Udupi: Exploring TB and HIV/AIDS Treatment

Last Friday our field visit took us into the Udupi District Hospital. There we talked with officials about TB and HIV/AIDS treatment in India, and we were able to observe the treatment services in action.

First we visited the Directly Observed Treatment Short (DOTS) course Center. The program has set-up such that each patient has a box assigned to him or her. This box contains all of the necessary medications for their course of treatment.

These were the medications. Different box colors correspond with different types of treatment. The red box indicates that a category I case – it is a newly diagnosed case or the sputum test is positive. The blue boxes indicate that it is a category II case – default/ did not complete the previous regimen, failure of the TB test after the first treatment regimen, or relapse (they took the treatment, it was cured, then it came back). TB drugs for children are in a yellow box and while the drugs are the same, the dosage is much less.

Category I treatment lasts 6 months and there are only 2 drugs given during the continuum phase for the last four months of treatment. In the continuum phase the patient returns to the center weekly. While the drugs are taken, the patient will take a tablet to help guard against neurological problems (that can be a side effect of the drug regimen). Category II treatment lasts 8 months and is much more intensive, requiring an injection along with the pills every other day for 3 months, the remaining 5 months are the continuum phase.

During the continuum phase the patient goes to the DOTS center weekly and brings home these pill packets. They bring back the empty packet the next week and retrieve a new one. This can continue for 4-5 months.

If a person contracts multi-drug resistant TB (MDR-TB), they must travel to the state capitol to receive treatment, as the more local centers are not equipped with the drugs. They must relocate to the state capitol for 18 months. They are not secured livelihood in the city, but can receive reimbursement for some relocation costs. For TB in this region there is about a 70% case detection rate and an 85% cure rate.

This card is used to record the TB treatments.

According to TBC India, India’s TB program is the second largest in the world, and the fastest growing.  The 2012 TB India Status Report mentions that a new objective is “Universal Access to TB Care.” However, this objective will have a hard time reaching achievement if MDR-TB medications remain only accessible in the state capitals. Patients cannot easily obtain treatment and are at risk for spreading MDR-TB. The report does mention that access to MDR-TB medication is being expanded, and fuller implementation is expected to occur by the end of 2012.

These are different types of HIV/AIDS medications.

After we visited the DOTS center we went to a different part of the hospital and learned about the anti-retroviral treatment (ART) center. The center was very busy, with about 80 patients daily, and 3,000 active HIV/AIDS cases in Udupi.

Individuals in Udupi care about their health and there is a great reduction in stigma in the region, however other districts in India still battle cases and problems of stigma. The stigma is borne because if somebody contracts HIV/AIDS there is automatically the assumption that the person was engaged in high-risk behavior. The treatment, where patients need to come regularly to the hospital happens their routine and their transportation cost is a burden.

Some ART+ treatments are also in the early stages of implementation. These are second line drugs that treat more serious cases of HIV/AIDS than regular medications.  The hospital must monitor the side effects of the patient: nausea, vomiting and gastrointestinal problems are the most common side effects.

There is about a 6% transmission rate of HIV/AIDS from mothers to babies during delivery and nursing in the Udupi district and in the state of Karnataka there is about an 11% transmission rate.

These treatment cards are used to record the patient history and treatment if they have HIV/AIDS. The patients are also given a personal booklet that they personally bring to doctor’s appointments to record their patient history.

The HIV/AIDS medication and the TB medication can be taken together, however if a person has both conditions, one of their TB pills is substituted for one that will not interfere with the HIV/AIDS medication.

The large numbers of ART patients in the region emphasize the need for a solid commitment to ART in India.  According to the National AIDS Control Programme, 99% of the Indian population is free from infection, and the focus has now shifted from treatment to preventative efforts. The approach first focuses on sex workers, homosexual males, and injecting drug users. The program then targets long-distance truckers, prisoners, migrants, and street children. After that there will be a focus on those trying to access STI services, and trying to increase the sale of condoms. The program also aims to provide first line antiretroviral (ARV) drugs. The program aims to help people lead each other to an AIDS-free country.

It was a very interesting a cool trip and we definitely learned a lot!

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