Extrapulmonary TB: India needs to do more
A call has been made for India to do more to combat the extrapulmonary form of tuberculosis. The Indian branch of Advocacy to Control TB Internationally (ACTION) says the country's TB control programme is failing to take sufficient action to diagnose cases of the condition.
“Extrapulmonary TB” describes TB of any part of body except the lungs. An estimated 15-25% of TB cases worldwide are extrapulmonary. Patients do not have a cough and so TB infection is often not suspected. Their sputum tests negative for TB bacteria, so this form of the disease is hard to diagnose, often requiring invasive procedures to obtain diagnostic specimens and the use of more sophisticated laboratory techniques. People living with HIV/AIDS face a high risk of developing extrapulmonary TB and the condition has become more common since the advent of HIV.
Diagnosing and treating people with extrapulmonary TB is now internationally recognised as a major public health concern but many countries have yet to accord it a sufficient level of priority in their control efforts. ACTION India says this is the case with India's Revised National TB Control Programme (RNTCP).
“Diagnosis of extrapulmonary TB is not covered by RNTCP – only treatment of extrapulmonary TB is covered”, says Mamta Jacob, Advocacy Officer, ACTION India. He points out that, “Medical colleges provide diagnosis services for extrapulmonary TB and then patients can be referred to treatment for extra pulmonary TB at RNTCP”. However, about 70-80% of patients in India seek care first from the private sector, where – if available – diagnostic tests for extrapulmonary TB are prohibitively expensive (US$30-120).
The difficulties and costs of diagnosing extrapulmonary TB add to the burdens faced by national TB programmes, particularly in the case of India where there are more people with TB than in any other country. According to India's country profile in WHO's latest Global Tuberculosis Control report, 1,296,000 new or relapsed cases were notified during 2007; 17% of new notified cases were of extrapulmonary TB. The rise of drug-resistant forms of TB is amongst the programme's other challenges.
TB programmes across the world need improved and affordable diagnostic tests for all forms of the disease.
ACTION India says it engages in country-level advocacy efforts to increase funding and demand for TB control programmes and address policy constraints to diagnosis and treatment in India. ACTION India works directly with the Indian government, multilateral agencies including the World Bank and Global Fund to Fight AIDS, TB, and Malaria (GFATM), the World Health Organization (WHO) and other technical organizations, and allies including the Stop TB Partnership and Global Health Advocates.
Bobby Ramakant and Paul Chinnock, TropIKA.net
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