Tuberculosis Elimination in India: Where the Country Stands

Angeline Grace G; Sujitha P

doi:10.55489/njcm.150120243403

Authors

Angeline Grace G Sree Balaji Medical College and Hospital, Chennai, India
Sujitha P Sree Balaji Medical College and Hospital, Chennai, India

DOI:

https://doi.org/10.55489/njcm.150120243403

Keywords:

India, tuberculosis, progress, challenges, strategies

Abstract

Tuberculosis (TB) remains a significant public health challenge in India, with the country bearing the highest burden of TB cases globally. This article provides an overview of India's ongoing efforts towards TB elimination, highlighting both progress and persistent challenges.

India's Revised National Tuberculosis Control Program (RNTCP), launched in 1997, has made remarkable strides in TB control. The introduction of the RNTCP and later its expansion as the National Tuberculosis Elimination Program (NTEP) in 2017, aimed to strengthen diagnostic and treatment services, with a focus on achieving universal access to TB care. DOTS (Directly Observed Treatment, Short-course) therapy has been a cornerstone of treatment, contributing to significant reductions in TB mortality. In recent years, India has made strides in adopting new technologies, including molecular diagnostics and telemedicine, to enhance TB case detection and patient care. The introduction of Bedaquiline and Delamanid, novel drugs for drug-resistant TB, has offered hope for patients with more resistant forms of the disease. However, the road to TB elimination in India is not without challenges. There is a pressing need for improved healthcare infrastructure, reduced stigma, and increased awareness among both the public and healthcare providers. The emergence of drug-resistant TB and the impact of the COVID-19 pandemic on TB services have posed additional hurdles. India's journey toward TB elimination is marked by significant progress and continued challenges. To achieve the ambitious goal of eliminating TB by 2025, concerted efforts are required to strengthen healthcare systems, improve diagnostic capabilities, and address social determinants of the disease.

References

Tuberculosis (TB) [Internet]. [cited 2023 Sep 19]. Available from: https://www.who.int/news-room/fact-sheets/detail/tuberculosis

Thakur G, Thakur S, Thakur H. Status and challenges for tuberculosis control in India - Stakeholders' perspective. Indian J Tuberc [Internet]. 2020 Oct 12 [cited 2023 Sep 19]; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7550054/

Annual Reports: Central TB Division [Internet]. [cited 2023 Sep 19]. Available from: https://tbcindia.gov.in/index1.php?lang=1&level=1&sublinkid=4160&lid=2807

WHO Global TB Report 2022 [Internet]. [cited 2023 Sep 19]. Available from: https://pib.gov.in/pib.gov.in/Pressreleaseshare.aspx?PRID=1871626

Michael JS, John TJ. Extensively drug-resistant tuberculosis in India: A review. Indian J Med Res. 2012 Oct;136(4):599-604.

Controlling the drug-resistant tuberculosis epidemic in India: challenges and implications [Internet]. [cited 2023 Sep 19]. Available from: https://www.e-epih.org/journal/view.php?doi=10.4178/epih.e2021022

Jain VK, Iyengar KP, Samy DA, Vaishya R. Tuberculosis in the era of COVID-19 in India. Diabetes Metab Syndr. 2020;14(5):1439-43. Doi: https://doi.org/10.1016/j.dsx.2020.07.034 PMid:32755848 PMCid:PMC7387287

Trajman A, Felker I, Alves LC, Coutinho I, Osman M, Meehan SA, et al. The COVID-19 and TB syndemic: the way forward. Int J Tuberc Lung Dis. 2022 Aug;26(8):710-9. Doi: https://doi.org/10.5588/ijtld.22.0006 PMid:35898126 PMCid:PMC9341497

Khanna A, Saha R, Ahmad N. National TB elimination programme - What has changed. Indian J Med Microbiol. 2023;42:103-7. Doi: https://doi.org/10.1016/j.ijmmb.2022.10.008 PMid:36402676 PMCid:PMC9672688

Barberis I, Bragazzi NL, Galluzzo L, Martini M. The history of tuberculosis: from the first historical records to the isolation of Koch's bacillus. J Prev Med Hyg. 2017 Mar;58(1):E9-12.

