TB patients struggle with treatment as three important drugs remain out of stock

Patients in Mumbai are struggling to access essential drugs for treating drug-resistant tuberculosis (TB). The shortage of medications poses a risk to patients' health and increases the potential for the disease to spread. Mumbai has been experiencing a high number of drug-resistant TB cases, with over 5,000 cases reported annually. Local health officials are working to address the issue and ensure a steady supply of medications.

Mumbai: Anjali Gupta, 21, an extensive drug-resistant patient (XDR-TB) has not taken three of her anti-tuberculosis (TB) medicines for the last two weeks. The Antop Hill resident has been on TB treatment since April 2022 and was supposed to finish her treatment next month. However, with the gap in medicines, Gupta said she started feeling unwell for the last few days.

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“Last two months have been a struggle for me to get medicines. It started off with one of the three medicines (Cycloserine 250 mg) not being available at the centre a month back and now the other two medicines too are not available for the last two weeks,” said Gupta, who added she has started getting chest pain and breathlessness for the last two days.

Rajjab Ali Khan, a taxi driver whose wife Ruksana, 27, was diagnosed with multi-drug resistant TB in the second week of August said, “As soon as Ruksana was diagnosed, we were counselled how important completing the course is and how we should not miss any dose. Irony is that since the time we started her treatment on August 23, we have been struggling to get the medicines and ensure she does not miss the dose.”

Khan said he has been checking with all distributors and centres in the day to get the medicines. “My day goes in searching for the medicines. My first problem is getting the medicines, the second is the cost as just one strip costs ₹600 and she needs three. I visit the local centre every day with the hope that the stock must have arrived but they too quickly appear helpless,” he said, expressing despair at the government’s commitment to end TB in the country. “If this is the state of affairs in Mumbai, which has the highest TB burden in the country, we can’t even fathom about what is happening in rural India,” he added.

Mostly clofazimine, Linezolid, and cycloserine are not available at all. They are important drugs in the treatment of drug-resistant TB. We raised the concern with the government bodies but the problem has remained unresolved. With the medicines not being available, the risk of the patient developing further resistance to drugs also goes up. At the same time, it also increases the risk of the disease transmission to a larger community, thereby adding additional burden on the TB programme,” said Ganesh Acharya, TB survivor and activist. The DOTS Plus Guidelines by the Centre’s Revised National Tuberculosis Control Programme to acknowledge a need for an interrupted supply of second-line drugs (Linezolid, Clofazamine, Pyridoxine and Delamanid).

Mumbai has been seeing more than 5,000 drug-resistant tuberculosis cases every year. In 2022, Mumbai saw 5,758 drug-resistant TB cases. In 2021, the city recorded 5,978 DR-TB cases while in 2020 there were 4,775 cases reported. In 2019 and 2018, there were 5,997 and 5,343 cases respectively.

A BMC health official said the stocks have been sporadic from the Centre. “We have purchased Linezolid at our level and placed an order for Cycloserine, which should be available in the next few days. Clofazimine, the other important antibiotic, is not available even from manufacturers and other distributors. We have informed the Centre and state trying hard,” said the official.

The official said they are planning to have a rate contract and start buying medicines at the corporation level as the city is the epicentre of TB in the country.

Dr Sunita Golait, state TB officer said the drugs are supplied by the Centre. “Since there is a delay from the Centre, we have asked the districts to purchase the medicines at their end. We are told by the district TB officers that drugs should be available within 8 days,” she said. Dr Golait added that the Centre is working on steps to ensure the shortage is not repeated again.