Demands immediate launch of National 3HP programme
DIMAPUR, MARCH 23: With only 3 years left for India to achieve its ambitious target of TB elimination, the ARK Foundation, Nagaland, has expressed disappointment that the country is nowhere near accomplishing it.
In a letter to the Additional Secretary & Director General of NACO, Alok Saxena and others, the General Secretary of NNagaDAO and Advisor to Indian Drug Users’ Forum, Ketho Angami listed structural and programmatic barriers such as lack of counselling, non-availability of proper diagnostic facilities and treatment drugs for multi-drug resistant (MDR) TB, non-release of monthly nutritional support on time, and systemic discrimination of the affected community as some of the causes that affect the progress towards TB elimination.
He stated that in January 2022, five States of Northeast India namely, Mizoram, Nagaland, Sikkim and Manipur had initiated a community feedback mechanism “to assess, identify and report” on Tuberculosis Prevention Therapy (TPT) after observing a poor partnership between the programme and the affected community.
“This community feedback mechanism targeted the PLHIV community, as they have a much higher rate of 25% risk of progressing from Latent Tuberculosis infection (LTBI) to active TB, was necessitated out of the failure in the only Isoniazid Prevention Therapy (IPT)-based TPT strategy available in the country, and also more importantly because of the research-proven and the WHO’s recommendation of a newer strategy in the form of 3HP in its 2020 consolidated guidelines on TB. The 3HP has been recommended as a preferred option to IPT, due to its nature of being a shorter regimen, lesser pill burden, better efficacy, less hepatotoxicity and better treatment completion rate in treating LTBI.
“However, we are disappointed about the delay in rolling 3HP out nationally by the Central TB Division and the National AIDS Control Organisation for the key populations, and also including the low ceiling of the PEPFAR Target with only 56,495 TPT patient courses, despite 3HP being the PEPFAR’s preferred TPT regimen, in its next funding cycle 2023, in India”, read the letter.
On the supply of Pyridoxine VB6 to address the side-effects of INH, he stated that 32.4% were reported to have been not provided with vitamin by the programme while 7% reported having to buy it themselves; 80.6% reported having to collect their INH dose every month; 17% reported getting the complete 6 months course on day one, while the remaining had to collect it quarterly.
“While 4.6% reported being denied INH, 6.2% were denied VB6 due to shortages and stock-outs of these medicines in the past. As a result of the lack of VB6, 26.9% of the IPT Client reported side effects during and post the 6 months treatment course. All these could well be the reason why 15.5% of the PLHIV community did not complete their 6 Months IPT course.
“On the larger perspective of TPT education and its need among the affected community, 81.3% reported not attended any TB meetings/training. However, 57.1% opined the need for Treatment literary Workshops and expressed interest to attend if conducted, while 16.5% responded in negative and 26.4% responded “maybe”. 84.6% responded to the need of the PLHIV community needing more awareness on TB and its prevention. And 70.3% demanded the need for all PLHIV to get treated for LTBI under the National/State Programme. All these community feedback analyses indicate a huge gap in the TPT programme in India”, stated the letter.
He reminded that the affected community has in the past, on several occasions, written to the CTD-NTEP and NACO-NACP to revitalise IPT and to introduce 3HP for PLHIVs, “but the bureaucracy at the national level did not have the audacity or the courtesy to consider such request, and demands of the affected community fell on deaf ears”.
The ARK Foundation questioned the credentials, credibility, and commitment of the authorities, and demanded immediate launch of a National 3HP programme for all key populations.
(Page News Service)