Regulation is vital to curbing TB in India

NEW DELHI // For Amit Kumar, the decision was easy.

Quit his job to stand in line for a half a day to receive free medication for tuberculosis and HIV or pay for private but expensive yet convenient treatment.

Mr Kumar, 38, was lucky to have a choice. He kept his job.

"The poor do not have a choice. I did, so I took it but there was no proper guidance," he said.

Today is World Tuberculosis Day - a stark reminder of India's struggle to curb the spread of the disease. India is the most infected country in the world with 20 per cent of the known 8.5 million cases.

Tuberculosis, caused by a bacteria that mostly affects the lungs, kills 300,000 Indians a day - more than HIV/Aids-related deaths, according to the World Health Organization.

There are several challenges facing India in its fight against the disease. Poor sanitation and housing, a poorly functioning public health care system, and unregulated pharmacies that hand out antibiotics without a prescription, all work against keeping the disease in check.

India adds an estimated 99,000 cases of drug-resistant tuberculosis every year, but only a tiny fraction of those infected receive the proper drugs to treat the disease through the government-funded programme.

The original form of the disease can be easily cured by taking antibiotics for six to nine months. But if that treatment is interrupted or the dose is cut down, the bacteria battle back by mutating into a tougher strain that can no longer be killed by standard drugs making it harder and more expensive to get treatment.

The easy availability of tuberculosis drugs in the private market and the casual over-the-counter sale of antibiotics is fuelling the development of drug resistance, Piero Gandini, head of Doctors Without Borders in India, said.

"There is an urgent need for regulatory control of sale and administration of [tuberculosis] drugs in the private sector," he said.

Mr Kumar, a purchasing manager in the hospitality industry, spends up to 4,000 rupees (Dh287) - half his monthly salary - on medication to treat tuberculosis and HIV. He was diagnosed with HIV in 2006, but it took a five-month case of tonsillitis before he received the proper diagnosis.

After he was diagnosed, "one doctor just wrote me a prescription for tuberculosis and for three months, I noticed no change. It was only later I realised I was on improper medication and taking it all wrong," said Mr Kumar, whose tuberculosis was a result of HIV.

In 2008, Mr Kumar lost his job as a cinema manager and was unable to afford private treatments, so he approached a doctor in Delhi at the National Aids Control Organisation for free medication.

"The doctor told me: 'You did private treatment before you came to us. We cannot treat you. We don't care if you live or die.' I gambled with my life and stopped treatments for two months till I found another job."

Last month, a hospital in Mumbai reported that some patients being treated for tuberculosis had stopped responding to the first line of drugs, a course that runs from six months to a year. The strain detected was worrisome. It meant a fresh set of cases who were multi-drug or extremely drug resistant.

The incident in Mumbai indicates that patients are being improperly treated, said Amit Sengupta, with the People's Health Movement in New Delhi. The organisation promotes equitable access to health care across the world.

* With additional reporting by Associated Press