Kerala - Thiruvananthapuram

State to launch Dots Plus treatment

Thiruvananthapuram: The State government has decided to make the Dots Plus treatment for Multi-Drug Resistant (MDR) tuberculosis available to patients in all districts from October this year.

This was decided at the first meeting of the State Dots Plus Committee here on Tuesday, which was chaired by Health Secretary Vishwas Mehta. Kerala has thus become the first State to launch the Dots Plus strategy across the State.

This is seen as a major achievement for the State, which had put up a good performance in the Revised National Tuberculosis Control Programme (RNTCP) last year.

Till now, the State has been following the DOTS strategy under the RNTCP for tackling tuberculosis.

However, with MDR TB emerging as a major concern, the State has to progress towards the next step, the DOTS Plus strategy, so that proper treatment can be provided for drug-resistant cases of tuberculosis.

It is to this end that the Intermediate Reference Laboratory (IRL), with sophisticated facilities for doing mycobacterium culture and drug sensitivity, was set up in the capital last year with assistance of Rs.50 lakh from the Central Tuberculosis Division.

The IRL, which has been studying sputum samples of patients for determining the prevalence of drug-resistance in the community, is expected to receive its accreditation from the Tuberculosis Research Centre at Chennai, a WHO collaborating centre for TB control, by September. Till then, arrangements would be made for doing the sputum culture and drug sensitivity tests of TB patients at the TRC, it was decided at the meeting. As of now, there is no official statistics on the prevalence of MDR TB in the community.

However, global studies as well as district-level studies conducted in Kerala and other States have put the prevalence of drug-resistant TB at around three per cent of the total new TB cases.

A patient is labelled as a case of MDR TB if the bacteria in the sputum sample is found to be resistant to two main first-line TB drugs, isoniazid and rifampicine.

These apart, there are also a certain number of Category II patients (old TB cases or cases of relapse) who might be resistant to first-line drugs.

“We expect to treat about 100 cases of MDR TB in an year,” a senior RNTCP official told The Hindu.

So far, the government had only been providing medicines worth Rs.50 lakh a year for the treatment of MDR cases.

These cases were not being diretcly monitored or supervised for treatment adherence.

Under the Dots Plus strategy, a patient with MDR TB would have to undergo a daily drug regimen, which includes six second-line drugs apart from some injections. The treatment period would be a minimum of two years unlike the Dots strategy, where six months’ of uninterrupted treatment is enough to cure the TB patient.

As Dots Plus involves more hospital-based treatment, two major Chest and Respiratory Medicine departments in Thiruvananthapuram and Kozhikode Medical Colleges have been chosen as the Dots Plus sites in the State. Patients taken in for Dots Plus treatment would be admitted here and the State government will take care of all the preliminary tests.

The treatment will be directly monitored by the experts’ committees in Dots Plus sites as well as community volunteers who will ensure that the patient presents himself at the hospital for the daily drug regimen.

The government has also decided to appoint a Medical Officer and a coordinator through the National Rural Health Mission for coordinating the programme.

“Ensuring treatment adherence by patients is a major challenge as far as the Dots Plus strategy is concerned because the drugs are of high toxicity and have to be taken daily for two years without fail.

“But we have to make a success of this programme as incomplete treatment could result in either XDR TB (extreme drug resistance) or the spread of MDR TB in the community.

The fact that we have few cases of MDR TB in the community could work in our favour,” a senior official said.

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