Sood A, Singh M, Rani S. Revisiting the tuberculosis and leprosy sanatorium era: for the post COVID healthcare in India. Int J Com-munity Med Public Health. 2021 Jan 27;8(2):1011-2. Doi: https://doi.org/10.18203/2394-6040.ijcmph20210259

Progress Toward Tuberculosis Control --- India, 2001 [Internet]. [cited 2023 Sep 19]. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5111a2.htm

Mandal S, Chadha VK, Laxminarayan R, Arinaminpathy N. Counting the lives saved by DOTS in India: a model-based approach. BMC Med. 2017 Mar 3;15:47. Doi: https://doi.org/10.1186/s12916-017-0809-5 PMid:28253922 PMCid:PMC5335816

Narasimhan P, Wood J, MacIntyre CR, Mathai D. Risk Factors for Tuberculosis. Pulm Med. 2013;2013:828939. Doi: https://doi.org/10.1155/2013/828939 PMid:23476764 PMCid:PMC3583136

Oxlade O, Murray M. Tuberculosis and Poverty: Why Are the Poor at Greater Risk in India? PLOS ONE. 2012 Nov 19;7(11):e47533. Doi: https://doi.org/10.1371/journal.pone.0047533 PMid:23185241 PMCid:PMC3501509

Peer V, Schwartz N, Green MS. Gender differences in tuberculosis incidence rates-A pooled analysis of data from seven high-income countries by age group and time period. Front Public Health [Internet]. 2023 [cited 2023 Sep 19];10. Doi: https://doi.org/10.3389/fpubh.2022.997025 PMid:36703824 PMCid:PMC9873377

Communities, Rights and Gender (CRG) Resources | Stop TB Partnership [Internet]. [cited 2023 Nov 21]. Available from: https://www.stoptb.org/prioritize-people-human-rights-gender/communities-rights-and-gender-crg-resources

Singh S, Kumar S. Tuberculosis in India: Road to Elimination. Int J Prev Med. 2019 Jun 12;10:114. Doi: https://doi.org/10.4103/ijpvm.IJPVM_492_17 PMid:31360361 PMCid:PMC6592106

National Strategic Plan 2017-2025 for TB Elimination in India :: Central TB Division [Internet]. [cited 2023 Sep 19]. Available from: https://tbcindia.gov.in/index1.php?lang=1&level=2&sublinkid=5450&lid=3266

Evaluating Digital Technologies to Improve Tuberculosis Treatment Adherence in India [Internet]. Results for Development. [cited 2023 Sep 19]. Available from: https://r4d.org/projects/evaluating-digital-technologies-to-improve-tuberculosis-treatment-adherence-in-india/

Chen AZ, Kumar R, Baria RK, Shridhar PK, Subbaraman R, Thies W. Impact of the 99DOTS digital adherence technology on tuberculosis treatment outcomes in North India: a pre-post study. BMC Infect Dis. 2023 Jul 31;23(1):504. Doi: https://doi.org/10.1186/s12879-023-08418-2 PMid:37525114 PMCid:PMC10391893

Hazarika I. Role of Private Sector in Providing Tuberculosis Care: Evidence from a Population-based Survey in India. J Glob Infect Dis. 2011;3(1):19-24. Doi: https://doi.org/10.4103/0974-777X.77291 PMid:21572604 PMCid:PMC3068573

Ni-kshay Poshan Yojana :: Central TB Division [Internet]. [cited 2023 Sep 19]. Available from: https://tbcindia.gov.in/index1.php?lang=1&level=1&sublinkid=5275&lid=3385

Community Engagement :: Central TB Division [Internet]. [cited 2023 Sep 19]. Available from: https://tbcindia.gov.in/index1.php?lang=1&level=1&sublinkid=5636&lid=3673

