Every year on 24th of March World TB Day iscommemorated globally to raise awareness about the elimination and strategizethe treatment of world Tuberculosis burden. The theme of World TB Day 2020 is IT’STIME TO END TB keeping in view that according to the World Health Organization´s (WHO) 2019 Global Tuberculosis Report that tuberculosis (TB) is still themost life threatening infectious disease globally, killing about 1.6 millionpeople annually. In 2018 India unfortunately accounts for quarter of world TBburden 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) and9,700 deaths (HIV+TB only). WHO’s SDG Target 3.3 includes ending the TBepidemic 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-economicburden of tuberculosis from last 50 years, as India starts investing in healthcare industry, inOctober 2014 MOHFW, Government of India announces India’s “TB- Mission 2020” atWorld Health Organization’s Global TB Symposium in Barcelona meet. Mainobjective of TB- Mission 2020 was to eliminate TB from India by 2020 with itsemphasis on free diagnosis and treatment to all patients, banning commercialserology for TB diagnosis, Creating separate schedule of Anti-TB drugs underNational Drug Law and mandatory notification of New TB cases.
Achievements so far
From past five decades India is acting as arobust leader in eradicating tuberculosis by launching programmes, schemes andtreatment regimens. In 1962 India set its first step towards the eradication oftuberculosis by launching The National TB Programme of India (NTP). In 1993,the Revised National TB Control Programme (RNTCP) was initiated with populationof 2.4 million in the states of Delhi, Gujarat, Kerala, Maharashtra and WestBengal which turned into a remarkable achievement that in 1997 the RNTCP waslaunched as a national programme to cover whole Indian population. Theprogramme was based on DOTS (directly observed treatment short-course)WHO-recommended strategy for TB control. In 2001 RNCTP collaborated withNational AIDS Control Programme which shined out as revised “National Frameworkfor Joint TB/HIV Collaborative Activities” in October 2009. In 2011, RNTCP hasachieved the NSP (new smear positive) Case Detection Rate of 71% and 88% oftreatment success rate. In 2012, Central TB Division (CTD) and NationalInformatics Centre (NIC) developed a Web Based application named Nikshay for onlinecase reporting also GOI banned commercial serological diagnosis of TB. Withsynergistic efforts of all healthcare professionals and Indian MedicalAssociation in 2014 under RNTCP 14, 43,942 cases of tuberculosis wereregistered for treatment among them 94% HIV infected TB patients were onCo-trimoxazole preventive therapy and 91% were on Anti retroviral therapy. In2016 government strategize the change in mission 2020 The National StrategicPlan (NSP 2017-25) for elimination of TB with the aim to rapidly decline TBincidence and mortality in India by 2025.With NSP government started NikshayPoshan Yojana (NPY) giving nutritional incentives of Rs 500 to every TB patientper Month. Besides funds from Indian government RNTCP also receives funds fromGlobal fund, World Bank, USAID and other international agencies. Theseinterventions along with the joint collaborative activities helped in reducingTB related fatalities by 82% from baseline 2010.
Obstacles in the way of elimination of TBand approaches to tackle them
Multi-drug resistance (MDR-TB)
As per concordant reports India contributesto 24% of the global burden of multidrug-resistant tuberculosis (MDR-TB) andwith the prevalence of MDR-TB approx. 3% in new TB cases and 12-17% amongretreated cases. RNTCP should introduce new drugs which are more sensitive toTB and less adverse and should make Bedaquiline (a new drug for MDR-TB)available all over India. Patients should always complete their recommendedtreatment courses which reduces the disease relapsing risk.
Improper reporting
In India about 5.4 lakh TB cases wentunreported last year according to WHO’s Global TB report, which increasedisease transmission and severity. Approaches which are community based likeWHO’s Mobile clinic and OPASHAs that went door to door and report TB cases inslums should be introduced. Nikshay a web based reporting system should be madeaccessible nationwide.
Occupational Hazards
Workers of workplaces which are lessventilated and overcrowded like Mines, Cement factories, textile industries,chemical industries etc are more vulnerable to TB and other respiratorydisorders. Such workplace should be provided with health policies includingproper medical checkup, medical insurances and also hazard proof workingenvironments.
Economic burden
TB cost about US$ 3 billion annually whichis very high for developing country like India. India should review its budgetto meet the financial requirements of RNTCP and should ask internationalagencies for more funds.
TB as social stigma
In India TB isn’t just a health andeconomic challenge, it is a big societal issue. India has highest stigma indexwith TB that patients often hesitate to take medical treatment and keep theirdisease confidential in the fear of losing social connections. While as raisingawareness and educating people through TV channels, social media, print media,street plays, rallies by students and campaigns can help in eradicating suchsocial taboos.
Poor hygiene and malnutrition
Lack of hygiene, proper housing, balancednutrition and sanitation are the factors contributing to TB burden on India.These loop holes should be treated with initiatives like National Nutritionmission, Housing for All and Swach Bharat Abhiyan.
Although politically committed goal for TBelimination by TB Mission 2020 is not achieved yet but work done on it so faris worth adulation and lets hope for TB free India by 2025 as per NationalStrategic Plan (2017-2025 for TB elimination).
Nyira Shafi is Student of M Pharm, Pharmacology, Dept. of Pharmaceutical Sciences, Kashmir university.