Tuberculosis in India

Topics Covered:

1.  Issues relating to Health, Human Resources.
2.  Issues relating to poverty

 What to study?

For Prelims:

• Tuberculosis- types, issues related to it like premature deaths, out of pocket expenditure etc.

For Mains:

• Causes of TB and MDR TB. Significance of the government measures, challenges associated with achieving the targets, diagnosis and treatment measures.

Context:

The Lancet Global Health article based on modelling for three high burden countries, including India, compared with 2015 data, 57% reduction in incidence and 72% reduction in mortality will be seen only by 2035.The Lancet Commission on TB was published ahead of World TB Day on 24 March.

Tuberculosis 

• It is a serious infectious disease that mainly affects The bacteria that cause tuberculosis are spread from one person to another through tiny droplets released into the air via coughs and sneezes.
• It was responsible for 1.6 million deaths worldwide in 2017.

Cases in India

• Of the 10 million new tuberculosis (TB) cases reported globally in 2017 by the World Health Organisation, 74 million were from India, showing a marginal reduction from 2.79 million in 2016. 
• TB incidence in the country was 204 cases per 1,00,000 in 2017.
•  In addition to the lives lost, even with optimal implementation of all existing tools, unavoidable deaths will cost the Indian economy at least $32 billion each year for the next 30 years

 Multi Drug Resistant TB

• With 1,35,000 cases in 2017, India has the highest number of multidrug-resistant TB (MDR-TB) cases in the world
• According to The Lancet Commission report, majority of MDR-TB cases in India due to direct transmission.
• According to the report, in India, only 14% of people with MDR-TB completed treatment and just 11% remained disease-free at the end of one year. 

 Government Initiatives

• Government has set a highly ambitious target of “eliminating TB by 2025”, five years ahead of the Sustainable 
• National Strategic Plan for TB Elimination (2017–25) has called for a six-time increase in private notifications to two million patients per year by 2020.
• Instead of waiting for people with TB to reach diagnostic centres for testing, India has now undertaken case-finding campaigns to cut the transmission cycle. So far 144 million people at risk of the disease in 447 districts have been screened and more than 50,000 new cases have been detected, 

 Whether Target Achievable or Not

• According to the Report, 57% reduction in incidence and 72% reduction in mortality will been seen only by 2035.
• It also emphasizes on strengthening the care cascade which could reduce cumulative TB incidence by 38% in the case of India.
• A tuberculosis-free world is possible only by 2045 and not 2030, the target year set by UN SDGs to end the epidemic, says the Lancet report

What is Lacking

• India has set an ambitious goal of eliminating TB by 2025, but integration of TB services with the primary health system to reduce diagnostic delays is not happening.
• Patients are not diagnosed and treated at the primary level, which is the first point of contact. Only this will lead to early diagnosis and help cut the transmission cycle.
• Even diagnosis delay up to two months have been seen in the private sector .

Other Challenges

• The proportion of people with TB completing treatment is 85%. 
• According to the article, 10% of individuals with TB die or self-cure before presenting for care. According to the survey in Gujarat, 40% of those bacteriologically tested positive for TB had not sought care.
• Patient delay before first presentation for care is 4.1 months. 
• High out-of-pocket expenditure incurred during TB treatment keeps people in poverty for seven years after completing treatment.

What Needs to be done

• The India report card says diagnosis and treatment for drug-sensitive and drug-resistant TB need improvement.
• Modelling 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.
• Budget Needed: 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
• In India, optimizing private sector engagement could avert eight million deaths between now and 2045.

 The Lancet Commission recommendations for India

• Scale up access to TB services for all those seeking them,
• Optimize engagement of private sector providers and
• Guarantee universal access to drug susceptibility testing and second line TB drugs.

Source: The Hindu & Livemint