New Delhi: Through a recent reply to the question raised in Rajya Sabha, Ministry of Health and Family Welfare informed about the Tuberculosis Eradication.
The minister informed that the Govt of India has committed to ending tuberculosis by 2025. Globally, the average rate of decline in the TB incidence rate was 1.8% between 2016 and 2017.In India, rate of decline in TB incidence rate was 3.3% between 2016 and 2017 as compared to 2.3% between 2015 and 2016. The National Strategic Plan 2017-25 for TB elimination by 2025 was developed in 2017 and included various interventions through multi-stakeholder engagement to reduce the burden of TB. These interventions are being implemented from 2017 onwards and the impact of these would be evident in the subsequent years.
There are various types of TB tests. When a tuberculosis skin test (TST) is positive, it is not always a cause of worry, as the person might only have infection and not have the disease. When a sputum microscopy or molecular test is positive, a diagnosis of TB is confirmed and although a cause for concern, the patient improves if promptly started on Anti-TB treatment and generally becomes non-infectious in 2-3 weeks.
The Government is focusing on identifying additional cases among family contacts of people whose sputum samples have tested positive.
As per the current guidelines preventive treatment is offered to those eligible below 6 years of age and immune compromised individuals like person living with HIV (PLHIV).
The Government has taken up many certain steps in order to tackle the problem of TB by 2025:
-Early diagnosis of all the TB patients, prompt treatment with quality assured daily treatment regimen along with suitable patient support systems to promote adherence to prevent the development of drug resistance among any patient. To identify the drug resistance at the early stage, all TB patient are being screened for detection of resistance under Universal Drug-Susceptible Testing (U-DST).
Revised guidelines for Programmatic Management of Drug Resistant TB (PMDT) are being implemented since December 2017.
Increase in diagnostic and management capacity for early detection and consequent earlier initiation of treatment. This will aid in decreasing mortality and cutting down transmission of the infection.
The country has 1180 functional CBNAAT sites, 89 Culture and Drug Susceptibility Testing (C-DST) laboratories certified in various technologies for drug resistance-TB detection.
Newer evidence-based regimens have been introduced to improve the treatment outcomes of drug resistance TB patients.
- The Shorter MDR Regimen for MDR/RR TB patients (9-11 months of regimen instead of 24 months of conventional regimen)
- Newer drugs (Bedaquiline) containing regimen has also been introduced country-wide under the program and made accessible to all districts during 2018.
- Newer drugs (delamanid) containing regimen has been introduced in 7 states.
Various interventions like Integrated mechanism for management of Adverse Drug Reactions (ADRs), provision of patients & family counselling at the time of diagnosis and during the course of treatment, airborne infection control as well as grievance redressal mechanism have been introduced to improve patient compliance.
The Nikshay Poshan Yojana provides 500 INR monthly to all TB notified TB patients in order to provide nutritional support and aid in the treatment of TB.
Private sector engagement is being promoted to reach out to all patients who are seeking treatment in the private sector and efforts are being made to provide them with all diagnostic, treatment and care facilities, including public health action such as counselling, nutritional support, contact tracing etc.
Targets for Tb Elimination
For the year 2018, the following has been achieved:
- In the 2018 year, 5, 36,752 TB patients have been notified from the private sector. There has been 40% increase in TB notification from the private sector as compared to 2017.
- 44,517 (8%) TB patients were given anti-TB drugs from the programme.
- As per State reports till 25.01.2019, 40% notified TB patients, 35% treatment supporters and 8% private practitioners have been paid incentives through DBT.
The shortfall in stated targets, reasons thereof and strategies are as follows:
- A massive partnership with the private sector has been initiated as a Joint Effort for the Elimination of Tuberculosis (JEET) for the elimination of TB by 2025, five years ahead of the global schedule. Though the MoU was signed in March 2018, the project was launched in May 2018 and has picked up from October 2018.
- To increase in the notification from the private sector, public-private support agency approach has been initiated in 85 districts from May 2018 onwards; Indian Medical Association has been engaged for large scale sensitization and advocacy with private practitioners with standardised digital material.
- States have been supplied anti-TB drugs to covering TB patients notified from the private sector based on demand. States have been guided to keep programme provided anti-TB drugs at private practitioner’s clinic or pharmacy
- Invalid or dormant bank accounts or holding of account in a branch which is yet to be integrated with PFMS (Public Finance Management System) are a few challenges being faced in scheme implementation. To overcome these issues and to ensure that beneficiaries of the schemes are not denied of DBT benefit, the flexibility of providing the benefit through the existing bank account of a blood relative has been given. States have also been advised to facilitate opening of zero balance accounts for TB patients, if necessary, under the PradhanMantri Jan DhanYojana (PMJDY) and Indian Postal Bank.
The Government is committed to achieving the target of TB elimination by 2025 and not considering any revision in targets, the minister stated