Till 2019, tuberculosis held its undisputed position as the most common cause of death from a single infectious pathogen, dislodged only by Covid-19 in 2020. It is now back to the ignominious first spot
Margaret J Wheatley aptly stated that “There is no power for change greater than a community discovering what it cares about.” This sentiment holds true for addressing the pressing issue of TB, claiming millions of lives annually. India is infamously home to over 25% of the world’s TB patients. Combatting TB demands a joint endeavour to prevent and cure the disease, which can be achieved through three crucial actions: educating the public about TB prevention and treatment, encouraging early diagnosis and treatment, and improving access to care.
One of the major hurdles in TB control is reaching otherwise unreachable populations. Additionally, there is a shortage of skilled healthcare workers to diagnose and treat TB, especially drug-resistant TB. According to the National TB Prevalence Survey India 2019-21, 64% of individuals exhibiting symptoms did not seek appropriate medical attention due to factors such as neglecting or not recognising symptoms, self-treatment, or financial barriers to treatment.
The government’s goal of eradicating TB by 2025 is challenging but a worthy cause. It will be more plausible with early diagnosis, treatment and preventive measures, awareness, and reaching unserved populations. Reaching out to unserved areas is now of vital importance. To address this, the government of India launched the Pradhan Mantri TB Mukt Bharat Abhiyaan in 2022, which aims to mobilise all community stakeholders in supporting those undergoing treatment and intensifying the fight to eradicate it.
Early diagnosis and treatment
To effectively combat TB, reducing transmission is a priority. For doing so, it is crucial to prioritise early identification and prompt treatment of individuals who are at high risk of having active TB. This requires a concerted effort from healthcare professionals, policymakers, and communities alike to raise awareness and promote the importance of early diagnosis, treatment, and preventive measures.
India is committed to an ambitious mission to reach nearly 3.5 million high-risk individuals to prevent new cases. Along with the conventional armament of treatments, the introduction of new drugs like Rifapentine-based regimens for prevention and TB treatment and reducing the duration of Drug-Sensitive TB treatment from six to four months enhances patient compliance and treatment outcomes. Recent years have also witnessed the development of highly effective drugs such as Bedaquiline, Pretomanid and Delamanid to combat drug-resistant TB.
In recent years, previously underserved rural and tribal communities have been provided TB care through a network of rural community and service providers, including NGOs, community-based organisations, and rural healthcare providers. By increasing access to TB screening and treatment, especially in rural and underserved areas, India can effectively reduce its burden. The government of India’s recent ‘Adopt a TB Patient’ (Nikshay Mitra) program is a commendable initiative aimed at reaching underserved populations. Launched in 2021, the program allows corporates, NGOs, public, and elected representatives to adopt individual or a group of TB patients and sponsor their treatment or nutrition, or even offer job opportunities to their family members. As per government data, over 75% of the 1.361 million TB patients undergoing treatment, including those with multi-drug resistance have given their consent to participate in the adoption program, and almost a million have been successfully adopted.
The role of the pharma industry
India’s fight against TB relies heavily on the partnership between the government and the pharmaceutical industry. Although the government’s National TB Elimination Program (NTEP) provides free TB diagnosis and medical care, the private sector remains a crucial source of treatment. One of the primary focus areas for pharmaceutical companies is to make existing treatment regimens more patient-compliant. The development and approval of the combination of Rifapentine and Isoniazid by the Government of India is a significant breakthrough in the global fight against TB by simplifying treatment and increasing patient convenience. By reducing treatment duration and enhancing treatment outcomes, these drugs will help prevent new cases and move India closer to achieving its goal of a TB-free nation.
The road ahead
As India aspires to eliminate TB by 2025, it is crucial to emulate the successful strategies implemented during the Covid-19 pandemic to fight against tuberculosis. Collaborative efforts from the government, pharma companies, public health organisations, citizen-action groups, and civil society groups are necessary. Collective action will provide significant momentum, with policymakers recognising the importance of combining clinical approaches with innovation and social interventions to support TB patients holistically.
It is essential to adopt innovative solutions tailored to India’s unique circumstances to fight the disease effectively. Empowering and educating the public about TB prevention and treatment, encouraging early diagnosis and treatment, and improving access to care will be critical in achieving the goal of a TB-free India
This article was first published in Financial Express on 7th April 2023