TB Uttar Pradesh

Gaurav Saigal

UTTAR PRADESH would be third state in India to provide treatment to Multi Drug Resistant-TB (MDR-TB) patients, after Gujarat and Maharastra.

MDR-TB drugs or second line TB drugs are given from Directly Observed Treatment shortcourse-Plus (DOTs-P) centres to those TB patients who have developed resistance to first line TB drugs.

Until now the State was providing only the first line TB drugs under DOTs programme.

Initially DOTs-plus centres would come up in Lucknow and Agra, the cities that have Intermediate Referral Laboratory (IRL), said the State Tuberculosis Officer, DK Jain.

The IRL are specialised labs for sputum culture test that can confirm a patient is resistant to first line of drug - Floroquinalone - and that the patient require second line or MDR-TB drugs.

“MDR-TB drugs are toxic and costly too thus we need to confirm a patient's resistance to first line of TB drug before starting the MDR-TB drug. This confirmation needs IRL support,” said Dr Rajendra Prasad, chairman of State Task Force on Revised National TB Control Programme.

First line treatment of TB takes a minimum 9 months while the treatment for MDR-TB takes at least 2 years. The approximate cost of treating MR-TB patients is Rs one lakh per patient.

“The lab in Lucknow is at Chhatrapati Shahuji Maharaj Medical University and the one at Agra is at State TB Demonstration Centre. These two labs would be linked to the National Referral Lab at Chennai,” said Jagdish Rai former State TB officer, who was working on DOTs-Plus project for last two years.

DOTs-Plus, according to experts, should have been started earlier but main hurdle was a clearance from World Health Organisation (WHO). It demands that unless a state has covered the entire population with the DOTs programme it can not start DOTs-Plus.

Training of doctors from Lucknow and Agra for running the lab has been completed, said Rai.

The next step would be to identify patients of MDR-TB and initiate the treatment so that the patients of MDR-TB do not convert in to Extreme Drug Resistant-TB (XDR-TB) that is considered fatal. This process could take another two month before MDR-TB patients would start getting medicine.


Category-wise TB treatment

TB patients are divided in to three category. Category-I is for those patients who test sputum positive for TB for the first time. The category-III is for those who are confirmed TB patient but the level of bacteria in them is such that their sputum test result comes negative. Patients in both these category get first line of drugs.

Those patients in whom treatment at category I and III fails, come under category II for a revised treatment. They too get first line of TB medicine but with few additional drugs.

Such patients in whom treatment fails even in category two are declared as category-IV patients ie. MDR-TB.