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[NEW DELHI] India plans to test a new tuberculosis strategy to treat people who are resistant to existing drugs. The DOTS-Plus project will begin at the L. R. S. Institute of Tuberculosis and Respiratory Diseases in Delhi next month.

The country will also launch a surveillance programme this year to measure resistance to tuberculosis drugs in four states, Lakhbir Singh Chauhan, a deputy director at India's ministry of health and family welfare, told a national conference on the disease held in Delhi last week.

The aim of the DOTS-Plus strategy, a revised version of the World Health Organization's tuberculosis detection and treatment programme, is to provide a standardised and affordable treatment to those infected with drug-resistant tuberculosis bacteria — about 3.4 per cent of cases in the country.

India has the highest number of tuberculosis cases in the world – one-third of the global total — and 40 per cent of the country's population carries the bacterium that causes the disease.

More adults die of tuberculosis than any other infectious disease in the country — an estimated 1,000 every day and more than 400,000 each year — according to a 2004 report by India's health ministry.

People with tuberculosis in India currently receive DOTS (Directly Observed Treatment, Short course), a treatment requiring an uninterrupted supply of medicine and regular monitoring of the patients.

DOTS uses a combination of four drugs. However, in some patients, the tuberculosis bacterium shows resistance to two of the most potent of these: isoniazid and rifampicin.

The risk of the tuberculosis bacterium developing resistance to several drugs increases when patients take wrong or poor quality drugs, when they take their treatment irregularly or when they stop taking the treatment because they cannot afford it.

Strains that are resistant to multiple drugs are 100 times more expensive to treat than ordinary tuberculosis, and drugs for it are harder to administer and, in some cases, poorly tolerated by patients.

Nani Nair, from the World Health Organization's regional office for South East Asia, told last week's conference that the international focus on tuberculosis India is tremendous.

Nair said previous Indian initiatives to ensure that patients keep to their treatment courses paved the way for a global DOTS strategy. "What happens in India with the DOTS Plus strategy may guide the [rest of the] world," she said.

The World Health Assembly set 2005 as the target year for countries to reach a goal of detecting at least 70 per cent of tuberculosis cases and successfully treating at least 80 per cent of these.

Although India is well on course to meet this target, several challenges remain.

A major concern is the country's high annual risk of tuberculosis infections. Vineet Kumar Chadha, a senior epidemiologist with the Bangalore-based Tuberculosis Research Institute, has estimated that 1.5 per cent of the population is at risk of infection each year. 

Despite national averages meeting the 2005 targets, there remain areas in India where the detection and treatment rates are far too low. Similarly, warned Chauhan, the growing numbers of people infected simultaneously with tuberculosis and HIV could neutralise the nation's efforts to control tuberculosis.