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RSTV: IN DEPTH- ENDGAME TUBERCULOSIS


RSTV: IN DEPTH- ENDGAME TUBERCULOSIS


Introduction:

            The World Health Organisation has released new data that reveals that TB cases have fallen by 50,000 cases in India since 2017. This is just a marginal fall for a country that’s still the world leader in TB cases. The figure also indicates an uphill battle against this infectious disease for India that has as many as 2.69 million patients, which is nearly 27% of the world’s TB population. WHO has published a global TB report every year since 1997. These reports provide an assessment of the TB epidemic, and the progress in prevention, at global as well as country levels. For India, Prime Minister Modi has set a goal to eradicate TB by the year 2025. In his address to the United Nations last month, he underscored the UN’s own target is to eliminate the disease by 2030.

 

Tuberculosis:

  • TB is one of the leading causes of death worldwide and the leading cause from a single infectious agent, ranking above HIV/AIDS.
  • TB is an infectious disease caused by the bacillus Mycobacterium tuberculosis.
  • It typically affects the lungs (pulmonary TB) but can also affect other sites.
  • The disease is spread when people who are sick with pulmonary TB expel bacteria into the air, for example by coughing.
  • Broader influences on the TB epidemic include levels of poverty, HIV infection, under nutrition and smoking.
  • Diagnostic tests for TB disease include – Rapid molecular test, Sputum smear microscopy, Culture-based methods
  • Without treatment, the mortality rate from TB is high.

 

The WHO report on TB has indicated that world is not on track to achieve the global TB target by 2030. It says that the global decline between 2015-18 was 11% which is less than one-third of the 35% reduction target.

 

Global tuberculosis report

WHO has published a global TB report every year since 1997.

  • The main aim of the report is to provide a comprehensive and up-to-date assessment of the TB epidemic, and of progress in prevention, diagnosis and treatment of the disease at global, regional and country levels.
  • This is done in the context of recommended global TB strategies and targets endorsed by WHO’s Member States and broader development goals set by the United Nations. 

For the period 2016–2035, these are WHO’s End TB Strategy and the United Nations’ (UN) Sustainable Development Goals (SDGs), which share a common aim: to end the global TB epidemic.

Findings:

  • Tuberculosis incidence rate in India has decreased by almost 50,000 patients over the past one year (26.9 lakh TB patients in India in 2018).
  • Incidence per 1,00,000 population has decreased from 204 in 2017 to 199 in 2018.
  • Number of patients being tested for rifampicin resistance has increased from 32% in 2017 to 46% in 2018.
  • Treatment success rate has increased to 81% for new and relapse cases (drug sensitive) in 2017, which was 69% in 2016.
  • TB remains the top infectious killer in the world claiming over 4,000 lives a day.
  • Leading killer of people living with HIV/AIDS,
  • However, more people received life-saving treatment in 2018 than ever before, largely due to improved detection and diagnosis. 
  • Reduction in the number of TB deaths: 5 million people died from TB in 2018, down from 1.6 million in 2017. 
  • Number of new cases of TB has been declining steadily in recent years.
  • The burden remains high among low-income and marginalized populations: around 10 million people developed TB in 2018.
  • Major cause of deaths due to anti-microbial resistance.
  • 50% children with TB don’t have access to quality care.
  • Only 25% children under 5 years get preventive treatment.
  • Shortfall of funds for TB prevention in 2019 was $3.3 billion.

 

India TB report 2019

  • The number of HIV-infected people who go on to develop Tuberculosis (TB) is increasing in India.
  • TB is the leading cause of morbidity and mortality among People Living with HIV (PLHIV). This group is 21 times more likely to develop TB than persons without the virus.
  • India is the third-highest HIV burden country in the world, with an adult prevalence of 0.22 per cent.
  • India ranks second in the world as far as TB-related mortality is concerned.
  • The highest percentage of patients who tested positive for TB and were also infected with HIV came from Nagaland (15.6 per cent), followed by Karnataka (10 per cent).
  • The co-morbidity of TB don’t come in form of HIV only. Diabetes and tobacco-related ailments too play a role.
  • Overall, the TB burden in India is highest in Uttar Pradesh.
  • Percentage of pediatric tuberculosis (TB among the population aged less than 15 years) cases have also slightly gone up.

 

Fight against TB:

In many ways, TB has never been more visible than before. The years 2018 and 2019 have been landmark years in the fight against TB, globally and in India, with the first ever High-Level Meeting on TB held at the United Nations last year.

In India, there is high political will and commitment to end TB, budgets are slowly increasing, new social support schemes have been announced and TB survivors are speaking up.

World TB Day is observed on March 24. The theme of World TB Day 2019 – ‘It’s time’ – puts the accent on the urgency to act on the commitments made by global leaders to:

  • scale up access to prevention and treatment;
  • build accountability;
  • ensure sufficient and sustainable financing including for research;
  • promote an end to stigma and discrimination, and
  • promote an equitable, rights-based and people-centred TB response.

 

What should be done to achieve the set targets under End TB strategy?

The targets set in the End TB strategy are global reduction of 20% in incidence and 35% in mortality by 2020, taking 2015 as the base year.

  • To reach that target, the global drop in incidence has to be 4-5% a year — currently it is about 2% a year.
  • The percentage of deaths should come down from the current 16% to 10%.
  • With India accounting for the highest TB incidence and mortality globally, success in realising the End TB targets hinges largely on the country strengthening its systems.
  • The major step in defeating the disease and achieving the targets is to record every diagnosed patient through case notification.
  • When a person is diagnosed with TB, it is reported to the national surveillance system, and then on to the WHO.
  • While better funding might help India inch closer to its stated goal of ending TB by 2025, much more is needed in terms of funding and commitment on all fronts.

 

Initiatives:

  • Tuberculosis (TB) remains the biggest killer disease in India, outnumbering all other infectious diseases put together this despite our battle against it from 1962, when the National TB Programme (NTP) was launched.
  • TB treatment is free in India.
  • India aims to eliminate TB by 2025.
  • UN aims to eliminate TB by 2030.
  • Mass BCG vaccination to prevent TB.
  • In 1978, the Expanded Programme on Immunisation (EPI) began, giving BCG to all babies soon after birth and achieving more than 90% coverage.
  • In 1993, the Revised National TB Control Programme (RNTCP) was launched, offering free diagnosis and treatment for patients, rescuing them from otherwise sure death.
  • Rs 12,000 cr fund to fight TB over the next 3 years.
  • Tamil Nadu, an erstwhile global leader in TB research during the 1960s through the 1990s, will now become the global leader in TB control.
  • TB Harega Desh Jeetega campaign.

 

Prevention of TB:

  • BCG vaccination for infants.
  • Maintaining respiratory hygiene.
  • Not spitting in public.
  • Avoiding damp areas.
  • Wearing face masks, if infected.
  • Avoiding close contact with people.
  • Directly Observed Treatment Short Course.

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