Almost 40 percent of the population in India are infected with the TB pathogen, every fifth new patient worldwide is living in this sub-continent. In India in 2008 (more recent figures are not available) 1.51 million TB patients were treated. In the past year, according to estimates, there were 110,000 new cases of MDR-TB (see glossary “TB”). The treatment of this form of TB is complex: more and other antibiotics with severe side effects have to be applied costing on average 3,000 Euros per patient. Moreover, MDR-TB can be diagnosed in only a few laboratories, so that the victims remain untreated or are not treated effectively and thus can infect other people.
General project aims
In India the governmental health services provide medical doctors, drugs and treatment centres for TB which, however, are often very anonymous and for the poorer patients not easily accessible. DAHW perceives itself as a partner of the government as well as of the affected patient, it bridges the gap between both. Thus, it is providing access to good quality TB treatment and diagnosis and is supporting the patients to finish the treatment as prescribed, irrespective of whether the disease is caused by sensitive (“normal”) or by resistant pathogens. Particularly in slum areas DAHW cares for the more endangered population and supports the patients individually, for example if side effects of the drugs occur or if they cannot take care of their family sufficiently.
DAHW offers training to community DOTS providers and pays them a small honorarium. The programme is called “community-based standardised TB treatment” and involves volunteers in the task of care for patients area-wide. DAHW is supporting patient friendly services: each TB patient will get his medication without having to walk long distances and at a time compatible with his occupation. The patient will be cared for individually if problems occur. In addition, DAHW supports health education and prevention, for example by means of street theatre.
To change lives
In a slum area in New Delhi Dr. Rajbir Singh, the medical advisor of DAHW for North India, accompanies a programme for community-based standardised TB treatment.
Community DOTS providers supervise patients to ensure they stick to the prescribed drug regimen. One of them is Mrs. Ruchi. The whole issue just takes a few minutes: she hands out the dose of tablets and a cup of water, the patient swallows the medicaments, the community DOTS provider notes down the intake in her patients’ register. If patients do not come, she will go to see them and inquire about their absence. It is her task to ensure daily and careful adherence to the treatment. A TB patient must take antibiotics daily over six months: the regular intake is absolutely necessary, otherwise one risks developing resistance.
Thus, a net of small meeting points is established which are attended daily by five, ten or twenty patients. The community DOTS providers are trained, but they do not need substantial medical expertise. For their efforts they receive an allowance equivalent to approximately 30 Euros per month. Dr. Rajbir Singh meets the community DOTS providers regularly and provides advice.
What was achieved in 2009?
DAHW has supported the community-based standardised TB treatment to the sum of 29,300 Euros. This support enabled around 80 DOTS providers to register and treat 429 new TB patients in an area with 300,000 inhabitants. The cure rate reached 85 percent.
Plans for 2010
DAHW granted an amount of 23,800 Euros for this programme. It aims to increase the number of patients who finish their treatment as prescribed and to reduce the non-compliance rate.
Since the government has been adopting the principle of community DOTS providers, DAHW is handing over these activities to the government step by step. Capacities thereby released will be used for other tasks, for example for the fight against MDR-TB and TB/HIV co-infection.
Risks for the project
An increase of multi-drug resistant tuberculosis could raise big problems for the project because there are too few laboratories and, above all, too few medicines, the costs would be disproportionately higher, as well.