National TB elimination programme in India [TB0080]

Khanna, A., Saha, R. and Ahmad, N., 2023. National TB elimination programme-what has changed. Indian Journal of Medical Microbiology, 42, pp.103-107.

  • Tuberculosis (TB) is the leading cause of death among adults from an infectious agent worldwide.
  • TB has been a global public health emergency for 25 years. See also: https://tbreadingnotes.blogspot.com/2024/07/tuberculosis-and-diabetes-in-low-and.html
  • TB incidence and death rates can be reduced through addressing poverty, malnutrition, HIV, and smoking.
  • In India, hundreds of millions have latent TB, with a significant portion at risk of reactivation due to malnutrition and risk factors like diabetes, air pollution, and smoking. See also: https://tbreadingnotes.blogspot.com/2024/07/diabetes-mellitus-and-latent.html
  • Inadequately treated TB can recur, particularly among patients seeking care from private providers, leading to poor outcomes.
  • Public sector TB care has better outcomes, but 1/3 of patients are lost to follow-up before successful treatment.
  • Overcrowded urban conditions contribute to TB transmission.
  • India has a high burden of multi-drug resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), which are difficult to treat.
  • Early detection through Active Case Finding (ACF) is crucial for controlling TB transmission. See also: https://tbreadingnotes.blogspot.com/2024/07/how-can-tuberculosis-services-better.html
  • New diagnostic techniques like TrueNat, CB-NAAT, and Line Probe Assay (LPA) are more sensitive but face challenges like infrastructure limitations and cost.
  • Whole Genome Sequencing (WGS) is emerging as a powerful tool for detecting drug resistance in TB.
  • CAD4TB software helps in interpreting chest radiographs for TB detection but has variable specificity.
  • TB diagnosis methods include molecular detection, culture, and microscopy, but these have limitations, especially in latent and pediatric TB cases.
  • Extrapulmonary TB diagnosis is challenging due to the need for invasive procedures and limited lab resources.
  • Improved diagnostic biomarkers are being developed, but many remain in development stages.
  • Treatment guidelines for drug-sensitive TB (DS-TB) involve a 6-month regimen, while new drugs like Pretomanid are used for drug-resistant TB (DR-TB).
  • Financial incentives are provided to patients and healthcare workers to improve TB treatment adherence, including direct benefit transfers under the Nikshay Poshan Yojana scheme for nutritional support.
  • Combating TB requires a multi-sectoral approach involving better living conditions, nutritional support, and expanded access to diagnostic and treatment services.
  • Collaboration from various sectors, including NGOs, corporates, and local governments, is essential to support government efforts in tackling TB.

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