Tuberculosis (TB), Symptoms, Causes and Treatment

Table of Contents

Context: World Tuberculosis Day is observed on 24th March annually.

About Tuberculosis (TB)

It is a bacterial infection spread through inhaling tiny droplets from the coughs or sneezes of an infected person.
Caused by: a bacterium called Mycobacterium tuberculosis, belonging to the Mycobacteriaceae family.
Transmission: Person to person through the air.
- When people with lung TB cough, sneeze or spit, they propel the TB germs into the air.
Affects: In humans, TB most commonly affects the lungs (pulmonary TB), but it can also affect other organs (extra-pulmonary TB).
Curable?: Treatable and curable disease.

Drug-Resistant TB

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.
DR-TB is spread the same way that drug-susceptible TB is spread.
DR-TB can also occur when the drugs used to treat TB are misused or mismanaged.
MDR TB: MDR-TB does not respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs.
XDR TB: People who are resistant to isoniazid and rifampicin, plus any fluoroquinolone and at least one of three injectable second-line drugs (amikacin, kanamycin, capreomycin) are said to have XDR-TB.

Facts on Tuberculosis (TB) in India

Incidence and Mortality: TB incidence in India fell below 200 per lakh in 2022, down from over 237 per lakh in 2015 — a 16% decline.
- TB mortality in India was 23 per lakh in 2022 — an 18% decline compared to 2015.
Treatment Success Rates (2021): Severely Drug-Resistant TB – Lowest success rate at 45%.
- MDR/RR-TB (resistant to rifampicin) – Success rate at 74%.
- Pre-XDR-TB (MDR-TB resistant to fluoroquinolones) – Success rate at 68%.
State Performance (TB Index):
- Top Performing States: Himachal Pradesh, Odisha, Gujarat.
- Bottom Performing States: Punjab, Bihar, Karnataka.

Tuberculosis (TB) in India

Health Expenditure and Coverage
- Over 10% of India’s population faces catastrophic health expenditure — 3rd highest among 14 lower-middle-income countries with a high TB burden.
- Health expenditure is catastrophic if it exceeds 10% of a household’s income or consumption.
- Just over 60% of India’s population has health coverage — 3rd highest among lower-middle-income countries.

Expansion of molecular testing for rapid detection of TB and drug resistance.

Introduction of the shorter, all-oral BPaLM regimen (Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin) for drug-resistant TB.
Launch of the 100 Days’ campaign for intensive case finding.
Establishment of a diagnostics network to optimise sample collection and transportation.

Ni-kshay Poshan Yojana (NPY) entitlement doubled to ₹1,000 per month for nutritional support.
AB-PMJAY offers full insurance coverage for TB care in both public and private sectors.
Efforts to reduce out-of-pocket expenditure (OOPE) through social protection schemes.

TB services integrated within Ayushman Bharat under:

Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) – for secondary and tertiary care.
Ayushman Arogya Mandirs (AAMs) – for primary care, including sputum collection and referral services.

Training of community health officers at AAMs to handle TB cases at the grassroots level.

Involvement of TB Champions (TB survivors) for patient counselling and support.
Community-based interventions like Tamil Nadu Kasanoi Erappila Thittam (TN-KET) for early referral and reduced TB mortality.

Adoption of a gender-responsive approach to TB care under NTEP.

Targeted outreach to vulnerable groups like tribal communities, migrants, and homeless populations.
Early work to address TB and disability through improved understanding of health vulnerabilities.

Strengthened public awareness campaigns to address TB stigma and misinformation.
Focus on drug-resistant TB and antimicrobial resistance (AMR).

Targeted Screening: Portable X-ray machines targeted high-risk groups like diabetics, smokers, alcohol consumers, HIV patients, the elderly, and TB patient contacts.
AI-Powered Diagnosis: AI-based X-rays flagged suspected cases instantly, and confirmed them through Nucleic Acid Amplification Tests (NAAT).
Widespread Reach: The campaign screened 12.97 crore vulnerable individuals, identifying 7.19 lakh TB cases, including 2.85 lakh asymptomatic cases.

Also Read: Elimination Of Tuberculosis (TB)

High Burden and Slow Decline in Incidence: TB incidence declined from 237 per 100,000 (2015) to 195 per 100,000 (2023) – but this pace is inadequate to meet the target of TB elimination by 2025.
Delayed Diagnosis and Treatment: Over 50% of TB patients still seek care in the private sector with uneven standards of care.
- Diagnostic delays, improper treatment, and mismanagement in the private sector contribute to drug resistance.
Out-of-Pocket Expenditure (OOPE): Despite AB-PMJAY and NPY, indirect costs like wage loss, transport, and caregiver support remain high.
- Financial burden increases the risk of treatment non-compliance and relapse.
Poor Health System Integration: Lack of integrated screening for other diseases (e.g., COPD, diabetes) in TB patients.
- Weak referral linkages between private and public health systems.
Stigma and Social Barriers: TB patients continue to face social stigma, especially women and vulnerable groups.
- Stigma discourages people from seeking care and completing treatment.
Limited Outreach to Marginalised Groups: Tribal, migrant, and homeless populations remain underserved due to geographical and socio-economic barriers.
- Health-seeking behavior among marginalised groups is influenced by cultural and logistical challenges.

Scale up rapid molecular testing at primary health centres (PHCs).

Expand AB-PMJAY coverage to include all indirect costs like wage loss, transport, and caregiver support.

Introduce a standardised TB treatment protocol for the private sector.

Establish a mandatory referral system for TB cases detected in private facilities.
Offer incentives to private healthcare providers for compliance with NTEP guidelines.

Improve diagnostic, treatment, and referral systems at Ayushman Arogya Mandirs.

Train community health workers to handle co-morbidities like COPD, diabetes, and depression.
Ensure uniform standards of care across rural and urban centres.