Many patients with drug-resistant TB that arrive at MSF’s clinic in Mumbai have received incorrect or inadequate treatment in the private sector. Although this form of TB is curable if treated early enough, some of the patients, like ‘Shanti’, are in such bad condition that their lives cannot be saved.

Like many other sufferers of multi-drug resistant TB (MDR-TB), ‘Shanti’s’ history of illness was a long and painful journey. Desperately trying to find something that would cure her debilitating illness, she visited many different doctors and took many treatment courses  – three in total – that had no effect. Eventually, she was told by a doctor that her form of TB was incurable and that, in any case, the medicines she needed would be far too expensive for her to afford. By then, she had spent a large proportion of her own tiny income on inaccurate tests and inadequate treatment.

Though deeply downcast, ‘Shanti’ did not give in. Finally, in 2011, she was admitted to MSF’s clinic in Mumbai which provides free treatment to HIV-positive patients who are also co-infected with drug resistant TB. She was subsequently diagnosed with MDR-TB and was put on treatment. It had taken years for Shanti to get the help she had needed for so long. Sadly, a few months later, she passed away due to complications as a result of her illness which had progressed too far.

Many new cases, not enough treatment

Unfortunately, Shanti’s story is far from unique. Patients who reach MSF’s clinic often arrive in very bad condition and some even die before their treatment can be started. A lot of them have already been treated in the private sector with inappropriate TB drug regimens. Often, there is a lack of monitoring among private practitioners to ensure that patients take their drugs continuously. The high drug costs also force many patients in the private sector to discontinue treatment before they have been cured.

“If the private market continues the casual over-the-counter sale of drugs, we are going to see even more cases of drug resistant TB developing” says Piero Gandini, Head of Mission for MSF in India. “There is an urgent need for authorities to regulate the private sector so that patients are given treatment and support of an acceptable standard.”

India has the second highest MDR-TB burden in the world with nearly 100,000 new cases every year. Yet only 2% of these cases receive second-line drug treatment under the national programme.

“It is really important that people with TB are correctly diagnosed at an early stage, and that appropriate care and treatment is provided. It’s very sad every time we are unable to save a patient’s life. But unless more is done by the authorities to address the growing problem of drug resistance we are just going to see more cases like this” says Gandini.

Drug-resistant tuberculosis is a form of TB that is resistant to standard first line TB drugs. A person can be directly infected by this form of TB or can develop it if treatment taken was not appropriate in terms of drug regimen, dosage or duration. HIV patients are particularly susceptible to developing TB due to the lowering of the immune system.

‘Shanti’ is an invented name to protect the patient’s anonymity.