THE CONTEXT: According to World Health Organization’s WHO Global Tuberculosis (TB) Report 2024, India has several hits and misses in its findings. India has significantly improved in its case detection and treatment success rates. But the trend is showing decline in funding of TB related initiatives and TB elimination programs. India is falling short of elimination targets by huge margin of 32% by 2025.
PROGRESS ACHIEVED:
- Decline in TB Incidence: India has recorded a 17.7% reduction in TB incidence, decreasing from 237 cases per 100,000 population in 2015 to 195 in 2023. This decline is more than double the global average reduction of 8.3% during the same period.
- Improved Treatment Coverage: In 2023, India achieved an 89% treatment coverage rate, up from 72% in 2015. This improvement is attributed to intensified case detection and treatment efforts.
ONGOING CONCERNS:
- High TB Burden: India accounts for 26% of global TB cases, with an estimated 2.8 million cases in 2023. It requires sustained and enhanced TB control measures to control it further.
- Drug-Resistant TB: India has the highest number of multidrug-resistant TB (MDR-TB) cases worldwide, comprising 27% of global MDR-TB cases. This presents significant treatment challenges and requires robust management strategies in context of contrasting socio-economic realities.
- TB Mortality: TB-related deaths in India were reported at 315,000 in 2023, accounting for nearly 29% of global TB deaths. While there has been a modest decline, the mortality rate remains a serious concern.
INITIATIVES:
- National TB Elimination Programme (NTEP): Aims to eliminate TB by 2025 through comprehensive strategies.
- Pradhan Mantri TB Mukt Bharat Abhiyan: Focuses on patient support, community involvement, and leveraging corporate social responsibility.
- Nikshay Poshan Yojana: Provides financial assistance to TB patients to ensure nutritional support during treatment.
- Nikshay Mitra Initiative: Encourages community participation in supporting TB patients’ recovery.
THE ISSUES:
- Impact of COVID-19: Covid-19 disrupted TB services, leading to a decline in case notifications and adherence to treatment. The WHO notes that the COVID-19 pandemic has reversed years of progress in TB control.
- Socio-Economic Barriers: TB disproportionately affects economically disadvantaged populations, leading to delayed diagnosis and treatment. The WHO duly recognized the need for social support systems to address these barriers effectively.
- Diagnostic Delays: In 2022, 3.1 million new TB cases globally went undetected, with a significant portion in India. The undiagnosed cases jeopardize control efforts.
- Drug-Resistant TB (DR-TB): India has the highest number of multidrug-resistant TB (MDR-TB) cases worldwide, comprising 27% of global MDR-TB cases. The state of Uttar Pradesh, contributing to 20% of India’s TB cases, faces significant challenges in managing DR-TB due to its vast population and geographical diversity.
- Pediatric TB Detection: Detecting TB in children is particularly challenging due to non-specific symptoms and difficulties in obtaining sputum samples for testing. Consequently, pediatric TB cases are often underdiagnosed and undertreated, contributing to ongoing transmission cycles.
- Co-infection with HIV: HIV-infected individuals are at a higher risk of developing TB. Co-infection complicates treatment protocols and increases mortality rates. Integrated management of TB and HIV remains a critical concern.
THE WAY FORWARD:
- Implementation of Rapid Molecular Testing: Expanding the use of rapid molecular tests, such as Xpert MTB/RIF, facilitates early detection of TB and drug resistance. India has established the world’s largest TB laboratory network, with 7,767 rapid molecular testing facilities and 87 culture and drug susceptibility testing laboratories nationwide.
- Universal Drug Susceptibility Testing (U-DST): Adopting U-DST for all presumptive TB cases ensures appropriate treatment regimens are administered promptly. Current guidelines in India align with WHO recommendations, including U-DST for all presumptive cases and short-term MDR-TB regimens of 9-12 months.
- Shorter, All-Oral Regimens: Implementing shorter, all-oral treatment regimens improves patient adherence and outcomes. The WHO recommends a 6-month BPaLM regimen, composed of bedaquiline, pretomanid, linezolid, and moxifloxacin, for patients with MDR/RR-TB.
- Access to Newer Drugs: Ensuring the availability of newer anti-TB drugs, such as bedaquiline, across treatment centers is crucial. India has made bedaquiline available across more than 500 drug-resistant TB centers to support the #EndTB program.
- Nutritional Support: Providing nutritional support to undernourished TB patients can improve treatment outcomes. In 2022, nearly 744,000 TB patients in India were undernourished, highlighting the need for such interventions.
- Co-Management of TB and HIV: Integrating TB and HIV services ensures comprehensive care for co-infected patients, reducing morbidity and mortality. Offering routine HIV testing to TB patients facilitates early detection and management of co-infections.
THE CONCLUSION:
India has made significant strides in expanding TB treatment coverage and preventive therapy, yet challenges remain with drug-resistant cases and high TB-related fatalities, as evidenced by the 315,000 TB deaths in 2023, accounting for 29% of global TB deaths. Continued innovation, resource allocation, and targeted interventions are crucial for India to meet its TB elimination goal by 2025.
UPSC PAST YEAR QUESTION:
Q. In a crucial domain like the public healthcare system the Indian State should play a vital role to contain the adverse impact of marketisation of the system. Suggest some measures through which the State can enhance the reach of public healthcare at the grassroots level. 2024
MAINS PRACTICE QUESTION:
Q. Despite significant progress in TB treatment coverage, India continues to shoulder the highest tuberculosis burden globally. Examine
SOURCE:
https://www.deccanherald.com/opinion/editorial/wake-up-to-flagging-tb-fight-outcomes-3260563
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