TB burden To India -Highest in The World
Despite being fully curable, India still has the highest TB burden in the world with people still dying from it. Suggest certain measures to help eradicate TB.
Introduction: (up to 30 words) Briefly explain the disease and how it spreads; statistics if any.
Body: (up to 100 words) Include programs/initiatives taken by the Government. How can they be improved? What can be done and the way forward.
Conclusion: (up to 30 words) Conclude by mentioning how increased disease burden affects livelihood and also economy. How effective and continuous tracking + implementation is crucial to control this disease as was seen in Polio.
Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs, but can also affect other parts of the body. Most infections do not have symptoms, in which case it is known as latent tuberculosis. About 10% of latent infections progress to active disease which, if left untreated, kills about half of those affected. The classic symptoms of active TB are a chronic cough with blood-containing mucus, fever, night sweats, and weight loss.
Tuberculosis is spread through the air when people who have active TB in their lungs cough, spit, speak, or sneeze. People with latent TB do not spread the disease. Active infection occurs more often in people with HIV/AIDS and in those who smoke. Diagnosis of active TB is based on chest X-rays, as well as microscopic examination and culture of body fluids. Diagnosis of latent TB relies on the tuberculin skin test (TST) or blood tests.
India has the highest burden of both tuberculosis (TB) and multidrug-resistant (MDR) TB based on estimates reported in Global TB Report. Although the available data suggest that the TB epidemic may be on the decline, the absolute number of new cases is still the highest. India accounts for about 24% of the global prevalence, 23% of the global incident cases, and 21% of the global TB deaths. Taking into consideration the magnitude of the disease burden, the Government of India has announced its plan to eliminate TB by 2025.
Indian Government launched National Tuberculosis Programme in 1962. However, the desired outcome could not be achieved. The program was reviewed, and then, Revised National TB Control Program (RNTCP) was launched in 1993 on a pilot basis. Yet by 1998, it covered only 2% of the population. By 2006, entire nation was covered by the RNTCP. Although RNTCP has made great strides in the last decade, but it is still facing challenges for example microscopy is still the mainstay of diagnosis, the disease is distributed unevenly throughout the country which makes it difficult to achieve the goals. Moreover, India has been in the news because of the international attention around the emergence of “totally drug-resistant” TB in Mumbai and the growing concern that routine TB control (i.e., the directly observed treatment, short-course strategy) may not be sufficient for reducing TB incidence in the country.
Over the last National Strategic plan (NSP 2012–2017) period, significant gains were made. This includes mandatory notification of all TB cases, integration of the program with the general health services (National Health Mission), national drug resistance surveillance, and many more. However, more needs to be done to drastically reduce the TB incidence in India. The NSP 2017–2025 focuses on consolidating the achievements of previous NSP. The new National Strategic Plan (NSP) for TB elimination has incorporated certain new features like: Provision of digital X-ray preferably enabled with Computer Aided Diagnosis (CAD) and teleradiology services across the health sector, Universal Drug Susceptibility Testing (DST) to at least Rifampicin for all diagnosed TB patients through offer of Cartridge-based nucleic acid amplification test (CBNAAT), a sentinel surveillance system in the country with National TB Institute, Bangalore as the nodal centre and setting up sentinel centres at 10 sites with additional human resource and sequencing equipment and reagents, establishment of 2 additional National Reference Laboratory (NRLs) (West and North-East), National TB Policy and TB Bill, National TB Elimination Board: An apex body to facilitate policy development, implementation etc.
What needs to be done?
- Creation of awareness and empowering of communities - a multilingual, multi-stakeholder awareness effort to ensure that every single Indian knows about the challenges of TB and where to seek treatment.
- Ensuring that we provide every Indian with access to correct diagnosis and treatment for TB, regardless of their ability to pay for it.
- This can only happen if government works with the private sector as did in the case of polio. There is a need to go door to door, identify TB patients, and provide each of them care with compassion.
- A key challenge is building a forward-looking plan to address and control drug resistance, a man-made menace that is a major roadblock in our fight against TB.
- Every TB patient must be tested for drug resistance at the first point of care, whether in the public or private sector, to rule out any drug resistance.
- Government machinery at the field level should work with communities and provide free diagnosis and treatment to every affected individual. We also need to look beyond treatment.
- Recognising that medicines are not enough, programmes like the Nikshay Poshan Yojana (under which TB patients receive Rs 500 every month while on treatment to ensure patients other needs) should be promoted.
- Multi-sectoral and community-led approach should be employed to tackle the TB problem.
- Government of India should declare TB as a public health emergency and combat it in a campaign mode
- Increase budgetary provisions (at present, it is only 3%) and launch a national TB campaign engaging ambassadors at regional level to increase visibility
- Rebrand RNTCP (name/logo/slogan) to minimize the stigmatization
- Engage diverse stakeholders, especially elected representatives and civil society, and establish intersectoral coordination
- Empower and engage TB community – TB patients must not be seen as passive recipients of care, and they should be made key stakeholders at all stages of planning, decision making, implementation, and monitoring.