Overcoming Challenges: Towards Necessary Changes



In late 2013, Meera Yadav began experiencing a persistent cough that wouldn’t go away. As her condition worsened, she started coughing up blood and was eventually diagnosed with multidrug-resistant TB (MDR-TB). However, her diagnosis was later changed to extremely drug-resistant TB (XDR-TB). Meera’s journey to recovery was difficult and spanned five years, during which she had to have her right lung removed. Not only did Meera have to deal with the physical toll of the disease, but she also faced stigma from friends and family, resulting in her being separated from her four-month-old baby.

There are several reasons why drug resistance occurs. It can happen if patients don’t adhere to their medication schedule or stop taking their drugs due to side effects. Additionally, treatment interruptions, such as drug shortages, can also lead to drug resistance. In some cases, doctors may not prescribe the correct combination of drugs, further contributing to resistance. There is also the possibility of primary drug resistance, where a loved one of a patient may acquire drug-resistant TB from them.

Treating drug-resistant TB is more challenging and time-consuming compared to drug-susceptible TB. While the treatment for drug-susceptible TB takes around 6-9 months, drug-resistant TB requires a minimum of 18 months of treatment. Furthermore, patients with drug-resistant TB need to take a minimum of 10-12 pills per day, including vitamin supplements.

India has been grappling with a shortage of TB drugs, including those for drug-resistant TB, which has made treatment even more difficult for patients. Cycloserine, linezolid, and clofazimine, which are essential drugs for drug-resistant TB, have been in short supply in recent months.

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While the world is exploring the integration of AI and digital technology into TB treatment, India, including Mumbai, also aims to incorporate whole genome sequencing (WGS) into the diagnosis of drug-resistant TB. However, it’s crucial to address the existing gaps in healthcare delivery systems before implementing these advanced plans. Mumbai alone witnesses thousands of TB cases annually, and with its densely packed houses lacking ventilation, the city provides an ideal environment for TB to thrive.

In 2022, India announced an ambitious target of achieving freedom from TB by 2025. To achieve this goal, there are several crucial aspects of TB healthcare in Mumbai that need improvement. Experts, including doctors, activists, and patients, stress the importance of prevention, diagnosis, and counseling support in tackling TB.

Prevention strategies include addressing poor eating habits, increasing nutritional support, and reducing stress levels, as compromised immunity makes individuals more susceptible to TB. Providing vitamin C, vitamin D, nitric oxide, and hydrogen peroxide as preventive measures has shown promising results. Infection control measures and improved ventilation are also essential in areas with high population density and limited sunlight.

To improve TB healthcare, a robust primary healthcare infrastructure is recommended, along with community involvement in treatment and support. Universal health coverage is crucial in achieving TB eradication, as demonstrated by the positive effects of Brazil’s Family Health Strategy. Additionally, more awareness at the community level and multi-stakeholder meetings involving various sectors can contribute to a more comprehensive approach to tackling TB.

Improvements in diagnosis and treatment procedures are necessary, with the implementation of accessible diagnostic tests like CB-NAAT, which can deliver results within two hours. Adequate availability of CB-NAAT machines is necessary to meet the demands of a city like Mumbai. Furthermore, an aggressive test-and-treat policy, coupled with active case finding, can help identify TB cases promptly. Addressing the adverse side effects of DRTB treatment is also crucial for better patient outcomes.

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Overall, addressing these crucial aspects in TB healthcare in Mumbai is essential to achieve the goal of freedom from TB by 2025. With concerted efforts from various stakeholders and a patient-centric approach, it is possible to improve the prevention, diagnosis, and treatment of TB in the city.



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