India accounts for a quarter of tuberculosis cases worldwide. However, recent research by the Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, suggests that the country has made remarkable strides in combating this deadly disease and stands a chance of eliminating it by 2025, five years ahead of the global target.

Since 1962, when the National Tuberculosis Programme (NTP) was launched, the strategies to tackle this communicable disease have evolved over time, culminating in the establishment of the National Tuberculosis Elimination Programme (NTEP) in 2020 with the stated aim of eradicating TB from the country.

There are multiple challenges along the way, topped by limited budget allocation. As the AIIMS-Bhubaneswar research paper, titled ‘India marching towards TB elimination: How far we are’, states: “There are some challenges which India needs to overcome to achieve its target five years ahead of the [United Nations] Sustainable Development Goals. Insufficient budget, inadequate diagnostic facilities, under-reporting, low success rate, high dropout rate, social stigma are some of the major challenges.”

Shortage of funds hinders the adoption of comprehensive strategies, and the expansion of diagnostic facilities and treatment options. The study calls on the government to prioritise TB elimination through higher budget allocation.

Early detection

Enhanced diagnostic capability is another key aspect of the battle against TB, the research notes. It is essential to equip healthcare facilities with advanced diagnostic technologies to accurately detect TB and determine drug resistance. Newer tools such as the Gene Xpert MTB/ RIF assay and MERM (medical event reminder monitor) can revolutionise TB diagnosis and choice of treatment.

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Similarly, early detection of the disease is vital for higher success rates. “For any disease to be eliminated, the idea is to identify all active cases at the earliest, prevent cross-infection from active cases to other people, treat the patient completely, and ensure good follow-up,” says Dr Anantha Krishnan, an infectious disease expert at Prashanth Hospitals, Chennai.

Social factors

TB has two forms: pulmonary (affecting the lungs) and extra-pulmonary. It can affect any part of the body, making diagnosis challenging. Accurate diagnosis through proper use of tools must be followed by the initiation of anti-tuberculosis treatment (ATT), ensuring patient’s compliance and completion of ATT, and adequate follow-up care.

Equally important is the need to address the social, economic, cultural, and nutritional vulnerabilities in the fight against tuberculosis. Factors such as overcrowding, migration, social stigma, and poor nutritional status contribute to the spread and persistence of the disease.

“To prevent tuberculosis, focusing on the overall health and immune system is essential. Dietary tips include incorporating a variety of fruits and vegetables, opting for whole grains, including pulses and legumes, consuming dairy products, and staying hydrated with traditional beverages,” says Madhavi Avate, a nutritionist and lactation counsellor.

Role of private sector

Sounding a note of caution, Dr Krishnan says, “India’s TB treatment is not centralised as it is not uniform. Nearly 50 per cent of TB patients are diagnosed in the private sector and the rest by the government sector. Although the private sector reporting of tuberculosis has gone up from 4 per cent to 25 per cent, there is a huge gap due to underreporting, so I do not think India is in any position to eliminate tuberculosis by 2025.”

The inclusion of private healthcare providers in TB elimination efforts can vastly expand the reach of diagnostic and treatment services, the study recommends. Policies, regulation, and advocacy are needed to ensure delivery of adequate treatment and care services.

An added challenge is TB’s co-infection with diseases like HIV and diabetes. Integrating TB services with existing health programmes can optimise resources and improve outcomes for those with dual burdens.

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