| Leena Menghaney |
Médecins Sans Frontières has been grappling with the limitations of drug-resistant TB medicines in India since 2007 when it began treating some of the most marginalised and severely ill patients in Mumbai for multi drug resistant TB/ HIV co-infection. Today 120 co-infected patients are treated, including 11 children. To control DR TB, India should begin adopting in the DOTs programme fixed-dose combinations for first line TB treatment that increase adherence, develop clear plans to regulate the sale, prescription and use of TB drugs in the private sector and most importantly strengthen lab capacity across the country so that treatment providers can adjust the treatment regime according to the resistance pattern of each patient as the ‘standard, one-fits-all’ MDRTB treatment regime is not a medically correct approach to treating DRTB.
For the first time in 50 years, there is hope. New drugs, effective against drug-resistant forms of TB, are becoming available. Policy makers must seize this opportunity and ensure that compassionate use programs for new TB drugs allows some of the sickest DR TB patients to receive these new medicines. India must participate in the research required to find the best treatment regimens incorporating these new medicines. New regimens must be shorter, more effective and less toxic than the current two-year regimen for DR TB. Drug manufacturers must make new drugs available for clinical research, register them in India and ensure they are affordable.
Most importantly India must have a plan to prevent the misuse of new TB drugs and here the Health Ministry and the Drug Regulatory Authority have to provide leadership.