Prelims cum Mains Social Issues

India’s Fight against TB

In News:

  • A 37-nation survey conducted by two NGOs found that India’s compliance with WHO’s TB treatment protocols is low.

In Focus: Tuberculosis

  • Tuberculosis is an airborne bacterial disease caused by the slow growing bacteria bacillus Mycobacterium tuberculosis.
  • Since they grow best in areas of the body with high amount of oxygen and blood, it typically affects the lungs (80%-pulmonary TB)
  • TB is a communicable disease that is transmitted through coughing, sneezing or spiting.
  • High-risk people include those infected with HIV, suffering from under-nutrition (weak immunity), diabetes (weak immunity), smoking (weak lungs) and alcohol consumption.
  • Dark and damp environments are more prone to infection where the bacteria thrive better.

Prevention and Treatment:

  • The BCG vaccine is widely administered among children to prevent severe forms of TB However, there is currently no vaccine that is effective in preventing TB disease in adults
  • Early diagnosis is extremely important in fighting TB.
  • Currently Bedaquiline and Delaminid are the new-generation drugs, recommended by the WHO for Drug Resistant-TB patients.
  • DOTS strategy (Directly observed Treatment Short Course) is globally a recognized cost effective strategy to reduce the disease burden of TB.

Sustainable Development Goal (SDG) on TB:

  • SDG Target: END TB By 2030
  • Vision: A world free of TB. Zero deaths, disease and suffering due to TB.
  • Goal: End the global tuberculosis epidemic.
  • Indicators:
  • 95% reduction by 2035 in number of TB deaths compared with 2015.
  • 90% reduction by 2035 in TB incidence rate compared with 2015.
  • Zero TB-affected families facing catastrophic costs due to TB by 2035.

TB in India

TB incidence in India:

  • India tops the list of 20 TB high burden countries in the world
  • TB kills an estimated 480,000 Indians every year and more than 1,400 every day.
  • The number of deaths per lakh population due to TB is 217 in India.
  • India also has more than a million ‘missing’ cases every year that are not notified and most remain either undiagnosed or unaccountably and inadequately diagnosed and treated in the private sector.

Eradicating TB in India:

  • National TB control programme is ongoing since 1962 which has not performed upto the mark.
  • Revised National TB control Programme (RNTCP) was adopted in 1997 after WHO declared TB as the global epidemic in 1993.
  • Objectives of RNTCP include:
    • To achieve and maintain a TB treatment success rate of at least 85% among new sputum positive patients.
    • To achieve and maintain detection of atleast 70% of the new sputum positive patients.
  • Under RNTCP about 4 lakh DOTS centres have been established so far.
  • In 2017, India started an initiative under which TB patients are given Rs 500 per month as nutrition support, as the disease is usually associated with undernutrition and low immunity.
  • At the End TB Summit, 2018, the prime minister of India made a bold commitment to end tuberculosis by 2025 — five years ahead of the global target.
  • In September 2019, the ‘TB HaregaDeshJeetega Campaign’ was launched to accelerate the efforts to end TB by 2025.
    • The campaign aims to initiate preventive and promotive health approaches, and proposes potentially transformative interventions such as engagement with the private sector healthcare providers, inter-ministerial partnerships, corporate sector engagement, latent TB infection management and community engagement.

National Strategic Plan for TB Elimination 2017-2025:

  • India adopted the National Strategic Plan for TB Elimination based on TB Elimination Strategy of WHO and SDG of UN.
  • The National Strategic Plan is built over 4 strategic pillars of “Detect – Treat – Prevent – Build”.
  • It aims to eliminate TB in India by 2025.
  • Specific targets compared to 2015 include
  • 80% reduction in TB incidence
  • 90% reduction in TB mortality
  • 0% patient having catastrophic expenditure due to TB.
  • Strategy:
    • Stepping up RNTCP
    • Supply of quality Anti TB Drugs through NIKSHAY Portal.
    • Active engagement of private sector in early diagnosis and treatment.
    • ‘Medicine till end’ and ‘nutrition till end’ strategy
    • Strong surveillance and quality improvement systems backed by IT to improve the effectiveness of interventions.

