A communicable disease, TB spreads through the air and if left untreated, a person with active TB can infect 10-15 people every year. A persistent cough that lasts more than 2 weeks may be a symptom of TB. Patients must promptly get themselves tested. TB is Treatable, timely diagnosis and adherence to treatment are essential for the successful treatment of TB .
- TB killed more people than HIV/AIDS in 2014, becoming the world's leading infectious killer. 1.5 million people died in 2014 globally.
- In 2014, there were an estimated 9.6 million incident cases of TB globally. India, Indonesia and China alone accounted for a combined total of 43% of global cases
- In India there were 2.2 lakh deaths due to TB in 2014 which is a decrease from 2.4 lakh in 2013
- Number of patients living with TB (prevalence rate) has also declined from 2.6 million in 2013 to 2.5 million in 2014
- India witnessed an increase in new TB cases emerging every year (incidence) from 2. 1 million in 2013 to 2.2 million 201412
Multi-Drug Resistant TB
- When TB is misdiagnosed or when the anti-TB drug regimen is poorly administered, or when patients do not follow the full course of DOTS medication, the tubercle bacillus mutates and stops responding to first-line anti-TB drugs. This is known as drug-resistant TB
- Multi-Drug Resistant TB (MDR-TB) shows resistance to the two most effective anti-TB used drugs: Isoniazid and Rifampicin. The number of MDR-TB cases in India in 2013 was 62,000
- Extensively-Drug Resistant TB (XDR-TB) is a more severe form of MDR-TB which is additionally resistant to the 2nd line drugs i.e. one drug from the ‘fluoroquinolone’ family and one of the 3 injectable anti-TB drugs
- The TB bacillus can cause an active infection in any individual with low immunity, including those who are malnourished, or People Living with HIV/AIDS (PLHA).
- TB is the leading cause of death among PLHA .
- 30,394 TB-HIV co-infections were notified to the government’s Revised National TB Control Programme (RNTCP) in 2014.
A communicable disease, TB spreads through the air and if left untreated, a person with active TB can infect 10-15 people every year. A persistent cough that lasts more than 2 weeks may be a symptom of TB. Patients must promptly get themselves tested. TB is Treatable, timely diagnosis and adherence to treatment are essential for the successful treatment of TB.
- Sputum smear microscopy is the most commonly used method of TB diagnosis. However, this diagnostic method is over a century old and detects only half of the cases
- Once diagnosed with TB, a patient must complete the prescribed course of medication(6 to 9 months), known as Directly-Observed Treatment Short Course (DOTS).
India’s Revised National TB Control Programme
- The National Tuberculosis Control Programme was rechristened to The Revised National Tuberculosis Control Programme (RNTCP) in 1997.
- Since its introduction, the RNTCP has worked towards providing universal access to TB diagnosis and treatment. In 2006, the RNTCP achieved complete geographical coverage within India and provides diagnosis to over 1.5 million TB patients every year.
- Operating through 600,000 DOTS providers9, the RNTCP has managed to detect over 70% of the estimated new sputum smear-positive cases of TB since 2008 with a treatment success rate of over 85%.
- In 2012, the Union Government declared inaccurate blood serology tests as illegal for TB diagnosis, and made it mandatory for all positive TB-diagnosed cases to be notified to the RNTCP.
- The RNTCP in collaboration with the National AIDS Control Program has also initiated the "Innovative intensified TB case finding and appropriate treatment at high burden anti-retroviral therapy (ART) centers in India" to strengthen TB case management services for PLHA.
Urban TB Control: New Initiatives
- Rapid and unregulated urbanization is a leading contributor to the rampant spread of TB in major cities. TB finds the ideal conditions for transmission in crowded and unhygienic spaces, particularly slum areas. Pilot projects in Mumbai, Patna and Mehsana are underway, exploring innovative mechanisms such as the Public Private Interface Agency (PPIA) model for more effective TB prevention and control
“Universal Access to TB Care” Pilot: Patna
- Launched in November, 2014, by Bihar Health Minister Shri Ramdhani Singh, the Patna pilot engages with qualified doctors, informal medical practitioners, chemist shops and diagnostics providers in the private sector.
- The project promotes a technology-based reporting platform, and an inclusive system of financial and service incentives, to motivate and facilitate the appropriate delivery of TB diagnosis and treatment in Patna.
- Within one year of its launch, a cumulative of 2144 providers have been engaged with the PPIA project in Patna, consisting of 643 formal health care providers, 676 informal health care providers, 678 chemists, and 147 labs. A cumulative of 15,794 patients have been notified through the PPIA of which 13,659 patients have been initiated on anti-TB drugs.
Mumbai Mission for TB Control
- Launched by the Municipal Corporation of Greater Mumbai (MCGM) in March 2013, a comprehensive strategy to address the growing challenges of TB and drug resistant TB in Mumbai.
- Latest MCGM data shows that Mumbai has 1,631 DOTS centres across 24 RNTCP-covered districts, up from 998 centres and 6 RNTCP districts in 2011.
- In December 2014, the MCGM launched the "TB Harega Desh Jeetega" awareness campaign, featuring Bollywood star Amitabh Bachchan as the face and voice of TB control. In March 2015, the campaign was adopted by the Government of India and to be scaled up nationwide
- PPIA Mumbai is currently operational in 212 hub centers in 23 wards of Mumbai. 9,975 patients availed free TB treatment from September 2014 onwards and 1,000 patients were put on first line TB treatment during October 2015 through PPIA.
“Universal Access to TB Care” Pilot: Mehsana
- Launched by the Central TB Division in August 2014, the objectives of this pilot include the reduction of costs incurred by privately-treated TB patients, and to attract additional TB notifications from privately-diagnosed TB patients
- The pilot project will also allow public sector staff to extend core services such as drug-susceptibility testing, contact investigation & chemoprophylaxis; and improve TB treatment adherence among privately-treated TB patients.
- Since the time of implementation, the 2223 patients have been registered for treatment. A total of 194 medical practitioners have been engaged with and close to 300 chemists have been sensitized. A 53% increase in notification rates from private sector has been achieved since the start of the pilot.
Challenges in TB Control in India:
In spite of the RNTCP’s continued successes, India still bears the largest burden of TB in the world. The obstacles to the successful prevention and control of TB in India are as follows:
- Lack of funding which prevents the RNTCP’s TB care interventions from reaching every last TB suspect and patient. Of the total requested budget of Rs. 2,858 crore between 2012-15, the approved budget stood at Rs. 1,607 crore.
- New, rapid tests for accurate TB diagnosis in the private sector are expensive and not affordable to the poor.
- Low risk perception, lack of awareness of TB symptoms and social stigma cause delay in initial diagnosis of the disease.
- Non-adherence to the prescribed course of treatment, which leads to TB relapse and drug resistance.
- Inadequate private sector engagement, as India’s health care system consists of both public and private providers with varying levels of appropriate expertise and training