Tuberculosis: Current Challenges and Strategies

Global and National Context

• Global Burden: Tuberculosis (TB) is the leading infectious disease killer worldwide. Efforts to meet the End TB targets by 2030 seem distant.
• India's Commitment: India pledged to accelerate its TB elimination goals by 2025, but the COVID-19 pandemic significantly hindered these efforts.
• Current Status: According to the WHO Global Tuberculosis Report 2024, India contributes to 26% of global TB cases, particularly drug-resistant TB (DR-TB) and TB deaths.

High-Risk and Vulnerable Groups

• Risk Factors: People exposed to industrial dust, such as miners, are at high risk due to conditions like silicosis, undernutrition, overcrowding, and diabetes.
• Migrant Workers: They often face poor access to healthcare, complicating treatment adherence and tracking.

Treatment and Supply Chain Challenges

• Treatment Achievement: Initiation of treatment has reached over 95% of notified cases due to a dedicated supply chain system.
• Supply Issues: In 2023, a nationwide supply chain disruption resulted in drug shortages, leading to disrupted treatments and increased health expenses.

Extrapulmonary TB (EP-TB) Diagnosis

• Diagnosis Challenges: EP-TB, comprising 24% of cases, is often missed or delayed due to its vague symptoms. There is a need for better training for general practitioners.
• Suboptimal Diagnosis Rates: Only 35% of private and 75% of government doctors correctly diagnose classical TB symptoms.

Implementation and Human Resource Challenges

• Resource Shortage: A lack of trained human resources affects NTEP implementation. Molecular tests are costly and not widely accessible.
• Technological Gaps: Equipment like CBNAAT and Truenat machines are limited in number and often face operational challenges due to supply shortages and lack of technical staff.

Community Engagement and Innovations

• Community Initiatives: Idukki district in Kerala collaborated with Kudumbashree for TB elimination, leading to significant community participation and advocacy.
• Leadership Advocacy: Political advocacy is crucial for cross-learning and implementing effective TB programmes.

Progress and Future Directions

• Notification and Mortality Improvements: TB case notifications are at an all-time high, and there has been a 24% drop in TB-related deaths since 2015.
• International Insights: Vietnam's active case-finding strategies provide a potential model for India to enhance targeted interventions.