Loss to follow-up among drug-resistant TB decreases from 16% to 2%

Mumbai: In the last five years, the Mumbai tuberculosis (TB) office has managed to drastically bring the loss of follow-up to treatment percentage among drug-resistant TB patients from 16% (864) in 2018 to 2% (138) in 2022.

TB health experts say the loss to follow-up (LTFU) among pulmonary TB patients is a significant challenge for TB control. It is also said to be a significant indicator of a high burden of drug-resistant tuberculosis.

Mumbai’s LTFU in TB patients dropped from 7% (3,268) in 2018 to 2% (920) in 2022. In women, the LTFU has dropped from 4% (1,035) in 2018 to 1% (280) in 2022 while in men the LTFU drop percentage is 9% (2,228) in 2018 to 2% (280) in 2022.

Dr Varsha Puri, deputy executive health officer and Mumbai TB officer said starting an adverse drug reaction clinic for TB patients became a major factor in bringing down the LTFU numbers in the city.

“We did a small study in Dharavi on LTFU with Share India in 2018 where we found adverse drug reactions formed a major reason behind leaving the TB treatment. 95% of these adverse drug reactions were minor like gastritis, allergic skin reaction, body ache etc which was solved by giving treatment. The rest needed tertiary care. We, therefore, started the adverse drug reaction clinics in Mumbai to address and it has helped in bringing down the LTFU in the city,” she said.

Mumbai has 23 adverse drug clinics run by the BMC. According to the BMC, adverse drug reactions, migration, and addiction was seen as the common reason behind leaving the treatment mid-way.

The corporation’s health department also took the help of TB survivors to counsel the TB patients and motivate them to complete the treatment.

“It was in mid-2019 that we, along with TISS, launched the Saksham Jan Urja project based on the ‘Peer Counselling Model’ where nine TB survivors were roped in for counselling. The counsellors were called “Saksham Saathi”. We started the programme with TISS to reduce LTFU. In a year, we managed to retrieve 200 patients back to regular treatment. We then appointed our own TB champions to counsel the patients,” said Dr Mangala Gomare, executive health officer, BMC. At present, BMC has 24 TB champions.

The corporation is now planning to rope in counsellors to further bring down the LTFU percentage in the city. “We are analysing how many dropouts were treated in private and public hospitals. We are also looking at how we can help the patients who are LTFU because of migration and if we can stop future dropouts because of it,” said Dr Puri.

BMC is also taking the help of artificial intelligence to predict tuberculosis (TB) patients who have a high probability of defaulting and not completing the treatment.

“We are in talks for the AI prediction. If the results are promising, it will help us have more focused attention and intervention like continuous counselling and home visits on these patients,” said Dr Puri.

Appreciating BMC’s effort to reduce the LTFU percentage, Dr Lancelot Pinto, pulmonologist and epidemiologist, PD Hinduja Hospital-Mahim said it is a big step forward by the corporation in TB control if they have managed to ensure patients complete the treatment and spread of the disease in the community is reduced. “A significant proportion of individuals do not adhere to TB treatment because it is a long one and has side effects. These people then potentially spread the disease more in the community. Therefore, it is extremely important to keep these numbers low,” he explained.