India’s Ministry of Health recently released the “Report of the First National Anti-Tuberculosis Drug Resistance Survey”. According to the report, the survey is the largest national drug-resistant (DR) TB survey ever conducted by any country in the world. The survey results reveal that more than 6% of all TB patients in India have multidrug-resistant TB (MDR-TB). Based on the estimates in the Global Tuberculosis Report 2017, the estimated number of MDR-TB in India is 147,000, accounting for one-fourth of the global burden.
Furthermore, resistance to the class of drugs called fluoroquinolones was found to be almost 22%. This translates to over 30,000 DR-TB patients who need immediate access to better treatment regimens, including the new drugs bedaquiline and/or delamanid. By September 2017, 698 people with extensively drug-resistant (XDR and pre-XDR) TB were initiated on bedaquiline-containing regimens in five states of India.
The findings of this important report need to be translated into action in terms of scaling up DR-TB testing and treatment, including improved regimens with newer drugs.
“The survey reaffirms that high levels of resistance to fluoroquinolones exist in India, and this is a matter of grave concern because this is associated with treatment failure and death, for people who are resistant to this class of drugs. We constantly struggle with patients having resistance to both fluoroquinolones and second-line injectables approaching our Mumbai clinic for treatment. High rates of resistance to these drugs, limit our options to create an effective treatment regimen. Although the national TB program has been planning and rolling out diagnostics and new drugs in the past year, there is a need to speed up and broaden access to effective treatment through expansion of Drug Susceptibility Testing (DST) and patient centred models of care. This will not only save lives but can also reduce the risk of transmission, including to family members. ”
Dr Stobdan Kalon, MSF Medical Coordinator in India
In its DR-TB programme in Mumbai, India, MSF provides access to DST and treatment regimens tailored to the individual needs of patients with drug-resistant strains of TB.