Express View: Taking on TB
A major challenge for any country’s TB elimination programme is to make sure that cases are reported. A patient falling outside the screening and treatment network is not only harmful to the individual concerned , it also exposes her contacts to the risk of infection.
Under-reporting of cases has, for long, been a major hurdle for India’s anti-TB programme. It’s, therefore, assuring that the latest factsheet on the disease in the country, the India TB Report 2024, shows that the gap between the estimated number and actual TB cases is closing. India has attained its 2023 target of initiating treatment in 95 per cent of patients diagnosed with the infection.
The government has set an ambitious target to eliminate the disease in the country by next year. Despite the anti-TB programme’s appreciable success in the past two years, the country does not seem to be on-course to attain this target. The disease’s multi-drug resistant (MDR) version has assumed epidemic proportions.
The latest India TB Report shows significant progress in charting this severe version of the disease. Close to 60 per cent of those diagnosed were offered a test to check whether their infection was resistant to the first-line drugs , an increase from 25 per cent in 2015.
In the coming months, the health authorities should reach out to more patients to ascertain the numbers of those whose illness requires the administration of second-line-drugs .
In recent years, experts have been recommending the use of molecular testing because microscopy cannot detect all MDR cases. But by all accounts , this state-of-the-art diagnostics is still not the predominant testing method in the country.
Although several drug regimens are available for MDR-TB, these are demanding on patients. A growing body of scholarship shows that less than 60 per cent of patients who require a second-line treatment complete the full course of medicines. Experts, therefore, suggest a transition to the short-duration drug, bedaquiline .
India’s patent office’s decision, last year, to not renew Johnson and Johnson’s copyright on this drug should enable the domestic industry to step in and develop cheaper generic versions . In recent years, mental healthcare has increasingly been seen as a critical part of TB treatment and epidemiologists have been advising physicians to handhold patients through the exacting therapy — this rarely happens in the country. Though TB can affect all social classes, records show that the poor, slum dwellers , and HIV/AIDS patients are the most affected. In the coming months, the country’s planners should deploy a combination of state of the art technology and humane methods to build on the gains of last year.