Dr Sarabjit Chadha, Regional Technical Director, India and SE Asia, FIND and Dr Aakshi Kalra, Project Lead, FIND explain about the Joint Effort for Elimination of Tuberculosis project and how it is striving to provide TB preventive treatment across 22 districts in India
Could you imagine leading your life harbouring a potentially deadly disease that could surface any moment? It may be a reality for many Indians. With 40 per cent of India’s population infected with the bacteria that cause tuberculosis (TB), it is critical to identify them and ensure that they get the TB preventive treatment that will reduce their risk of developing active TB disease while also tackling the TB epidemic in India and meeting our ambitious national elimination targets.
While we know TB remains a pressing public health challenge in India, the scale of the silent TB infection is often overlooked. In people with TB infection, the bacteria remain dormant and don’t cause illness but in about 10 per cent of cases they can start to multiply causing active TB disease. The problem is that we can’t always predict who will become ill from TB infection. The disease often becomes active when the immune system is compromised, for example when a person has diabetes, is malnourished, has HIV or is on immunosuppressive medicines (like steroids). , if n some other conditions like tobacco use.
Active TB disease poses a substantial risk to people affected and their communities: those affected face the danger of illness and threat of death, as well as social and economic hardships. And unfortunately, once someone has active TB, they can also spread it to their families and other close contacts. The World Health Organization estimates that each person with untreated TB may infect another 5 to 15 people every year.
The progression from infection to active TB can be prevented through simple treatment which is sensitive to the needs of vulnerable communities. This is where innovative solutions such as JEET 2.0, the Joint Effort for Elimination of Tuberculosis, have a crucial role to play. A partner run project, JEET 2.0 is striving to provide TB preventive treatment across 22 districts in India. Through its work, the intervention intends to save over 200,000 people from contracting active TB by March 2024 and contribute to India’s goal to eliminate TB by 2025. JEET is also working to bridge India’s public/private healthcare divide and reach people with active TB under both sectors.
As part of the project, fieldworkers visit people with active TB in the community to counsel the household contacts about TB and preventive treatment that can stop them from developing the disease. During the visit, household contacts are screened to determine if they’re eligible for preventive treatment by ruling out active TB and testing for infection (wherever applicable), and then if so, linked with the nearest health facility to start the TB preventive treatment. The project staff also follows up with people on preventive TB medications to help them adhere to treatment. The TBI can be treated via two methods – by administering isoniasid for six months or via a newer shorter 3HP regimen which is a 3-month course comprising weekly doses of both isoniasid and rifapentine. It must be noted that through JEET 2.0, India for the very first time is rolling out 3HP and driving accelerated efforts towards effective TB prevention and control.
So far, JEET 2.0 has screened over 78,000 people for TB infection, with over 30,000 household contacts started on preventive treatment. Looking forward, JEET 2.0 will work towards engaging the private sector to provide education on TB infection guidelines. This will ensure access to quality, accurate diagnosis to all household contacts, within the private sector.
Achieving India’s goal to end TB by 2025 can be possible if we proactively address the burden of silent TB infection, through early diagnosis and preventive treatment to eliminate the infection before people become ill.
Hence, investments in TB are particularly pertinent for India, where healthcare and TB services are still recovering from the devastating effects of the COVID-19 pandemic. We need urgent investment to combat silent TB transmission and provide people with lifesaving treatments that can prevent the damaging effects of active TB. We need to focus on actively reaching people at high risk of TB infection, rather than waiting for them to seek testing. Innovative projects such as JEET 2.0 will be critical in this effort, to disrupt a reservoir of new TB infections in a high-burden country like ours. However, we also desperately need support from the rest of India’s health workforce to mobilise and bring people in for TB infection testing. Now more than ever, it’s time for India to invest in resources, and mobilise funding and political will to meet its national TB elimination goals. Addressing the silent epidemic of TB infections is an important step in the right direction.
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