ISLAMABAD, Sept 24: The Global Fund to fight AIDS, TB and Malaria (GFATM) Geneva has committed $56 million grant for Pakistan to control Tuberculosis (TB). The grant documents will be signed tomorrow between GFATM, Ministry of Health, National TB Control Programme and Mercy Corps.

Pakistan ranks sixth among the 22 high burden TB countries in the world with incidence of 181 per 100,000 populations. Every year around 280,000 people develop TB and 62,000 people die of TB in the country. TB is responsible for 5.1 per cent of the total national disease burden.

Under the World Health Organisation (WHO) recommended DOTS (Directly Observed Treatment Short Course) Strategy, the National TB Control Programme is running free of cost diagnosis and treatment facilities at all public health centres.

Terming TB as a declared national emergency, Dr Hassan Sadiq, National Manager TB Control Programme, while talking to Dawn, said: “During five years of grant life, this intervention is expected to benefit 33,500 Sputum positive TB patients, 6,000 adult difficult-to-diagnose TB patients, and 10,000 childhood TB cases.

Besides the areas of Drug Resistant TB and TB-HIV co- infection will also been addressed.

Although there is no exact data available, Multi-Drug Resistant (MDR) is a serious concern for Pakistan. According to Dr Sadiq, “this is because other than public sector, majority of the patients are being treated by private sector”.

There are many reasons why a drug-sensitive TB turns into drug-resistant TB (MDR) in Pakistan. Patients who do not take DOTS treatment for complete duration (six months mostly) or take inadequate drugs (not adhere to the treatment regime), for a range of reasons, are most likely to develop drug resistant TB.

A patient who has developed Multi-Drug Resistant TB (MDR) will then need second line drugs, which are very expensive, (Rs200,000 compared to Rs15,000-Rs3,000) while treatment duration may take more than two years, instead of six to eight months.

In case the patient does not take second line drugs for entire duration or takes them inadequately, he is likely to develop resistance to second line drugs as well.

This is called Extensively Drug Resistant TB or XDR-TB. Treatment options are seriously limited because people with XDR are already resistant to first line and second line drugs. Mortality is also very high.

Mobility of patients, living far away from TB clinic, once they start feeling better in one to two months of treatment, they get back to work and hard terrain makes them miss drugs and thus may tend to develop resistance.

Some institutes in Pakistan, like the Ojha Institute in Karachi and Gulab Devi Hospital in Lahore, are treating MDR cases but on a limited scale with partial diagnostic facilities and limited drug availability, says Dr Abdul Khalique Ghauri, Senior Programme Manager Communicable Diseases, Greenstar Social Marketing.

As Pakistan moves from a low prevalence country to concentrated epidemic of HIV and Aids amongst Injecting Drug Users, TB for HIV positive person forms ‘a lethal combination’ with difficulty in diagnosis.

DOTS is the internationally-recommended TB control strategy that includes standardised case detection, treatment and patient support. It requires consistent drug supply and effective monitoring systems.