Note4Students:
The MoHFW has released the India TB Report 2024. You should know the basics of TB. From the Mains perspective, 3 key points in this article are the issue of drug resistance (we have had PYQs in 2014), the challenges in eliminating TB (PYQs on Covid challenges in 2020), and our target to eradicate it by 2025 (this makes it an important theme for UPSC).
The treatment course for TB mentioned in Back2Basics will help you prepare for any difficult questions that may come out of the woods!
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UPSC Microthemes & Mains PYQ:
Q1.) GS3 Can overuse and free availability of antibiotics without Doctor’s prescription, be contributors to the emergence of drug-resistant diseases in India? What are the available mechanisms for monitoring and control? Critically discuss the various issues involved. (2014)
Q2.) GS3: COVID-19 pandemic has caused unprecedented devastation worldwide. However, technological advancements are being availed readily to win over the crisis. Give an account of how technology was sought to aid management to the pandemic. (2020)
Microthemes: Medical and Health Technologies; Achievements of Indians in S&T
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Tuberculosis (TB) remains a major health issue for India, which accounts for 26% of the world’s TB cases. The 2024 India TB Report by the Ministry of Health and Family Welfare highlights significant achievements, challenges, and areas of concern as the country strives toward its ambitious target of TB elimination by 2025. Here’s a concise look at the findings, challenges, and government initiatives to tackle TB.
Key Highlights: India TB Report 2024
| Year | Total TB Cases (lakh) | Mortality Rate (per lakh) | Private Sector TB Cases (lakh) |
|---|---|---|---|
| 2015 | 19.1 | 28 | 1.9 |
| 2023 | 25.5 | 23 | 8.4 |
- Decline in Mortality Rate: TB mortality dropped from 28 per lakh in 2015 to 23 in 2022.
- Increase in Private Sector Involvement: Private sector notifications rose from 1.9 lakh in 2015 to 8.4 lakh in 2023, showing improved engagement in TB detection.
- Case and Mortality Trends: While estimated TB incidence slightly increased to 27.8 lakh in 2023, TB mortality held steady at 3.2 lakh.
Challenges to Eliminate TB by 2025
| Challenge | Explanation |
| High burden of TB cases | India accounts for 28% of all global TB cases (Global TB Report 2022). This makes it difficult to identify and treat cases on time. |
| Drug-resistant TB | Drug-resistant TB is widespread in India, making treatment more expensive and complicated. This is due to improper antibiotic use and poor adherence to treatment. |
| Limited access to healthcare | Many people, especially in rural areas, lack access to quality healthcare, leading to delayed diagnosis, treatment, and increased TB spread. |
| Stigma and discrimination | The stigma surrounding TB prevents people from seeking treatment or disclosing their illness due to fear of discrimination or isolation. |
| Poor living conditions | Overcrowded homes, poor sanitation, and lack of clean water increase the risk of TB transmission. |
| Limited awareness | Many people don’t know the symptoms of TB or the importance of completing treatment, leading to delays and further spread. |
| Insufficient funding | Despite the severity of TB in India, it receives inadequate funding and attention from policymakers and healthcare providers. |
Government Initiatives Against TB
| Initiative | Description |
|---|---|
| Pradhan Mantri TB Mukt Bharat Abhiyan | Community-based program offering nutritional support through Ni-kshay Mitras |
| National Strategic Plan (NSP) | Aims to eliminate TB by 2025, targeting no more than 44 new TB cases per lakh |
| Digital Tracking (Nikshay Portal) | Digital platform for monitoring patient progress and ensuring treatment adherence |
| Free Treatment and Drug Access | Free supply of essential drugs like Bedaquiline and Delamanid |
| Expanded Testing Access | Increased use of molecular diagnostics (CB-NAAT, TureNat) across districts |
Innovative Approaches Adopted by States:
- Chhattisgarh: By involving Village Health Committees in TPT efforts, Chhattisgarh improved grassroots-level awareness, screening, and treatment adherence for TB prevention, leveraging local networks effectively.
- Tamil Nadu: Tamil Nadu adopted local procurement of the 3HP TPT regimen, ensuring a shorter, accessible TB prevention therapy, which enhanced patient compliance and streamlined medication availability.
