India’s goal to end the epidemic by 2025 was too “ambitious” and “unrealistic”- Medical Journal Lancet

India accounted for 27% of the 10 million people, who had developed TB in 2017. Also, India accounted for 32% of global TB deaths among HIV-negative people, and 27% of combined TB death in 2017. 

Team Seeker's Thoughts

Medical Journal Lancet had undertaken a study on Tuberculosis (TB) in three burden countries, including India. The finding of the burden of the TB in India is:

- India’s goal to end the epidemic by 2025 was too “ambitious” and “unrealistic”, hence unattainable.

- 57% reduction in incidence and 72% reduction in mortality will been seen only by 2035 and strengthening the care cascade could reduce cumulative Tb incidence by 38% in the case of India.
- India needs to adopt measures to prevent TB commensurate with the population levels to eliminate the disease in the coming decades.

-     - India needs to improve diagnosis and treatment for drug-sensitive and drug –resistant TB.

-   - Lives of eight million 28% people with TB can be saved over the next 30 years if tests are subsidised and patients are supported to complete treatment.

-  For this subsidised and compete care, India requires an extra $290 million each year. This is significantly less than $32 billion losses which India incurs associated with TB mortality each year.

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- India needs to scale up access to TB services for all those seeking them, optimise engagement of private sector providers and guarantee universal access to drug susceptibility testing and second-line TB drugs.
- Integration of TB services with the primary health system to reduce diagnostic delays is not happening.

- The majority of MDR-TB cases in India due to direct transmission. Early diagnosis and prompt initiation of effective treatment should be a high priority and prompt initiation of effective treatment should be a high priority for India to curb MDR-TB transmission since only 14% of people with MDR-TB completed treatment and just 11% remained diseases-free at the end of one year.

National Strategic Plan (NSP) 2017-2025
One of the main changes in this strategic plan is that the emphasis is going to be reaching patients seeking care from private providers. So, this NSP builds on the work already done with the new RNTCP operating guidelines.

The RNTCP will also be helping private providers to provide quality care and treatment, rather than encouraging the private providers to send their patients to get care from the RNTCP. The cost of implementing the new NSP is estimated at US$2.5 billion over the first three years.

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The NSP plans to provide incentives to private providers for following the standard protocols for diagnosis and treatment as well as for notifying the government of cases.

Also, patients referred to the government will receive a cash transfer to compensate them for the direct and indirect costs of undergoing treatment and as an incentive to complete treatment. This has already been trailed in some pilot projects.

 National inter-ministerial commission had been set up in 2018 to achieve fast-tracking universal access to health care through all state and non-state care providers by adopting WHO-recommended TB diagnostics, drugs, technologies and standards of care. It is supposed to ensure attention to high-risk groups and vulnerable populations such as migrants, refugees and prisoners.

Providing financial support for nutritional support to the TB patients

In tuberculosis as in many other infectious diseases, there is bidirectional interaction between nutritional status and active disease. Under-nutrition is a risk factor for TB which in turn worsens the nutritional status, generating a vicious cycle which can lead to adverse outcomes for patients with active TB including those with multi-drug resistant TB.

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 This interaction is particularly important in the Indian context where food insecurity and under-nutrition coexist with a large burden of TB. To address this issue, it is proposed to launch a scheme to provide a monthly cash incentive for every TB patient through DBT.  All individual with active TB would receive.

International initiatives to end TB

Moscow declaration emphasizes need for fixing multisector responsibility towards ending TB by 2035, the global target. It recognises need for multi-sectoral accountability framework to end TB, which is both political and technical.

This framework is critical to create operational environment for multi-sectoral action, fast-tracking priority interventions, monitoring overall progress, and accelerating advocacy at all levels within different sectors, all of which are necessary to achieve committed milestones and targets to end TB epidemic.

GOVERNMENT’S STRATEGIES

The first step in defeating the disease and achieving the target is to record every diagnosed patient through case notification that is when a person is diagnosed with TB, it is reported to the national surveillance system and then to the WHO.

There was 34% increase in case notification by health-care providers in the private sector. Ministry of health and family welfare introduces daily drug regimen for treatment of TB.

It will provide daily drug to TB patients across the country. Drugs will be available in private pharmacy stores, private practitioner dispensary all along in the major hospitals of the country.

Awareness programmes are already taken place in several states where TB cases are severe in the country. These steps will help to prevent TB in the country.