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Mumbai’s Fight Against Tuberculosis

March 26, 2013

Mumbai has TB in its sights. That was the message conveyed by a recent meeting of government officials, medical experts, and others to address an unprecedented rise in cases of tuberculosis in the past few years in India’s business capital and most populous city.

Kenneth Castro, director of the US Centers for Disease Control and Prevention’s Division of Tuberculosis Elimination, said of his visit to Mumbai last year, “I found the situation there— including extensive occurrence of highly drug-resistant TB—remarkably reminiscent of the resurgence of TB we experienced in NYC.”

Castro was referring to the 1990s, when New York City’s declining public health infrastructure, combined with a swelling population, poverty, poor airborne infection control, and a rising tide of HIV/AIDS, made TB a public health crisis.

Much like New York did, however, Mumbai is fighting back. The Brihanmumbai Municipal Corporation, Mumbai’s primary administrative body, convened the recent meeting of officials, laboratory and other technical experts, civil society organizations and stakeholders from the private sector to develop a comprehensive citywide TB response plan.

The meeting focused on strengthening the already existing TB program and creating a partnership between the public and private sector to address the disease more effectively. Components of the plan include easy access to diagnostics and accurate and appropriate treatment. The city will increase its engagement of private-sector and informal health care providers as well as the wider community to improve TB services in Mumbai’s extensive slums.

The national government has taken notice of Mumbai’s special challenges and is responding with additional financing, drugs, diagnostics, and guidance. With support from the Revised National TB Control Programme, Mumbai authorities recently introduced an Xpert MTB/RIF (or GeneXpert) machine at a city-run hospital for swift and accurate diagnosis of tuberculosis and of drug resistance. It’s only the second of its kind in Mumbai and they plan to place a total of twenty-four across the city over time. GeneXpert is a WHO-approved diagnostic that reduces the time needed to diagnose drug-resistant TB to just two hours. Earlier, such a diagnosis could take several days.

The inauguration of the GeneXpert machine was attended by leading politicians from the parties that govern Mumbai, as well senior officials such as the deputy mayor and the commissioner of the municipal corporation. This signals the rising political support and commitment to TB control in Mumbai. More GeneXperts are to arrive in Mumbai by the end of the year.

Mumbai’s authorities are demonstrating remarkable leadership in the fight against TB. Challenges certainly remain, but they will be met if the tenacious determination shown so far by the city administration continues. Mumbai will need increased funding to strengthen TB facilities, and it must make drug susceptibility testing a core part of all diagnosis and increase surveillance of affected pockets of the city. If these measures are implemented with strong collaboration between the public and private sectors, Mumbai will emerge as the winner in its fight against TB.

Note: The President of India released this message for World TB Day, highlighting successes and challenges remaining to achieve a TB-free India.

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