- Maharashtra and Rajasthan: These states introduced TPT in high-risk groups like prison inmates, integrating preventive therapy into Active Case-Finding (ACF) efforts, reducing TB prevalence in vulnerable populations.
WHO Recommendations for TB Control
- Molecular Diagnostics: Faster, more accurate diagnostics similar to COVID-19 testing.
- MDR-TB Management: Better prescription practices, drug quality, and treatment completion.
- Patient-Centered Care: Improved support for managing treatment side effects, enhancing treatment completion.
Moving Forward: Key Recommendations
- Strengthen Multi-Sectoral Collaboration: Engage healthcare, social services, and education to address TB’s root causes.
- Enhance Rural Access: Boost local healthcare infrastructure, deploy mobile health units, and train community health workers.
- Stigma Reduction and Awareness: Implement public campaigns to reduce stigma and educate on TB prevention, symptoms, and treatment.
India’s path to TB elimination by 2025 requires a holistic, coordinated approach, addressing healthcare gaps and social determinants to ensure accessible and effective TB care. By fostering cross-sector collaboration, enhancing diagnostics, and addressing the social factors influencing TB, India can accelerate its progress toward a TB-free nation.
#BACK2BASICS
Understanding Tuberculosis
| Parameter | Details |
|---|---|
| Cause | Bacterial infection caused by Mycobacterium tuberculosis |
| Transmission | Airborne, particularly in dense, poorly ventilated areas |
| Common Symptoms | Cough, chest pain, weakness, weight loss, fever, night sweats |
| Global Impact | TB infects 10 million and causes 1.5 million deaths annually, affecting HIV patients |
| Treatment | Standard 6-month, four-drug course with supervised support |
Drug-Resistant TB:
- MDR-TB: Resistant to isoniazid and rifampicin, requiring second-line drugs like bedaquiline.
- XDR-TB: Highly resistant, responding poorly to standard and even second-line treatments.
TREATMENT FOR TB
Standard 6-Month Treatment Course
| Phase | Details |
| Intensive Phase (2 months) | For new TB cases, the intensive phase includes four drugs: Isoniazid (INH), Rifampicin, Pyrazinamide, and Ethambutol. |
| Continuous Phase (4 months) | After completing the intensive phase, the continuous phase follows for 4 months. |
| For Previously Treated Cases | The intensive phase lasts 12 weeks, with an injection of streptomycin given for 8 weeks along with four drugs. |
| Regimen Duration | A strictly followed 6-month drug regimen cures most people with TB. |
BPaLM Regimen
| Feature | Details |
| Drugs Used | Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin. |
| Advantages | – Faster, safer, and more effective compared to traditional treatments. |
| – Cures MDR-TB in 6 months (compared to 20 months with traditional treatment). | |
| – Higher success rate for drug-resistant TB treatment. | |
| – Fewer and milder side effects. | |
| – Shorter treatment duration and reduced side effects lead to lower overall costs. |
Multidrug-Resistant TB (MDR-TB)
| Feature | Details |
| Diagnosis | CBNAAT (Cartridge Based Nucleic Acid Amplification Test) is used for early diagnosis. |
| Resistance | MDR-TB is resistant to at least Isoniazid and Rifampicin, the two most powerful anti-TB drugs. |
| Treatment Challenges | Treatment options for MDR-TB are limited and expensive. |
Causes of MDR-TB
| Cause | Details |
| Mismanagement of Treatment | Inappropriate or incorrect drug use, ineffective drug formulations, or premature treatment interruption. |
| Transmission | Person-to-person transmission of the disease. |
Extensively Drug-Resistant TB (XDR-TB)
| Feature | Details |
| Resistance Profile | XDR-TB is a form of MDR-TB with additional resistance to fluoroquinolones and at least one second-line injectable drug (amikacin, kanamycin, capreomycin). |
Treatment for Drug-Resistant TB
| Treatment Type | Details |
| MDR-TB Treatment Success | Treatment success for MDR-TB is about 54%. |
| XDR-TB Treatment Success | Treatment success for XDR-TB is about 30%. |
| Treatment Duration | XDR-TB requires a combination of eight drugs for over a year. |
| Success Factors | Treatment success depends on the extent of resistance, disease severity, immune system strength, and adherence to treatment. |
| Side Effects | Drugs used for treating MDR-TB and XDR-TB can cause serious adverse effects, including deafness. |
