Tuberculosis in India

In 2020, India contributed significantly to the global gap, known as the "missing millions," in tuberculosis (TB) cases, where there was a 24% discrepancy between estimated TB incidence and newly diagnosed and reported cases. This issue highlights the challenge in identifying and treating all TB cases. India, among other low- and middle-income countries, has initiated several programs aimed at actively seeking out these missed cases. These efforts have resulted in a substantial increase in TB case detection; from 2013 to 2019, the number of newly diagnosed TB cases in India rose from 1.2 to 2.2 million, marking a 74% increase. Despite this progress, TB mortality remains a critical issue, with nearly 0.44 million deaths attributed to TB annually in India. Moreover, the country grapples with a high prevalence of multidrug-resistant TB (MDR-TB), accounting for one third of global cases.[1]

Tuberculosis (TB) remains the leading cause of death from an infectious disease worldwide, with India bearing a particularly heavy burden. Despite being a declared global health emergency for over two decades, TB persists due to underlying issues like poverty, malnutrition, HIV, and smoking. In India, the situation is worsened by widespread latent TB infections, which often progress to active disease due to factors such as malnutrition, diabetes, air pollution, and tobacco use. While public sector treatment generally leads to better outcomes, challenges like patient loss to follow-up and reliance on inadequate private healthcare regimens continue to undermine TB control efforts.[2] See also: https://tbreadingnotes.blogspot.com/2024/07/diabetes-mellitus-and-latent.html

Urban overcrowding further fuels TB transmission, contributing to rising cases of multi-drug resistant (MDR) and extensively drug-resistant TB (XDR-TB). Early detection through Active Case Finding (ACF) and advanced diagnostics like TrueNat, CB-NAAT, and Line Probe Assay (LPA) are crucial but often limited by infrastructure and costs. Emerging tools such as Whole Genome Sequencing (WGS) and CAD4TB software offer promise in improving diagnosis and resistance detection. Treatment has advanced with newer drugs and financial support programs like the Nikshay Poshan Yojana, which provides nutritional aid to enhance adherence. Ultimately, combating TB in India requires a comprehensive approach that includes improving living conditions, expanding nutritional and diagnostic support, and fostering cross-sector collaboration to strengthen government initiatives.[2]

Scaling up nutritional support for people receiving TB treatment and their household contacts in India could have a significant long-term impact. At 50% coverage from 2023 to 2035, the intervention is projected to prevent around 880,700 TB cases and 361,200 deaths—equivalent to reducing TB incidence by 2.2% and TB mortality by 4.6%. Expanding coverage to 80% could avert nearly 1.4 million cases and over 570,000 deaths. If the intervention targets only adult TB patients at 50% coverage, it could still prevent 46,700 cases and 234,300 deaths. The number needed to treat is 10 households to prevent one TB case and about 24 households to prevent one TB death.[3] See also: https://tbreadingnotes.blogspot.com/2024/07/tuberculosis-and-diabetes-in-low-and.html

The nutritional support program is also highly cost-effective. The incremental cost-effectiveness ratio (ICER) is estimated at $139 per DALY averted for patients alone, and $208 per DALY averted when household contacts are included. The total budget impact is projected at $664 million for patients, with an additional $685 million to cover household contacts. Despite the upfront costs, both intervention and treatment expenses are expected to decrease over time. The effectiveness remains consistent across different BMI groups, and longer-lasting protection would enhance outcomes further. In conclusion, scaling up this intervention could prevent nearly 900,000 TB cases and more than 350,000 TB deaths by 2035 and is likely to be cost-effective across most willingness-to-pay thresholds.[3] See also: https://tbreadingnotes.blogspot.com/2024/07/how-can-tuberculosis-services-better.html

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.