India continues to account for the largest share of the global TB burden with approximately 25% of the global TB cases. To address this, India launched the National Tuberculosis Elimination Programme (NTEP) with the ambitious goal to eliminate TB.
Strides made in reducing TB incidence:
- Reduction in Incidence: India recorded a 17.7% decline in TB incidence between 2015 and 2023, surpassing the global average of 3.8%.
- Increase in Notifications: TB patient notifications increased from 24.22 lakh in 2022 to 25.52 lakh in 2023, indicating improved case detection.
- Treatment Initiation: 95% of diagnosed patients were initiated on treatment in 2023.
- Mortality Reduction: TB-related mortality declined by 18% since 2015.
- Use of Technology in Diagnostics: Deployment of portable chest X-rays with AI, molecular diagnostic kits, and non-invasive swab-based testing helped detect subclinical and drug-resistant cases.
- Financial Support: 70% of patients received benefits under the Nikshay Poshan Yojana, which provides ₹500/month to support nutrition.
- Community Engagement: Programmes like TB Mukt Bharat Abhiyaan, TB Mukt Panchayat, and Tribal TB Initiative have encouraged local participation and equity.
Persistent Challenges:
- Despite these advancements, multiple challenges continue to obstruct the path to TB elimination:
- Missed Diagnoses and Underreporting: In 2023, an estimated 2.7 million TB cases globally remained undiagnosed or unnotified. In India, subclinical TB (symptomless yet infectious) leads to “silent transmission”, especially in high-burden clusters.
- Drug-Resistant TB (DR-TB): DR-TB poses a serious threat. The treatment success rate among DR-TB patients was only 65%, indicating the need for patient centred care.
- Healthcare Infrastructure Gaps: Weak primary healthcare in rural areas, lack of human resources, and unregulated private healthcare contribute to delays in diagnosis and treatment.
- Socio-economic Determinants: Poverty, undernutrition, overcrowding, HIV, and tobacco use continue to fuel TB transmission.
- Limited Vaccine R&D: Despite having the infrastructure, India still lacks a dedicated TB vaccine apart from BCG, which has limited efficacy in adults.
Way Forward:
- Close the Diagnostic Gap:
- Expand use of AI-assisted chest X-rays, molecular tools like Truenat, and non-invasive swab-based testing.
- Strengthen referral networks and Ayushman Arogya Mandirs to decentralize diagnostic services.
- Leverage COVID-19 Experience:
- As with the COVID-19 vaccine, public investment, global collaboration, and streamlined approvals can accelerate TB vaccine development.
- Integrate Risk-Based Patient Care:
- Stratify patients by drug-resistance, comorbidities, and severity to ensure appropriate inpatient/outpatient care.
- Nutritional and Financial Support: Expand schemes like Nikshay Poshan Yojana as the Lancet 2023 RATIONS trial in Jharkhand showed that nutritional support significantly reduces TB mortality.
- Dynamic Surveillance and Notification:
- Improve the Nikshay portal to capture real-time data and ensure continuous follow-up.
- Boost Community Participation:
- Strengthen TB Mukt Panchayat and CSR-led initiatives under Pradhan Mantri TB Mukt Bharat Abhiyaan.
- Invest in Research and Innovation:
- Support ICMR and TB Vaccine Accelerator Council to fast-track indigenous vaccine development.
- For instance, WHO estimates a $39 return for every dollar spent on TB screening.
Conclusion:
The elimination of TB requires renewed political will, deeper investments in R&D, and a paradigm shift toward prevention, early detection, and community-centred care. By integrating lessons from COVID-19 and strengthening the public health ecosystem, India can turn its ambitious vision of a TB-free nation into a reality.
‘+1’ Value Addition:
- “No one should die from a disease that is preventable and curable” – WHO
- WHO’s #ENDTB Strategy goals:
- 95% reduction by 2035 in number of TB deaths compared with 2015.
- 90% reduction by 2035 in TB incidence rate compared with 2015.
- Zero TB-affected families facing catastrophic costs due to TB by 2035.
https://indianexpress.com/article/opinion/columns/closing-in-on-tb-10104959/lite
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