Date : 14/08/2023

Relevance – GS Paper 2 – Social Justice

Keywords – WHO, MDR-TB, Mortality rate

Context –

The issue of drug-resistant tuberculosis (DR-TB) presents a significant and complex problem that requires immediate and focused intervention. India's approach to this challenge carries considerable weight, considering it accounts for a quarter of the global DR-TB cases. The way India responds can influence how other nations address the escalating threat posed by DR-TB.

About Drug-Resistant Tuberculosis (DR-TB)-

• Drug-Resistant Tuberculosis (DR-TB) refers to a situation where the bacteria causing tuberculosis become resistant to the drugs used for its treatment. This resistance renders the drugs ineffective in killing the TB bacteria. DR-TB spreads in the same manner as drug-susceptible TB.
• DR-TB can arise due to improper use of TB drugs. This includes instances where individuals fail to complete the full course of TB treatment, healthcare providers prescribe incorrect treatment in terms of dosage or duration, the necessary drugs for proper treatment are unavailable, or the drugs are of subpar quality.
• The occurrence of DR-TB is more prevalent in individuals who don't consistently take their prescribed TB medications, fail to complete the entire course of treatment, experience a recurrence of TB after a previous treatment, originate from regions where DR-TB is widespread, or have been in close contact with someone diagnosed with DR-TB.

DR-TB Scenario in India

• According to the World Health Organization (WHO), approximately 119,000 new instances of multidrug/rifampicin resistant TB (MDR/RR-TB) arise annually in India. Nevertheless, the Indian TB initiative officially recorded just over half of this estimate, with 64,000 MDR/RR-TB cases reported in the year 2022.

India's TB Eradication Initiative

• Targeting the elimination of Tuberculosis is a sustainable development objective for the global community to accomplish by 2030. However, India has set a more ambitious goal of achieving this milestone by 2025.
• The national strategic plan for the period 2017 to 2025 outlines India's objectives, aiming to report no more than 44 new TB cases or 65 total cases per one lakh population by 2025. The program also strives to curtail mortality to three deaths per one lakh population by the same year. Notably, the estimated TB mortality rate for the year 2020 was recorded at 37 per one lakh population.
• This strategic plan also pursues the reduction of financial hardship for affected families to zero. However, the report highlights that a substantial proportion—ranging from 7 to 32 percent for drug-sensitive TB and 68 percent for drug-resistant TB—still grapple with catastrophic costs associated with their treatment.
• These objectives align with the World Health Organization's (WHO) "End TB" strategy, which envisions an 80% reduction in new cases, a 90% reduction in mortality, and the elimination of catastrophic costs by the year 2030.

Primary Challenge to India's TB Eradication Efforts: MDR-TB

Rifampicin Resistance:

• Rifampicin, a potent first-line drug, faces critical resistance concern.
• Rifampicin-isnoiazid resistance defines MDR-TB. WHO highlights persistent DR-TB threat in India.

Mixed Treatment Approach:

• Despite WHO endorsing BPaL regimen in Dec 2022 (89% success, fewer pills, shorter duration), India uses varied, challenging treatments.

Injectables Usage:

• In 2021, 22,000+ Indian MDR/RR-TB patients had injectables-based treatment, against WHO recommendation since 2019. Only 68% initiated treatment in 2020 complete it. In 2022, 53% (~31k) received preferred bedaquiline-containing regimen.

Detection Methods:

• Recent WHO Standard advocates molecular diagnostics as initial, accurate, drug-resistance detecting, cost-effective test. India's reliance on outdated sputum smear microscopy persists; only 23% TB-presumed underwent recommended tests in 2022, failing to identify drug-resistance, covering just half cases.

Additional Hurdles to India's TB Eradication Efforts

• A significant segment of the population experiences malnutrition, which can weaken immunity and potentially reactivate TB.
• A considerable portion of those afflicted with the disease discontinue treatment due to resource limitations and financial constraints.
• Delayed diagnosis, insufficient treatment, recurring TB, drug resistance, diabetes, HIV, malnutrition, and urbanization contribute to the persistent TB epidemic.
• Engaging the private sector poses challenges. Their increased involvement is crucial as they can significantly contribute to treatment efforts.
• Another substantial obstacle is the elevated count of DR-TB cases in India. This form of TB demands more complex treatment with pricier, specialized drugs and extended durations.
• Insufficient research and inability to implement measures curbing treatment and drug costs are fueling the epidemic's spread.

Notable Strides in TB Treatment

Enhanced Diagnosis:

• Swift identification of TB is possible through rapid molecular diagnostics, widely employed for Covid-19 testing during the pandemic.

Reduced DR-TB Treatment Duration:

• Cutting down DR-TB treatment from 24 months to 6 months marks a substantial advancement.
• Severe TB cases can now be managed using oral medications, eliminating the need for painful injections.

Way Forward

Adopt WHO's BPaL Regimen:

• India should shift from mixed treatments to WHO-recommended BPaL regimen for DR-TB patients, promising higher success rates. Globally, transitioning to BPaLM/BPaL could save $740 million annually, with India potentially saving around $250 million per year, being a major MDR/RR-TB treatment hub.

Maximize Pretomanid Utilization:

• India, being the sole global provider of pretomanid, a vital BPaL component, should leverage this advantage. Presently, only 403 patients have received the pretomanid-containing BPaL regimen via clinical trials.

Accessible Tools for DR-TB:

• Leveraging precise DR-TB detection tools, India can achieve six-month oral medication-based DR-TB cure.
• Equitable access to advanced diagnostics and treatments is a fundamental right. As cutting-edge tools emerge, India must harness their potential to prevent suffering and deaths from drug-resistant TB.

Source – Indian Express