Consultancy Corner: Overcoming tuberculosis need of the hour in India

Due to its infectious nature, the individual is isolated from family and members, further affecting the mental well-being of the infected person.  

India is  home to the largest number of TB patients as well as the highest in numbers of death due to TB.  Globally, 10 million people are suffering from TB and 2 million has succumbed to it. India has been engaged in TB control activities for more than 50 years. Yet, TB continues to be India’s severest health crisis. TB kills an estimated 480,000 Indians every year and more than 1,400 every day. India also has more than a million ‘missing’ cases every year that are not notified and most remain either undiagnosed or inadequately diagnosed and treated in the private sector.  This tragic loss of life, continued suffering and poverty need to end with concerted efforts from all of us. 

Though India declared TB as a notifiable disease in 2012, which means that all private doctors, caregivers and clinics treating a patient suffering from TB will have to report every single case of the air-borne disease to the government-TB program, especially in view of the required massive increase in notification from the private sector, and building patient support mechanisms for all TB patients. The private sector in India, has unfortunately, been a source of mismanagement of TB and hence of drug resistance. This includes the use of incorrect diagnostics (e.g. blood tests), incorrect regimes and a lack of supervision to ensure all TB patients complete their TB treatment. The RNTCP has tried to involve private health providers in promoting TB care, but it is believed that many patients continue to seek treatment elsewhere and currently go unreported. 

TB control faces daunting challenges in India. Decades of unrestrained transmission has left hundreds of millions of Indians with latent TB infection, which may re activate at any time. A significant proportion of the population is undernourished, which weakens immunity and drives TB reactivation. Also, people are immuno compromised, due to several health conditions including HIV being one of the major reasons for TB reactivation.  

A considerable number suffer from risk factors for tuberculosis, including diabetes, indoor air pollution from cook stoves, or smoking. The dense, growing urban environment facilitates the transmission of the disease cutting across all economic strata. Infectious TB cases spread disease to their family and  community, perpetuating the age-old cycle of transmission and risk.  

The overwhelming challenge for TB control in India is the delayed diagnosis and inadequate treatment, particularly among patients seeking care from private  providers. Patients seeking care in the  public sector have a better chance of treatment but still 1/3rd are lost between care-seeking and successful cure. 

India also has a large burden of multi-drug resistant (MDR-)TB and extensively drug resistant (XDR-)TB most of whom are undetected and continue to transmit disease.  

We have to take collective responsibility as Indians for the current state of affairs of the disease as TB is preventable and 100% curable if detected and treated early. Let us collectively take action to stop stigmatising and discriminating people infected with TB.