Category Archives: Public Health

Third Line Drugs for HIV

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The government will soon include Third Line Therapy in its Anti-Retroviral Treatment (ART) programme for persons living with HIV. According to Department of AIDS Control – Ministry of Health and Family Welfare, preliminary work has begun in this regard and the process is expected to be completed in 8 to 10 months.

First Line and Second Line Therapy are already included in ART program and available to HIV-affected persons. Third line drugs are needed when HIV-affected person become resistant to second line drugs.  At present, patients requiring third line treatment are forced to go to the private sector for treatment, which is very costly and out of reach for majority of Indians.

The government would have to identify the number of patients who need such treatment before it can place orders for the medicines and formulate a budget. The Technical Research Group (TRG) had taken the government’s suggestion to include third line treatment and approval was received last week. It is expected that the third line treatment will be included in next year’s budget.

Prevention of Parent-to-Child Transmission

Department of AIDS Control will also roll out programme for Prevention of Parent-to-Child Transmission (PPTCT) this year. In the first year, it is expected to cover 90 per cent of the problem districts, and the entire country will be covered by next year. The PPTCT is already in place in Tamil Nadu, Karnataka and Andhra Pradesh.

Polio Free India: Joy & Caution

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Polio Free India

With no cases of polio being reported for three consecutive years, India will be declared as polio-free by the WHO on February 11 after testing random samples. On February 24, 2012 WHO removed India from the list of countries with active, endemic, wild polio transmission. The last case of polio was reported in 2011 from West Bengal.

Polio-endemic Pakistan

With no polio case for three years, the focus is to ensure that no cases come up in future. So the government has put in place a new policy that requires every Pakistani travelling to India after January 30, 2014 to compulsorily receive oral polio vaccination at least six weeks prior to departure to India.

The step is being taken to safeguard India’s polio-free status attained after sustained efforts and investment. The rule applies to both children and adults. Contrary to common perception, adults can also get affected by polio, when they have neither received polio vaccination nor been naturally infected with polio virus before.

New Policy to Stop Cross-border Polio

The new policy is applicable to anyone who travels to India from all countries where polio is endemic or where polio cases have been reported. The rationale behind this policy is to reduce the chances of an individual coming from a polio-endemic country from spreading the virus here.

Though a person, be it child or adult, is healthy, he may still be a carrier of the polio virus and can spread the virus when in India. So oral polio vaccination given to people prior to departure to India boosts their immunity and cuts the risk of virus transmission.

Unlike the polio injection that uses inactive (dead) polio virus as antigens, the oral polio vaccine uses live, attenuated (weakened) virus. While it takes a longer time to boost immunity with polio injection, oral polio vaccine boosts the immunity very quickly. This is because each drop of the oral polio vaccine contains millions of viruses. Oral polio vaccine is also preferred as it is commonly used and is easy to administer.

[Courtesy – The Hindu, WHO]

IPQAT: Xpert TB Test

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About IPAQT Initiative

The Initiative for Promoting Affordable and Quality TB tests (IPAQT) is a platform to bring Revised National TB Control Programme (RNTCP) or WHO-approved tests at affordable prices to patients in the private sector. Under the Initiative, 54 private sector labs and clinics have come together with a commitment to provide quality tests for Tuberculosis (TB) at a subsidised price in India. These tests are:

  • GeneXpert test
  • Hain Genotype test
  • MGIT test
  • BacT/Alert test

This disease affects 2 million people annually in India, and each undiagnosed and falsely diagnosed case spreads the disease in their family and their community. The early diagnosis, followed by early treatment is the solution to this disease that even today, kills about 1000 Indians every 24 hours.

Objectives of the Initiative

  1. To facilitate the delivery of validated tests to the TB patient at affordable prices.
  2. To promote the use of validated TB tests through a coordinated communications and behaviour change effort to replace suboptimal tests and build awareness about the validated tests among health providers.

In eight months since the novel initiative IPAQT was launched, the number people accessing these labs for the subsidised tests has risen to 30,000. Of them, over 15,000 people have availed the geneXpert test.

But starting January 15, 2014, the cost of the subsidised geneXpert test will go up from Rs.1700 to Rs.2000. Probably the compulsion to increase the price was due to the depreciation of rupee against the U.S. dollar. Labs which are not part of the IPAQT initiative charge anywhere between Rs.3500 and Rs. 5000 for the geneXpert test.

GeneXpert Advantages

While the sensitivity of smear microscopy (a popular but suboptimal testing method) is about 50 per cent, Xpert has 90 per cent sensitivity. It can therefore diagnose more people who have TB and with a greater degree of confidence. It can turn in results in about two hours.

And unlike smear microscopy, geneXpert can also indicate resistance to rifampicin-a first-line TB drug. Almost 98 per cent of people who are resistant to rifampicin are also resistant to isoniazid, another first-line TB drug. A person is said to have Multi-Drug Resistant TB (MDR-TB) when he is resistant to at least two first-line TB drugs. In short, Xpert can help doctors know if a patient suffers from MDR-TB even before starting treatment.

Replacement of unreliable Serological test

A ban on the serological test by the government of India, will go a long way in correctly diagnosing TB disease on time. The serological TB test diagnoses TB disease based on the presence of antibody response. But the presence or absence of antibody response does not reflect the true TB disease status. Hence, serological test is a highly unreliable for diagnosing TB disease. This ban had created a void in the diagnostic tests that the private labs could offer. The IPAQT initiative is now successfully filling this vacuum.

While the Revised National TB Control Programme (RNTCP) uses geneXpert and other WHO-approved diagnostic tests only for retreatment cases (where the patient had earlier been successfully treated for TB), private practitioners prefer geneXpert even in the case of fresh cases.

[Courtesy – The Hindu, ipaqt.org]

Malaria Diagnosis by Light

Researchers in the U.S. have come up with a way to rapidly diagnose malaria simply by shining brief pulses of laser light through the skin. This method is distinct from all previous diagnostic approaches, which all rely upon using a needle to obtain blood, require reagents to detect the infection, and are time and labour consuming.

Mechanism

When a malaria parasite invades Red Blood Cells, it eats up the oxygen carrying molecule haemoglobin and turns the iron-containing haeme component into an insoluble pigment, haemozoin. The technique developed by Dr. Lapotko and his colleagues relies on detecting the haemozoin in red blood cells.

They achieve this by using a narrow band of near-infrared light that is strongly absorbed by haemozoin but not haemoglobin. The laser heated up the tiny particles of haemozoin, causing a formation of “vapour nanobubble” around each particle. These bubbles expand explosively and then collapse with a characteristic sound that could be picked up with an ultrasound sensor.

The scientists demonstrated the technique in animal trials using malaria-infected mice. The first trial of the technology in humans was expected to begin in early 2014.

Limitations

The method would be unable to distinguish between two species of the parasite, Plasmodium falciparum and Plasmodium vivax that cause malaria in India. Treatment depended on which parasite was infecting a patient.

Moreover, haemozoin may persist in the blood even after the parasite has been cleared. With this technique, a previously-infected individual who had another bout of fever from some other cause might potentially be misdiagnosed as having malaria.

[Courtesy – The Hindu]

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