67% of TB patients fall through the cracks in Tamil Nadu

CHENNAI: A simple gaffe in protocol for TB diagnosis is turning out to be fatal for patients who are going missing from the state’s records. At least three of 10 patients registered with Tamil Nadu government-run tuberculosis clinics could not be traced because the contact details were either illegible or missing, reveals a study by the Chennai-based National Institute for Research in Tuberculosis (NIRT).

While a central notification has threatened to send private doctors to jail if they don’t notify every infected case along with name and address of the patient, Chennai’s public clinics have failed to follow up with several patients who walked into their centres. The study shows that when patients were tracked, one in 10 didn’t start their treatment within the recommended two weeks, and a nearly equal number were lost or dead before they could be registered with the revised national tuberculosis therapy, which uses the WHO DOTS strategy to deliver free treatment including a cocktail of antibiotics for six or 18 months.

Last week, medical journal British Infectious Diseases published a paper titled ‘Pre-treatment loss to follow-up of tuberculosis patients in Chennai, India: A cohort study with implications for health systems strengthening’. Conducted by a team of scientists, including those from the NIRT, Tufts University School of Medicine in Boston, and officials in the state health department, the research exposed the loopholes in the healthcare system in the city.

The first author, Beena Thomas, at NIRT said pre-treatment loss to follow-up (PTLFU) —the loss of patients between diagnosis with TB and registration for treatment — is one of the biggest barriers to battle against the disease. “There was a high PTLFU rate in Chennai, especially in patients with prior TB history, who are at a greater risk of having drug-resistance,” she said. The study by her team concluded that enhancing quality of care and health system transparency is critical to improve linkage of newly diagnosed patients to TB care in urban India.

Chennai, Mumbai, Kolkata, Bengaluru and Delhi, have more than a quarter of the country’s homeless population. NIRT director Dr Srikanth Prasad Tripathy said all TB cases should be diagnosed early and treatment initiated within two weeks.

“Otherwise, they could spread the disease. And if they have drug-resistant strain, they could be spreading that too,” he said.

State TB officer K Senthil Raj said the situation is likely to change as the state is planning to give `500 as incentive to patients taking TB treatment at government hospitals. “We will be going to test people instead of waiting for them to come to us. Our grassroots workers in rural and urban areas will update data and will also carry the device to the patients’ home, monitor treatment outcome and report if patients do not adhere to the drug regimen,” he said.