Tuberculosis (TB) remains the biggest killer disease in India, outnumbering all other infectious diseases put together — this despite our battle against it from 1962, when the National TB Programme (NTP) was launched. Each year, we commemorate World Tuberculosis (TB) Day on March 24 to raise public awareness about the devastating health, social and economic consequences of TB, and to step up efforts to end the global TB epidemic.

TB situation:

In India:

• Tuberculosis incidence rate in India has decreased by almost 50,000 patients over the past one year (26.9 lakh TB patients in India in 2018).
• Incidence per 1,00,000 population has decreased from 204 in 2017 to 199 in 2018.
• Number of patients being tested for rifampicin resistance has increased from 32% in 2017 to 46% in 2018.
• Treatment success rate has increased to 81% for new and relapse cases (drug sensitive) in 2017, which was 69% in 2016.

In World:

• Each day, over 4000 people lose their lives to TB and close to 30,000 people fall ill with this preventable and curable disease.
• Global efforts to combat TB have saved an estimated 58 million lives since the year 2000.

India’s efforts to eliminate TB:

• In 2018, Indian government launched Joint Effort for Elimination of Tuberculosis (JEET), to increase the reporting of TB cases by the private sector.
• National Strategic Plan (NSP) for TB Elimination (2017-2025) was launched in 2017. The government also called for the elimination of TB by 2025, five years prior to the international target (2030).
  • The NSP plans to provide incentives to private providers for following the standard protocols for diagnosis and treatment as well as for notifying the government of cases.
  • Further, patients referred to the government will receive a cash transfer to compensate them for the direct and indirect costs of undergoing treatment and as an incentive to complete treatment.
• “Nikshay,” (2012) an online tuberculosis reporting system for medical practitioners and clinical establishments was set up. The aim is to increase the reporting of tuberculosis, especially from the private sector.
• In 1992, the WHO devised the Directly Observed Treatment-Short Course (DOTS) strategy and advised all countries to adopt the strategy to combat the menace of tuberculosis. The DOTS strategy is based on 5 pillars:
  • political commitment and continued funding for TB control programs
  • diagnosis by sputum smear examinations
  • uninterrupted supply of high-quality anti-TB drugs
  • drug intake under direct observation
  • accurate reporting and recording of all registered cases
• The Indian government has been implementing Programmatic Management of Drug Resistant TB (PMDT) services, for the management of multi-drug resistant tuberculosis (MDR-TB) and TB-HIV collaborative activities for TB-HIV

Global efforts to end TB:

• The World Health Assembly-approved Global TB Strategy aims for a 90 per cent reduction in TB deaths and an 80 per cent reduction in the TB incidence rate by 2030 compared with 2015 levels. The Strategy established milestones for 2020 of a 35% reduction in TB deaths and a 20% reduction in the TB incidence rate from 2015 levels.
• The World Health Organization (WHO) has launched a joint initiative “Find. Treat. All. #EndTB” with the Global Fund and Stop TB Partnership, with the aim of accelerating the TB response and ensuring access to care, in line with WHO’s overall drive towards Universal Health Coverage.
• This World TB Day, WHO calls on governments, affected communities, civil society organizations, health-care providers, and national/international partners to unite forces under the banner “Find. Treat. All. #EndTB” to ensure no one is left behind.
• Ending the TB epidemic by 2030 is one of the targets under SDG 3, which is to “ensure healthy lives and pro-mote well-being for all at all ages.”
• The UN Political Declaration on TB in 2018 includes 4 new global targets:
  • Treat 40 million people for TB disease in the 5-year period 2018-22 (7 million in 2018).
  • Reach at least 30 million people with TB preventive treatment for a latent TB infection in the 5-year period 2018-22.
  • Mobilize at least US$13 billion annually for universal access to TB diagnosis, treatment and care by 2022.
  • Mobilize at least US$2 billion annually for TB research

Way forward:

• It is important to address the social conditions and factors which contribute to and increase vulnerability to tuberculosis. Concerted efforts should be made to address the issues of undernourishment, diabetes, alcohol and tobacco use.
• Increased political will, financial resources and increasing research to develop new ways to diagnose, treat and prevent TB will help achieve the goal.
• Private sector engagement in combating TB needs to be strengthened. The private sector should also be incentivized to report TB cases. Example: The Kochi Model– Increasing TB cases reporting from private sector
• There is an urgent need for cost-effective point-of-care devices that can be deployed for TB diagnosis in different settings across India.
• Universal access to drug, susceptibility testing at diagnosis to ensure that all patients are given appropriate treatment, including access to second-line treatment for drug-resistant TB.
• To ensure public participation — a missing element in the RNTCP —in public-private participation mode.
• Mass awareness campaigns like ‘TB Harega Desh Jeetega’ can play an important role in breaking social taboos regarding TB.

India has the highest TB burden in the world. Given our inter-connected world and the airborne spread of TB, we need collective global action. Ending TB in India will have massive global impact in addition to saving the lives of tens of millions of India’s people over the next 25 years. Even if ending TB by 2025 is not complete, pulling the TB curve down by 2025 and sustaining the decline ever after is a possibility.