This week the World Health Organization (WHO) released updated data to compliment their 2009 Global Tuberculosis Control Report released on World TB Day. The earlier report released in March contained dramatic new data showing rates of TB-HIV co-infection twice as high as originally estimated.
Our visit to Mumbai has focused on health challenges that face the densely-populated urban population. More than 18 million people dwell in the city and overcrowding is a major cause of transmission of airborne diseases such as TB.
To learn more about TB in India we visited the Hinduja Hospital, a private hospital that also provides free services to those who cannot afford to pay fees. Although TB treatment is provided free by the government, 70% of people prefer private healthcare even if they don’t earn enough to pay for it.
Dr Zarir F. Udwadia, an internationally renowed TB specialist, explained that TB is an epidemic of neglect and injustice. Although we have the tools to prevent and treat it, too many patients are receiving inadequate services. Poor practice is creating a dangerous pool of drug-resistant TB and resulting in many unecessary deaths. We heard the tragic story of a woman who had to undergo seven years of treatment and have one of her lungs removed before she was put on the correct treatment for her multi-drug resistant TB (MDR-TB)
At least 5% of TB cases in India are MDR-TB but Dr Udwadia believed that this was an underestimate. There is currently no data for the levels of extensively drug-resistant TB (XDR-TB) because there are insufficient diagnostic services. Patients who cannot afford private health care are denied access to expensive second-line drugs and left to their fate. A survey carried out by Dr Udwadia’s team found that only 3% of private physicians knew how to give the correct treatment for an MDR-TB patient.
With more than three-quarters of Indians infected with latent TB, India is clearly sitting on a TB timebomb. We heard that the government cannot afford to treat all of its cases of drug-resistant TB but it seems that they cannot afford not to act. Urgent efforts are needed to ensure that all patients with standard TB successfully complete their treatment which will reduce the number of new MDR cases. The government, possibly with the support of donors such as the UK, must also ensure that all patients with drug-resistant TB receive the necessary care and treatment that they need to both save their lives and reduce further transmission.