Maharashtra

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).

IN 2017

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.

MSF Clinic

115

People living with HIV on treatment

82

DR-TB patients on treatment

924

Counselling sessions held

193

DR-TB patients completed their treatment

15

Health education sessions held

50

Support group meetings conducted

M/East Ward

1,424

DR-TB patients on treatment

468

Health education sessions held

112

Support group meetings conducted

7,682

Counselling sessions held

193

DR-TB patients completed their treatment

Group of TB Hospitals, Sewri

2,230

Counselling sessions held

221

Health education sessions held

127

Support group meetings conducted

KEM ART Centre

851

Enhanced adherence counselling (EAC) sessions conducted

391

Health education sessions conducted