Achieving the global tuberculosis targets

Aggressive scaling of a single intervention is insufficient to achieve the post-2015 End TB Strategy targets on a global scale. In South Africa, a combination of targeted measures could significantly reduce tuberculosis rates. These include continuous isoniazid preventive therapy for individuals receiving antiretroviral treatment, expanded facility-based screening for tuberculosis symptoms at health centers, and enhanced tuberculosis care. Together, these interventions make substantial reductions in tuberculosis feasible, increasing the likelihood of meeting the 2025 targets. In other high-burden countries such as China and India, additional country-specific strategies are essential. In China, addressing latent tuberculosis among the elderly is a critical focus, while in India, tackling undernutrition is key to achieving the global tuberculosis targets.[1]

Active Case Finding (ACF) for tuberculosis under India’s National TB Elimination Program (NTEP) faces both enabling factors and significant barriers, as perceived by healthcare providers. Key enablers include well-structured operational planning with sufficient budget allocation, systematic ACF cycles, and strong stakeholder engagement through local collaboration and community-friendly initiatives. Technological advancements, such as the use of rapid diagnostic tests and digital tools, also facilitate streamlined ACF implementation. However, barriers such as administrative burdens, logistical challenges like delayed incentives and transport issues, and socio-cultural factors like stigma and healthcare distrust undermine the effectiveness of ACF activities.[2]

To address these barriers, providers suggest adopting a more integrated health approach, combining TB ACF activities with other health programs to enhance community participation. Timely incentives for Accredited Social Health Activists (ASHAs) are essential for maintaining motivation, while external quality monitoring mechanisms and physical oversight during ACF cycles are recommended for data reliability. Simplifying the Ni-kshay portal to make it user-friendly and enabling easier data entry can also enhance the program’s efficiency. These changes, coupled with optimized laboratory diagnostic tools, improved sputum transport mechanisms, and mobile applications for field data entry, are seen as vital improvements.[2]

The study emphasizes the importance of capacity building to strengthen ACF implementation. Training gaps among ASHAs can be addressed through tailored modules that enhance their knowledge and skills. Scaling up resources, such as recruiting more staff and introducing mobile tools, is also critical. By focusing on these multi-pronged strategies—improving community engagement, ensuring adequate incentives and resource allocation, streamlining technological platforms, and enhancing training and infrastructure—India can overcome current challenges and accelerate progress toward its TB elimination goals.[2]

References:

1. Houben, R.M., Menzies, N.A., Sumner, T., Huynh, G.H., Arinaminpathy, N., Goldhaber-Fiebert, J.D., Lin, H.H., Wu, C.Y., Mandal, S., Pandey, S. and Suen, S.C., 2016. Feasibility of achieving the 2025 WHO global tuberculosis targets in South Africa, China, and India: a combined analysis of 11 mathematical models. The Lancet Global Health, 4(11), pp.e806-e815.

2. Shewade, H.D., Ravichandran, P., Pradeep, S.K., Kiruthika, G., Shanmugasundaram, D., Chadwick, J., Iyer, S., Chowdhury, A., Tumu, D., Shah, A.N. and Vadera, B., 2024. Bridging the “know-do” gap to improve active case finding for tuberculosis in India: A qualitative exploration into national tuberculosis elimination program staffs’ perspectives. PloS one, 19(11), p.e0309750.