India’s approach to end TB

Source: This post on India’s approach to end TB has been created based on article “ India’s winding road to ‘#EndTB’” published in The Hindu on 24^th January 2025.

UPSC Syllabus topic: GS Paper 2- Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources.

Context: This article delves into India’s ongoing battle against tuberculosis (TB) and its efforts to achieve the ambitious ‘End TB’ targets by 2025. Despite TB being a curable disease, it remains the leading infectious killer globally, with India contributing 26% of the global TB burden. The COVID-19 pandemic significantly hindered India’s progress toward its TB elimination goals, set ahead of the global 2030 target.

Why is TB a global concern, and what are the End TB targets?

1. TB remains the leading infectious disease killer globally.
2. End TB targets aim for a 90% reduction in TB deaths, an 80% reduction in new cases, and zero catastrophic costs for TB-affected families by 2030.
3. India pledged to achieve these targets by 2025 but faces setbacks due to the COVID-19 pandemic.

What is India’s current status in TB burden and drug-resistant TB?

1. According to the Global Tuberculosis Report 2024, India:
   1. Accounts for 26% of global TB cases.
   2. Is a hub for drug-resistant TB (DR-TB) and TB-related deaths.
2. Ground realities need better understanding to make national policies effective.

Who are the vulnerable groups affected by TB in India?

1. High-risk groups include:
   1. People exposed to dust (e.g., miners, stone carvers).
   2. Those suffering from undernutrition, overcrowding, and diabetes.
   3. Migrant workers who lack access to consistent healthcare.
2. Contributory factors like silicosis and poor living conditions exacerbate TB risk.

How effective is India’s treatment system for TB?

1. India’s National Tuberculosis Elimination Programme (NTEP) ensures free and effective drugs, achieving 95% treatment initiation for notified cases.
2. However, in 2023, supply chain disruptions caused:
   1. Drug shortages, forcing patients to buy medicines from private sources.
   2. Higher risk of antibiotic resistance and catastrophic health expenses.

What is extrapulmonary TB, and why is it often neglected?

1. Extrapulmonary TB (EP-TB) affects organs other than the lungs, such as the lymph nodes, kidneys, brain, and bones.
2. EP-TB constitutes 24% of notified TB cases, but:
   1. Symptoms are often vague and mimic other diseases.
   2. There is a lack of focus on EP-TB in NTEP’s screening algorithms.
3. Experts emphasize training general practitioners and frontline workers to improve early diagnosis.

What challenges exist in diagnosing TB?

1. Studies show:
   1. Only 35% of private practitioners and 75% of government doctors can correctly diagnose classical TB symptoms.
   2. Molecular tests (e.g., CBNAAT, Truenat) are available mostly at the district level, causing delays and extra costs.
2. Key challenges include:
   1. A shortage of trained human resources.
   2. Dependence on specialists for diagnosis.
   3. Reluctance among private practitioners to notify TB cases.

What successful initiatives can India learn from?

1. Idukki district, Kerala:
   1. Partnered with Kudumbashree women’s self-help groups to achieve TB elimination targets through community participation.
2. Vietnam: Demonstrated the effectiveness of active case finding among high-risk populations for better-targeted interventions.

What are the key takeaways for India’s fight against TB?

1. Multisectoral action is needed to address region-specific challenges.
2. Strengthening the supply chain is crucial to prevent treatment disruptions.
3. Advocacy by political leaders and active community involvement can drive progress.
4. Restructuring conventional frameworks and adopting best practices from other countries is essential.

Is there any progress toward achieving the End TB goals?

Despite challenges, there is hope:

• India’s TB case notification reached the highest level ever.
• TB deaths declined by 24% compared to 2015, surpassing the global decline.

What needs to change for India to achieve its targets?

1. Ownership and accountability at all administrative levels.
2. Focus on early diagnosis, active case finding, and comprehensive training.
3. Improved access to diagnostic tools like CBNAAT and Truenat at local levels.
4. A shift in approach to address geographical and social disparities