Why in news: According to the India TB Report 2024 released by the Union Health Ministry, the gap between the estimated number of tuberculosis (TB) and actual cases is narrowing. This is an important marker because “missing cases” are believed to be those who have not received treatment, thereby spreading the infection to others.
Syllabus:
Preliminary Examination: Economic and Social Development
Main Examination: General Studies II: Issues relating to the development and management of Social Sector/Services relating to Health, Education, and Human Resources.
India TB Report 2024 – key takeaways
The India TB Report 2024 presents a comprehensive overview of the current status and progress in the fight against tuberculosis (TB) in India.
Increase in reporting from the private sector: There has been a significant increase in notification of TB cases from the private sector, which reported about 33% (about 8.4 lakh) of the total 25.5 lakh TB cases in 2023. This represents a considerable increase from 1.9 lakh. The cases reported in 2015 reflect the increasing involvement of private health centers in TB control efforts.
Marginal increase in projected incidence: The projected incidence of TB in India increased slightly from 27.4 lakh last year to 27.8 lakh in 2023. Despite the increase, concerted efforts in TB detection and treatment are reflected in the overall management of the disease incidence.
Stable Death Rate: As per the latest data, the death rate due to TB remains stable at 3.2 lakh. This stability in mortality rates has occurred despite a modest increase in estimated TB incidence, indicating improved treatment outcomes and disease management strategies.
Acceptance of new estimation methodology: The report highlights that the new methodology developed by India to estimate TB cases and mortality has been accepted by the World Health Organization (WHO). This method led to a revision of the mortality data, reducing the TB death rate from 4.94 lakh in 2021 to 3.31 lakh in 2022.
High treatment initiation rates: India achieved its target of initiating treatment in 95% of TB patients diagnosed in 2023. This high treatment initiation rate is critical to controlling the spread of the disease and ensuring that patients get the care they need promptly.
Increase in drug resistance testing: The report also indicates improvements in the management of drug-resistant TB, with 58% of diagnosed patients being offered testing for resistance to first-line drugs. This is a significant increase from 25% in 2015, emphasizing the importance of identifying drug-resistant TB cases early and treating them effectively.
The gap of missing cases is narrowing: The gap between the estimated number of TB cases and the actual cases reported is narrowing, with only 2.3 lakh “missing cases” in 2023, compared to 3.2 lakh last year. This reduction in missing cases, partly due to the government’s Ni-Kshaya portal tracking all TB patients, is important to ensure that more individuals receive treatment and reduce the spread of TB.
Tuberculosis (TB)
- Tuberculosis, often called TB, is an infectious disease caused by the bacterium Mycobacterium tuberculosis. Primarily targeting the lungs, it spreads through the air when a person with the active form of the disease coughs or sneezes, releasing droplets containing the bacteria.
- India bears 27% of the global TB burden.
- Through adequate medical treatment and care, individuals suffering from TB can make a complete recovery, which is a significant advancement in the fight against this infectious disease.
Treatment:
- TB is treatable and curable with timely and appropriate treatment, involving a 6-month regimen of four antimicrobial drugs.
- Healthcare professionals or trained volunteers support patients through medication, supervision, and guidance to ensure treatment adherence and manage side effects.
- Despite the effectiveness of traditional anti-TB medicines, drug-resistant TB strains have emerged globally, presenting significant challenges.
- Multidrug-resistant tuberculosis (MDR-TB) is resistant to isoniazid and rifampicin, the two most potent first-line anti-TB drugs.
- MDR-TB can be treated and cured using second-line drugs, including newer medications like Bedaquiline.
- Extensively drug-resistant TB (XDR-TB) shows resistance to both first-line drugs and the most effective second-line treatments, severely limiting treatment options.
- The emergence of drug-resistant TB highlights the necessity for ongoing research and development of new TB therapies, the importance of maintaining treatment adherence to prevent resistance, and the vital role of global health initiatives in the fight against TB.
