Tackling Tuberculosis in India: A Strategic Approach
Context
In 2023, India made significant strides in addressing the challenge of ‘missed’ TB cases, diagnosing 25.1 lakh patients as having TB, which highlights the country’s strengthened efforts in case finding.
- The Prime Minister has called upon citizens to work towards TB elimination, signaling the need for a concerted and innovative approach to tackle this deadly disease.
- The introduction of new treatments, the use of advanced diagnostic technologies, and a proactive approach to identifying at-risk populations are critical components of this strategy.
- This analysis explores the current state of TB in India, the significance of new treatment regimens, and the way forward in the quest to make India TB-free.
Key Highlights:
- India bears the highest global TB burden, with the disease predominantly affecting poor and marginalized populations.
- Traditional TB treatment regimens are long and arduous, leading to high rates of treatment default and drug resistance.
- The problem of ‘missed’ TB cases contributes to the continued transmission of the disease.
- A comprehensive approach is needed to improve case finding, early diagnosis, and treatment.
What is TB?
- Tuberculosis (TB) is a contagious bacterial infection.
- It mainly affects lungs but also has potential to impact other parts of the body.
- It primarily affects the lungs(Pulmonary TB).
- It can also affect other organs too (extra-Pulmonary TB).
- It is caused by the bacterium Mycobacterium tuberculosis.
- TB spreads through air when an infected person coughs or sneezes.
- Symptoms: Persistent cough, chest pain, weight loss, and fatigue.
Understanding TB:
- It is an ancient disease that traces back that affects millions worldwide.
- The earliest written records of TB date back 3,300 years in India and 2,300 years ago in China. Hence, it must be viewed not only as a medical issue but also as a social, economic, and gendered challenge.
Global Impact:
- TB is a global health concern with India itself reporting a high burden.
- 1.8 million TB cases were reported in 2019 in India (One of the top countries with high TB burden).
- However, the number of tuberculosis patients fell marginally to 2.23 million in 2023, from 2.42 million in 2022.
- MultiDrug Resistant Tuberculosis (MDR-TB) raises another daunting challenge to TB control efforts.
- MDR-TB is a variant of tuberculosis.
- It is immune to the two primary first-line medications for TB treatment.
- XDR-TB- is a type of tuberculosis caused by bacteria resistant to multiple potent anti-TB drugs.
- The BCG vaccine, developed in the early 20th century, is used worldwide to prevent TB.
BCG Vaccine:
- BCG, or bacille Calmette-Guerin, is a vaccine for tuberculosis (TB) disease.
- It is named after its inventors Albert Calmette and Camille Guérin.
- BCG also has some effectiveness against Buruli ulcer infection and other nontuberculous mycobacterial infections.
- It is sometimes used as part of the treatment of bladder cancer as well.
- The BCG vaccine was first used medically in 1921.
- It is on the World Health Organization’s List of Essential Medicines.
Dimensions of the Article
- What is the Issue?
- About the New Treatments
- Significance
What is the Issue?
- Tuberculosis continues to be a major public health challenge in India, despite decades of efforts to control and eliminate the disease.
- India accounts for over a quarter of the global TB burden, making it the country with the highest number of TB cases in the world.
- The disease predominantly affects the poor and marginalized sections of society, leading to significant socio-economic consequences. The burden of TB is exacerbated by the emergence of drug-resistant strains, which are more difficult and expensive to treat, and often result in poorer outcomes.
- The traditional TB treatment regimens are long and arduous, requiring patients to take multiple drugs daily for several months, sometimes even years. This prolonged treatment is not only physically and psychologically draining for patients but also leads to high rates of treatment default, drug resistance, and mortality. Moreover, the long duration of treatment and the need for regular visits to TB clinics result in loss of employment for many patients, pushing families further into poverty.
- The issue is further complicated by the problem of ‘missed’ TB cases, where individuals with TB remain undiagnosed and untreated, contributing to the continued transmission of the disease. Addressing this challenge requires a comprehensive approach that includes improved case finding, early diagnosis, and the use of new, more effective treatment regimens.
About the New Treatments
- In response to the challenges posed by drug-resistant TB and the limitations of traditional treatment regimens, the World Health Organization (WHO) recommended the introduction of new shorter regimens for drug-resistant TB in 2022.
- These regimens, known as BPaL/M, are shorter, safer, and more effective than the traditional regimens.
- Patients on the BPaL/M regimen need to take only three to four tablets every day, and they can complete their treatment within six months, compared to the nine to 24 months required by traditional regimens.
- This is a significant improvement, as it reduces the burden on patients, improves treatment adherence, and leads to better outcomes.
- The BPaL/M regimen has been shown to have a treatment success rate of 89%, significantly higher than the 68% success rate reported in India in the 2023 India TB Report for traditional regimens.
- Moreover, the new regimen has fewer side effects, which is crucial for improving the quality of life of patients during treatment. Given its efficacy and safety, close to 80 countries around the world have already procured the BPaL/M regimen, and about 20 of the highest burden countries are already rolling it out.
- The adoption of the BPaL/M regimen in India is expected to result in significant cost savings for the health system. Research indicates that implementing this regimen could lead to savings of 40% to 90% of the cost of current treatment regimens. An immediate transition to BPaL/M could save approximately $740 million (or approximately ₹6,180 crore) annually for health systems globally. These savings could be reinvested in other areas of TB control and elimination, further strengthening the fight against the disease.
- Key Points:
- WHO recommended new shorter regimens (BPaL/M) for drug-resistant TB in 2022.
- The BPaL/M regimen is shorter, safer, and more effective than traditional regimens.
- The treatment success rate for the BPaL/M regimen is 89%, compared to 68% for traditional regimens in India.
- The adoption of the BPaL/M regimen in India is expected to result in significant cost savings for the health system.
Significance
- The BPaL/M regimen is a game-changer in the fight against TB, leading to higher success rates and fewer cases of treatment default.
- The regimen has fewer side effects, improving the quality of life of patients and reducing the risk of treatment discontinuation.
- The cost savings associated with the regimen can be reinvested in other areas of TB control.
- The adoption of the BPaL/M regimen is a testament to the progress India has made in the fight against TB.
Way Forward
- A multi-faceted approach is required to eliminate TB, focusing on improving case finding, diagnosis, and treatment adherence.
- India must adopt a proactive approach to screening and testing, using advanced diagnostic technologies and health datasets to identify at-risk populations.
- There is a critical need to expand the use of rapid molecular tests for faster detection and drug resistance profiling.
- The fight against TB must be supported by strong political will, adequate resources, and collaboration with international partners
