"The STDC would house requisite infrastructure to demarcate the multi-drug resistance (MDR) cases from normal TB patients. The MDR is an advanced stage of TB where patients require multiple drug treatment prescribed through culture tests diagnosis," said Bhagwan Pawar, chief medical officer-cum-director of STDC. The work for setting up the facility has already started at the first floor of Aundh civil hospital and will become operational within a year, he added.

Tuberculosis can become resistant if a patient is not treated long enough, doesn't take prescribed medications properly, or doesn't receive the right drugs. "The percentage of MDR is two to three per cent of the total TB patients," said Pawar. The culture lab at the STDC will ascertain the diagnosis of MDR as per guidelines of World Health Organisation (WHO), he added. "Around 4,000 TB patients are diagnosed every year in the city, of which more than 85 per cent are cured," said Dilip Jagtap, assistant medical officer and city TB officer.Of the remaining, deaths constitute less than 5 per cent, defaulters (those who discontinue treatment) less than 4 per cent, relapses more than 3 per cent and failures up to 3 per cent. The failure category is a chunk of patient who are not responding to treatment, added Jagtap.

"They are the patients who form what we call as multiple-drug resistant TB patients. Such patients are put on category II drugs for eight months and when it is found that they are still not responding, they are asked to undergo culture sensitivity test (CST)," he said.If they are found positive, then they are given DOTS Plus treatment either at the city TB unit based at Kotanis Hospital or at the TB unit at Sassoon General Hospital. DOTS Plus treatment, which is meant for MDR TB patients is costly and may run into lakhs per year per patient.

"There are labs at all the major hospitals that carry out CST. But they are not accredited labs. The STDC will house an accredited lab that will diagnose MDR through CST as per the guidelines of WHO," said Jagptap.Stressing on the benefits of the facility, Ashok Ladda, state tuberculosis officer said, " Initially, two samples will be taken for CST. One will be carried out at STDC at Aundh and another will be sent to National Tuberculosis Institute in Bangalore. Results of both the reports will be matched at a stretch for 6 months to streamline the working of STDC. Then it will be operational."

The STDC has also received funding of Rs 20 lakh from National Rural Health Mission (NRHM) to provide training to technicians, pharmacist, microbiologists etc at the STDC, added Ladda. Besides Pune, it will cater to MDR patients in Satara and Solapur. Later, it will expand its services to other cities in Western Maharashtra, added Ladda.

Estimated prevalence of multi-drug resistant TB In India:

• 3.4 per cent in new cases
  
• 12 per cent in re-treatment cases.