India’s TB problem and the right to treatment

Source: The post is based on the article “India’s TB problem and the right to treatment” published in “The Indian express” on 12th August 2023.

Syllabus: GS2- Issues relating to development and management of Social Sector/Services relating to Health.

News: The author highlights the challenge of drug-resistant tuberculosis (DR-TB) in India. While new diagnostic tools and treatments exist, India often relies on outdated methods. The WHO recommends modern solutions that are more effective and cost-saving. The author urges India to adopt these to prevent DR-TB deaths and suffering.

What are India’s achievements in relation to drug-resistant tuberculosis (DR-TB)?

Detection: India identified 64,000 MDR/RR-TB cases in 2022, a significant number though below WHO estimates.

Molecular Tests: Several Indian companies manufacture advanced molecular tests for DR-TB detection.

Investment: India heavily invested in molecular platforms during the Covid-19 pandemic, which can be repurposed for TB.

Cost-effective PCR: Many Indian companies made affordable PCR (polymerase chain reaction) components during the Covid-19 crisis.

Treatment Time: India has treatments that reduce DR-TB treatment duration from 24 months to 6 months.

Drug Supply: India is the global supplier of pretomanid, a crucial drug in the BPaL(Bedaquiline, Pretomanid, and Linezolid)regimen for DR-TB.

What are the challenges of drug-resistant tuberculosis (DR-TB) in India?

High Cases: India accounts for a quarter of the world’s DR-TB cases, with 119,000 new cases estimated yearly by WHO.

Underreporting: Only 64,000 MDR/RR-TB cases were reported in 2022, missing a substantial number.

Delayed Diagnosis: Rapid diagnosis of DR-TB is limited, leading to treatment delays.

Old Diagnostic Methods: 77% of suspected TB patients were diagnosed using traditional sputum smear microscopy, an outdated method.

Treatment Adherence: India uses a mix of DR-TB treatments, many of which are hard to follow.

Reliance on Injectables: Over 22,000 MDR/RR-TB patients in 2021 received treatments with injections, despite WHO’s recommendation against it.

Incomplete Treatment: Only 68% of the MDR/RR-TB patients initiated on treatment in 2020 completed it.

Limited Access: Only 53% of MDR/RR-TB patients in 2022 received the WHO-recommended shorter bedaquiline regimen.

What should be done to address these challenges?

Enhance Reporting: Increase efforts to identify and report all MDR/RR-TB cases.

Adopt Rapid Tests: Embrace rapid molecular diagnostics as the initial test for suspected patients.

Increase Molecular Testing: Aim for all suspected TB patients to undergo the recommended molecular tests.

Update Treatment Protocols: Adopt WHO’s recommendation of the BPaL regimen for DR-TB.

Phase Out Injectables: Heed WHO’s advice to stop using injectable treatments from 2019.

Expand Access: Increase the number of patients receiving the bedaquiline-containing regimen and BPaL regimen.

Utilize Resources: Repurpose molecular platforms from the Covid-19 era for TB testing.