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Tuberculosis UPSC NOTE

 TB, a serious infectious disease, and the challenges of ending it despite having the tools and knowledge to do so

  • India remains a TB hotspot. 

  • The TB control programme in India has undergone several changes since its inception in 1962.

  • Incorporating evidence from various domains of public health and health systems, including pharmacology, microbiology, epidemiology, the social sciences, and information technology.

  • The theme for World TB Day 2024 (March 24), ‘Yes! We can end TB!’.

  • This underscores the potential to eradicate TB with existing disease control mechanisms, infrastructure, training, and the political will. 

  • Yet, TB in its various avatars — drug-resistant (DR-TB), totally drug-resistant (TDR-TB), extensively drug-resistant (XDR-TB), pulmonary TB (P-TB) and non-pulmonary TB — seep out, akin to trying to hold sand in one’s hand, only to have it slip through one’s fingers.

  • We are in an era of hope where public health discourse has gained importance and technology has narrowed the gaps that were previously unimaginable. 

  • The COVID-19 pandemic, despite its disruptive and uncertain nature, has brought to the fore preventive aspects of public health.

  • This highlighting social determinants of health in the scheme of things. 

  • Despite the passage of World TB Day 2024, looking at rapid urbanisation, migration, and the stresses on the existing health systems, I propose a 10-point agenda towards ‘ending TB’.

10-point agenda to control TB in India 

  • First, early detection. 

  • Symptoms are often ignored and mistaken for other common ailments, leading to delays in reporting. 

  • Compulsory screening for family and contacts of each index case is essential, necessitating availability of laboratory facilities and efficient follow-up mechanisms within health systems.

  • Second, precise treatment categorisation

  • With increasing DR-TB, it is imperative to know the resistance status at the time of diagnosis to assign appropriate treatment regimens as per their phenotypic susceptibility.

  • Third, treatment adherence and follow-up.

  • Unlike other bacterial diseases, TB requires a long period of sustained treatment. 

  • Often, this leads to non-compliance, which could be due to observable improvement in health status, or change of residence, movement across States and districts. 

  • Even though the TB control programme has a built-in follow-up system, compliance to complete treatment is not 100%. 

  • Leveraging technology to monitor compliance needs focus.

  • Fourth, zero mortality

  • Mitigating mortality due to TB, be it DR-TB or non-pulmonary TB, is necessary.

  • Fifth, controlling drug resistance

  • Drug resistance in TB remains a man-made phenomenon. 

  • Unregulated use of antibiotics and non-compliance with treatment regimens lead to selective evolutionary pressure on the bacillus.

  • In turn resulting in developing drug resistance.

  • Poor regulatory mechanisms for drug control and non-compliance with treatment regimens are the main reasons for such a high degree of drug resistance.

  • Sixth, assessing the extent of drug-resistant TB.

  • There needs to be data on the proportion of people diagnosed with TB who have rifampicin-resistant TB (RR-TB) and multidrug-resistant TB (MDR-TB).

  • This is resistance to both rifampicin and isoniazid, collectively referred to as MDR/RR-TB

  • This helps in better plan and design of the control programme, resource allocation for diagnosis, the treatment regime as well as availability of trained staff mandated for DR-TB.

  • Seventh, availability of appropriate medicines.

  • Assured medical supply is mandated under the TB control programme. 

  • However, procurement challenges for DR-TB medications such as bedaquiline and delamanid must be addressed.

  • In addition to ascertaining treatment facilities for all DR-TB cases which require in-patient care.

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Learnerz IAS | Concept oriented UPSC Classes in Malayalam: Tuberculosis UPSC NOTE
Tuberculosis UPSC NOTE
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