Lessons learned from India, Nigeria, etc.

1. TB Burden and Case Detection

• India significantly contributes to the global “missing millions” of undiagnosed TB cases.
• Active Case Finding (ACF) has improved detection, increasing reported TB cases by 74% from 2013 to 2019.
• Advice: Expand outreach programs to detect undiagnosed TB cases, especially in rural and overcrowded urban areas.

2. Risk Factors and Challenges in TB Control

• Poverty, malnutrition, HIV, diabetes, smoking, and air pollution increase TB susceptibility.
• Private healthcare often leads to poor treatment adherence compared to public sector treatment.
• Advice: Strengthen social programs addressing malnutrition and air quality while improving TB management in private healthcare settings.

3. Drug-Resistant TB and Diagnostic Advances

• India has one-third of global multidrug-resistant TB (MDR-TB) cases, worsened by poor living conditions and inadequate treatment.
• Advanced diagnostics (TrueNat, CB-NAAT, Line Probe Assay) and emerging tools (Whole Genome Sequencing, AI-driven CAD4TB) show promise but are costly.
• Advice: Increase investment in affordable diagnostic tools and ensure proper TB drug adherence to prevent resistance.

4. Nutrition and Cost-Effective TB Interventions

• Scaling up nutritional support can prevent up to 1.4 million TB cases and over 570,000 deaths by 2035.
• The program is cost-effective, reducing TB incidence and mortality significantly.
• Advice: Expand nutritional aid programs like Nikshay Poshan Yojana to all TB patients and their families for long-term benefits.

5. Diabetes, Metabolism, and TB Treatment Outcomes

• Diabetes increases TB risk, particularly in older adults, and leads to worse treatment outcomes.
• Poor glycemic control extends TB treatment duration (up to 12 months vs. 6 months for well-controlled diabetes).
• Advice: Screen TB patients for diabetes and implement integrated TB-DM care programs to improve treatment success.

Yoseph Samodra

References:

1. Vaishya R, Misra A, Vaish A, Singh SK. Diabetes and tuberculosis syndemic in India: A narrative review of facts, gaps in care and challenges. J Diabetes. 2024 May;16(5):e13427. doi: 10.1111/1753-0407.13427.
2. Khanna, A., Saha, R. and Ahmad, N., 2023. National TB elimination programme-what has changed. Indian Journal of Medical Microbiology, 42, pp.103-107.
3. McQuaid, C.F., Clark, R.A., White, R.G., Bakker, R., Alexander, P., Henry, R., Velayutham, B., Muniyandi, M., Sinha, P., Bhargava, M. and Bhargava, A., 2025. Estimating the epidemiological and economic impact of providing nutritional care for tuberculosis-affected households across India: a modelling study. The Lancet Global Health.
4. Madaki, S., Mohammed, Y., Rogo, L.D., Yusuf, M. and Bala, Y.G., 2024. Age and gender in drug resistance tuberculosis: a cross-sectional case study at a national tuberculosis reference hospital in Nigeria. Journal of Global Antimicrobial Resistance, 39, pp.175-183.
5. Akinshipe, B.O., Yusuf, E.O., Akinshipe, F.O., Moronkeji, M.A. and Nwaobi, A.C., 2019. Prevalence and Determinants of Pre-diabetes and Latent Tuberculosis Infection Among Apparently Healthy Adults in Three Communities in Southern Nigeria. International Journal of Immunology, 7(2), pp.23-32.
6. Smith, A. G. C., Kempker, R. R., Wassie, L., Bobosha, K., Nizam, A., Gandhi, N. R., Auld, S. C., Magee, M. J., Blumberg, H. M., & Tuberculosis Research Unit: Role of Antigen Specific Responses in the Control of TB (TBRU-ASTRa) Study Group. (2022). The impact of diabetes and prediabetes on prevalence of Mycobacterium tuberculosis infection among household contacts of active tuberculosis cases in Ethiopia. Open Forum Infectious Diseases, 9(7), ofac323.
7. Adane, H.T., Howe, R.C., Wassie, L. and Magee, M.J., 2023. Diabetes mellitus is associated with an increased risk of unsuccessful treatment outcomes among drug-susceptible tuberculosis patients in Ethiopia: A prospective health facility-based study. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 31, p.100368.
8. Gebreweld, A., Fiseha, T., Kebede, E., Tamir, Z., Gebremariam, B., Miruts, F. and Haileslasie, H., 2024. Immuno-Hematological and Biochemical Changes in Patients with Tuberculosis in Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia. Journal of Blood Medicine, pp.147-155.
9. Harahap, E.C.L., Purwanti, A. and Hardianto, N., 2024. Perbedaan Proporsi Sputum Bakteri Tahan Asam Positif pada Pasien Diabetes Melitus Terkendali dan Tidak Terkendali. Jurnal Laboratorium Khatulistiwa, 8(1), pp.168-180.
10. Widihastuti, A., Sirait, R.H., Simatupang, A. and Idhayu, A.T., 2023. Effect of Poor Glycemic Control with Length of Pulmonary Tuberculosis Treatment in Type 2 Diabetes Mellitus Patients. Jurnal Farmasi Klinik Indonesia, 12(1), pp.1-10.

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