TB - cough cough (ADR)

Continuing our series on health, we now dive into the issue becoming a big headache for policy makers - Tuberculosis or TB. Compounding the problem is the issue of Drug resistant TB(MDR/ XDR TB) & HIV/TB. 


First let us get the scale of TB prevalence in India.

• 2.2 million of 9.6 million TB cases worlwide are found in India i.e. roughly 25% of TB patients are Indian  or every 4th TB patient is an Indian. (TB capital of world)
• India also is largest host of MDR-TB.

Cost ? 

• Human cost - kills more than 300,000 people in India every year
• Economic cost - causes economic losses of $23.7 billion annually.

What measures have been taken in past ? 

• NTP - 1962
• RNTCP - free WHO-DOTS((Directly Observed Treatment, Short-Course)) dosage
• Phase I (1998–2005): focus was on ensuring expansion of quality DOTS services to the entire country.
• Phase II (2006-11) : aims to firstly consolidate the gains made to date, to widen services both in terms of activities and access, and to sustain the achievements.
• NIKSHAY web based portal since 2012
• May 2012 India declared TB to be a notifiable disease - aim of improving the collection of patient care information. in future all private doctors, caregivers and clinics treating a TB patient had to report every case of TB to the government.

Flaws in existing scheme of things? What is the cause that despite programmes targeting TB patients , there are no signs of ending TB prevalence in India ? 

• low awareness among TB patients about free drugs
• stigma attached to the disease
• incomplete treatment cycle
• lack of reliable data on patient record
• low notifications by doctors in the private sector to government despite catering large TB patient
• Poor nutrition due to prevalence of poverty

Recent Schemes : 

• National Strategic Plan 2012–17, with a vision of achieving a "TB free India", and aims to achieve Universal Access to TB control services.
• Free Bend-aquiline for MDR-TB on case to case basis. 
• Improving Access to Affordable & Quality TB Tests (IPAQT) - 2013 @ subsidized price
• National Action Plan to combat Antimicrobial Resistance(AMR)
• India's Red Line campaign to curb over-the-counter use of antibiotics
• National nutrition mission

Way Forward : 

• enhancing awareness, 
• strengthening surveillance, - completion of treatment cycle
• improving rational use of antibiotics, (including in Poultry) 
• reducing infections and promoting research.
• efficient data collection mechanism
• effective use of technology e.g. SMS to patient  
• public-private partnership : engaging private hospitals in constructive manner -  very important in India as nearly 80% of the population in India first seek the private sector.
• incentivizing better performing states
• Poverty allevation

To conclude, TB cannot be fought by drugs alone but requires comprehensive approach to address all factors related to the disease including many social issues such as alleviation of poverty, overcoming illiteracy and universal access to primary health care.

What's causing steep rise in MDR-TB cases ? 

• overuse of anti-biotics 
• rampant misuse of antibiotics in the poultry industry. 
• antibiotic misuse in aquaculture in West Bengal

Solution : 

• Rational drug use & regulation - Red line campaign to curb over-the-counter use of antibiotics is a welcome move
• Surveillance 
• R&D 
• Clean animal husbandry, agriculture & aquaculture

Thus, it will require holistic approach in which inter-ministerial effort is required and working in silos will not work.