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Eliminating TB in India

Kashmir Times. Dated: 5/15/2017 12:58:54 AM

Aggressive efforts should be made for breaking the transmission cycle of the drug-resistant strain of TB

The NDA-government's ambitious target of working towards eliminating Tuberculosis by 2025 announced about two month ago appears to be headed for a doom in view of a recent study indicating that India's TB crisis is set to snowball by 2040 when one in ten cases could be drug-resistant. The study published in the science journal 'The Lancet' also indicates that one in ten cases could become both multidrug-resistant TB or MDR-TB, resistant to more than one of the first drugs and extensively drug-resistant TB or XDR-TB, also resistant to fluoroquinolones and at least one of the second-line injectable drugs. The prediction that the increased number of drug-resistant cases will be coming from direct transmission from infected people to other rather than by strains acquiring resistance to TB drugs is alarming in the case of India. Moreover, this could happen during treatment due to inadequate treatment or discontinuation of treatment midway. The same trend is also seen in the case of XDR-TB. As a result, in high MDR-TB burden countries such as India, improved treatment outcomes in citizens might only reduce and not eliminate drug-resistant TB. Till 2015, only about 93,000 people with MDR-TB had been diagnosed and put on treatment across the country. This could also happen in a place like India where such cases are high in number of because of the lack of affordability by a large number of patients or due to discontinuation of the treatment mid-way due to other factors including shortage of drugs for such patients. Apart from this, there is also high occurrence of patients unable to reach the medical centres in the urban areas from the far flung and geographically remote areas where such facilities are not available. The government's project to provide medical care at the doorsteps of the people has not been able to reach out to every individual across the length and breadth of the country for various reasons. Funding has been one of the casualties of such schemes as allocation has been found to be deficient for such schemes during the past few years. Another factor for making medicines out of reach of the people has been decontrol of prices of life-saving drugs twice during the past three years. This resulted in price escalation of many medicines which have been three-fold cheaper in the previous years. Such steps have been initiated by the central government under pressure from the drug manufacturing companies operating on multi-national levels. Due to decontrol of their prices, some of the drugs have become manifold costlier for the common citizens.
The medical study, based on a mathematical model to forecast how TB is likely to progress in the four most-affected countries - Russia, Philippines, South Africa and India, also suggests that new MDR-TB cases a year in India will touch 12.4 percent by 2040, up from 7.9 percent in 2000. With respect to XDR-TB, the incident cases will rise to 8.9 percent, from 0.9 percent in 2000. In 2015, the four countries accounted for about more than 40percent (more than 230,000) of all drug-resistant TB cases in the world. Besides targeting early diagnosis and treatment of those with the disease, India's TB control programme has identified enhanced interventions to break the transmission cycle of the bacteria in the community. Contact screening of family members and preventive treatment of all children below the age of five who have not developed the disease are already a part of the Revised National Tuberculosis Control Programme, but rarely done. It was mainly due to half-hearted efforts of the medical community and the government which set unachievable and unrealistic targets in the past. As such the campaigns carried out in the past have not been successful to achieve the targeted results. Another important strategy that has to be adopted is making drug-susceptibility testing universal and mandatory in the entire country. Developing more accurate, cheaper and effective diagnostic tests besides improved treatment regimens that are less expensive and of shorter duration will also go a long way in winning the war against the TB disease. The targets have to be set on realistic basis so that they can be achieved within the fixed timeframe.