World TB Day: These key challenges could certainly fail India's TB elimination goal

India has pledged to end tuberculosis by 2025, five years ahead of the global Sustainable Development Goals target of 2030. This looks like an over ambitious and an unattainable goal considering the various challenges that needs to be addressed.Instead of a total elimination, a more sustainable and pragmatic goal would be towards a rapid decline in the TB burden, morbidity and mortality. This might gradually pave the way for its elimination.World TB Day is observed annually on March 24 to raise awareness about TB and the efforts to end the global epidemic. This also marks the day in 1882 when the bacterium causing TB was discovered.The World TB Day 2023, with the theme — Yes! We can end TB – aims to inspire hope and encourage high-level leadership, increased investments, faster uptake of new WHO recommendations, adoption of innovations, accelerated action, and multisectoral collaboration to combat the TB epidemic.Also Read: World Tuberculosis Day 2023: All you need to knowTuberculosis is a communicable disease that is a major cause of ill health and one of the leading causes of death worldwide. TB is caused by the bacillus Mycobacterium tuberculosis, which is spread when people who are sick with TB expel bacteria into the air.TB continues to be a major health problem across the globe and is still associated with social stigma in many parts of the world. Positive efforts have been made in terms of diagnostics and treatment but monitoring the progress of TB control and the burden caused by the disease continues to be a challenge.Disease BurdenEliminating TB in India cannot be attained by simply making the health drivers robust. This also requires a firm political commitment and multi-layered collaborations spread across various stakeholders including the private sector.The WHO Global TB Report 2022 shows that India had an estimated 3 million new TB cases and over half a million TB deaths. The number of new estimated drug-resistant TB cases has been hovering around 150,000 every year, which includes those who got infected with drug-resistant bacteria as well as those who have been through TB treatment earlier.The Report mentions that Drug-resistant TB continues to be a public health threat. Resistance to rifampicin – the most effective first-line drug – is of greatest concern. Resistance to rifampicin and isoniazid is defined as multidrug-resistant TB . Both MDR-TB and rifampicin-resistant TB require treatment with second-line drugs. Globally, the estimated number of people who developed MDR-TB or RR-TB each year was 1 For further details, see Section 2.4 of the report webpages. relatively stable between 2015 and 2020, but it grew in 2021.According to the National TB Prevalence Survey 2019-2021 the prevalence of microbiologically confirmed Pulmonary TB among 15 years and above in India was 316/lakh population with the highest PTB prevalence of 534/lakh in Delhi and the lowest PTB prevalence of 115/lakh in Kerala.Higher PTB Prevalence was observed in the older age group, males, malnourished, smokers, alcoholics and known diabetics. Prevalence of PTB infection among the surveyed in India was 21.7 percent. 63 percent of the chest symptomatic did not seek health care and majority had ignored the symptoms and did not recognise it as illness.Public awareness should be increased about the social and economic consequences of TB and global efforts should be stepped up to end the epidemic. There has to be a collective responsibility to confront the inequalities and end the disease.Challenging canvasAlthough India is better prepared to fight TB, there are still several challenges that needs to be addressed if the disease is to be eliminated. Firstly, a large proportion of the country’s population is undernourished and this can cause a reactivation of TB because of weakened immunity. A large section of those afflicted with the disease leave the treatment mid-way because of poor resources and financial constraints.Delay in diagnosis, inadequate treatment, high rates of recurrent TB, drug resistance, diabetes, HIV, undernutrition, urbanisation are important drivers for the persisting TB epidemic.Private sector engagement is a challenge. The involvement of private sector has to be scaled up as they can play a pivotal role in treatment.Another major challenge is the high number of drug-resistant TB cases in India. This type of TB is much harder to treat and requires more expensive, specialised drugs and a longer duration of treatment. Lack of research and an inability to implement measures to cap the treatment and drug costs are aiding the spread of the epidemic. TB VaccineThe BCG vaccine remains the only licensed vaccine against TB; it provides moderate protection against severe forms of TB in infants and young children.WHO recommends that, in countries with a high TB burden, a single dose of the BCG vaccine should be provided to all infants as soon as possible after birth.There is however, a growing need for a new vaccine to address the challenges. The new vaccine should cater to the problem of drug resistance.Target TBAlthough India has managed to scale up basic TB services in the public health system, the rate of TB decline is slow to meet the elimination deadline. While sufficient expertise exists, these resources have often been underutilised for quantitative analysis and improvements in TB control policy and implementation.According to the 2019 Tuberculosis Profile of India collated by the WHO the total TB incidence in the country was 2640000. Total cases notified in India in 2019 was 24,04,815 of which the new and relapses figured at 2162323. For TB financing the 2020 National TB Budget was pegged at $497 million of which 85 percent was domestically funded.Communication strategies should be revamped and designed with high visibility for demand generation and stigma reduction. India needs to spruce its research in TB with a focus on the development and validation of new tools and better diagnostics.The focus should be on financial needs to scale up implementation and speed up research and development of new tools, access to new rapid molecular diagnosis and to new shorter and more efficient treatment regimens.Advances in R&D, access to newer drug regimens, public-private partnerships and other efforts to address broader socioeconomic conditions can help in the TB elimination goals.—The author, Dr Vanita Srivastava, is an independent science and health writer. The views expressed are personal.Read her previous articles here

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World TB Day: These key challenges could certainly fail India's TB elimination goal

By Vanita Srivastava Mar 24, 2023 10:36:25 AM IST (Published)

TB continues to be a major health problem across the globe and is still associated with social stigma in many parts of the world. Positive efforts have been made in terms of diagnostics and treatment but monitoring and controlling the progress of TB continues to be a challenge.

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World TB Day: These key challenges could certainly fail India's TB elimination goal

By Vanita Srivastava Mar 24, 2023 10:36:25 AM IST (Published)

TB continues to be a major health problem across the globe and is still associated with social stigma in many parts of the world. Positive efforts have been made in terms of diagnostics and treatment but monitoring and controlling the progress of TB continues to be a challenge.

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