Chennai: “In Tamilnadu, we have 198 cases of tuberculosis for every one lakh population,” said Institute of Thoracic Medicine Director, Dr Mahilmaran.
As per the data provided by Revised National Tuberculosis Control Programme (RNTCP), it is stated that a total of 1,12,877 patients have been diagnosed with the deadly disease in Tamilnadu in 2018.
On the eve of World Tuberculosis Day (24 March), News Today brings you an analysis of the campaign launched a few years ago to eliminate the disease.
“There has been increase in the data provided by the government as 60 per cent of the country’s population reach out to private institutions. The mandate passed recently stated that the number of TB cases has to be notified by private hospitals which is the reason behind the rise. Over time, it will start coming down,” added Dr Mahilmaran.
Echoing similar thoughts, Chennai-based NGO working in TB for the past two decades Resource Group for Education and Advocacy for Community Health (REACH) executive director, Dr Ramya Ananthakrishnan, said, “There is a lot of private sector engagement and healthcare professionals are reaching out to every nook and corner of the country to detect TB cases.”
LATENT TB, STILL A CHALLENGE
“Even before diagnosing tuberculosis, the patient would have surely infected at least 10 individuals who become carriers. Among them, only one will contract tuberculosis and the lifetime risk for them is just 10 per cent, but can develop the disease. Healthcare professionals, sanitary workers and NGO volunteer are vulnerable, latent TB population,” said Dr Mahilmaran.
He further states that 38 per cent of the country’s population already have latent tuberculosis. When asked about intervention, he said, “The government is charting out a plan to initiate preventive therapy, but that has not materialised yet.”
According to the ‘End TB by 2025’ campaign, the government aims to bring down the count to 44 per one lakh population. However, according to The Lancet Commission, a report published ahead of World Tuberculosis Day, it is stated that the world would become TB-free only by 2045 with financial resources and political will.
“India has shown strong political commitment to ending TB, pledging to eliminate the disease by 2025. The TB program has moved into high gear, prioritising person-centered care, engaging the private sector and focusing on prevention. But the country must now accelerate on three fronts: involving TB survivors and affected communities as key drivers of the TB response, improving the quality of care of TB services and integrating TB services into the primary health system to reduce diagnostic delays and out-of-pocket expenditure. The commission’s recommendations with reference to accountability, rapid scale up of proven technologies and investing in research, are important strategic directions to adopt,” said co-author and REACH director, Dr Nalini Krishnan, in the report.
“As per WHO’s Sustainable Growth Development, the yardsticks of development certainly shows that it is possible by 2030 if we fulfil the criteria provided by them. It is a mathematical model prepared based on factual data on treatment and detection in our country. However, the study shows that it is scientifically impossible,” said Dr Mahilmaran.
On financial assistance, Dr Mahilmaran said, “The government has pumped in resources for this campaign. Depending on the needs, the funds will be increased and should be done in several stages. We have an ambitious project to eliminate the disease by 2025 for which the Centre and State have already charted out the plan.”
Dr Ramya stated that the country has been able to bring down the number of incidences only by 2 per cent which is below the standards despite having a control programme from the 1960s. “The efforts have to be accelerated to a greater extent and we need to reduce the cases at least by 10 or 15 per cent annually if we want to eradicate TB by 2025,” she said.
LAGS IN DETECTION
Though RNTCP has been extensively working in remote areas to diagnose the disease, professionals feel that it has always been a challenge owing to the lack of infrastructure.
On the diagnosis front, Gleneagles Global Health City Infectious Disease senior consultant, Dr Subramania Swamy, said, “Management of tuberculosis continues to face several challenges. The newer nucleic acid amplification (NAA) tests are not available at the point of care (PoC) in remote areas. The diagnosis of extrapulmonary tuberculosis (EPTB) still remains a problem due to difficulty in obtaining appropriate clinical sample, especially from the non-reachable sites and secondly due to the poor sensitivity of diagnostic tests for these conditions. Drug compliance continues to be another big challenge, as patients may take a treatment just until they feel well, which can foster the development of resistance and lead to the spread of the disease.”
The 2019 theme for World Tuberculosis Day is ‘It’s Time’ and organisations across the country are joining hands to boost efforts to eliminate it.
“We have been battling the disease which was discovered over a century ago and had control programmes from the 1960s and have been initiating dialogues for a long time now. The time has come to leverage the political commitment and increase the investment for TB,” added Dr Ramya.