Non-Availability of ATT

By Azizullah Sharif

Renowned specialist in infectious diseases, Dr Naseem Salahuddin, apprehend that if the current situation of drug interruption continues any longer, thou sands of Tuberculosis (TB) patients will die untreated.

Moreover, some of them (TB patients) will develop complications and die slow deaths and those who started treatment and had to disrupt it will develop multidrug resistant (MDR) TB and among them, women and children, will be the worst sufferers, she deplored.

Having rich experience in treating patients suffering from different infectious diseases such as TB, MDR, HIV and victims of dog-biting cases, etc., Dr Naseem Salahuddin, who had earlier served as the founding president of Infectious Diseases Society of Pakistan and currently working  as Consultant Infectious Diseases at the Indus Hospital, said that it was an irony that anti-TB treatment (ATT) is no longer available in the country as the drugs have suddenly disappeared from the market reportedly owing to a controversy over pricing of drugs among the Ministry of National Health Services, the Drug Regulatory Authority of Pakistan and the pharmaceutical firms.

However, it was an irony that thousands more people will continue to be added to the tuberculosis pool as long as the issue of non-availability of ATT is resolved.

"It seems as if the health ministry, Drap and the pharmaceutical fir;8ms are waiting for an explosion of TB," she opined, saying such a situation will ultimately lead to multidrug resistant TB which has already increased to 5 per cent of all TB disease, and is a real threat to our population.

Drawing a parallel between private and public sector hospitals vis-à-vis availability of anti-TB drugs, Dr Naseem said that it was heartening to note the management of TB in hundreds of public sector hospitals and clinics across the country is better than that of private healthcare facilities.

Elaborating, she said that as a matter of fact TB centres falling under the control of the National TB Programme (NTP) are meeting international targets of diagnostics and treatment.

About the NTP, she said, the programme is financed through global funding, and it pursues a robust programme of TB care. But, keeping in view the huge burden of the disease, NTP cannot reach the vast numbers of patients in towns and villages and as such most of the patients approach private healthcare institutions where they go through the ordeal of finding the right doctor, getting correctly diagnosed and receiving correct treatment.

She was, however, of the view that errors of judgement or prematurely stopping treatment will convert 'simple' TB into a complex condition, resulting in death.

ORDEAL: Talking about the ordeal of patients who, in the absence of anti-TB drugs, develop multidrug resistant (MDR) TB, she said that the second-line treatment of the MDR TB patients not only extends over two years but it is cumbersome also because it involves one injection daily for at least eight months plus four to five tablets every day for 20-24 months, besides such patients are required to visit the concerned health facility every month.

On the one hand, the pills and the injection are toxic and expensive and, on the other hand, they are not always effective, she further explained, pointing out that MDR TB success rate around the globe is 50-60 per cent and at the Indus Hospital, it is up to 78pc.

Elaborating, she said that TB is completely curable, provided the treatment is taken promptly and correctly. However, if the drugs are of inferior quality, taken erratically, incorrectly or with interruption, the bacteria mutate, converting sensitive TB into the dreaded multidrug resistant (MDR) TB.

TB is a global problem as around two billion people worldwide are infected with the bacteria, and are at high risk of developing active disease.

Quoting the World Health Organisation’s (WHO) global report- 2014, she said that it says 9.6m people were ill with TB, of which 1.5m died.

Regarding Pakistan, she said that the country bears the fourth highest disease incidence in the world, with 500,000 new cases detected in 2014 that were responsible for a colossal 48,000 deaths.

No age group is immune, but the most serious consequences occur among children and the elderly while the young women of childbearing age are most frequently hit, she said, adding that often there are several persons affected within a family or household. As always, the poor and the marginalised bear the greatest burden of infectious diseases because of illiteracy, marginal food sustenance, overcrowded living conditions and non-existent healthcare facilities.

In fact, TB is the most prevalent infectious disease whether it is in the lungs, or the glands, brain, bones, joints, intestine, kidneys, heart, spine, skin, eyes, etc. When a person with lung infection coughs, sneezes or laughs, the spray containing millions of bacteria disperses in the air; if ventilation is poor, others will inhale the spray and the bacteria will start the process of destruction in their organs.

SYMPTOMS: For months, years or decades, the invading germs may remain latent and never be activated; however, in 10pc of infected individuals they reactivate and invade a vulnerable organ, causing fever, night sweats, poor appetite and weight loss. If the person has other conditions such as poorly controlled diabetes, AIDS, or is a smoker, TB will appear sooner and manifest itself more vigorously and, left untreated, the disease will gradually destroy the affected organ.

Dr Naseem was, however, optimistic that the authorities concerned will help resolve the issue of non-availability of anti-TB drugs, amicably and once for all, thus bringing an end to the sufferings of TB patients, besides saving the image of the country from being tarnished in the comity of nations.