Write with me , on Drug-resistant Tuberculosis

 Let's start with a pitch,

Drug-resistant tuberculosis

Causes of drug-resistant tuberculosis

Drug-resistant TB treatment

Preventing drug-resistant tuberculosis

Multidrug-resistant TB (MDR-TB)

Extensively drug-resistant TB (XDR-TB)

Tuberculosis prevention strategies

Drug-resistant TB statistics

Considering the above given are the words in your mind//

How do you want to position? Well, that will depend a lot on what you have right ? 

So, let's explore, 

For instance : 

PITCH on rising DR-TB cases- India

<Context: The increase in multi-drug resistant cases of tuberculosis is emerging as a global public health concern and India records one of the highest numbers of cases in the world>

*Though TB is treatable and curable, if not treated properly it can be fatal. A deadly form of TB exists which is drug-resistant TB which occurs when bacteria become resistant to the drugs used to treat TB. DR-TB is also spread through the air and If untreated it is far more dangerous than other forms of TB. *

Series 1: Explainer

This series would explain the diagnostics and medication of Drug-resistant tuberculosis, what the illness means, and the various stages and types: MDR, XDR, and EDR/TDR. 

 

This is important because, often late diagnosis of tuberculosis results in developing drug-resistant tuberculosis which is harder to treat. 

 It is important that this series deals with answering some of the very first questions that appear when one thinks of tuberculosis and Drug-resistant tuberculosis (which are two different illnesses and are not widely discussed) 

The diagnostic pattern that India follows and the diagnostics facilities.  

The diagnosis and medication are also intertwined with the stigma associated with and lack of awareness about the difference between tuberculosis and drug-resistant tuberculosis. 

Diagnostics (in India) and facilities in our medical system to contain the bacteria and the varied regimens offered to cure the illness can be covered in this series if not detailed (that can avoid panic from too much information) 

Long-term isolation as a part of the regimen 

The explainer will break down complex medical terms, for instance, In medical terms <Resistance to one first-line anti-TB drug is mono resistance, resistance to more than one first-line anti-TB drug other than both isoniazid and rifampicin is called polyresistance, resistance to at least both isoniazid and rifampicin is called Multidrug resistance (MDR).  MDR-TB occurs when one or two first-line tuberculosis drugs are resistant to two first line of drugs.’  Instead in simpler terms, this means the TB drug that is supposed to kill bacteria would no longer work when one's body becomes resistant to certain medicines that are meant to treat TB. 

availability of medicines, ration, and pension schemes by the govt for people living with DR-TB

A person living with Drug-resistant tuberculosis will be put through a medication regimen as per the World Health Organisation protocols and constant monitoring to check whether the medicines are responsive or not and also drug susceptibility tests to see if the body is resistant to any more drugs. 

The medication regimen to treat DR-TB used to include daily injections that come with adverse side effects ranging from skin rashes to disabilities like hearing loss.

The injectables like Kanamycin and Capreomycin that might not even pass the safety trials today were part of the DR-TB medication regimen.

medication given to a DR-TB patient is mostly a set of pills- depending on what The World Health Organisation WHO suggested, the medication regimen is prescribed by the doctor in the location (district TB centre in case of India), they will be monitored at the centre and medicine will be provided at the centre. Intake of the medicine is monitored under the DOT scheme which is direct observational therapy.

The combination of pills differs from regimen to regimen, body weight of the person, medication response, and overall health. Regular (monthly routine check-ups) follow-up check-ups will be considered for administering the drug to patients as the medicines are of high dosage.

Symptoms and asymptotic TB

Sources to quote: Epidemiologists (like Anant Bhan), Doctors working along with the Union for lung diseases (like Doctor Rakesh P.S), or any from the medical community who are specialised in the area, Public health professionals 

 

If Chennai (district TB doctor ) ,

State TB research center doctors , 

Doctors at the local health depts of the TB wards

medical officers who deliver meds 

Doctor of the AIDS control unit, TB unit// to know the logistics of medicines, procurements, and delivery, District TB officer

Patient support groups that work with government functionaries can be featured here

Series 2:

      Lived experiences and legal battles in India

This series can feature survivors of different strains of drug-resistant tuberculosis 

TB community who still go through the side-effects they had to endure from older regimens (the regimen with injectables that are no longer used) Personal note: I was given these injections.

Who got access to the new and shorter regimens and recovered with minimal side-effects

Who fought long legal battles against big pharmaceuticals who patented lifesaving drugs, and fought against their monopoly over lifesaving drugs. 

This series would feature the latest verdict on bedaquilin patents by J&J 

According to the Medicine Sans Frontiers (MSF) website; A person being treated for multidrug-resistant tuberculosis typically swallows up to 14,600 pills & endures 240 painful injections. After all that, the chance of being cured is only 50%. And this too will depend on the recovery patterns, in case of resistance to more drugs means more medicines and a longer regimen.

There is the availability of lifesaving drugs like bedaquiline and delamanid that can be taken orally for shorter regimens that shows better result. According to the updated WHO guidelines, Bedaquiline-based treatments are now recommended for DR-TB treatment. Implementation of WHO’s recommendations by countries can increase the number of people who should receive this drug.

Antimicrobial resistance, antibiotic resistance (also part of the discourse)

Urging governments to mass educate on TB as the pandemic already slowed down TB-centric services. 

Sources to quote: Petitioners against the patent challenge

 (Nandita Venkatesan, Phumesa Tisile )

Communities like Survivors against TB (few like Debashree faced severe side-effects)

If Chennai-based, then REACH foundation, the TB community (online and offline), and Doctors like Jaya Sreedhar whose work is associated with the TB community in Chennai. (example) 

Series 3: The literature and portrayal of tuberculosis and drug-resistant tuberculosis 

This series can shed light on the literature on tuberculosis, 

How the portrayal of TB and DR-TB in media is not completely true  (with some examples like, a character who coughs blood is diagnosed as a TB patient in movies, the character establishment in some movies show people living with TB to often spit blood, this repetitive narrative spreads misinformation that all strains of TB have similar symptoms) 

Personalities in different time periods and places have tried to document their experience with TB (Kafka, Katherine Mansfiled, Brontes, Orwell, and many more) 

Drawing the then and now of tuberculosis medication too is significant here. 

           It was nature therapy in the past, just sunlight and good rest, and now proper medication without missing any doses cures the illness (the bacteria mutated to be a strain that affects one adversely but advancements in medicine have made recovery possible). 

This series should make one understand that the existence of TB in the air means anyone who is breathing can contract TB, everyone is prone to the illness and this needs political attention. This series is important because there is a lot of misinformation about medication patterns and regimens, and the understanding of the illness within the medical community also when it comes to patient rights and WHO protocols has to be covered in the series. 

The very basic info on the illness is – if medication is not proper—the bacteria mutates and become more resistant – availability and accessibility of medication should be covered in parts of India. 

Include state-wise data and highlight state-wise DR-TB services

Sources to quote: 

TB-proof (NGO) 

Stop TB partnership - released usage of DR-TB language  

NGOs and TB patient support group community organizations based in India. 

Survivors who have already talked about it. 

Global Coalitions and TB activists 

Anyone associated with illness, even online polls and understanding of TB -online survey

So, you see a pitch is as flexible as it is. Even if your organisation follow a format, you can easily frame the format with information you have, given you are passionate about the subject. 

See you with the next post on how it will materialise into an article

Guess which series we are writing on