“Tuberculosis remains a significant public health challenge in India despite various control measures.” Discuss the factors contributing to this persistence and suggest measures needed to achieve India’s goal of eliminating TB by 2025.

Why?

The World TB Day 2024 theme, ‘Yes! We can end TB!’, highlights the possibility of eradicating TB using current resources and political commitment. However, the disease’s persistence, including drug-resistant forms, illustrates the challenge as akin to sand slipping through fingers.

Approach:

• Introduce your answer by presenting TB’s impact in India and how it remains a major public health challenge in spite of progress.
• In the main body, highlight factors contributing to TB’s persistence like socioeconomic determinants, high prevalence of drug-resistant TB, inadequate healthcare infrastructure, stigma, inadequate public health funding, etc. Next address the measures needed like emphasizing early detection, precise treatment categorization, treatment adherence, controlling drug resistance, ensuring medication availability, community engagement, etc.
• Conclude by stressing the need for a comprehensive, multi-faceted approach to overcome TB by 2025.

Answer:

Tuberculosis (TB), caused by the bacterium Mycobacterium tuberculosis, primarily targets the lungs but can also affect other organs. The WHO’s Global TB Report 2023 highlights that India has made significant progress in combating TB through enhanced case detection and treatment coverage, resulting in marked reductions in both incidence and mortality. Despite these efforts, TB remains a major public health challenge in India, with 2.42 million cases (27% of global cases) and 331,000 deaths reported in 2022.

Factors Contributing to the Persistence of TB:

• Socioeconomic Determinants: Poverty, malnutrition, overcrowding, and inadequate living conditions significantly increase the risk of TB transmission and hinder access to healthcare.
• High Prevalence of Drug-Resistant TB: The misuse or mismanagement of TB medications has led to the emergence of drug-resistant TB strains, complicating treatment and control efforts.
  • According to the WHO, India is among the countries with the highest burden of both multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB).
• Inadequate Healthcare Infrastructure: Limited access to quality healthcare services, especially in rural and remote areas, delays TB diagnosis and treatment.
• Stigma and Discrimination: associated with TB leads to delayed healthcare seeking, non-disclosure of disease status, and non-adherence to treatment.
  • Studies have documented that TB stigma results in social isolation and reluctance to seek timely medical help.
• Inadequate Public Health Funding: Insufficient allocation of resources to TB control programs limits the scale and effectiveness of intervention strategies.
• Migration and Rapid Urbanization: contribute to overcrowded living conditions and the spread of TB in urban slums.
• Co-morbidities and Lifestyle Factors: Conditions like HIV, diabetes and substance abuse (tobacco and alcohol use) compromise the immune system and exacerbate TB risk.
  • TB is a leading cause of death among people living with HIV and diabetics face a twofold increase in TB risk.
• Insufficient Public Awareness: about TB symptoms and transmission contributes to delayed health-seeking behavior.

Measures Needed to Eliminate TB by 2025:

• Prioritize Early Detection: through widespread screening and robust follow-up mechanisms. Enhance laboratory capabilities to address delays in diagnosis and reporting.
  • Government’s initiative to distribute over 5,000 NAAT machines across the country by 2022.
• Implement Precise Treatment Categorization: This requires understanding a patient’s resistance status at diagnosis to tailor treatment regimens effectively, especially for DR-TB cases.
  • Gather accurate data on the prevalence of drug-resistant TB.
• Treatment Adherence and Follow-up: Ensuring patients complete their treatment, is vital for reducing TB transmission and preventing drug resistance.
  • Leveraging AI for addressing challenges in TB diagnosis and treatment adherence.
• Controlling Drug Resistance: through regulated antibiotic use, strict adherence to treatment protocols and ensuring a steady supply of essential TB medications, like bedaquiline and delamanid.
• Community Engagement: Mobilizing community support and involvement in TB care, reducing stigma, and promoting health-seeking behavior.
  • “TB Harega Desh Jeetega” campaign.
• Nutritional Support: Providing nutritional assistance to TB patients to support their recovery and treatment outcomes.
  • Nikshay Poshan Yojana.
• Integration into Larger Health Systems: Strengthen referral networks within and across public and private health systems. This integration is crucial for ensuring symptomatic cases are promptly identified, treatments are adhered to, and contacts of TB cases are systematically screened.
  • Improve the TB notification system ‘Ni-Kshay.’
• Addressing Population Mobility and Migration: Ensuring the portability of TB treatment within India is fundamental for maintaining treatment continuity.
• Aiming for Zero Mortality From TB: including drug-resistant and non-pulmonary forms. This involves comprehensive healthcare support and timely intervention for all TB patients.

While TB remains a formidable challenge in India, adopting a holistic, patient-centered approach and addressing both health and socio-economic factors are crucial for achieving the ambitious goal of eliminating TB by 2025.

‘+1’ Value Addition:

• The Pradhan Mantri TB Mukt Bharat Abhiyan has received a tremendous response across the country with over 1 lakh Ni-kshay Mitras coming forward to adopt over 11 lakh TB patients. Ni-kshay Mitras offer additional support, including nutritional and vocational assistance.
• Newer patient centric initiatives like Family Care Giver Model and Differentiated Care have been introduced.
• India’s efforts have resulted in reduction of TB incidence by 16% and mortality by 18% from 2015 to 2022.