Can India eliminate TB by 2025?

According to the Global TB Report 2017 released by WHO, India has the highest number of TB cases in the world. Photo: AP

According to the Global TB Report 2017 released by WHO, India has the highest number of TB cases in the world. Photo: AP

New Delhi: The Narendra Modi government is set against major challenges as it looks to achieving its ambitious target of eliminating tuberculosis (TB) by 2025, five years ahead of the global target.

Prime Minister Narendra Modi on Tuesday launched a campaign to eradicate TB from India by 2025 five years ahead of a globally set deadline.

Elimination of TB will mean there should be less than one case of TB for a population of 10 lakh by 2025, according to the World Health Organisation (WHO).

The ministry of health and family welfare recently announced a new National Strategic Plan (NSP) to eliminate TB by 2025. According to TB India annual report 2017, the incidence of TB has reduced from 289 per lakh per year in 2000 to 217 per lakh per year in 2015, and mortality due to TB has also reduced from 56 per lakh per year in 2000 to 36 per lakh per year in 2015.

However, a deeper look at statistics and calculations depicts the pace is too slow to achieve the target the government is looking at, experts said.

“It is almost a Herculean task to eliminate TB by 2025 going by the current scenario. With the current rate of annual decline of TB cases globally being 1.5%, India is lagging behind in its national decline rate, which is less than 2%. Even if incidence decline rate is increased, elimination of TB from the face of the earth is not expected before 2100,” said Rajendra Prasad from the Department of Pulmonary Medicine, Era’s Lucknow Medical College and Hospital.

WHO’s “END TB Strategy” adopted by the World Health Assembly in 2014 aims to end the TB epidemic globally. It aims at 95% reduction by 2035 in the number of TB deaths compared with 2015, 90% reduction by 2035 in the TB incidence rate compared with 2015 and Zero TB-affected families facing catastrophic costs due to TB by 2035.The strategy also sets interim milestones for 2020, 2025 and 2030 as the United Nations sustainable development goals include ending the TB epidemic by 2030.

“Even the WHO target for elimination of TB by 2050 from the face of the earth would require acceleration of decline of TB incidence to 15-19% per year instead of the present decline rate of 1.5% per year. If India wants to end TB by 2025, the rate of decline of incidence of TB needs to be more than 10-15% per year over the next 8 years,” Prasad said.

“The government also needs to quickly roll out daily fixed-dose regimen under directly observed short course treatment throughout the country and introduce new diagnostic technology and newer anti-TB drugs. The huge private sector in the country, where at least 50% cases of TB are reported for treatment, needs to be engaged rapidly and effectively,” he said.

India’s NSP for TB elimination details the Revised National Tuberculosis Control Program’s (RNTCP) intention to increase access to improved diagnostics and treatment support, engage with the private sector and strengthen the healthcare system and TB surveillance. According to the government’s own admission, the total cost of this new effort is estimated at around $2.5 billion. In contrast, India’s current healthcare spending is barely 1.4% of the GDP.

“The government’s Joint Monitoring Mission observed that the implementation of the NSP for 2012-2017 did not achieve the projected increase in case detection by the RNTCP. In addition, the ambitious expansion of resources planned under the NSP, 2012-2017, will have tripled the expenditure of the prior plan but has not been matched by allocations. While RNTCP expenditure has increased 27% since 2012, there is a growing gap between the allocation of funds and the minimum investment required to reach the goals of the Plan,” said Anil Jacob Purty, vice-chairman of RNTCP National Task Force, in the latest issue of the Indian Journal of Community Medicine.

Also, government officials claimed that diagnosis and treatment remains a difficult task in hilly areas and not many private practitioners and hospitals are notifying the disease which hinders the government in having accurate data on TB cases.

“The Indian government recently announced a NSP to eliminate TB by 2025, but much is still unknown about the epidemic, in part due to a weakly regulated and highly privatized health sector. To successfully eliminate TB, India will need to broadly improve the quality of care that TB patients receive. Simulated patient studies have shown that the current quality of care is poor, especially in the private sector where drug sales estimate over one million TB patients seek care annually,” said Madhukar Pai, associate director, McGill International TB Centre, Canada.

“Cascade of care studies indicate that TB patients are lost at every stage of care-seeking. Access is suboptimal for new diagnostic technologies such as GeneXpert and new drugs such as bedaquiline. Additionally, research in the social determinants of health indicates that factors such as under nutrition, smoking, and diabetes are major driving forces behind the TB epidemic,” said Pai.

According to the Global TB Report 2017 released by WHO, India has the highest number of TB cases in the world. In 2016, there were an estimated 10.4 million new TB cases worldwide. In India, an estimated 27.9 lakh patients were suffering from TB in 2016 and up to 4.23 lakh patients were estimated to have died during the year.

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