ELIMINATION OF TUBERCULOSIS || Tindit India ||

Author - Dr. Radhey Shyam Mishra 

Tuberculosis is a communicable disease (through the air) caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs (pulmonary TB) and sometimes also affects other organs (extrapulmonary TB). It is commonly known as TB. TB is among India’s most deadly infectious diseases, with an estimated 2.8 million confirmed cases in 2015, according to a World Health Organization (WHO) report. India’s TB burden is the highest in the world, followed by Indonesia and China. About a 1/3rd of the world's population is diagnosed with latent TB (without evidence of clinically manifested active TB), which means they have been infected by the TB bacteria from actively sick people without their knowledge.

 Recently, the World Bank and the Government of India signed a loan agreement of $400 million for the Program Towards Elimination of Tuberculosis. This program will cover nine States and it will support the government's National Strategic Plan to end TB in India by 2025 a provide financial incentives to private-sector care providers for reporting cases of TB and ensuring that their patients complete the treatment regimen. It will also provide Direct Benefit Transfers to patients for acquiring the critical nutrition needed during treatment. The program will help the Government of India strengthen the monitoring and implementation of Nikshay—the government’s web-based TB case monitoring system.

Why India leads in burden in TB? 

• Poor medical infrastructure: Public-health facilities that specialize in TB in India are already overstressed and unregulated, with the little political will to change the situation.
• Misuse of Drugs: Irrational use of first-line and second-line anti-TB drugs are the other problem with TB care in India. New strains of TB have developed resistance to the standard medicines.
• Unaware about the disease and delayed diagnosis: A high proportion of missed and mistreated cases fuel India’s TB epidemic. These cases are not notified to the public system and most remain either undiagnosed or inadequately diagnosed. 
• Non accessibility of drugs: Indian patients have been fighting to get access to new anti-TB drugs such as bedaquiline and delamanid which has been only introduced in a few centres.
• Less effective Treatment: In India, the regimen of antimicrobial drugs are often spread out over a longer period of time than in other countries, making it harder for patients to see signs of progress. So, some people simply stop taking their medication.
• Lack of awareness: The first line of defence against the spread of TB is raising awareness in communities which is severely hampered by lack of money.
• Linkage with air pollution: Several studies have concluded there is a possible link between air pollution and the risk of active tuberculosis. In India, the rise of TB infections has coincided with the dismal air quality index in many Indian cities. 
• Other health-related factors: Among the other major risk factors for TB, including alcohol, smoking, diabetes, HIV and undernourishment. 

Govt intervention to eliminate TB-

Under the Universal Immunization Programme, Vaccination is provided for 12 life-threatening diseases: tuberculosis, diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, measles, Hepatitis B, Diarrhoea, Japanese Encephalitis, rubella, Rotavirus and Pneumonia (added in May 2017) 

Under Mission Indradhanush, Immunisation against seven vaccine-preventable diseases namely; Diphtheria, Pertussis, Tetanus, Childhood Tuberculosis, Polio, Hepatitis B and Measles. 

Revised National TB Control Programme (RNTCP) is being implemented under the umbrella of the National Health Mission which has achieved the global benchmark of case detection and treatment success and achieved millennium development goals in 2015 of halting and reversing the incidence of TB.

National Strategic Plan to end TB in India by 2025-

RNTCP released this framework in 2017 for the control and elimination of TB in India by 2025. It provides goals and strategies for the country’s response to the disease during the period 2017-2025 and aims to direct the attention of all stakeholders to the most important interventions to eliminate TB also targets to eliminate TB five years ahead of the global End TB targets under Sustainable Development Goals to attain the vision of a TB-free India. TB elimination has been integrated into the four strategic pillars of “Detect – Treat – Prevent – Build” (DTPB).

Detect: Find all Drug Sensitive TB and Drug-Resistant TB cases with an emphasis on reaching TB patients seeking care from private providers and undiagnosed TB in high-risk populations. 

Treat: Initiate and sustain all patients on appropriate anti TB treatment wherever they seek care, with patient-friendly systems and social support. 

Prevent the emergence of TB in susceptible populations. 

Build and strengthen enabling policies, empowered institutions, additional human resources with enhanced capacities, and provide adequate financial resources. 

Global Efforts for TB-

•  Moscow Declaration to End TB: It is the outcome of first global ministerial conference on ending TB, in 2017. 
• WHO- End TB Strategy Vision: A world free of TB with zero deaths, disease and suffering due to TB. It has three high-level, overarching indicators and related targets for 2035: 

1. 95% reduction in the number of TB deaths compared with 2015. 
2. 90% reduction in TB incidence rate compared with 2015. 
3. Zero the level of catastrophic costs for TB-affected families