Road to Ending Tuberculosis

Table of Contents

Context: There has been a rise in cases of tuberculosis (TB) in Maharashtra after the outbreak of Covid-19.

What is Tuberculosis (TB)?

Tuberculosis (TB) is a bacterial infection spread through inhaling tiny droplets from the coughs or sneezes of an infected person.
- TB is caused by a bacterium called Mycobacterium tuberculosis, belonging to the Mycobacteriaceae family.
- Worldwide, TB is the 13th leading cause of death and the second leading infectious killer after COVID-19 (above HIV/AIDS).
Transmission: TB spreads from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air.
- In humans, TB most commonly affects the lungs (pulmonary TB), but it can also affect other organs (extra-pulmonary TB).
Cure: TB is a treatable and curable disease.
Vaccine: Currently, Bacille Calmette-Guérin (BCG) is the only licensed vaccine available for the prevention of TB.
- BCG works well in some geographic locations and not so well in others.
- Generally, the farther a country is from the equator, the higher is the efficacy.
- It has a high efficacy in the UK, Norway, Sweden and Denmark; and little or no efficacy in countries on or near the equator like India, Kenya and Malawi, where the burden of TB is higher.
Drug-Resistant TB: Sometimes drug-resistant TB occurs when bacteria become resistant to the drugs used to treat TB. This means that the drug can no longer kill the TB bacteria.

Diagnosis and Mortality Globally: Around 10.6 million people across the world were diagnosed with tuberculosis (TB) in 2021, an increase of 4.5% from 2020, while 1.6 million patients died of the bacterial disease.
- Of the total TB deaths, 187,000 patients were also positive for HIV (human immunodeficiency virus).
- Nearly 82% of global TB deaths among HIV-negative people occurred in the African and South-East Asia regions.
India and TB: With 28% cases, India was among the eight countries accounting for more than two-third (68.3%) of the total TB patients’ count.
- India accounted for 36% of the global TB related deaths among HIV negative people.
- India was among the three countries (along with Indonesia and the Philippines) that accounted for most of the reduction in 2020 (67% of the global) and made partial recoveries in 2021.
Underreporting of Cases: Underreporting is more of a problem in India; the country is among the top five contributors – India (24%), Indonesia (13%), the Philippines (10%), Pakistan (6.6%) and Nigeria (6.3%).
Rise in Drug-Resistant TB: The burden of drug-resistant TB (DR-TB) increased by 3% globally between 2020 and 2021, with 450,000 new cases of rifampicin-resistant TB (RR-TB) being reported in 2021.

Global Fund: It is a worldwide movement to defeat HIV, TB and malaria.
- Global Fund has become the single largest channel of additional money for global TB control.
Stop TB Partnership: It is a United Nations hosted organization that takes initiatives to serve the needs of the people, communities, and countries affected by TB.
- It has 1500 partner organizations which include international, non-governmental and governmental organizations and patient groups.
Global Plan to End TB 2023-2030: It maps out how to end TB as a public health challenge by 2030.
- It focuses on the need to invest in a new TB vaccine and approve it by 2025.
- It shall mobilize a global investment of US$250 billion for diagnosis and treatment of 50 million people with TB.
SDG Goal: Ending the TB epidemic by 2030 is among the health targets of the United Nations Sustainable Development Goals (SDGs).

Pradhan Mantri TB Mukt Bharat Abhiyaan: The Ministry of Health and Family Welfare (MoHFW) is implementing this campaign.
- Objectives:
  - Provide additional patient support to improve treatment outcomes of TB patients.
  - Augment community involvement in meeting India’s commitment to end TB by 2025.
  - Leverage Corporate Social Responsibility (CSR) activities.
- Components:
  - Ni-kshay Mitra Initiative: It is to ensure additional diagnostic, nutritional, and vocational support to those on TB treatment.
  - Ni-kshay Digital Portal: It will provide a platform for community support for persons with TB.
Ni-kshya Poshak Yojana: It is centrally sponsored scheme under National Health Mission (NHM), where financial incentive of Rs 500/- per month is provided for nutritional support to each notified TB patient for duration for which the patient is on anti-TB treatment.
National TB Elimination Programme (NTEP): It aims to strategically reduce TB burden in India by 2025, five years ahead of the Sustainable Development Goals.
National Strategic Plans for TB: It was launched to achieve the target of ending TB by 2025 in a mission mode.
- The requirements for moving towards TB elimination in India have been arranged in four strategic areas of Detect, Treat, Prevent & Build.
TB Harega Desh Jeetega Campaign: It has three strong pillars which include clinical approach, public health component and active community participation.

Development of Adult TB Vaccine: The current vaccine, delivered at birth and useful particularly for children, is 100 years old. India should make efforts for a new vaccine like it did for the COVID 19.
Anti-TB Drugs: There are only a few new anti-TB drugs available that have high costs. There is a dire need to move to an injection-free and shorter duration of oral pills for TB.
Diagnostics: The of AI-assisted handheld radiology with 90-second reporting and 95% plus accuracy for diagnosing TB should be made available universally.
- Confirmatory diagnosis using nucleic acid amplification should be done.