TB control requires multi-level approach

Every year, March 24 is observed as world tuberculosis (TB) day. On this day in 1882, Dr Robert Koch stunned the scientific community by proclaiming that he has discovered the cause of tuberculosis, the TB bacillus. At the time of Koch's announcement in Berlin, TB was prevalent in Europe and the Americas, causing the death of one out of every seven people. Koch's discovery opened the way towards diagnosing and curing TB.

This year on the world TB day, the World Health Organisation (WHO) is calling for “global solidarity and action” to support a new 20-year strategy aiming to end the global tuberculosis epidemic. Recent years have seen tremendous progress in the fight against TB, with over 37 million lives saved, but much more needs to be done.
An estimated 1.5 million people still die of tuberculosis each year. The disease has devastating economic consequences for affected families. This year seen as a critical year for action to adapt and execute the strategy in diverse country settings.
WHO’s End TB Strategy’, approved by governments at the World Health Assembly last year, is designed to drive action in three key areas: integrated patient-centered TB care and prevention for all in need, including children; bold policies and supportive systems; and intensified research and innovation. The strategy sets ambitious targets of a 95 per cent reduction in TB deaths and a 90 per cent reduction in cases of TB by 2035.

Even after two decades of high economic growth, TB remains an urgent public health problem in India. India has the highest burden of TB in the world accounting for approximately one fifth of the global incidence, with an estimated 2 million cases annually. It is assumed that about 40 per cent of the Indian population is infected with TB bacteria, the vast majority of whom have latent rather than active disease.
The WHO estimates that 3,00,000 people die from TB each year in India. Drug resistant TB has frequently been encountered in India ever since anti TB drugs were introduced for treatment. The enhanced detection of drug-resistant TB has increased the intricacy of managing the disease, as it requires additional resources, manpower, laboratory facilities and infrastructure.

The TB care in India is provided by the Revised National TB Control Programme (RNTCP) as well as through private sector health facilities. The Indian government's RNTCP was started in 1997 and was then expanded across India until the entire nation was covered by March 2006. The programme uses the WHO recommended Directly Observed Treatment Short Course (DOTS) strategy and reaches over a billion people.

Whilst national data for India is not available a number of studies and surveys of TB prevalence including self reporting of TB occurrence have suggested that up to 46 per cent of patients may not be currently reported. There are many reasons why people may seek care outside the RNTCP. These include: poor knowledge about TB, poor awareness about services available through the national programme, the convenience of services, a desire for confidentiality, a desire for personalised care etc.

Free TB medicines
Many people, being unaware that all the medicines needed to treat TB patients are available free of cost at government hospitals, tend to spend huge amounts in private hospitals. There is also a lack of regulation for over the counter drugs for TB and this contributes to the problems of drug resistant TB. With the aim of improving the collection of patient care information, in May 2012, India declared TB to be a notifiable disease, meaning that in future, all private doctors, caregivers and clinics treating a TB patient must report every case of TB to the government.

With more than 50 per cent of India’s TB patients seeking care in the private sector, its engagement is vital for effective TB control. Access to new and accurate diagnostics for TB should be rapidly expanded and provided for patients at reasonable prices. Ventilated housing is essential to prevent its aggravation. Providing nutritional supplements and financial incentives during the treatment would go a long way in ensuring completion of therapy.

(The writer is with Christ University, Bengaluru)

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