Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis (MTB). Tuberculosis generally affects the lungs, but can also affect other parts of the body. Most infections do not have symptoms, in which case it is known as latent tuberculosis. Tuberculosis is spread through the air when people who have active TB in their lungs cough, spit, speak, or sneeze. People with latent TB do not spread the disease. Active infection occurs more often in people with HIV/AIDS and in those who smoke.

About DOTS:

DOTS (directly observed treatment, short-course), also known as TB-DOTS, is the name given to the tuberculosis control strategy recommended by the World Health Organization. According to WHO, The most cost-effective way to stop the spread of TB in communities with a high incidence is by curing it. The best curative method for TB is known as DOTS.

DOTS has five main components:

1. Government commitment (including political will at all levels, and establishment of a centralized and prioritized system of TB monitoring, recording and training).
2. Case detection by sputum smear microscopy.
3. Standardized treatment regimen directly of six to nine months observed by a healthcare worker or community health worker for at least the first two months.
4. A drug supply.
5. A standardized recording and reporting system that allows assessment of treatment results.

TB Burden in India

Each year about 2.2 million people develop TB in India and an estimated 220,000 die from the disease.1 Some estimates calculate the deaths as being twice as high. TB can affect any age, caste or class but cases are mainly poor people. Slum dwellers, tribal populations, prisoners and people already sick with compromised immune systems are over-represented among the cases, compared to their numbers in the population. The economic burden of TB is extremely high. Between 2006 and 2014, TB cost the Indian economy a massive USD 340 billion.

Challenges while dealing with Tb in India.

1. TB Case notification

The notification of TB cases is estimated to be only 58%. Over one third of cases are not diagnosed, or they are diagnosed but not treated, or they are diagnosed and treated but not notified to the RNTCP. This could be even higher, and the WHO (World Health Organization) estimates that possibly as many as another 10 lakh (1,000,000) Indians with TB are not notified. One of the reasons for the low case notification is the largely unregulated and unmonitored private sector which accounts for almost half of the TB care delivered in India.

2. Private sector care for TB

The private sector in India, has unfortunately, been a source of mismanagement of TB and hence of drug resistance. This includes the use of incorrect diagnostics (e.g. blood tests), incorrect regimes and a lack of supervision to ensure all TB patients complete their TB treatment. So every effort is being made to engage the private sector in India and improve the quality of care provided by private practioners.

3. Demographic profile:

General susceptibility of population to TB bacteria due to malnutrition & low immunity as a result of poverty and unhygienic conditions.

4. Public health infrastructure:

In many parts of the country the public health infrastructure is not upto the mark to cater the needs of the people.  Inefficient medical infrastructure to implement the DOTs programme across the country has led to the variation in disease control program

5. Role of other stakeholders:

Awareness among people and no early detection will spread the disease is not upto the mark. Lack of responsibility among local TB program implementing agencies and negligence on their part to involve private practitioners and NGOs is one of the hindrance in implementation of the program. 

Steps to eradicate TB:

• India needs to double its investment in TB prevention, early diagnosis and treatment. The government still doesn’t have enough capacity to meet the needs of all TB patients, a majority of whom seek care in the private sector.
• India has a plan to eradicate TB by 2025. It is a very ambitious challenge to implement.
• Currently, the government runs the Directly Observed Treatment Short or DOTS course for TB treatment where the patients would take seven or eight anti-TB medicines on alternate days of the week. Each dose is handed out by a healthcare provider at a clinic. The practice makes it cumbersome for patients to follow and when they drop out often leads to drug resistance.
• Patients with both HIV and TB are even less inclined to adhere to this programme. They have a better chance with the method used worldwide of a fixed dose combination treatment which involves taking three or four pills every day.
• Government has discussed active case finding, which allows the health system to look for a patient rather than depending on patient walk ins at healthcare centers. The TB department has proposed to have an active case detection drive “in campaign mode”