India's TB Mission 2020

TB remains world's deadliest infectious disease: WHO

Every year on 24th of March World TB Day is commemorated globally to raise awareness about the elimination and strategize the treatment of world Tuberculosis burden. The theme of World TB Day 2020 is IT’S TIME TO END TB keeping in view that according to the World Health Organization ´s (WHO) 2019 Global Tuberculosis Report that tuberculosis (TB) is still the most life threatening infectious disease globally, killing about 1.6 million people annually. In 2018 India unfortunately accounts for quarter of world TB burden with an estimated 2.69 million Incidence of TB cases (includes HIV+TB), 130,000 Multidrug-resistance TB cases, 440,000 deaths (excluding HIV+TB) and 9,700 deaths (HIV+TB only). WHO’s SDG Target 3.3 includes ending the TB epidemic by 2030. The End TB Strategy defines milestones (for 2020 and 2025) and targets (for 2030 and 2035) for reductions in TB cases and deaths.

India has been fighting socio-economic burden of tuberculosis from last 50 years, as India  starts investing in healthcare industry, in October 2014 MOHFW, Government of India announces India’s “TB- Mission 2020” at World Health Organization’s Global TB Symposium in Barcelona meet. Main objective of TB- Mission 2020 was to eliminate TB from India by 2020 with its emphasis on free diagnosis and treatment to all patients, banning commercial serology for TB diagnosis, Creating separate schedule of Anti-TB drugs under National Drug Law and mandatory notification of New TB cases.

Achievements so far

From past five decades India is acting as a robust leader in eradicating tuberculosis by launching programmes, schemes and treatment regimens. In 1962 India set its first step towards the eradication of tuberculosis by launching The National TB Programme of India (NTP). In 1993, the Revised National TB Control Programme (RNTCP) was initiated with population of 2.4 million in the states of Delhi, Gujarat, Kerala, Maharashtra and West Bengal which turned into a remarkable achievement that in 1997 the RNTCP was launched as a national programme to cover whole Indian population. The programme was based on DOTS (directly observed treatment short-course) WHO-recommended strategy for TB control. In 2001 RNCTP collaborated with National AIDS Control Programme which shined out as revised “National Framework for Joint TB/HIV Collaborative Activities” in October 2009. In 2011, RNTCP has achieved the NSP (new smear positive) Case Detection Rate of 71% and 88% of treatment success rate. In 2012, Central TB Division (CTD) and National Informatics Centre (NIC) developed a Web Based application named Nikshay for online case reporting also GOI banned commercial serological diagnosis of TB. With synergistic efforts of all healthcare professionals and Indian Medical Association in 2014 under RNTCP 14, 43,942 cases of tuberculosis were registered for treatment among them 94% HIV infected TB patients were on Co-trimoxazole preventive therapy and 91% were on Anti retroviral therapy. In 2016 government strategize the change in mission 2020 The National Strategic Plan (NSP 2017-25) for elimination of TB with the aim to rapidly decline TB incidence and mortality in India by 2025.With NSP government started Nikshay Poshan Yojana (NPY) giving nutritional incentives of Rs 500 to every TB patient per Month. Besides funds from Indian government RNTCP also receives funds from Global fund, World Bank, USAID and other international agencies. These interventions along with the joint collaborative activities helped in reducing TB related fatalities by 82% from baseline 2010.

Obstacles in the way of elimination of TB and approaches to tackle them

Multi-drug resistance (MDR-TB)

As per concordant reports India contributes to 24% of the global burden of multidrug-resistant tuberculosis (MDR-TB) and with the prevalence of MDR-TB approx. 3% in new TB cases and 12-17% among retreated cases. RNTCP should introduce new drugs which are more sensitive to TB and less adverse and should make Bedaquiline (a new drug for MDR-TB) available all over India. Patients should always complete their recommended treatment courses which reduces the disease relapsing risk.

Improper reporting

In India about 5.4 lakh TB cases went unreported last year according to WHO’s Global TB report, which increase disease transmission and severity. Approaches which are community based like WHO’s Mobile clinic and OPASHAs that went door to door and report TB cases in slums should be introduced. Nikshay a web based reporting system should be made accessible nationwide.

Occupational Hazards

Workers of workplaces which are less ventilated and overcrowded like Mines, Cement factories, textile industries, chemical industries etc are more vulnerable to TB and other respiratory disorders. Such workplace should be provided with health policies including proper medical checkup, medical insurances and also hazard proof working environments.

Economic burden

TB cost about US$ 3 billion annually which is very high for developing country like India. India should review its budget to meet the financial requirements of RNTCP and should ask international agencies for more funds.

TB as social stigma

In India TB isn’t just a health and economic challenge, it is a big societal issue. India has highest stigma index with TB that patients often hesitate to take medical treatment and keep their disease confidential in the fear of losing social connections. While as raising awareness and educating people through TV channels, social media, print media, street plays, rallies by students and campaigns can help in eradicating such social taboos.

Poor hygiene and malnutrition

Lack of hygiene, proper housing, balanced nutrition and sanitation are the factors contributing to TB burden on India. These loop holes should be treated with initiatives like National Nutrition mission, Housing for All and Swach Bharat Abhiyan.

Although politically committed goal for TB elimination by TB Mission 2020 is not achieved yet but work done on it so far is worth adulation and lets hope for TB free India by 2025 as per National Strategic Plan (2017-2025 for TB elimination).

Nyira Shafi is Student of M Pharm, Pharmacology, Dept. of Pharmaceutical Sciences, Kashmir university.