Context: New evidence from Reducing Activation of Tuberculosis by Improvement of Nutritional Status (RATIONS) trial shows that improved nutrition among contacts of patients with infectious lung TB can reduce the incidence of all forms of TB by 40 per cent and of infectious TB by nearly 50 per cent.

About RATIONS trial

• It was conducted between 2019 and 2022 in four districts of Jharkhand in collaboration with the National TB Elimination Programme and National Institute for Research in Tuberculosis.

• This was supported by the Indian Council of Medical Research (ICMR).

• The objective of the trial was to estimate the effect of nutritional support in reducing tuberculosis incidence among household contacts of patients in a setting with high prevalence of undernutrition.

Key Findings of Trials

• Improved nutrition among contacts of patients with infectious lung TB can reduce the incidence of all forms of TB by 40% and of infectious TB by nearly 50%.

• Early weight gain in underweight patients with TB can reduce their risk of mortality by 60%.

• Instantaneous risk of death was reduced by 13% for 1% weight gain and 61% for 5% weight gain.

• Cure or treatment completion, deaths during treatment, loss to follow-up, and treatment failure were the outcomes documented by National Tuberculosis Elimination Programme.

• No deaths occurred in patients with multidrug-resistant tuberculosis or HIV–tuberculosis co-infection.

About Tuberculosis

• It is caused by a bacterium called Mycobacterium tuberculosis.

• These bacteria usually affect the lungs but can also attack other organs in the body, such as the kidneys, spine, and brain.

• The most common symptoms of TB are persistent cough with blood or sputum, fever, loss of appetite, weight loss and sweating at night.

• Not everyone infected with TB bacteria becomes sick.

• As a result, two TB-related conditions exist: latent TB infection (LTBI) and TB disease.

Latent TB Infection (LTBI)

• TB bacteria can live in the body without affecting, this is called a latent TB infection.

• In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing.

• People with latent TB infection have no symptoms, don’t feel sick, can’t spread TB bacteria to others and usually have a positive TB skin test reaction or positive TB blood test.

• TB can be spread through air when people cough, sneeze or speak.

• People with TB are most likely to spread it to people they spend time with every day including family members, friends, coworkers or schoolmates.

TB Disease

• When the immune system can’t stop bacteria from growing, they become active (multiplying in your body), this is called TB disease.

• Some people develop TB disease soon after becoming infected (within weeks) before their immune system can fight the TB bacteria.

• If not treated in a timely manner or properly, TB disease can be fatal.

Symptoms of TB disease

• TB symptoms depend on the location of the growth of TB bacteria in the body.

• They usually grow in the lungs (pulmonary TB).

TB disease in the lungs may cause symptoms such as:

• Bad cough (lasting 3 weeks or longer),

• Pain in the chest,

• Coughing up blood or sputum (phlegm from deep inside the lungs)

• Other symptoms of TB disease are weakness or fatigue, weight loss, loss of appetite, chills, fever, etc.

TB Vaccine

• Bacille Calmette-Guérin (BCG) is a vaccine for tuberculosis (TB) disease.

• It is often given to infants and small children and it does not always protect people from getting TB.

• The National Prevention Information Network (NPIN) offers resources for public health professionals seeking information about TB statistics, guidelines, and materials.

Prevalence of TB in India

• India is the largest contributor to global TB cases.

• India accounts for 28% of all TB cases and 35% of deaths in the world, according to the Global TB Report 2022.

• There were 21.3 lakh cases detected in 2021 as compared to 18.05 lakh cases in 2020.

• According to the WHO Global Tuberculosis Report, 2022, in India, 3 million new TB cases were recorded in 2021 with 4,94,000 deaths.

India’s TB Elimination Targets and Challenges

India’s TB Elimination Targets

• Elimination of TB is one of the sustainable development targets to be achieved by 2030 by the world.

• India has set a target of eliminating TB by 2025.

National strategic plan 2017-2025

• The national strategic plan 2017-2025 sets the target of India reporting no more than 44 new TB cases or 65 total cases per lakh population by 2025.

• The estimated TB incidence for the year 2021 stood at 210 per lakh population.

• Achieving this target is a big task as the plan had envisaged an incidence of only 77 cases per lakh population by 2023.

• The programme also aims to reduce the mortality to 3 deaths per lakh population by 2025.

• The estimated TB mortality for the year 2020 stood at 37 per lakh population.

• The plan aims to reduce catastrophic costs for the affected family to zero.

• The report states that 7-32% of those with drug-sensitive TB, and 68% with drug-resistant TB experienced catastrophic costs.

• The goals are in line with the World Health Organisation’s End TB strategy that calls for 80% reduction in the number of new cases, 90% reduction in mortality, and zero catastrophic cost by 2030.

Challenges

• Major challenges to control TB in India include poor primary health-care infrastructure in rural areas.

• Unregulated private health care leads to widespread irrational use of first-line and second-line anti-TB drugs.

• Poverty, lack of political will and corrupt administration are the major causes of concern.

India’s initiatives to eliminate TB

National Tuberculosis Elimination Programme (NTEP)

• It was earlier known as the Revised National Tuberculosis Control Programme (RNTCP).

• It functions as a flagship component of the National Health Mission (NHM) and provides technical and managerial leadership to anti-tuberculosis activities in the country.

TB Harega Desh Jeetega Campaign

• It was initiated by Health Ministry in 2019.

• Three pillars: Clinical approach, public health component and active community participation.

Pradhan Mantri TB Mukt Bharat Abhiyaan (Ni-kshay Mitra Initiative)

• It was launched by the Ministry of Health and Family Welfare (MOHFW) to accelerate the country’s progress towards TB elimination by 2025.

Objectives

• Provide additional patient support to improve treatment outcomes of TB patients

• Augment community involvement in meeting India’s commitment to end TB by 2025

• Leverage Corporate Social Responsibility (CSR) activities.

Ni-Kshay Poshan Yojana

• Nikshay Poshan Yojana is a government scheme in India to provide 500 rupees per month for tuberculosis patients to buy food.

• It was launched by the Union Health Ministry in 2018 as part of National TB Elimination Programme (NTEP).

New vaccines

• The two new vaccines VPM (Vaccine Project Management)1002 (produced by Serum Institute of India) and Mycrobacterium Indicus Pranii (MIP) have been developed and are under trial