India needs to fight multi drug-resistant tuberculosis, before it gets late

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Budget 2019 : Wearing a face mask and weighing just 32 kg, 39-year-old Vaishali Shah appeared more a lanky teenager than an adult when IndiaSpend met her in October 2018, at her one-bedroom apartment in Dombivli, a city in Maharashtra’s Thane district, 40 km away from central Mumbai in the Mumbai Metropolitan Region.

Shah, a tuition teacher and mother of a 14-year-old, is an extensively drug-resistant tuberculosis (XDR-TB) patient. XDR-TB is an advanced form of multi drug-resistant tuberculosis (MDR-TB). As the names suggest, MDR-TB patients are resistant to first-line drugs such as rifampicin and isoniazid, which are used to treat the more common drug-sensitive TB. XDR-TB patients are resistant to some second line drugs as well.

While TB is not uncommon in congested Mumbai, Shah’s case is unique because she is among the few drug-resistant TB patients in India who has been able to access two new oral drugs--bedaquiline and delamanid--to fight XDR-TB, along with an add-on drug imipenem.

Shah received bedaquiline from a government programme; the delamanid and imipenem were donated by international humanitarian aid organisation Medecins Sans Frontieres (MSF). She, however, had to endure a delayed diagnosis and then correspond with the prime minister’s office before she finally received bedaquiline. During this prolonged ordeal, Shah narrowly escaped death.
If India follows new World Health Organization (WHO) guidelines released in August 2018 and reiterated on December 21, 2018, other drug-resistant TB patients will not have to struggle similarly. The guidelines recommend bedaquiline and other new oral drugs for drug-resistant TB patients, while minimising the use of drugs with severe side effects.

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