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In Pictures: India’s drug-resistant TB crisis

Mismanagement has led to drug resistance and untreatable strains, stoking fears of a worsening health crisis.

A multi drug resistant TB patient. She works as a day labourer to support her family of four.
By Bijoyeta Das
Published On 17 Feb 2014

India accounted for the greatest increase in multi-drug resistance Tuberculosis (MDR-TB) with an estimated 64,000 new cases in 2012.

MDR-TB can occur as a primary infection or develop during a patient’s treatment. But experts say drug-resistance is a man-made problem. “It is powerful sign of system failures,” says Madhukar Pai of McGill International TB Centre. Treatment is expensive with greater risks of side effects and lasts up to two years.

Pai says incorrect regimens, poor quality drugs, lack of treatment adherence, and inadequate testing of drug-susceptibility leads to drug resistance. There are reports of patients totally resistant to all existing drugs.

The drug-resistant strain of TB complicates India’s battle against the disease. Two people die of TB every three minutes in India, which accounts for 26 percent of the cases globally.

The World Health Organisation estimates that four-fifths of drug resistance cases worldwide are still undetected. Government health officials told Al Jazeera increase in MDR-TB cases was because of better diagnostics.

TB is an opportunistic disease and HIV patients are more susceptible, says Akke Boere, India director of Medicins Sans Frontieres. “The HIV patients are already taking drugs and treatment for MDR-TB is long and includes very strong drugs.”

A healthcare provider of Medicins Sans Frontieres shows a dose of medicines given to MDR-TB patients.
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The government TB hospital in Manipur. This northeastern Indian state has the highest prevalence rate of HIV. TB is a major co-infection along with Hepatitis C.
A patient who is currently under treatment for MDR-TB is isolated from other family members to prevent infection, especially among children.
India provides free treatment for all primary TB patients. But half of the TB patients go to private sector, where antibiotics are misused often leading to drug resistance.
A former drug resistant TB patient who took regular doses of TB medicines. He suffered from recurring TB complications, took different treatment courses from doctors in the private sector. His cure was long and arduous.
MDR medication is expensive, which causes many patients to abandon their drug regimen. This results in worse form of drug resistance.
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Drug resistant patients do not respond to standard first-line drugs. A person may be directly infected by DR TB or can develop resistance due to lack of adherence.
India registered the greatest increase in multi-drug-resistance TB in 2012.
The WHO recommends that India speed up its capacity for diagnosis and treatment, especially MDR-TB.