A pilot research project in Himachal Pradesh calls for roping in Ayurveda doctors in the Revised National Tuberculosis Control Programme (RNTCP) to jack up presumptive TB referrals.

Taken up in the districts of Kangra and Shimla, which have diverse terrain, the project showed that the arrival of referrals of presumptive TB cases by Ayurveda doctors doubled in TB testing centres when the latter was engaged formally in RNTCP. The project was supported by Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund).

Kangra is in the lower hills the with good road connectivity, whereas Shimla has a tough hilly terrain with bad roads in the interiors.

The state the registered 16000 TB cases in 2017-18. There are 450 MDR (Multi-Drug Resistant) TB patients under treatment in the state.

However, Himachal is on top in the registration of TB patients as per a NITI Aayog report. The missing TB cases remain a major concern for RNTCP at the national level.

“We compared the change in referral and case notification of presumptive TB cases from January 1, 2015, to December 30, 2016 and after an interventional package in two districts from January 1, 2017 to 30 December 2017. Compared with AYUSH referral arrivals (in TB testing centres) of 318 and 321 in 2015 and 2016 respectively, the figure rose to 648 after intervention in 2017. Out of these 105 tested positive for TB,” said Dr Rakesh R Bhardwaj, Principal Investigator of the Project.

Dr Bhardwaj, a public health specialist, is an Officer on Special Duty with the Department of Health Safety and Regulation in Himachal.

As many as 365 referrals of presumptive TB by AYUSH practitioners were recorded in Shimla district in 2017, and 1127 in Kangra during the same period.

Under RNTCP, however, out of 29999 referral arrivals, 2866 tested positive for TB in 2017 in these two districts.

Dr Bhardwaj said the intervention package included the capacity building, logistics, referral formal and linkages (referral mechanism).

The study population constituted 360 public sector AYUSH practitioners in Shimla (110) and Kangra (250).

Besides, increase in the referral of presumptive TB cases from villages, the pilot project in two districts brought out major gaps in the field ~ right from vacancies in Ayurveda and health departments to problems faced in transportation of sputum in some areas to unawareness, local faiths and social stigma, which hamper TB detection and cure.

“Our findings recommend that RNTCP should be mainstreamed in Ayurvedic Health Institutions considering it the first point of contact for TB patients also. The Ayurvedic medical officers and pharmacists should be trained for identifying the presumptive TB cases and early referral for sputum examination,” Dr Bhardwaj said.

The project calls for formal engagement of AYUSH and RNTCP at national level, replication of pilot project in entire Himachal and strengthening of sputum transport mechanism, filling of vacant posts and continued training and monitoring.

Missing TB cases

TB had a global incidence of 10.4 million in 2016, 2.8 million of them in India. As per records, about three million TB cases are not reported to the national TB programmes every year. India accounts for about one third of these ‘missing millions’.