One of the greatest challenge to TB Control is the problem of Multi Drug Resistant TB(MDR TB).India has 2nd highest MDR-TB burden in the world after China. In India, the available information from the several drug resistance surveillance studies conducted in the past suggest that the rate of MDR-TB is relatively low in India. As per WHO estimates 99,000 MDR cases emerged in 2008. However this translates into a large absolute number of cases and as yet the management of patients with MDR-TB is inadequate. The prevalence of multi-drug resistant TB (MDR-TB), defined as resistance to isoniazid and rifampicin with or without resistance to other drugs, is found to be at a low level in most of the region.
Specific measures are being taken within the Revised National Tuberculosis Control Programme (RNTCP) to address the MDR-TB problem through appropriate management of patients and strategies to prevent the propagation and dissemination of MDR-TB. MDR-TB is essentially a man-made phenomenon – poor treatment, poor drugs and poor adherence lead to the development of MDR-TB. The key focus is on prevention through sustained high-quality DOTS implementation and rational use of anti-TB drugs
Traditionally, DOTS-Plus refers to DOTS programmes that add components for MDR-TB diagnosis, management and treatment. It is envisioned that by the year 2010 the DOTS Plus services will be introduced in all the states across the country. By 2012, it is aimed to extend these services to all smear positive retreatment cases and new cases who have failed an initial first line drug treatment. And by 2015, these services will be made available to all smear positive pulmonary TB cases registered under the programme. It is intended to treat at least 30,000 MDR cases annually by 2012-13.
The five essential components of the DOTS-Plus strategy are
• Sustained government commitment;
• Accurate, timely diagnosis through quality assured culture and drug susceptibility testing;
• Appropriate treatment utilizing second-line drugs under strict supervision;
• Uninterrupted supply of quality assured anti-TB drugs; and
• Standardized recording and reporting system.
In India,10 States are implementing DOTS Plus services while another 5 States will be initiating the services shortly. In Nagaland, DOTS Plus services is expected to roll out in two phases. In the 1st phase which is expected to be launched by Dec 2011 at TB Hospital Khuzama the districts of Kohima, Dimapur Kiphire, Peren, Phek and Wokha will be covered. Subsequently, in the 2nd Phase, TB Hospital Mokochung will cater to the remaining five Districts. Investigation and treatment will also be free of cost.
Specific measures are being taken within the Revised National Tuberculosis Control Programme (RNTCP) to address the MDR-TB problem through appropriate management of patients and strategies to prevent the propagation and dissemination of MDR-TB. MDR-TB is essentially a man-made phenomenon – poor treatment, poor drugs and poor adherence lead to the development of MDR-TB. The key focus is on prevention through sustained high-quality DOTS implementation and rational use of anti-TB drugs
Traditionally, DOTS-Plus refers to DOTS programmes that add components for MDR-TB diagnosis, management and treatment. It is envisioned that by the year 2010 the DOTS Plus services will be introduced in all the states across the country. By 2012, it is aimed to extend these services to all smear positive retreatment cases and new cases who have failed an initial first line drug treatment. And by 2015, these services will be made available to all smear positive pulmonary TB cases registered under the programme. It is intended to treat at least 30,000 MDR cases annually by 2012-13.
The five essential components of the DOTS-Plus strategy are
• Sustained government commitment;
• Accurate, timely diagnosis through quality assured culture and drug susceptibility testing;
• Appropriate treatment utilizing second-line drugs under strict supervision;
• Uninterrupted supply of quality assured anti-TB drugs; and
• Standardized recording and reporting system.
In India,10 States are implementing DOTS Plus services while another 5 States will be initiating the services shortly. In Nagaland, DOTS Plus services is expected to roll out in two phases. In the 1st phase which is expected to be launched by Dec 2011 at TB Hospital Khuzama the districts of Kohima, Dimapur Kiphire, Peren, Phek and Wokha will be covered. Subsequently, in the 2nd Phase, TB Hospital Mokochung will cater to the remaining five Districts. Investigation and treatment will also be free of cost.
Dr. K.T. Lotha
State TB Officer (RNTCP)
Directorate of Health & Family Welfare
Nagaland, Kohima
