Patients at the Kohima TB Centre. Nagaland’s dependency on laboratories outside the state to confirm Multi Drug Resistant (MDR) or Drug Resistant (DR) Tuberculosis (TB) in patients has impacted treatment processes for patients.
Ketholeno Neihu
Kohima | February 26
In the first part of this series (The Morung Express, February 14), it was reported that Multi Drug Resistant (MDR) or Drug Resistant (DR) Tuberculosis (TB) patients in Nagaland were often found not adhering to the treatment process, thus leading to re-infections.
While lack of awareness and knowledge among the patients was found to be an underlying cause, it has also been found that lack of testing facilities, such as Line Probe Assay (LPA) or Culture and Drug Susceptibility Testing (DST) which are yet to be set up in Nagaland, has led to delays in detection of cases. This in turn holds up the treatment process as the state is still dependent on laboratories outside the state.
Take for example, the case of Zachamo who battled drug resistant Tuberculosis for two years and has now taken on the role of TB Champion—a key member of the national, state or district level TB Forums where they will have an opportunity to influence policy level decisions.
Zachamo recalled that he has had his share of mental trauma and pain as his test results came in a month after it was sent to Guwahati. “The medicines and injection I was first put into for treatment were changed after my test results that were sent to Guwahati returned after a month and it felt very prolonged since the all oral drug regime would go for 18 months,” he said.
In the case of Nagaland, rapid detection of Tuberculosis and drug resistance through robust techniques is crucial to “End TB in India by 2025.” However, the lack of testing facilities to aid immediate diagnosis of drug sensitivity denotes that the state is lagging behind.
In this connection, Dr Kezhasino Meru, medical officer at the Kohima District TB Centre, said that the state has been using Cartridge-based Nucleic Acid Amplification Test (CBNAAT) and Truenat for a few years now. The results, she informed, can return in a minimum of 2 hours time and patients are put into treatment immediately.
Similarly, the CBNAAT and Truenat tools which were introduced to the state in 2018 are being used in other district TB centres as well. According to the National TB Elimination Programme (NTEP), State Cell’s Medical Officer Dr Swuduvelu Ngully, Nagaland has 11 CBNAAT and Truenat machines and 52 Designated Microscopic Centres (DMCs).
Although these facilities have been found to be helpful, smear positives that are positive for acid-fast bacilli (AFB) which is a type of bacteria that causes tuberculosis and certain other infections, drug resistance to rifampicin (RPM) and isoniazid (INH) has to be confirmed through appropriate diagnostic tools and laboratory capacities that are not available in Nagaland. For this, sputum samples of patients have to be sent to Guwahati for First Line Probe Assay (LPA) testing.
The District TB Centres are responsible for making arrangement to send the samples to Guwahati.
For instance, in Kohima district, Dr Meru informed that collected samples are sent through overnight passenger buses or through courier and on receipt and return, it takes about 2 weeks or sometimes up to one or two months. The similar arrangement is also followed by other DTCs, she said.
While, rapid diagnosis of TB and drug resistance has obvious benefits for both patients and public health, including better prognosis, increased survival, prevention of acquisition of further drug resistance and reduced spread of drug-resistant strains to vulnerable populations, these formidable obstacles faced by the state is compounded by a lack of diagnostic tools and laboratory.
Authorities in the state NTEP cell said a Culture and Drug Susceptibility Testing Laboratory is on the pipeline at the Naga Hospital Authority, Kohima (NHAK) for the state. “It is already a year that arrangements are said to have been made and pursuing with the government authorities on this provision, however, concerned companies are yet to come for machine installation otherwise all renovations have been arranged,” the NTEP state cell informed.
Meanwhile, at present, there was no arrangement for setting up LPA lab in the state and NHAK authorities did not respond for comments on the progress.
