Coming to the end of phase one, of a multi center operational study in Manipur, on barriers to accessing and adhering to TB treatments, especially with a focus on people living with HIV AIDS, the study highlights both patient end and provider end causes for delays in getting appropriate TB diagnosis and treatment initiated. Lack of awareness and knowledge about TB ranks high among the patient end causes for delay in seeking appropriate TB diagnosis and treatment services. Distance to the nearest TB service delivery point is a key barrier from the provider end, with average travel times exceeding 90 minutes for over half of the population surveyed. Nearly a third of the survey population also reported paying for their medications, indicating an incomplete reach and awareness of the free national TB control program (RNTCP).
People living with HIV/AIDS are among the most vulnerable to getting TB infections. Any delay in this vulnerable population getting life saving TB treatments is also indicative of broad systemic issues of accessibility that need to be addressed quickly, said Dr. Venkatesan Chakrapani, MD, the lead researcher on this study from INP+. The delay in getting appropriate diagnosis for HIV co-infected individuals also reflects on the failure to get newer diagnostic tests on to the market and in our healthcare delivery points, he added. The currently used standard microscopy based sputum tests fail to detect TB in samples from people living with HIV and having infectious TB, leading to false negative tests and delays in getting a correct diagnosis.
There needs to be a further deepening of the service delivery to avoid long travel times for sick people, said Dr. Bobby John from Global Health Advocates, one of the advisors on this study. Distance, and poor understanding cause people to drop out of their medications more often than not, he added. 10 percent of the survey participants reported stopping their treatments for a week or more. Incomplete treatment adherence raises the risk of multi drug resistant TB for the individual and in the community.
Supporting the study findings, and echoing the urgency to see greater coordination between HIV services delivered through the national AIDS control program, Vivek Dharmaraj from the Advocacy to Control TB Internationally (ACTION) Project in India said: People living with HIV should get TB diagnosis and treatment services from one window. It is no point putting people on life saving anti retroviral treatments for HIV, to see them die of TB. Indias national AIDS control program has put nearly 250,000 on anti retroviral treatment, of the estimated 2.4 million people living with HIV.