[Answered]What are the various reasons for the failure of Tuberculosis control in India? Suggest some measures to prevent Tuberculosis in India.

Tuberculosis (TB) is an infectious airborne bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs but can also damage other parts of the body. According to WHO’s 2018 Global TB Report, India accounted for 27% of the total new TB infections in 2017, the highest in the world. The prevention and control of TB is a challenge and needs the efforts of all the stakeholders.

Reasons for failure of TB control in India:

1. Poverty: A majority of TB patients in India get affected due to undernourishment. Poverty impacts their accessibility to food and ability to get treated. It is still a big problem in India associated with problems of undernourishment and poor and unhygienic living conditions.
2. Underreporting: One of the major factors of TB prevalence in India is under-reporting of TB cases. This leaves the risk of spread of TB to other healthy individuals. Inaccurate estimates of the tuberculosis burden in India between 2000-2015, has led the World Health Organisation (WHO) to seriously underestimate the TB epidemic. The Global TB Report 2016, stated that India had reported only 56% of TB burden in 2014 and 59% in 2015.
3. Wrong Diagnosis: The doctors in India are less and untrained quacks most of the time mis-diagnose the disease. Further, important diagnostics infrastructure that identify individuals at highest risk of progression to disease are not adequate.
4. Treatment: Inequitable access to quality diagnosis and treatment remains a major issue in combating tuberculosis. Further, the private sector which contributes a major part of TB care is fragmented, made up of diverse types of healthcare providers, and largely unregulated.
5. Drug resistance to TB: Standard TB treatment is not followed uniformly across the private sector, resulting in the rise of drug resistance. Patients on getting treated for symptoms do not follow the complete treatment dosage and regimen. Due to lack of consistent follow-up of treatment regimens, situation often turn into Multi-drug resistance TB and Extreme-drug resistance TB.
6. Outdated Drugs: The drugs used to treat TB, especially multi drug-resistant TB are decades old. It is only recently that Bedaquiline and Delamanid (drugs to treat MDR-TB) has been made available. Further, access to such drugs remain low.
7. Social Stigma: Patients often hesitate to seek treatment or deny their condition altogether for fear of social discrimination and stigmatisation. Many other issues like human resource shortage, payment delays, procurement delays and drug stock-outs add to TB prevalence.

Solutions to the issue:

1. Accountability: Government should build accountability among health professionals and ensure sufficient and sustainable financing to provide access to prevention and treatment.
2. An after care system: All hospitals should create an after care system in which every TB case should be followed up regularly at periodic intervals. ASHAs should be trained for the same.
3. Social upliftment: It is important to address the social conditions and factors which contribute to and increase vulnerability to tuberculosis. Efforts should be made to address the issues of undernourishment, diabetes, alcohol and tobacco use.
4. Sensitisation: We need to sensitise healthcare providers to the issues faced by those with TB and ensure that they act in a non-discriminatory manner.
5. Awareness: Mass awareness campaigns against social taboos regarding TB should be done through media educating people about the disease, precautions and its cure. The Government of India has launched a new multimedia campaign ‘#India vs TB’ featuring Amitabh Bachchan for the same.
6. Research and development: It is important to invest more in R&D to come up with new drug regimens for responding to the spread of drug-resistant strains. In the last few years, India has made considerable progress in advancing TB research, but private sector involvement in R&D is very low.

Tuberculosis remains the biggest killer disease in India. It is the active involvement of TB survivors and champions that can give an impetus to a collective efforts to improve public understanding of TB, reducing stigma and prevent discrimination to end TB in India. Without a holistic approach India cannot achieve SDG 3.3 which envision to ‘end of epidemic of tuberculosis by 2030’.