Drug-resistant tuberculosis remains a major threat to global health. Of the 10 million people who fell ill with TB in 2016, over half a million are estimated to have resistance to the most effective drugs used to treat TB. India has 84,000* (Global Tuberculosis Report 2017) cases of drug-resistant TB with the highest number of TB deaths worldwide.
Highly drug-resistant forms of TB are much harder to cure than drug-sensitive TB, as the standard TB drugs don’t work, and the limited treatment available involves long, complex, toxic and expensive treatment. Therefore there is a need to broaden access to effective treatment through expansion of drug susceptibility testing (DST), patient-centered models of care, and better access to new drugs bedaquiline and/or delamanid for patients affected by severely resistant forms of TB.
WHAT WE DO
In Mumbai, where drug-resistant strains of tuberculosis are on the rise, we have been running a clinic since 2006, where we treat patients who require treatment regimens which are not available in the public sector.
Additionally, since 2016 we have been supporting the Revised National TB Control Programme (RNTCP) in one of the highest TB-burden wards of Mumbai (M/East Ward) to provide high quality and holistic, patient-centred care for multidrug-resistant TB (MDR-TB) patients.
MSF teams also provide support to two major hospitals in Mumbai: KEM (viral load monitoring for people living with HIV) and Group of TB Hospitals, Sewri (patient counselling and infection control).
MSF’s clinic in Mumbai treats patients with severe drug resistance, who have no remaining treatment options, with the new drugs bedaquiline and delamanid. Interim outcomes are promising: 74 per cent patients had sputum conversion at six months, 17 were cured and completed their treatment until the end of December 2017.
In the M/East Ward of Mumbai, MSF collaborates with the national program for a cohort of 1500 DR-TB patients. MSF built a model TB OPD at the Shatabdi Hospital in Govandi in 2016, and initiated use of GeneXpert for testing all presumptive TB cases as well as baseline drug susceptibility tests to implement individualised treatment regimen. In June 2017, full coverage of this diagnostic algorithm was achieved in the ward. Now MSF is planning to initiate a community-based model of care for comprehensive patient-centred follow up of this cohort to support them complete the treatment
In the Group of TB Hospitals, Sewri, MSF appointed a peer-educator to strengthen patient support activities. The peer-educator supports TB education sessions in the inpatient and outpatient department of the hospital and acts as a role model for other patients.
The MSF HIV collaborative project in KEM Hospital – offering support through an innovative 1st line ART model of care – has been accepted by National AIDS Control Organization (NACO) and is now implemented in all ART centres in Mumbai.