About: ‘Missing Millions’

  • Each year, 10 million people worldwide develop active tuberculosis (TB) disease, but millions of these individuals are “missed” each year by health systems and do not get the TB care they need and deserve.
  • More than 75 percent of missed cases are concentrated in just 13 countries.
  • There are an estimated 4.3 million people who are “missed” by health care systems – that is those with TB but not yet in government’s record as a TB patient. As per successive global TB reports, India alone has one million “missing” TB patients.
  • In addition, in a single year, people who are living with TB disease can infect up to 10 to 15 people/others with whom they are in close contact. This means that each missed case can add to the current TB burden, compounding the challenge to end TB.
  • Many of the missing cases are among vulnerable or underserved populations that are hard to reach or have difficulty accessing public health services, such as children, people living with HIV (PLHIV), migrants, refugees, and mine workers, among others.
  • Finding the “missing millions” has always been the biggest challenge in achieving the global goal of ending tuberculosis (TB) by 2030.

India’s work on the ‘Missing Million’:

  • In 2017, India started an initiative under which TB patients are given Rs 500 per month as nutrition support, as the disease is usually associated with undernutrition and low immunity.
  • India has set its sights on achieving the End TB goal by 2025, five years earlier than the global deadline.
  • In a dramatic leap towards that aim, India has managed to trace 70 per cent — around 7 lakh TB patients — in the last year (March 2019 to March 2020).
  • This was achieved through a combination of incentives for doctors, expansion of diagnostic network, nutrition support for patients and a legal provision to punish non-notification of patients by private sector doctors.

News Summary:

  • A survey of 37 high TB-burden countries was conducted by an international NGOs Médecins Sans Frontières/Doctors Without Borders (MSF) and the StopTB Partnership.
  • The findings were released in “Step Up for TB” report.
  • The survey found that the COVID-19 pandemic is derailing the global response to tuberculosis (TB).

“Step Up for TB” report Summary

WHO’s TB treatment protocols not being followed:

  • The survey shows that many countries continue to lag in getting their policies in line with new World Health Organization (WHO) guidelines.
  • As a result, critical medical innovations are reaching far fewer people who urgently need them.
  • The report finds that only 22% of countries surveyed allow TB treatment to be started and followed up at a primary healthcare facility such as a clinic, instead of travelling to a hospital, and for medicines to be taken at home.
  • Additionally, 39% do not use a modified all-oral shorter treatment regimen and 28% of countries surveyed still are using injectable medicines when treating children with DR-TB.
    • This, despite the fact that DR-TB treatment protocols no longer include older, toxic drugs that have to be injected and cause serious side effects.
  • 85% of countries surveyed do not use the lifesaving point-of-care urinary TB LAM test for routine diagnosis of TB in people living with HIV, as recommended by WHO.

India’s approach against drug-resistant TB needs to be more proactive:

  • It found that India’s compliance with WHO’s TB treatment protocols is also low, with new drugs and testing not getting to people quickly enough.
  • Experts said that India is still following a very cautious approach regarding the new medicines for drug resistant TB (DR-TB), including Bedaquiline and Delamanid.
  • Until March 2020, India had 1.2 lakh MDR-TB (multi drug resistant TB) patients who were eligible for Bedaquiline. However, only about 11,000 had received it.
  • In India, the new drugs bedaquiline and delamanid are not available in private shops, but are accessible only through government TB centres.

TB control affected due to Covid:

  • The survey found that the COVID-19 pandemic is derailing the global response to tuberculosis (TB).
  • They noted that scaling up of new DR-TB drugs — Bedaquiline and Delamanid — is needed even more during Covid-19.

Way ahead:

  • The report has called on governments to accelerate testing, treatment, and prevention for TB.
  • It has also called on the donors to provide financial support to ensure increased access to new medical tools for diagnosing and treating millions with this disease.

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