Gill CM, Dolan L, Piggott LM, McLaughlin AM. New developments in tuberculosis diagnosis and treatment. Breathe [Internet]. 2022 Mar 1 [cited 2023 Sep 19];18(1). Doi: https://doi.org/10.1183/20734735.0149-2021 PMid:35284018 PMCid:PMC8908854

Dhamnetiya D, Patel P, Jha RP, Shri N, Singh M, Bhattacharyya K. Trends in incidence and mortality of tuberculosis in India over past three decades: a joinpoint and age-period-cohort analysis. BMC Pulm Med. 2021 Nov 16;21:375. Doi: https://doi.org/10.1186/s12890-021-01740-y PMid:34784911 PMCid:PMC8597252

Subbaraman R, Nathavitharana RR, Satyanarayana S, Pai M, Thomas BE, Chadha VK, et al. The Tuberculosis Cascade of Care in India's Public Sector: A Systematic Review and Meta-analysis. PLoS Med. 2016 Oct 25;13(10):e1002149. Doi: https://doi.org/10.1371/journal.pmed.1002149 PMid:27780217 PMCid:PMC5079571

Clark RA, Weerasuriya CK, Portnoy A, Mukandavire C, Quaife M, Bakker R, et al. New tuberculosis vaccines in India: modelling the potential health and economic impacts of adolescent/adult vaccination with M72/AS01E and BCG-revaccination. BMC Med. 2023 Aug 4;21:288. Doi: https://doi.org/10.1186/s12916-023-02992-7 PMid:37542319 PMCid:PMC10403932

Zhu H, Zhou X, Zhuang Z, Li L, Bi J, Mi K. Advances of new drugs bedaquiline and delamanid in the treatment of multi-drug resistant tuberculosis in children. Front Cell Infect Microbiol [Internet]. 2023 [cited 2023 Sep 19];13. Doi: https://doi.org/10.3389/fcimb.2023.1183597 PMid:37384221 PMCid:PMC10293792

Ignatius EH, Dooley KE. New Drugs for the Treatment of Tuberculosis. Clin Chest Med. 2019 Dec;40(4):811-27. Doi: https://doi.org/10.1016/j.ccm.2019.08.001 PMid:31731986 PMCid:PMC9178517

India and the Global Fund: A strategic partnership with a national, regional, and global future [Internet]. [cited 2023 Sep 19]. Available from: https://www.theglobalfund.org/en/opinion/2023/2023-08-29-india-global-fund-a-strategic-partnership-with-a-national-regional-and-global-future/

Public Private Partnership: Central TB Division [Internet]. [cited 2023 Sep 19]. Available from: https://tbcindia.gov.in/index1.php?lang=1&level=1&sublinkid=4151&lid=2798

Involvement of communities and patients in tuberculosis care and prevention. In: Implementing the WHO Stop TB Strategy: A Handbook for National Tuberculosis Control Programmes [Internet]. World Health Organization; 2008 [cited 2023 Sep 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK310754/

Sahu S. Innovations triggered by India's bold vision to end tuberculosis. Indian J Med Res. 2023;157(2-3):131-3. Doi: https://doi.org/10.4103/ijmr.ijmr_373_23 PMid:37202932 PMCid:PMC10319377

Using digital tools to track TB cases in India-by the millions [Internet]. [cited 2023 Sep 19]. Available from: https://www.path.org/articles/digital-tools-tb-india/

TB Surveillance & Notification :: Central TB Division [Internet]. [cited 2023 Sep 19]. Available from: https://tbcindia.gov.in/index1.php?lang=1&level=1&sublinkid=4529&lid=3135

Quraishi S, Quraishi H, Yadav H, Singh A, Fasih I, Vasquez NA, et al. Digital Storytelling and Community Engagement to Find Missing TB Cases in Rural Nuh, India. Trop Med Infect Dis. 2022 Mar;7(3):49. Doi: https://doi.org/10.3390/tropicalmed7030049 PMid:35324596 PMCid:PMC8955008