Context-The tuberculosis incidence rate in India has decreased by almost 50,000 patients over the past one year, according to the World Health Organization (WHO)

Key findings

• The report notes that in 2017, India had 27.4 lakh TB patients which came down to 26.9 lakh in 2018.
• Incidence per 1,00,000 population has decreased from 204 in 2017 to 199 in 2018.
• The number of patients being tested for rifampicin resistance has increased from 32% in 2017 to 46% in 2018.
• And the treatment success rate has increased to 81% for new and relapse cases (drug sensitive) in 2017, which was 69% in 2016.

Disease trends

• According to experts, TB remains the top infectious killer in the world claiming over 4,000 lives a day.
• This report presents progress towards targets set at the first-ever United Nations General Assembly high-level meeting on TB in 2018, that brought together heads of state, as well as the targets of the WHO End TB Strategy and Sustainable Development Goals.

Covering all cases

• Meanwhile, the India TB-Report 2019 notes that India is closest ever to covering all TB cases through the online notification system (NIKSHAY). “With the aim of universal access to free diagnostics and treatment services, state-of-the-art diagnostic tests and quality assured drugs have been extended to all patients seeking TB care,” notes the India report.
• In India, of the estimated 2.69 million TB cases emerging in 2018, 2.15 million were reported to the Government of India — leaving a gap of 5,40,000 patients who are going unreported.

What is Tuberculosis?

• Tuberculosis -- or TB, as it’s commonly called -- is a contagious infection that usually attacks the lungs. It can also spread to other parts of the body, like the brain and spine. A type of bacteria called Mycobacterium tuberculosis causes it.

How Does Tuberculosis Affect Your Body?

A TB infection doesn’t mean you’ll get sick. There are two forms of the disease:

• Latent TB: You have the germs in your body, but your immune system stops them from spreading. That means you don’t have any symptoms and you’re not contagious. But the infection is still alive in your body and can one day become active. If you are at high risk for re-activation — for instance, you have HIV, your primary infection was in the last 2 years, your chest X-ray is abnormal, or you are immunocompromised --- your doctor will treat you with antibiotics to lower the risk for developing active TB.  
• Active TB disease: This means the germs multiply and can make you sick. You can spread the disease to others. Ninety percent of adult cases of active TB are from the reactivation of a latent TB infection.

What Are the Symptoms of TB?

There aren’t any for latent TB. You’ll need to get a skin or blood test to find out if you’re infected. But there are usually signs if you have active TB disease. They include:

• A cough that lasts more than 3 weeks
• Chest pain
• Coughing up blood
• Feeling tired all the time
• Night sweats
• Chills
• Fever
• Loss of appetite
• Weight loss.

How Is TB Spread?

• Through the air, just like a cold or the flu. When someone who’s sick coughs, sneezes, talks, laughs, or sings, tiny droplets that contain the germs are released. If you breathe in these nasty germs, you get infected.
• TB is contagious, but it’s not easy to catch. You usually have to spend a lot of time around a person who has a high load of bactilli in their lungs. That’s why it’s often spread among co-workers, friends, and family members.
• Tuberculosis germs don’t thrive on surfaces. You can’t get the disease from shaking hands with someone who has it, or by sharing their food or drink. 

Lancet’s Findings on India

• India’s goal to end the epidemic by 2025(five years ahead of the UN SDG) is too “ambitious", “unrealistic", and, therefore, unattainable. As it requires high quality of care to every person from diagnosis to treatment.
• TB incidence in the country being 204 cases per 1,00,000 in 2017.
• 10% of individuals with TB die or self-cure before presenting for care.
• Patient delay before the first presentation for care is 4.1 months.
• The proportion of people with TB completing treatment is 85%.
• India has the highest number of multidrug-resistant TB (MDR-TB) cases in the world. the majority of cases due to direct transmission.
• The early diagnosis and prompt initiation of effective treatment should be high priority to curb MDR-TB transmission.

Challenges

• While curative treatment is the patient’s urgent need, it will not control the spread of TB as germs already gets spewed due to delayed diagnosis.
• As cough is a very common symptom, TB isn’t suspected until other treatments have failed, which delays targeted treatment.
• Inclination to self-medication thought pharmacies, where patients don’t see a doctor until thing get complicated is another worry in India.
• Additionally, according to RNTCP guidelines, testing is done only after two weeks of consistent cough, which results in the loss of precious lead time.
• Also, 70% of people seek treatment in the private sector and as the mandatory reporting system for TB isn’t rigourous – incidences might be underestimated.
• Hence, strengthening public-private sector health partnership and establishing efficient primary health care services is essential for early diagnosis of TB.

Recommendations

• Integration of TB services with the primary health system will lead to early diagnosis and help cut the transmission cycle.
• Strengthening the care cascade(visualising problems with the implementation of ‘treatment as prevention’) could reduce cumulative TB incidence by 38% in the case of India.
• India has to adopt measures to prevent TB on a population level to eliminate the disease in the coming decades.
• India needs improvement in diagnosis and treatment for drug-sensitive and drug-resistant TB.
• It suggests that lives of eight million (28%) people with TB can be saved over the next 30 years if tests are subsidised and patients are supported to complete the treatment.
• This would cost an extra $290 million each year, which is significantly less than India’s $32 billion losses associated with TB mortality each year.
• India should scale up access to TB services for all those seeking them, optimise engagement of private sector providers and guarantee universal access to drug susceptibility testing and second line TB drugs.
• National TB control programme is encouraging, there is political will and the programme mentions all the correct initiatives to bring the disease under control. Accountability is vital component.