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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