We are working in top gear to offset derailment of tuberculosis elimination target due to COVID-19: NIRT director C Padmapriyadarsini

Dr C Padmapriyadarsini is a clinician by training and has been involved in clinical research in tuberculosis and HIV among adults and children for nearly 20 years at the ICMR-National Institute for Research in Tuberculosis. She is the Principal Investigator of multiple collaborative, multicentric projects, both at the national and international level and has played a pivotal role in framing National Guidelines for the Management of Extra-pulmonary TB (INDEX TB Guidelines), Introduction of Bedaquiline for drug resistant TB patients in India, and Nutritional Guidelines for TB patients.

In a chat with Moneycontrol, Padmapriyadarsini talks about efforts to quickly meet the target of eliminating TB from India and key research studies being undertaken by her institute. Edited excerpts:

The 2025 elimination does not mean there is going to be zero TB. The target is to reduce cases by a certain percentage. So, all of us are working towards it and we hope and pray that we achieve the target. But these two COVID-19 pandemic years have set everything back. Whatever gains we were making, the pandemic has derailed.

That is a decision I cannot take. All we are doing now is increasing our pace of work. So, earlier if we were working, say, at the rate of 80 km/hr, now we are working at the rate of 95 km/hr.

We are not setting a target for 2025 that way. We want to bring down new cases; we want to bring down deaths, we want zero deaths to happen due to TB and we want to make sure there is no cost involved for patient management. Also, there should be no catastrophic cost involved in managing a TB patient.

MDR and XDR TB cases are only 2 percent of the whole TB but for me drug-sensitive TB is the biggest menace, extra pulmonary TB is a big menace. People think TB only affects lungs but there are so many other forms of TB. People need to be aware about various forms of the disease and be able to get the right treatment in time. TB can affect the abdomen, it can affect bones, it can affect the brain. Another myth about TB is that it is a disease of the poor. This disease can affect a person working in a call centre as well as the managing director of a company, who mostly operates in an air-conditioned room and may not exercise, does not take nutritious meals. These notions around TB need to change.

So, we want to reduce the duration of treatment. Second, our focus is on finding diagnostics for non-lung TB, like bone TB. How can you diagnose bone TB? How can you diagnose abdominal TB where you don't have any specimen? We are trying to develop a blood test through which TB can be diagnosed.

There are guidelines already, and under the Revised National TB Control Programme, there is a lot of training for doctors. There are also public-private partnerships bringing private practitioners on board. So, now, awareness among doctors has gone up but awareness among the public is not there. People should know that TB can happen even without symptoms such as coughing.

I would always say no. But there has been a lot of change under the current government and current director general (ICMR). The support now is much more than what it was earlier, but we will definitely want more support. For example, we are planning a study to assess whether revaccination with the BCG vaccine can reduce India’s TB burden. The study is planned with 8,000 subjects at eight sites and enrolment will take nearly six months. If we had more money, we could have done it at more sites and the enrolment would have taken one month only.