Context:

India’s battle against tuberculosis (TB) has seen significant strides, particularly under the National Tuberculosis Elimination Program (NTEP). Despite facing various challenges, the country has achieved substantial progress towards its ambitious goal of eliminating TB by 2025. The Global Tuberculosis Report 2024, published by the World Health Organization (WHO), provides an in-depth analysis of the global TB epidemic. The report reveals concerning statistics while highlighting areas where progress is being made.

Key Findings from the 2024 Report:

• Global TB Cases: In 2023, 8.2 million people were newly diagnosed with TB, marking the highest number recorded by WHO since 1995. This figure shows an increase from 7.5 million in 2022.
• Global Death Toll: TB deaths remained high in 2023, with 1.25 million deaths, although this marks a slight decline from 1.32 million in 2022. Despite the decrease, TB deaths still outnumbered COVID-19 deaths, which were reported at 320,000 in the same year.
• Burden in LMICs: 87% of the global TB burden is concentrated in 30 low- and middle-income countries (LMICs). India, alongside Indonesia, China, the Philippines, and Pakistan, accounts for over half (56%) of the global TB burden.
• Risk Factors: Major risk factors for new TB cases include undernutrition, HIV, alcohol use disorders, smoking, and diabetes.

India’s Role in the Global TB Burden:

• India is the world’s largest contributor to the TB burden, accounting for 26% of all new cases globally in 2023, with an estimated 27 lakh cases.
• The country’s treatment coverage has improved significantly, reaching 89% in 2023 compared to 72% in 2015.
• India’s TB incidence has reduced by 17.7%, from 237 per lakh population in 2015 to 195 in 2023, demonstrating significant progress.

National Tuberculosis Elimination Program (NTEP)

The NTEP is the cornerstone of India’s TB elimination strategy. It is based on the National Strategic Plan (NSP) for TB Elimination (2017–2025), which aims to reduce the TB burden by ensuring early detection, timely treatment, and preventive care.

Goals of NTEP:

• End TB by 2025: India aims to eliminate TB by 2025, ahead of the global target of 2030 as per Sustainable Development Goal 3.3.
• Reduction Targets:
• 80% reduction in TB incidence compared to 2015 levels.
• 90% reduction in TB mortality by 2025.
• Ensure zero catastrophic expenses for TB-affected households.

Key Achievements in 2023:

• Diagnostic Expansion: In 2023, India conducted approximately 1.89 crore sputum smear tests and 68.3 lakh nucleic acid amplification tests, marking a significant step in expanding access to early diagnosis.
• Shorter Treatment Regimens: The introduction of new, shorter regimens for drug-resistant TB (DR-TB) has been a major success, improving treatment adherence and reducing the burden of prolonged therapy.
• Preventive Therapy: TB Preventive Treatment (TPT) coverage has been scaled up, reaching approximately 15 lakh beneficiaries in 2023. This is part of India’s effort to prevent the emergence of active TB, particularly among vulnerable populations.

Supportive Services and Community Engagement

Financial and Nutritional Support:

• The Ni-kshay Poshan Yojana provides financial assistance to TB patients through Direct Benefit Transfers (DBT), amounting to Rs. 2,781 crore disbursed to over 1 crore beneficiaries in 2023.
• These funds are used for nutritional support, ensuring that TB patients can maintain a healthier diet during their treatment.

Community Engagement:

• Ni-kshay Mitras: More than 1.5 lakh community volunteers have committed to supporting TB patients through treatment and recovery. These volunteers are critical in ensuring treatment adherence, offering emotional support, and helping with logistics.
• Pradhan Mantri TB Mukt Bharat Abhiyaan (PMTBMBA): Launched in 2022, this initiative engages political leaders, officials, and NGOs to raise awareness, combat stigma, and mobilize communities in the fight against TB.

Patient-Centric Care:

• The NTEP emphasizes the role of ASHA workers, TB champions (TB Vijeta), and family caregivers (Ni-kshay SAATHI). These individuals help patients adhere to their treatment regimen, provide care, and ensure patients are receiving proper nutritional and emotional support.

Preventive Measures and Innovations

Prevention remains a critical component of India’s TB elimination strategy. The government has introduced several preventive measures to reduce TB transmission, particularly in vulnerable populations.

TB Preventive Treatment (TPT):

• Preventive therapy is now being extended to high-risk groups, such as close contacts of TB patients and individuals with compromised immunity. Approximately 15 lakh beneficiaries received TPT in 2023, helping to reduce new cases in vulnerable communities.

Bacillus Calmette-Guerin (BCG) Vaccination:

• India is also exploring the potential of the BCG vaccine for preventing adult TB, particularly among those living in high-burden areas. Ongoing studies are evaluating its effectiveness in reducing TB incidence among adults.

Addressing Risk Factors:

• The NTEP integrates TB care with broader health programs targeting undernutrition, HIV, smoking cessation, and diabetes management. This approach ensures that TB patients receive holistic care, addressing underlying conditions that can worsen TB outcomes.

Challenges in TB Elimination

·         High Burden in Vulnerable Populations:

• Men account for 55% of all TB cases, while women and children account for 33% and 12%, respectively. Vulnerable populations such as those living in poverty, with poor nutrition, or facing social stigma, face greater barriers to accessing care.

·         Drug-Resistant TB (DR-TB):

• The rise of drug-resistant TB strains continues to pose a major challenge. DR-TB requires complex and longer treatment regimens, which are costly and often less effective.

·         Social Determinants of Health:

• Risk factors such as malnutrition, smoking, alcohol use, and diabetes are prevalent in many TB hotspots and complicate the elimination efforts.

·         Access to Healthcare:

• Access to quality TB services, especially in rural and underserved areas, remains an ongoing challenge. Timely diagnosis and prompt treatment initiation are often delayed in these regions.

The Way Forward

• Expansion of Diagnostic Access: Expanding molecular diagnostic testing and improving data management systems will be crucial for ensuring no TB case is missed.
• Scaling Up Preventive Therapy: Rapidly scaling up TB Preventive Treatment (TPT) for at-risk groups will be critical to prevent new infections.
• Community-Based Approaches: Strengthening community engagement through initiatives like PMTBMBA and Ni-kshay Mitras will be key to sustaining treatment adherence and awareness.
• Addressing Social Determinants: Integrating TB care with broader public health programs that address malnutrition, diabetes, and smoking will be essential for reducing TB incidence.

Conclusion

India’s journey toward a TB-free future is a monumental task, but the country has made considerable progress in its fight against the disease. With substantial reductions in TB incidence and mortality, along with enhanced treatment coverage and support systems, India is on track to meet its 2025 elimination target. While challenges remain, continued investment in innovative diagnostics, community engagement, and integrated care will ensure that India can achieve its goal of a TB-free nation, setting a global example in the fight against tuberculosis.