TB in India: Incidence, Needs, Intervention, and Actions

This report provides a comprehensive overview of Tuberculosis (TB) in India. It begins by defining TB, its clinical manifestations, and associated risk factors, including low body weight, HIV infection, and overcrowded areas. The report then delves into the epidemiology of TB in India, highlighting its status as a high-burden country, with a significant number of cases and deaths annually. It references data from the WHO and the Indian government, including the NSP 2017-2025 framework. The report identifies key concerns, such as the rise of multi-drug resistant TB (MDR TB) and challenges in TB care, including fragmented healthcare delivery and the high cost of treatment. It also addresses barriers to TB notification, such as operational complexities and geographical limitations. To reduce the burden of TB, the report suggests implementing fixed-dose regimens, improving disease surveillance, and strengthening patient tracking. It outlines the actions needed for effective implementation, including increased budgetary provisions, intersectoral coordination, and stakeholder engagement. The report emphasizes the importance of public and private care providers, policymakers, and health informatics groups in achieving the goals of the RNTCP.

TUBERCULOSIS IN INDIA

Objectives:
To give an overview of the incidence of
tuberculosis in India
To describe the needs of the Indians using
epidemiological, quantitative or qualitative data
on tuberculosis
To discuss about one intervention that could
reduce the burden of tuberculosis
To present actions needed to implement the
intervention described previously

Tuberculosis
Tuberculosis (TB) is an airborne disease caused by the
spread of Mycobacterium tuberculosis bacteria that
spreads from one individual to other through air
Tuberculosis mainly attacks the lung, however it can
damage other body parts such as kidney and the brain
too
Some of the basic clinical manifestations of TB is
sickness, night sweating and weight loss.
Due to progression of the disease, other symptoms
seen in patient includes frequent cough, spitting of
blood and chest pain.
Mantoux skin test is done to diagnose TB (CDC, 2014).

Risk factors
Low body weight
Head or neck cancer
HIV infection
People who are more vulnerable to risk of TB include
individuals with weak immune system such as
malnutrition, HIV and people using tobacco.
For people with HIV, risk of TB increases by 20 times.
All people irrespective of age has the possibility to
be infected by
Risk of transmission is high in overcrowded areas
(Silva et al., 2018)

Epidemiology
TB accounted for 1.5 million deaths globally in the year
2018
Another most crucial statistics is that India is leading
across the high TB burden countries WHO, 2019).
According to the Global TB report 2017, the prevalence of
TB in India was 28, 00, 000 and this data is equivalent to
quarter of the global TB cases.
In the year 2015, the estimated number of deaths due to
TB was 0.48 million.
Although the Indian government goal is to end TB by 2025,
this goal can be achievable only when incidence of TB
decreases by more than 10-15% per year (Prasad, Gupta &
Banka, 2017).

NSP 2017-2025 Results Framework
Impact indicators of the NSP 2017-2025. Source: (Ministry of
Health and Family Welfare, 2018)

Self-reported cases of TB across Indian
states
Source: (Mazumdar, Satyanarayana & Pai, 2019).

Concerns associated with TB prevention:
The rise in the incidence of multi-drug resistant TB
(MDR TB) is one of the greatest barrier to TB prevention
MDR TB is the disease that is resistant to two most
efficacious anti-TB drug namely Rifampin and Isoniazid.
According to the WHO (2019) report, there were 4, 84,
000 new cases of MDR TB which were resistant to
rifampicin.
Apart from China and Russia, the burden of MDR TB
falls on India too. These three countries together
accounts for 50% of the global MDR-TB cases (CDC,
2014).

Quality of TB care in India
The cost of TB treatment is not uniform in India
because of fragmented health care delivery system
• 80% of the individuals with TB first contact health care
and 50%of the TB care occurs in private care
(Arinaminpathy et al., 2019)
• Anand et al. (2017) highlights treatment of TB is
mostly dominated by private secror in India
Evidence has reported people being challenged by
high cost of treatment
A systematic review on quality of TB care in India
revealed suboptimal quality of TB care particularly in
private sector (Satyanarayana et al., 2015).

Barrier to TB notification
One of the alarming statistics related to TB in India is rise in
number of missing cases
A recent report shows that India contributes to 25% of the
missing cases globally
Another major shortcoming of the TB screening in India is that
only 50% of TB diagnosed and treated cases are notified to
public health care system.
Some of the barriers to complete notifications included
operational complexities, lack of time, poor awareness about
complexity and fear of breaching complexities (Siddaiah et al.,
2019).
Geographical barrier to TB management and prevention is also
a concern as lack of transportation facilities is a major barrier
for treatment adherence (Negandhi et al., 2017).

Health strategy to reduce burden of TB in
India
There is a need for the Indian government to implement
fixed dose regimen throughout the country and improve
disease surveillance activity to prevent TB.
WHO recommends use of fixed dose combinations (FDCs)
of anti-TB drugs
This strategy can eliminate prescription errors
Strengthening TB surveillance system in India is important
to get better estimate of TB incidence and reach out to
groups which cannot afford treatment (Pai, Bhaumik &
Bhuyan, 2016)
It is recommended to improve patient tracking by
improving specimen transport mechanism too (Shewade et
al., 2018)

Actions needed to implement the intervention:
To effectively implement the above health intervention,
the Indian government needs to take the following
actions:
Increase budgetary provisions needed to achieve the
goals of the RNTCP.
Promote intersectoral coordination to streamline
services and achieve uniform quality of care in both
private and public sector
Engage diverse stakeholders like user interface
agencies, political groups, quality control groups and
epidemiologist so that innovative steps related to
surveillance and FDCs are implemented.