With India having the largest number of Tuberculosis patients in the world, we definitely encounter high proportion of alcohol and drug users with TB (approx. 2 in 10 alcohol and drug users are diagnosed with TB). At present India does'nt have any screening mechanisms in place to identify asymptomatic TB patients at the drug and alcohol rehabilitation centres but data is collected on the basis of self reporting and screening of symptomatic patients. Any patient at the drug /alcohol rehabilitation centre showing symptoms of TB is referred for TB testing and if identified as TB positive these patients are sent for TB treatment but are never usually followed up or retained for alcohol de-addiction treatment. The patients are sent back home and don't continue their stay at the center potentially due to lack of infection control facilities at the rehabilitation centre.
Even recently at the community conversation for NCD voices on Our Views, Our Voices" conducted by Nada India, a patient undergoing treatment for alcohol shared his story of being a TB patient who could not even continue with the treatment at the local government TB centre (known as Directly Observed Treatment centre) due to lack of awareness on importance of taking complete TB treatment and its risk factors (alcohol being one of them). There is already lot of stigma around TB in India and alcohol addiction adds up to that stigma. There is a need to generate evidence and strategize mechanisms so as to link the rehabilitation centres with the TB treatment centres.
There is a strong association between heavy alcohol use/alcohol use disorders (AUD) and
TB. A meta-analysis on the risk of TB for these factors yielded a pooled relative risk of 2.94 (95% CI: 1.89-4.59). Numerous studies show pathogenic impact of alcohol on the immune system causing susceptibility to TB among heavy drinkers. In addition, there are potential social pathways linking AUD and TB. Heavy alcohol use strongly influences both the incidence and the outcome of the disease and was found to be linked to altered pharmacokinetics of medicines used in treatment of TB, social marginalization and drift, higher rate of re-infection, higher rate of treatment defaults and development of drug-resistant forms of TB. Based on the available data, about 10% of the TB cases globally were estimated to be attributable to alcohol.
Nada India recommendation
Drug treatment and rehabilitation programs should designate one staff person as TB Liaison, and another as backup. The role of TB
Liaison includes the following activities:
· Conduct basic TB education sessions for program residents
· Provide program staff with basic TB education and TB symptom awareness
· Provide consultation to staff for TB-related questions
· Maintain TB screening procedures within the program for residents and staff
· Communicate with TB Control as needed for questions and guidance
http://sandiegohealth.org/disease/tb/comprehensiveguidlines.pdf
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Best,
Suneel Vatsyayan