that will curb irrational sale and use of drugs," said Professor (Dr) Surya Kant, Chairman of UP State Task Force for TB Care and Control and Vice President of Indian Chest Society.

According to the notification, the pharmacy has to keep a copy of the medical prescription and record details such as name of patient and doctor, among others. A mandatory warning in a red box will also have to be printed on the label of these listed 46 drugs, violation of which can result in prosecution as per the Drugs and Cosmetics Act, 1940.

Dr Surya Kant, who is also the head of Department of Pulmonary Medicine, King George's Medical University (KGMU), has been crusading for stopping over-the-counter sale of anti-TB drugs without medical prescription for the past 22 years. He said this measure from the government will certainly curb irrational use of anti-TB medicines, which will have a pronounced public health impact.

Dr Susheel Chaturvedi, District TB Officer (DTO), said to Citizen News Service (CNS) that India's TB programme is moving towards providing universal access to TB-care services. To realize this vision it clearly means that spread of TB cannot be arrested unless we reach out to every person with TB who needs quality-assured diagnostic and treatment services. Unless we accurately diagnose TB and provide complete course of standard and effective TB treatment to every person in need, TB will continue to remain a challenge. If left untreated a TB patient can infect 10 to 15 more people every year, which makes it a public health imperative to find, diagnose, treat and cure every patient. That is why Stop TB Partnership is facilitating 'Reach The 3 Million' campaign to underline the urgency to reach out to 3 million TB patients who are currently being missed by the programmes across the world.

In a conversation with CNS, Dr Surya Kant said that it is important for the TB programme to manage every patient. He pointed out that earlier patients with drug resistant TB were not included in the programme but since the roll out of Programmatic Management of Drug-resistant TB (PMDT) in India, now every state has a robust programme to provide diagnostics and treatment services for patients with drug-resistant TB. India has scaled up PMDT at an unprecedented pace over the past two years, said Dr Surya Kant.

The fight against TB should not be limited just to TB-care providers and other stakeholders but must expand to engage everyone, said Dr Surya Kant. We have to do social mobilization as never before to involve everyone in the fight against TB. Over the last 40 years eradicating smallpox and polio would not have been possible if the efforts were only confined among those directly affected or care providers. So we need to reach out to leaders with influence in society such as political leaders, religious leaders, health and social activists, broader civil society, influencers in media including social media, and most importantly cured TB patients and affected communities so that the vision of eradicating TB can be achieved in our lifetime. Dr Chaturvedi also seconded this call for mass awareness on TB. "Every person should be made aware that TB is curable and services are free of cost in public sector" said Dr Chaturvedi.

Dr Surya Kant said that we are still missing one-third of TB patients, which is clearly unacceptable. "We have to reach to every patient of TB and provide standard care without delay. Whether a patient is managed in public or private sector, the diagnosis and treatment must be as per the standards of TB care outlined by the programme," said Dr Kant.

Every state of India has a well-equipped laboratory and diagnostic capacity to diagnose TB and anti-TB drug resistance so that proper and effective treatment could be provided. Managing drug-resistant TB needs trained professionals which are already working in PMDT sites across the country. So patients of drug-resistant TB must benefit from these services in public sector. We need to reach out to every patient, said Dr Surya Kant. He called for stronger legislative measures to ensure no TB patient gets irrational treatment in private sector.

Dr Susheel Chaturvedi, DTO, said that government of India had made TB a notifiable disease in May 2012. Although close to two years have passed since then, all private doctors are not yet notifying every case of TB. Dr Chaturvedi called for implementing notification of TB by private doctors more stringently.
TOBACCO AND TB: Deadly Synergy
Dr Surya Kant has noticed in his clinical experience spanning over two decades that smoking and tobacco use increases risk of TB. Tobacco-control measures such as tobacco-cessation clinics and anti-tobacco campaigns must complement TB control programmes.

Effective control of diabetes is required for management of TB as diabetes increases TB risk 2-3 fold, said Dr Surya Kant. We have not done enough on diabetes and TB collaborative activities despite alarming incidence of diabetes in our population. We need to scale up effective diabetes and TB collaborative activities just like we upped the implementation of TB and HIV collaborative activities across the country.
Exposure to sunlight kills the TB bacteria (apart from other health benefits). So we must ensure our housing plans have paid due attention to proper ventilation and sunlight in every room, said Dr Surya Kant. He also called for providing proper housing for every family regardless of socio-economic background and said that there should be no slums. Government of India has schemes to provide housing for the poor and marginalized, which need to be implemented fully on the ground. These houses provided by the government to the poor must ensure proper ventilation and entry of sunlight in every room. Such measures will not only benefit TB control but have pronounced broader outcomes in terms of public health and social justice.

Adherence to TB treatment is certainly important so that every TB patient who is diagnosed accurately completes effective standard treatment as well. This is not possible to achieve unless we engage cured TB patients and other support groups to provide home-based care if possible, said Dr Surya Kant. Role of key populations (such as people at risk of TB) is key not only because they are at an elevated risk of TB but also because their contribution to the response is key.

Rahul Kumar Dwivedi, Citizen News Service -- CNS

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