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Guidelines adopted for preventive treatment of TB

Dechen Tshomo

Despite interventions to control multi-drug resistant tuberculosis (MDR-TB), 77 new MDR-TB cases were reported from across the country as of December 30. This is 14 more than the previous year.

Altogether, the health ministry also recorded 863 tuberculosis cases in 2019.

However, health officials said the reported figures may change after final verification from the National TB Control Programme.

MDR-TB is a form of TB infection caused by bacteria that are resistant to treatment with at least two of the most powerful first-line anti-TB medicines—isoniazid and Rifampicin.

MDR-TB occurs due to various reasons including partial or irregular TB treatment, non-completion of the full course of TB treatment, no direct observed treatment, side effects of the medicines and social or economic barriers. MDR-TB is also caused in people with HIV, diabetes, the under-nourished and those abuse substances and psychiatric conditions.

TB and MDR-TB are mostly prevalent among the productive age group of 15 to 44 years with about 72.4 percent of the cases falling in this age group.

Health officials with the National TB Control Programme at the health ministry said gaps in TB and MDR-TB case detection was the biggest challenge for the programme. 

 The case detection rate for TB and MDR-TB is 83.54 and 42 percent respectively in 2018.

Bhutan is also experiencing the evolving burden of XDR-TB (Extensively Drug-Resistant Tuberculosis), a rare type of MDR-TB. It is a form of tuberculosis caused by bacteria that are resistant to some of the most effective anti-TB drugs.

Currently, eight pre-XDR-TB cases are on treatment.

Health officials said the drug-susceptible TB and drug-resistant TB are spread the same way.

 

Prevention

To address or prevent the infection, the health ministry has recently adopted the guideline which includes preventive treatment along with the adoption of new and effective regimen for preventive treatment.

There are two types of treatment regimens for MDR-TB. The shorter MDR-TB regimen is for nine to12 months and the longer MDR-TB regimen is for 20 months.

“We will be implementing the preventive treatment which is known as latent TB treatment,” a health official said.

Children under five years of age who are in close contact of pulmonary TB, People living with HIV including children and adolescents, patients undergoing hemodialysis, recipients of immunosuppressive therapy (receiving anti-TNF) and patients receiving an organ transplant will be prioritized for latent TB treatment.

Health official said the TB programme also plans to offer latent TB treatment to adults who are close contacts of pulmonary TB in a scalable manner and to special groups deserving attentions like health care workers, and prisoners among others.

The programme has listed several interventions to achieve the SDG goals and END TB strategy.

It includes the adoption of the recent update to guidelines for infection control, preventive treatment and drug-resistant TB, along with the adoption of new and effective regimen for preventive treatment and management of drug-resistant TB.

Improving treatment outcome is one of the interventions. Officials said all persons including migrants with TB should be assessed for other co-morbidities and related risk factors such as HIV, diabetes, and alcohol or substance use, standardise capacity and tools for capacity building in co-morbidities beyond HIV, and optimise ICT to improve treatment adherence.

Health officials said ending TB is not possible without using measures to prevent transmission. Strengthening preventive treatment, intensifying case finding with community engagement to find the missing cases, scaling up TB/HIV collaborative activities, and strengthening the management of childhood TB are the other interventions.

People are advised to get themselves screened if they cough for more than two weeks, have a fever with sweating, weight loss, loss of appetite, coughing up blood, chest pain and tiredness.

The way forward to prevent the transmission of the infection including increasing case detection, according to health officials are active outreach screening for the targeted population, strengthening contact investigations, expansion of GeneXpert sites and strengthening TB awareness programme.

GeneXpert machine is a diagnostic equipment to find out if a person is infected with tuberculosis (TB) and also if the TB bacterium of the person has resistance to one of the common TB drugs.

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