Take lessons from survivors in India’s fight against TB

Why in News?

• On World Tuberculosis (TB) Day 2023, Prime Minister Narendra Modi addressed the One World TB Summit in his parliamentary constituency Varanasi.
• Each year, the World TB Day is celebrated on March 24 and the theme of this year’s World TB Day is ‘Yes! We can end TB!’.

 

One World TB Summit

• It is being organised by the Union Ministry of Health and Family Welfare (MoHFW) and the Stop TB Partnership.
  • The Stop TB Partnership is a United Nations-hosted organisation founded in 2001 to amplify the voices of the people, communities and countries affected by TB.
• During the event, the PM will launch various initiatives, including TB-Mukt Panchayat initiative, official pan-India rollout of a shorter TB Preventive Treatment (TPT), family-centric care model for TB and India’s Annual TB Report 2023.
• Besides, the PM will also award select states/UTs and districts for making progress towards ending TB.

 

How many cases of TB are found in India?

• India accounts for 28% of all TB cases in the world, according to the Global TB Report 2022.
• The government’s Ni-kshay portal reported 3 lakh TB cases in 2021 as compared to 18.05 lakh cases in 2020.
  • The numbers are still lower than the 04 lakh cases reported before the covid pandemic in 2019.
• The incidence of TB, i.e., new cases detected throughout the year, reduced by 18% in 2021 over the 2015 baseline, dropping to 210 cases per lakh population as compared to 256 cases per lakh population.
  • A survey conducted across 20 states pegged the incidence at a higher 312 cases per lakh population.
  • The incidence of drug-resistant TB also went down by 20% during the period from 1.49 lakh cases in 2015 to 1.19 lakh cases in 2021.

 

What are the Reasons for High TB Incidence in India?

• Even though TB is India’s severest health crisis, yet cavalier attitude exists due to critical failure in addressing information gaps that exist around it.
  • Most Indians still do not know the symptoms of TB, and doctors rarely order enough TB tests, while a staggering one million cases remain unreported in India.
• The accurate, reliable and affordable diagnostics and testing both for drug-sensitive and drug-resistant remain inaccessible to most of the India’s population.
• The Nikshay Poshan Yojana, faces gaps in implementation, and its amount for support - a mere Rs 500 remains inadequate for the TB-affected patients.
  • It aims to support every TB Patient by providing a Direct Benefit Transfer (DBT) per month for nutritional needs.

 

What is India’s TB Elimination Target?

• The SDGs targeted the elimination of TB by 2030 by the world, but India has set the target of 2025.
  • The WHO End TB strategy calls for 80% reduction in the number of new cases, 90% reduction in mortality, and zero catastrophic cost by 2030.
• The National Strategic Plan 2017-2025 (NSP) sets the target of India reporting no more than 44 new TB cases or 65 total cases per lakh population by 2025.
  • However, achieving this target is a challenge as the plan had envisaged an incidence of only 77 cases per lakh population by 2023.
  • The estimated TB incidence for the year 2021 stood at 210 per lakh population.
• The NSP aims to reduce the mortality to 3 deaths per lakh population by 2025. However, the estimated TB mortality for the year 2020 stood at 37 per lakh population.
• The plan also targets to reduce catastrophic costs for the affected family to zero.

 

What are the Steps taken to Achieve TB Elimination Targets in India?

• Actively looking for cases among vulnerable and co-morbid populations, screening for it at the health and wellness centres (HWCs), and calling on the private sector to notify all TB cases.
• An online Ni-kshay portal has been set up to track the notified TB cases.
• The pandemic has led to improved access to the more accurate molecular diagnostic tests like CB-NAAT and TureNat that were also used to test for Covid-19.
  • At present, there are 4,760 molecular diagnostic machines available, covering all districts of the country.
• The government has also implemented a universal drug susceptibility test (UDST), which ensures that the patients are given antibiotics that will work for them from the beginning.
  • This is unlike earlier when patients were started on first line treatment and were tested for drug resistance only if the therapy did not work.
• The government has also launched the community engagement programme where Ni-kshay Mitras can adopt TB patients and provide them monthly nutritional support.
  • So far, 71,460 Ni-kshay Mitras have adopted about 10 lakh TB patients under the programme.

 

What are the Improvements in Treatment Protocols?

• Newer drugs such as Bedaquiline and Delamanid for the treatment of drug-resistant TB have been included in the government’s basket of drugs provided free of cost to the TB patients.
  • These oral drugs could replace the injectable kanamycin that was associated with serious side effects like kidney problems and deafness.
  • These new drugs have also been included in the new National List of Essential Medicines that gives the government power to regulate their market price as well.

 

Way Forward

• India needs to launch a national campaign for stigma reduction and mental health support to TB-affected individuals alongside.
  • The TB survivors can also play a critical role in helping design such communication and community support strategies.
• India could roll out large-scale shorter regimens for adult and paediatric populations to have holistic population coverage under TB dosage.
• It could also consider options such as compulsory licensing, if the costs for TB vaccines are high.
• The amount for Nikshay Poshan Yojana needs to be increased to at least Rs 2,500 for sufficiently addressing nutritional gaps for TB patients.
• India needs to urgently invest in diagnostics, focusing on the scale-up of new diagnostic tests and offering universal drug-susceptibility testing (DST) to all TB patients.
  • It also needs to ensure that every Indian seeking care can easily access accurate TB tests for free.
• India needs an innovative and well-thought-out people-centred private sector engagement strategy to solve its TB crisis.
• India also needs to rapidly invest in TB-related research to bring innovation and rethinking current strategies in TB elimination related efforts.

 

Conclusion

• The universal implementation of the shortest and best available TB regimens for TB prevention is the need of the hour and India could play a leadership role in this trajectory.

 

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Q1) What are health and wellness Centres (HWCs)?

HWCs under Ayushman Bharat scheme deliver Comprehensive Primary Health Care (CPHC) like free essential medicines and diagnostic services, teleconsultation, and health promotion including wellness activities like Yoga.

 

Q2) What is National List of Essential Medicines (NLEM)?

NLEM is a list released by the MoHFW promoting rational use of medicines considering the three important aspects i.e. cost, safety and efficacy.

 

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Source: The Indian Express

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