[Answered] India is among the countries that accounted for most of the reduction in TB cases in 2020. Enumerate the factors behind the reduction in TB cases in India and suggest what more can be done to sustain the progress.

Tuberculosis (TB) is an infectious airborne bacterial disease. According to WHO’s Global TB report 2022, India had done better in major metrics as compared to other countries over time. The National Tuberculosis Elimination Programme (NTEP) aims to strategically reduce TB burden in India by 2025.

Factors behind the reduction in TB cases in India:

• A range of forward-looking policies have been implemented including critical schemes such as Ni-kshayPoshan Yojana (NPY), which helped meet the nutritional requirements of TB patients, especially the underserved.
• Ayushman Bharat – Health and Wellness Centresare established to decentralize comprehensive primary healthcare including TB care services at the grassroots level.
• Initiated strategies to engage the community and create a Jan Andolanto reach out to the underserved and marginalized and support patients in accessing care.
• Creation of Patient Support Groups (PSGs)to facilitate conversations between patients, doctors and their caregivers to address common issues in treatment.
• Using Information Technology (IT) toolsfor monitoring the programme and treatment adherence.
• Incentives to private providersfor following the standard protocols for diagnosis and treatment as well as for notifying the government of cases.
• Patients referred to the government receive a cash transferto compensate them for the direct and indirect costs of undergoing treatment and as an incentive to complete treatment.

What more can be done?

• There is an urgent need for cost-effective point-of-care devicesthat can be deployed for TB diagnosis in different settings across India.
• Service deliveryshould be optimised so that the diagnostics and drugs reach to people who need them the most.
• Poverty and malnutritionare two main reasons for TB. Elected representatives need to ensure steps for the eradication of these.
• There is a need to aggressively scale up testing with innovative strategiessuch as active surveillance, bidirectional screening for respiratory tract infections using the most sensitive molecular diagnostics, and contact tracing.
• The government must ensure that social security programmes are duly implemented. They work towards prevention of modifiable risk factors like malnutrition, poverty etc.
• There is also a need to consider telemedicine and remote support as important aspects of health services that could play a pivotal role in early detection and treatment.

Collective effort is desired at local, national and international level to attain SDG 3.3 which aims to end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases by 2030.