Council helps TB patients take their medication | Bombay News


Mumbai: In 2020, when Sharmila Rajbhar (36) was referred to the Médecins Sans Frontières (MSF) clinic in Govandi, she was unwilling to continue treatment for her extensively drug-resistant tuberculosis (called XDR-TB), which she had been taking since 2016. She was exhausted from the side effects of the medication and worried about overwhelming her husband, who had recently recovered from multidrug-resistant tuberculosis and returned to his job as a courier. However, 18 months later, Rajbhar has not missed a single day of his medication.

“I just want to heal so I can get back to work,” said the Bhandup resident and mother of a four-year-old.

Patients like Rajbhar who suffer from drug-resistant tuberculosis are hanging by a thread, always on the verge of abandoning medication, which makes adherence to treatment a challenge for healthcare professionals. Typically, drug-resistant TB drugs include multiple pills and have toxic side effects. In addition to the prolonged treatment, the loss of income that often results from their poor health deters them from continuing their medication. Healthcare workers, including respirologists, counselors and patient support supervisors, use a range of interventions to motivate and ensure patients adhere to the regimen to cope with illness. MSF patient support supervisor Santosh Jha, for example, heard Rajbhar’s concerns and involved her husband in counseling sessions. “Building compliance depends on several factors: how healthcare professionals communicate with patients, build their trust and provide support they may lack,” said Jha, who has worked at the MSF clinic for 10 years. years.

Tuberculosis is a serious infectious disease caused by Mycobacterium tuberculosis, which usually affects the lungs. Infection that responds to the first line of TB drugs is called drug-susceptible TB. However, when the bacteria becomes resistant to certain drugs, it is called multidrug-resistant tuberculosis (MDR-TB). When they become resistant to most available anti-tuberculosis drugs, the infection is XDR-TB. In Rajbhar’s case, for example, she was first diagnosed with tuberculosis in 2005 and had taken medication. Eventually, she developed XDR-TB, as the bacteria became resistant to most of the drugs available for treatment.

Before the pandemic, Maharashtra recorded 20,000 new cases of tuberculosis every month. Almost 22% of these cases are from Mumbai. In Mumbai, 54,983 new TB cases were diagnosed on average every year between 2018 and 2021. This included 5,385 MDR-TB cases and 439 XDR-TB cases per year. The rate of “lost to follow-up” fluctuated between 5% and 7% per year.

The independent clinic is located in the M-East district. According to the civic body, the M-East ward has nearly 2,800 patients on active treatment for drug-resistant tuberculosis, making it the largest such cluster in Mumbai. The clinic offers individualized treatment, psychosocial support and integrated psychiatric care under one roof. The clinic treats some of the most complex drug-resistant cases and has started treatment for more than 750 patients since 2012, most of them with the two new TB drugs, bedaquiline and delamanid.

The clinic implements several methods to improve medication compliance. “We start by understanding what the patient’s support system looks like and plan our interventions accordingly. Generally, patients who lack family support are more likely to drop out mid-career. Other aspects such as loss of income, inability to continue household chores and illness of other family members also play a role,” Jha said, adding that some patients are also offered travel and nutritional support.

“We try to connect the benefits of treatment with the patient’s short- and long-term life goals and create awareness of health improvements due to adherence,” he said.

Treatment for drug-resistant tuberculosis lasts 18 to 24 months. Overloading pills and their toxic side effects, including nausea, rashes, ulcers, hearing loss and blurred vision, are among the main reasons why patients drop out of treatment.

“Even in a simple case of diarrhoea, when a patient can be prescribed a course of five days, there is a tendency to suddenly stop the drugs. Imagine a patient with drug-resistant tuberculosis having to consume 13 or more tablets a day. They are bound to falter easily,” said Dr. Vikas Oswal, a pulmonologist from Shatabdi Hospital in Govandi, who believes that the aspect of counseling is crucial in medication adherence.

MSF collaborated with the civic body and also replicated its independent clinic model at Shatabdi Hospital. Campaigners say all citizen-run clinics should also offer similar comprehensive care to increase medication adherence.

“Some clinics don’t even have a counselor attached to the TB outpatient department,” said patient-activist Ganesh Acharya. “The approach is too medicalised, relying heavily on drugs and tests. Although these are important factors, TB care needs much more to ensure that the patient continues to take the drugs and has regular tests,” said Acharya.

Mumbai patients get 500 in the form of direct benefit transfer (DBT) for their nutritional support. “It’s a very small amount to afford a proper diet of eggs, chicken, milk and other things that doctors recommend,” said Shivaji resident Shehnaz Khan (26). Nagar. Khan has been on XDR TB treatment at MSF’s independent clinic for 16 months. “But I am determined to fight the disease to take care of my child,” said the mother of a four-year-old.

A city official said a comprehensive approach, which includes medical, nutritional and psychological support, has markedly improved adherence to treatment. “Many nutritional and other supportive interventions are being undertaken in the city,” the official said.


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