Context: India’s needs to scale up investment, find new ways and formulate new strategies to meet its goal of Tuberculosis eradication by 2025.
Tuberculosis
- Tuberculosis is an airborne communicable disease caused by the bacteria Mycobacterium tuberculosis. Typically the bacteria grow in the body where oxygen and blood are in high amounts. As a result, 80% of TB cases are pulmonary which infect the lungs and 20% of cases are extra-pulmonary which infect the brain, uterus, stomach, mouth, kidneys and bones.
- Mode of transmission: Airborne- through coughing, sneezing or spitting.
- High-risk groups: People weak immunity like those infected with HIV, Under-nutrition, Diabetes, Smoking and Alcohol consumption.
- TB incidence in India: India tops the list of 20 TB high-burden countries in the world. India has more than 25% of the total TB patients in the world.
- Treatment: DOTS strategy (Directly Observed Treatment Short Course) is a WHO-recommended cost-effective strategy to reduce the disease burden of TB.
India’s efforts
- India’s National TB Elimination Programme, previously known as the Revised National Tuberculosis Control Programme or RNTCP) was adopted in 1997 after WHO declared TB as a global epidemic in 1993.
- Focus of RNTCP has been Early Diagnosis and Treatment in accordance with DOTS strategy.
- Patients are supported with free diagnostics and medicines.
- Under RNTCP about 4 lakh DOTS centres have been established so far.
- The programmee has introduced several measures to find, notify and treat TB cases, with case notifications rising from 15.6 lakhs in 2014 to over 24 lakhs in 2022.
- National Strategic Plan for TB Elimination 2017-2025 was adopted in 2018 in line with the TB Elimination Strategy of the WHO and SDG of the UN.
- It aims to eliminate TB in India by 2025.
- Includes 4 strategic pillars: “Detect – Treat – Prevent – Build”.
- Specific targets include:
- 80% reduction in TB incidence
- 90% reduction in TB mortality
- 0% patients having catastrophic expenditure due to TB.
- Nikshay Portal to serve as a national online individual-based TB notification and management system. Nikshay Poshan Yojana in 2018 to provide free nutritional support of Rs. 500 per month to all the TB patients registered in the Nikshay portal till completion of treatment.
- Pradhan Mantri TB Mukt Bharat Abhiyan campaign was launched in September 2022 where the community is encouraged to adopt TB patients and support them in the form of nutritional support, nutritional supplements, additional investigations, and vocational support for a minimum period of six months or maximum period of up to three years.
- Novel approaches including engagement with the private sector, the launch of social support provisions and introduction of diagnostic tools and new drug regimens, have improved TB management.
- India had established of centres of excellence which will facilitate collaboration between Indian Council of Medical Research laboratories and the private sector, which among others, will strengthen and expand research and development efforts for TB.
Concerns
- Lack of widespread awareness about the disease and lack of access to quality care continues to be a challenge.
- The recent National TB Prevalence Survey (in India) found that 64% of people with infectious TB did not seek care.
- As a result, national-level estimates suggest that for every person notified with TB, we miss detecting almost two more cases.
- Excessive focus on affected patients only while ignoring the ‘potential’ patient who might be in contact with the patients.
- Gender divide – There is a significant difference in how males, females and transgenders receive such health care services.
- COVID-19 pandemic has increased the TB burden.
Way Forward
- Prioritise TB vaccine trials: Bacille Calmette-Guérin (BCG) vaccine for TB does not adequately protect adolescents and adults who are at the highest risk for developing and spreading TB. There are currently over 15 TB vaccine candidates in the pipeline; it must be ensured that their clinical trials are prioritised to assess their efficacy in various community settings and for different target groups.
- Affordable test and trails for TB: Testing for, and diagnosing TB needs to become more accessible and affordable to allow each person with suggestive symptoms or frontline worker get results within minutes, at minimal costs. E.g., Point-of-Care Tests (POCTs), such as home-based tests for COVID-19, allowed decentralised, rapid and low-cost diagnostics to provide results within minutes.
- New innovations such as nasal and tongue swab-based tests for TB can be game changers by reducing diagnostic delays.
- Handheld digital X-ray machines (with artificial intelligence-based software) can now be taken to villages and urban settlements to screen large numbers of high-risk individuals, safely and conveniently.
- Develop new therapeutic models: Development and introduction of new therapeutic molecules can play a crucial role in the long run. There is a need to invest more in drug discovery, scale up newer and more effective regimens which are for short time-periods yet effective.
- Regulatory frameworks and collaboration: There is a need to creating regulatory and policy frameworks for strengthening the innovation ecosystem and maximising reach to the public. This requires greater collaboration between policymakers, scientists, product developers and clinical researchers across the countries and governments.
- Harmonisation of standards: Harmonisation of standards and regulatory processes between countries can enable mutual recognition of evidence-based standards and licences and save critical time towards rollout.
