By Rohan Gupta
Published on 17, May, 2018
Tuberculosis is India’s most pressing health issue. About 480,000 people die every year in India due to TB. But the problem is bigger, there are more than a million missing TB cases every year which are undiagnosed, unreported or poorly taken care of by the private sector.
Statistics show that in 2016, TB incidence in India was 211 for every 100,000 people. If India wants to achieve the goal of zero TB, it will have to bring down the incidence to 10 for every 100,000 people.
To achieve this goal, India launched the ‘National Strategic Plan for Tuberculosis Elimination 2017-2025’ (NSP). The plan aims at eradicating TB by 2025.
This seems like a challenging task if we start looking at the current trend. For the last 5 years, the average rate of TB eradication has been 2.62%. Continuing with the current trend TB incidence will go down to 166/100,000 people.
This is nowhere near to the goal of 10/100,000 people. An average eradication rate of 28% needs to be achieved if India wants to eliminate TB in the expected time-frame. So is India on track to fulfil its promise of TB eradication?
In 2017, Medecins Sans Frontieres (MSF) and Stop TB Partnership published a study on 29 countries to identify the gaps in implementation and progress towards ending TB. These 29 countries house 82% of global TB patients and are the worst TB affected countries.
According to the report, many countries aren’t adhering to the WHO guidelines for TB eradication which is imperative to the goal. The report outlined the following problems with India’s approach to TB eradication policy –
• India uses smear microscopy as initial diagnostic tests instead of expert MTB/RIF which has showed an over 5-fold increase in detection of rifampicin resistance.
• Most rifampicin-resistant patients in India are not put through first-line Drug Sensitivity tests (DST) that could detect isoniazid resistance. Rifampicin and Isoniazid are the strongest first-line TB drugs.
• There is a dearth of DST labs across the country.
• Usage of Delamanid is not a part of India’s TB control activities. The problem exits with another drug Bedaquiline.
But the new NSP 2017-2015 is relief in some ways. It has tried to address some of the problem which were outlines in the MSF report –
• According to the targets laid out by the report, it plans to increase the proportion of notified TB patients offered DST to 100% by 2025 from 25% as of 2015. For this it intends increase the number of first and second-line DST laboratories from 124 in 2015 to 310 by 2025.
• The NSP program plans to introduce shorter Multi Drug Resistance (MDR)-TB regime as per WHO guidelines and also scale up the availability and sale of new drugs like Bedaquiline and Delamanid.
The target of TB eradication by 2025 sounds very optimistic and for this the pace of eradication needs to be at an extraordinary rate achieved by no other country. Ramping up the scale of operations and allocations of funds to increase the eradication pace by around 9-fold seems like a challenging task.
India’s history of bureaucracy and deferred implementation in policies will prove to be a barrier which needs to be eliminated if the goal needs to be achieved.