TB is treatable and curable if patients take the prescribed, anti-tubercular medicines on a regular way.
By Dr Gargi Maitra
Tuberculosis (TB) is caused by Mycobacterium tuberculosis, it is a bacterium that spreads in air as droplets (tiny particles) when people with active tuberculosis sneeze or cough. TB contributes as a major source of infectious diseases globally and has received considerable attention in current years, particularly in developing countries where it is closely associated with various other co-morbidities like diabetes, HIV/AIDS etc. Treatment has Poor adherence which is very common despite several interventions that have been executed to improve treatment completion. Non – adherence and poor compliance to tuberculosis treatment are in fact two major obstacles in preventing the spread of this infection and its cure. Poor adherence to treatment not only causes medical complications for the patients in the form of disease relapse, treatment failure, emergence of drug resistant tuberculosis, but also exposes the surrounding community to risk of various medical , psychological and economic challenges which further become hurdles in the path of tuberculosis management.
TB incidence is the number of new cases of active TB disease during a given time period (usually a year).The World Health Organisation (WHO) TB statistics for India for 2018 gave an estimated incidence figure of 2.69 million new cases and the incidence of Drug resistant (cases that are resistant to standard anti-tubercular treatment drugs) tuberculosis for the aforementioned period was 1.3 lac/100,000 population.
TB can be cured by taking anti-tubercular treatment daily for at least six months. But many patients fail to complete the prescribed treatment because the medicines sometimes have unpleasant side-effects, patients may face physical difficulty in procuring the medicines specially in hilly areas and the treatment is complicated in itself. Also, after beginning the treatment, people may feel better, therefore they may stop taking the medicines before all the bacteria in their body are dead (that is termed as treatment completion). If proper treatment is not followed the patient can remain infectious for a longer period of time, spreading infection to many and they are also more likely to relapse and even die. Poor compliance to treatment also contributes to the emergence of drug-resistant tuberculosis. Management of drug resistant tuberculosis is much more complicated involving multiple drugs, as compared to drug sensitive tuberculosis. Treatment of drug resistant tuberculosis is longer in duration and is fraught with challenges like greater economic burden on the managing community (care giver) and various medical and psychological complications for the patients as well (care receiver).
To help people complete their treatment, the World Health Organization introduced a strategy known as DOTS (directly observed treatment, short course)- where a health worker or a TB treatment giver watches the patient take his/her antibiotics. Although DOTS has contributed to improved TB treatment adherence, better patient compliance is needed to stop spread of this infection globally. Treatment adherence and compliance are complex issues and require proper understanding, of the factors that prevent people from taking medicines. Treatment adherence and compliance –these two factors need to improve to improve treatment outcomes and reduce death, TB associated morbidities and emergence of drug resistant TB.
TB is treatable and curable if patients take the prescribed, anti-tubercular medicines on a regular way. Poor adherence to treatment has been identified as one of the most serious problem in TB control and a major obstacle to elimination of this disease, both nationally and internationally. Therefore, adherence to treatment is critical for cure of individual patients, controlling further spread of infection and minimizing the emergence of drug resistance tuberculosis.
(The author is Associate Consultant, Pulmonology, Fortis Memorial Research Institute, Gurugram. Views expressed are personal.)