Dimapur, March 23 (MExN): On the eve of World TB Day 2022 and with only three years remaining for India to achieve its ambitious target of TB elimination, the ARK Foundation, Nagaland has expressed its sheer disappointment to state that “the country is nowhere on the track to achieving it.”
This was stated by Ketho Angami from ARK Foundation, Nagaland in a letter addressed to Alok Saxena, AS & DG, NACO; Nidhi Kesarwani, Director, NACO; Dr Shobini Rajan, DDG, NACO; Dr Anoop Kumar Puri, DDG, NACO; Dr Sudarsan Mandal, DDG, CTD; Dr Ritu Gupta, ADDG, CTD; Dr Lalit Mahendru, National Consultant-DSTB/LTBI+Research, CTD; Sophia Khumukcham, National Consultant (Community Engagement), CTD; Nirman Bhavan, Ministry of Health and Family Welfare, GoI.
Structural and programmatic barriers such as the lack of counseling, non-availability of proper diagnostic facilities and treatment drugs for Multi-Drug Resistant (MDR) TB, non-release of monthly nutritional support on time, and the systemic discrimination of the affected community are some of the highlighted causes that affect progress towards the elimination targets, he stated.
He said that in 2018, Global world leaders demonstrated their political will by committing to a five-year target of providing Tuberculosis Prevention Therapy to 30 Million people around the world. “However, in India, the expected progress on this has not been made.”
“Thus, observing a poor partnership between the program and the affected community, we have initiated a community feedback mechanism from January 2022 “to assess, identify and report” on TPT, in five states of North East India namely, Mizoram, Nagaland, Sikkim, and Manipur State,” he said.
This community feedback mechanism targeted the PLHIV community, as they have a much higher rate of 25% risk of progressing from Latent Tuberculosis infection (LTBI) to active TB, was necessitated out of the failure in the only Isoniazid Prevention Therapy (IPT) based TPT strategy available in the country, and also more importantly because of the research-proven and the WHO’s recommendation of a newer strategy in the form of 3HP in its 2020 consolidated guidelines on TB.
The 3HP has been recommended as a preferred option to IPT, due to its nature of being a shorter regimen, lesser pill burden, better efficacy, less hepatotoxicity, and better treatment completion rate in treating LTBI, he stated.
However, Ketho are expressed disappointment about the delay in rolling 3HP out nationally by the Central TB Division and the National AIDS Control Organization (NACO) for the key populations, and also including the low ceiling of the PEPFAR Target with only 56, 495 TPT patient courses, despite 3HP being the PEPFAR’s preferred TPT regimen, in its next funding cycle 2023, in India.
To appraise our preliminary report of the community feedback mechanism derived which commenced from January 2022 till the March 17, 2022 and is ongoing, 91 PLHIV participated in the exercise from these five states. The responses highlighted the gaps in the existing IPT program and also clearly indicated the high demand for 3HP among the respondents. Some of the reports generated mentioned that 73.6% of PLHIV who participated in the exercise had not heard of LTBI, 70.3% were not aware of TPT, While 82.4% have not heard of 3HP.
He also mentioned that the affected community group comprising of PLHIV and Drug Users Network has in the past, on several occasions written to the CTD-NTEP and NACO-NACP to revitalize IPT and to introduce 3HP for PLHIVs, “but the bureaucracy at the national level did not have the audacity or the courtesy to consider such request, and demands of the affected community felt on deaf ears. The CTD/NACO choosing to remain a silent spectator is not helping the program in any manner.”
An RTI response received by ARK Foundation, vide the RTI application dated April 26, 2021, from the CTD on August 3, 2021, stated that the 3rd Meeting of National Technical Working Group (NTWG) on LTBI held in May 2020, reviewed and agreed to the new WHO-recommended TPT options, formulations, dosages and have recommended considering the use of shorter regimens for TPT in PLHIV. Accordingly, the NTEP had updated its TPT guidelines in line with the WHO recommendations, and to consider 3HP for PLHIV. The former DDG- CTD also in the meeting mentioned the 29,212 courses of 3HP by WHO to fast-track the availability of Rifapentine under the program, noting that 6H, 3HP, and 3RH are doable. However, India is yet to see any developments in the progress made.
Therefore, the ARK Foundation has once again put forth the demand to immediately launch a National 3HP program for all key populations without further delay. Affected communities should no longer be denied the right to equitable access to Short-Course TPT, and everyone who needs it must be prioritized and have access to TPT treatment, he added.
