Consultations with private hospitals come in the wake of an advisory issued by the World Health Organisation (WHO) against commercial serological tests for both pulmonary and extra-pulmonary TB, that it said were inaccurate. The advisory was immediately endorsed by the Health Ministry.
The three districts assume importance as they report some of the highest number of HIV-positive cases in the State. Studies have consistently proved that the incidence of TB in people living with HIV/AIDS (PLWHA) is alarmingly high.
Statistics released by the Health Ministry say that PLWHA are six times more susceptible to TB, compared to others who have a 10 per cent lifetime risk. Hence, the three districts have more TB patients.
A senior officer at the State Health Department said private hospitals in these areas were not willing to accept the department’s suggestion that instant blood tests be abandoned in favour of sputum smear microscopy examinations that are a more reliable method of diagnosing the disease.
The opposition from private hospitals is due to the fact that sputum smear tests are conducted only in government hospitals and for free.
Under the government’s Revised National Tuberculosis Control Programme (RNTCP), detection and treatment are both free. Sending patients to government hospitals will mean not being able to charge patients for the tests.
Refer patients
“We want them to refer the patients to us, so that we can observe them directly, conduct tests and then do a follow-up. Our Designated Microscopy Centres (DMCs) have trained laboratory technicians who can do a sputum test for conclusive results,” the officer said.
The other problem is the dropout rate. Unlike the Directly Observed Treatment, Short-course (DOTS) programme under the RNTCP, there is no follow-up of any sort by private hospitals.
“In many cases, patients stop taking their medications after a month and private hospitals do not check on these people. This ends up with the patients developing a multi-drug resistant (MDR) TB. The regular treatment costs Rs 3,000 for the government, but the MDR TB costs more than Rs one lakh.”
If blood tests are inaccurate and give a high number of false positives or negatives, then the results are disastrous.
In false positive cases, people without active TB will get treated with potent medicines which could potentially make them multi-drug resistant, while those whose results are false negative will go untreated.
“Private hospitals charge anywhere between Rs 2,500 and Rs 3,000 for a blood test. If the results are positive, then the medication is also charged. So, there is a lot of money to be made,” says Dr Banu, who works at a government hospital.
He observes that the stakes are high, with the increased incidence of HIV/AIDS in the last decade. “Ten years ago, I would say, we had TB under some control. But with HIV, it has re-emerged and is no longer under control,” Dr Banu says.
Now, the Health Department is looking at conducting awareness programmes among the public as they have no other option except to persuade the people against approaching private hospitals.