“One of the historic ironies of tuberculosis research is that it has always been assumed that the current interventions would eliminate this disease as a major public health problem. BCG, an attenuated bovine tuberculosis strain, was discovered in 1908, and was thought to be the vaccine for tuberculosis. Streptomycin in the 1940s was hailed as the wonder drug for tuberculosis. Yet even with better antibiotics, tuberculosis remains a major global health problem. Concomitant with these historically shortsighted miscalculations were reductions in support for research on new tools and strategies, based on the assumption that with existing interventions the disease would disappear. It has not.”
– Barry Bloom, MD, Harvard University Distinguished Service Professor.
1. India carries the burden of having the maximum Tuberculosis affected patients in the world, which is precisely one-fifth of the global incidence. Nearly 250,000 people die of TB annually, and ironically it is a curable diseases. Supplemented with factors such as poverty, malnutrition, smoking, and diabetes, the problem has aggravated.
2. It is more of a stigma than a disease given several complications related to it such as cause, transmission and the methods of treatment. This often turns out to be a frightening experience for the people affected from it. Most of them are discriminated, children have to leave schools, women are forced to leave homes and rendered helpless, remote communities boycott their social presence.
3. Since this disease inflicts mostly those who are impoverished and marginalized, the proliferation and reckless treatment has made it chronic. It affects people who are mostly in their productive age group that is 15-54 years on an average. Two-thirds of the affected are male, yet the young girls have to bear the devastating brunt of this malady.
4. This disease can be classified in two types:
MDR-TB: This is Multi Drug Resistant Tuberculosis where patients are resistant to two-first line drugs, isoniazid and rifampicin. This is primarily as a result of inadequate TB therapy and poorly administered treatment, where patients often stop consuming medicines before proper cure.
XDR-TB: Extreme Drug Resistant is MDR-TB plus resistance to any one second-line injectable aminoglycoside.
TDR-TB: Total Drug Resistant is defined as resistance to all available drugs or all tested drugs.
5. People infected with HIV/AIDS are more susceptible to TB. An estimated 2.08 million people are infected with HIV in India.
6. The Ministry of Health and Family Welfare in India organize the Revised National Tuberculosis Programme (RNTCP), which was initiated in 1997 and has expanded to the entire country by 2006. The Government and Civil Society in partnership have initiated Project AXSHYA that is funded by the Global Fund that aims to improve the quality of TB healthcare.
7. The key policy recommendations are:
Empowering communities to participate and fight against Tuberculosis, by either gender sensitive media campaign or through civil society initiatives.
Rational use of diagnostics and drugs over the patients. Conducting research, innovation, Advocacy, communication and social mobilization (ACSM) for tuberculosis control, Public Private Mix (PPM), TB Epidemiology, Operations Research and more.
Strengthening of the state and district level centres, empowering the local healthcare personnels, finding inkages between HIV and TB, and requisite administrative support.
8. WHO and several developing countries have banned serological tests yet it continues to be used in India. Diagnosis through smear microscopy is an extremely reliable technique used by RNTCP, however private units in India still prefer antibody based blood tests (serological tests) which is both unnecessary and ineffective. It just incurs useless cost burden. Around 1.5 million such test are performed in India, and this needs to be stopped.
9. Recently, RNTCP has created a comprehensive National Strategic Plan (NSP) as well as has formulated the Standards for TB care in India that will provide universal access to quality treatment and diagnosis against Tuberculosis. It has to be done on an urgent basis as the quality of treatment here is suboptimal, often inaccurate and inadequate. Treatment regimes have to be revised and synchronized with international guidelines. The ecological and epidemiological approach needs to be taken in order to exterminate the prevalence.
10. Laboratory capacities need to be increased, nationwide survey has to be taken for extensive identification of patients, archaic and irrelevant methods of testing has to be banned, dysfunctional relations between the public-private partnership needs to be resolved, new drugs need to be introduced, infections need to be controlled and finally proper legislation must be passed by policy-makers to remove this deadly disease from the ground.