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]

 See also: https://tbreadingnotes.blogspot.com/2024/07/diabetes-mellitus-and-latent.html

Tuberculosis (TB) continues to be the leading cause of death from an infectious agent globally, with India facing a particularly severe burden. Despite being declared a global public health emergency for the past 25 years, TB's impact can be mitigated through tackling underlying issues such as poverty, malnutrition, HIV, and smoking. In India, the scenario is complicated by the vast number of people with latent TB, many of whom are at risk of developing active disease due to factors like malnutrition, diabetes, air pollution, and smoking. The treatment of TB often falters when patients opt for private healthcare, where outcomes can be poor due to inadequate treatment regimens. Although the public sector offers better treatment outcomes, a significant number of patients are lost to follow-up, undermining the effectiveness of the care provided.[2]

See also: https://tbreadingnotes.blogspot.com/2024/07/how-can-tuberculosis-services-better.html

Urban overcrowding in India exacerbates TB transmission, contributing to the high incidence of multi-drug resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), both of which present significant treatment challenges. Early detection through Active Case Finding (ACF) is vital for controlling TB spread, with new diagnostic technologies like TrueNat, CB-NAAT, and Line Probe Assay (LPA) offering more sensitive detection options. However, these technologies often encounter barriers due to infrastructure and cost issues. Additionally, Whole Genome Sequencing (WGS) is becoming a valuable tool for pinpointing drug resistance, while CAD4TB software aids in TB detection from chest radiographs, though its specificity can vary.[2]

See also: https://tbreadingnotes.blogspot.com/2024/07/tuberculosis-and-diabetes-in-low-and.html

Diagnosing TB remains complex, with methods ranging from molecular detection to culture and microscopy, each with its own set of limitations, particularly for latent, pediatric, and extrapulmonary cases, where invasive procedures might be necessary but are often limited by available resources. New biomarkers for improved diagnostics are under development, yet many are still not widely available. Treatment protocols have evolved, with a standard 6-month regimen for drug-sensitive TB (DS-TB) and newer drugs like Pretomanid for drug-resistant strains. To enhance treatment adherence, financial incentives are now being offered through schemes like Nikshay Poshan Yojana, providing direct benefit transfers for nutritional support.[2]

Addressing TB in India necessitates a multi-faceted approach beyond medical treatment, requiring improvements in living conditions, nutritional support, and broader access to diagnostic and therapeutic services. This effort demands collaboration across various sectors including NGOs, corporate entities, and local governments to bolster the government's initiatives in combating this persistent health challenge.[2]

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.