Maharashtra

When tuberculosis patients are resistant to two of the key first-line TB drugs (isoniazid and rifampicin), they are said to have multidrug-resistant tuberculosis (MDR-TB). Extensively drug resistant tuberculosis (XDR-TB) is a rare type of MDR-TB that is resistant to these first-line drugs, plus any fluoroquinolone and at least one of three injectable second-line drugs (amikacin, kanamycin and capreomycin). Both MDR-TB and XDR-TB are more difficult and more expensive to treat than standard TB, with treatment taking up to two years and potentially causing side effects such as deafness and psychosis.

MSF provides free, comprehensive and individualised treatment at its independent private clinic in Mumbai to people living with HIV, and to people with severe forms of drug-resistant TB (DR-TB). Patients seen by MSF have often previously been treated with ineffective regimens for several years by public and private practitioners. Some are also believed to have been directly infected in the community by extensively resistant strains.

MSF also works in close collaboration with the national TB programme to reduce the mortality and morbidity linked to TB in Mumbai. To this end, MSF provides support for diagnosis, treatment and community-based follow-up of patients with drug-resistant tuberculosis in a ward (M/East ward) with one of the highest TB burdens in Mumbai. In collaboration with the Ministry of Health (MoH), MSF provides OPD-based DR-TB services at Shatabdi Hospital located in this ward.

Since May 2016, MSF in partnership with Mumbai District AIDS Control Society (MDACS) and Municipal Corporation has been offering enhanced adherence counselling (EAC) and routine viral load testing for people living with HIV at the antiretroviral treatment (ART) centre in King Edward Memorial (KEM) Hospital. A small team of MSF counsellors also provides psychosocial support to both inpatients and outpatients in the Group of TB Hospitals, Sewri.

At Shatabdi Hospital, one of the few decentralised sites to offer Bedaquiline-based treatment regimens in Mumbai, 87 patients were put on Bedaquiline-based regimens between June–December 2018 the highest number for a site of its kind in a span of six months. The MSF team also started an outreach (mobile) intervention with the objective of ensuring systematic clinical and psychosocial follow up of DR-TB patients from seven health posts in Mumbai. Through this approach, MSF intends to demonstrate a community-based model of DR-TB care that the national programme could replicate in high-burden contexts.

In KEM Hospital’s ART centre, MSF’s model of care resulted in improved outcomes for people living with HIV. The model was adopted by the MDACS and implemented across Mumbai, and MSF is advocating the country-wide replication of this approach.