On World TB Day 2024, *Dr K Madan Gopal, Dr Suneela Garg & Dr K S Uplabdh Gopal highlights that in India’s multifaceted healthcare environment, numerous individuals opt for care from private doctors and clinics. The Public-Private Interface Agency (PPIA) model is crucial in integrating these private providers into the TB elimination efforts, guaranteeing smooth testing, notification, and treatment support
Tuberculosis (TB), one of the oldest and deadliest infectious diseases, has relentlessly challenged humanity throughout history. Every day, TB claims over 3,500 lives and inflicts nearly 30,000 people with this preventable and curable disease, hitting countries like India particularly hard. Yet this year’s World TB Day theme, ‘Yes! We can end TB! Injects a potent dose of global and national optimism. This hopeful message transcends a mere rallying cry; it strategically mobilises us towards action, spotlighting the vital role of high-level leadership, escalated investments, and swift implementation of new WHO recommendations in reversing the TB epidemic’s course.
The onset of a national crusade
Before 1997, the battle against TB in India faced significant challenges, with high costs making diagnosis and treatment inaccessible to many, especially the less fortunate. This situation contributed to the unchecked spread of TB and the emergence of drug-resistant strains. The year 1997 became a watershed moment with the launch of the Revised National Tuberculosis Control Programme (RNTCP), which introduced the DOTS strategy, granting patients free access to diagnosis and medication. Fast forward to 2022, and India’s efforts have evolved remarkably, as highlighted by the rollout of the Nikshay Poshan Yojana. This initiative underlined the critical connection between nutrition and TB recovery by offering nutritional support to TB patients, showcasing India’s holistic approach to combating this enduring health menace.
A leap towards innovation and inclusivity
The Revised National Tuberculosis Control Programme (RNTCP) played a crucial role, yet India’s dedication to defeating TB goes even deeper. With the National Strategic Plan (NSP) for TB Elimination set for 2017–2025, India has committed itself to eradicating TB by 2025, setting its sights five years ahead of the global target. The plan is comprehensive, focusing on several key strategies:
- Active case finding involves community outreach to screen high-risk individuals, ensuring early TB detection.
- Universal Drug Susceptibility Testing guarantees that every TB patient receives testing, facilitating proper treatment to avert drug resistance.
- Preventive treatment aims to protect close contacts of TB patients by providing them with preventive medication.
- Enhanced Surveillance & Research ensures precise tracking of TB trends, which is vital for formulating targeted responses.
In 2022, the NSP marked a significant achievement, with over 24.2 lakh TB cases notified, indicating a 13 per cent increase from the previous year and resulting in a notification rate of about 172 cases per lakh population.
A cornerstone of the NSP, the Nikshay Poshan Yojana, addresses the critical link between nutrition and TB recovery. Recognising that malnutrition compromises the immune system and increases susceptibility to TB, the initiative financially supports TB patients. This support ensures patients can access nutritious food, significantly enhancing their recovery prospects.
Mobilising technology for TB care
India’s TB program has masterfully integrated technology to enhance patient care and disease management. At the heart of this technological revolution is the Nikshay platform, a web-based system that dynamically tracks TB patients and notifications nationwide. This system empowers health officials with real-time data analysis, paving the way for data-driven decisions.
The game-changing introduction of CBNAAT machines has transformed TB diagnosis, offering swift and precise detection of TB, including its drug-resistant variants. Furthermore, the program leverages mobile health initiatives to broaden its reach. Services such as missed call information lines provide an effortless method for the public to acquire TB-related information. At the same time, SMS reminders align patients with their medication schedules and critical appointments.
These technological advancements have been crucial to the success of India’s TB program. The Nikshay platform’s nationwide patient tracking capabilities ensure consistent treatment adherence, and the deployment of CBNAAT machines has revolutionised the diagnosis process, facilitating the quick and accurate identification of drug-resistant TB strains.
Expanding the reach: Public-private partnerships
In India’s multifaceted healthcare environment, numerous individuals opt for care from private doctors and clinics. The Public-Private Interface Agency (PPIA) model is crucial in integrating these private providers into the TB elimination efforts, guaranteeing smooth testing, notification, and treatment support.
The battle against TB transcends the health sector’s solo efforts, demanding a unified response from every societal corner. Addressing the TB challenge is deeply entangled with combating poverty, inequity, undernutrition, comorbidities, discrimination, and stigma — all of which perpetuate the TB crisis. Embracing a multisectoral approach enables the provision of apt services and support, cultivating a supportive environment for those touched by TB, ensuring no one is left behind in the journey towards a TB-free society.
Challenges and opportunities
The stigma associated with tuberculosis frequently keeps people from getting the treatment they require, which poses a significant barrier to recovery. To counter this, India has created community clubs, patient support networks, and national awareness initiatives. By educating people that tuberculosis is curable, these initiatives hope to give them the confidence to seek a diagnosis and treatment.
Despite our strides towards a TB-free future, challenges like drug-resistant TB and the impact of socio-economic factors such as poverty and undernutrition persist, especially in marginalised communities. Addressing these complex issues requires a multifaceted approach. Innovations in TB care are at the forefront of this battle. India has embraced novel treatment regimens that are shorter and less toxic, improving outcomes for patients with drug-resistant TB. Collaborative research efforts are underway to develop vaccines that promise to prevent TB before it starts. Moreover, integrating TB care with programmes to alleviate poverty and improve nutrition reflects our holistic approach to overcoming these hurdles. By tailoring solutions to the needs of vulnerable populations, we strive not just to treat TB but to dismantle the conditions that allow it to thrive.
India’s progress is remarkable, yet challenges remain. Drug-resistant TB, TB/HIV co-infection, and socio-economic factors like poverty continue to present hurdles, particularly in marginalised communities. However, India’s scientists are at the forefront of TB research, developing new treatments and exploring vaccines that could prevent the disease altogether.
*About authors:
- Dr K Madan Gopal is an Advisor at PHA NHSRC and a former Senior Consultant with NITI Aayog
- Prof Dr Suneela Garg is Chair of the Program Advisory Committee, NIHFW MoHFW New Delhi
- Dr K S Uplabdh Gopal is a Health Care Professional