Global Initiative:
The World Health Organization (WHO), in collaboration with the Global Fund and the Stop TB Partnership, has launched “Find. Treat. All. #EndTB” to strengthen the fight against tuberculosis globally. Additionally, WHO publishes the annual Global Tuberculosis Report, which provides comprehensive data and analysis on the disease situation around the world, helping to formulate strategies to effectively combat TB.
Efforts in India:
- India has prepared a strong framework to eliminate TB through the National Strategic Plan (NSP) for the year 2017 to 2025.
- The Nikshay ecosystem, India’s national TB information system, plays a vital role in monitoring and managing TB patients and treatment.
- To assist patients, Nikshay Poshan Yojana (NPY) was launched in 2018, recognizing the vital role of nutrition in treatment success, to provide financial assistance of Rs 500 per month to each TB patient for their nutritional needs. Provides.
- The “TB Harega Desh Jeetega” campaign exemplifies India’s commitment to TB eradication by raising awareness and taking action across various sectors of society.
In terms of vaccine development, significant progress has been made with two vaccines, VPM1002 and Mycobacterium indicus prani (MIP), currently in phase-3 clinical trials.
These vaccines represent promising advances in tuberculosis prevention, providing hope for more effective TB control and prevention strategies in the future.
Different Issues in Curing TB Burden in India:
Tackling the burden of tuberculosis (TB) in India involves overcoming many medical and systemic challenges.
Medical and systemic challenges: A significant shortcoming in the fight against TB has been the failure to understand the real-life experiences of individuals affected by TB fully. There is a tendency to ignore the patient’s perspective regarding his needs, difficulties, and expectations.
Medicalization versus recognition of the humanitarian crisis: Approaches to TB are often overly medicalized, thereby neglecting the broader humanitarian crisis it represents, including its gender-specific implications, economic consequences, and broader social and environmental impacts. Are included.
Disproportionate impact on marginalized communities: TB disproportionately impacts marginalized sections of society, including children, the urban poor, prisoners and people living with HIV/AIDS. This reflects not only a health crisis, but also an economic crisis, with significant losses to the country and devastating effects on families and communities.
Drug Resistance: Drug resistance in TB is a significant challenge, which mainly arises due to irregular use of antibiotics and non-adherence to treatment regimens. Poor regulatory mechanisms and adherence issues are major factors behind the high rates of drug resistance.
Screening and diagnosis: Current reliance on symptomatic testing cannot identify all infectious TB cases, suggesting the need for more effective diagnostic methods such as X-ray imaging to find asymptomatic but infectious individuals.
Cost and accessibility of tests: While molecular diagnostic capabilities have increased significantly, the high cost and accessibility issues of these tests limit their usefulness, especially in remote areas.
Co-morbidities such as diabetes mellitus (DM): The presence of DM in TB patients may lead to worse treatment outcomes, highlighting the need for an integrated care approach that addresses both TB and DM.
Steps for Mitigation:
Patient-centered approach: It is important to emphasize the needs and interests of patients and communities within the health care system. This involves incorporating the perspectives of TB survivors into program design and policy-making.
Bridging policy and reality: Efforts should aim to bridge the gap between policy intentions and actual ground reality with targeted interventions to improve access to TB diagnosis and treatment, especially in rural and deprived areas.
Multi-sectoral approach: Addressing the socio-economic determinants of TB requires a multi-sectoral approach, with a focus on poverty alleviation, improving nutritional status, and improving living conditions to reduce risk factors for TB. Be focused.
Technology and Innovation: By leveraging technology such as AI-powered diagnostic tools and digital health solutions, TB care efforts can be enhanced, offering new avenues for diagnosis, treatment adherence, and monitoring.
Comprehensive care model: Strengthening community-based TB care models and empowering frontline health workers to provide comprehensive care can meet not only the medical but also the social, economic, and mental health needs of TB patients.
India’s ambitious goal of eliminating TB by 2025 faces significant challenges, requiring a concerted effort by the government, healthcare professionals, and civil society. Addressing these challenges through a patient-centric, innovative, and multi-disciplinary approach will be critical to achieving this goal.