Tuberculosis rate going down, but not fast enough to meet WHO target
India is unlikely to reach the WHO target of elimination of tuberculosis (TB) by 2050 going by the rate at which incidence of the disease is declining in the country.
“Incidence of TB in India is declining at the rate of about 2 per cent per year. However, in order to reach the TB elimination target by 2050, the rate should be 19 to 20 per cent per year,” WHO Representative to India Nata Menabde toldPTI.
She, however, said that on using available strategies and technologies effectively, along with universal health coverage and social protection, the country could achieve a reduction of TB incidence rate of 10 per cent per year by 2025.
“To hasten the decline of TB incidence beyond that would require new tools such as new effective vaccines, new points of care, effective diagnostics and new effective shortened treatment regimens,” she suggested.
Additionally, social determinants of TB such as under-nutrition, overcrowding and poor ventilation in slums and clinical risk factors such as diabetes mellitus, smoking etc should be addressed simultaneously, she added.
Citing the WHO Global TB Report 2014, Ms. Menabde said that India has already met the Million Development Goals (MDG) target of 50 per cent reduction in the prevalence of TB by 2015 compared to 1990. “India is also well on track for reducing TB death by 50 per cent by 2015,” she stated.
Ms. Menabde, however, said there was a need to improve the quality of care provided to TB patients at private clinics and hospitals as most approached such facilities for treatment, especially in urban areas.
“At least one-half of the TB patients in India, especially in urban areas, approach private sector for TB care. But the quality of care in the private sector in most situations is not satisfactory.
“There is a need for wider dissemination of ‘standards for TB care’ to the private sector, targeted approaches to engagement with them and more stringent implementation of mandatory notification of TB cases.
Ms. Menabde said, “Public health measures such as contact tracing, chemoprophylaxis, HIV testing, treatment adherence monitoring, access to social support etc should also be available to patients seeking care at private facilities.”
On social dogma attached to TB contributing to its spread in India, she said that “sustained and innovative mass awareness campaigns need to be developed to reach out to the community to reduce stigma associated with TB”.
“Community support groups/NGOs can be effectively used to create awareness and both WHO and government of India should pursue these collaborations,” she added.
According to her, the proportion of Extrapulmonary Tuberculosis (EPTB) in India was approximately 15-30 per cent and it was more difficult to diagnose and treat. She also stressed on the need for specialised care in some of its forms which are life-threatening, especially to children.
“Towards this goal, WHO’s Global TB programme has designated Delhi-based AIIMS as the centre of excellence for EPTB to develop guidelines and tools for the management of EPTB within the TB programme. This collaboration is expected to develop new and improved strategies for diagnosis and treatment of extra-pulmonary TB in India,” she said.
Ms. Menabde admitted that achieving global TB targets in the BRICS countries (Brazil, Russia, India, China and South Africa), which account for around half of the globe’s detected tuberculosis cases, would be critical.
“Each BRICS country needs to formulate an approach that is based on country-specific context, share experiences and extend collaborative activities for TB control.
“BRICS countries can together stimulate price reduction in diagnostics and drugs for TB. There is also a need for joint actions for research and development,” she said, adding that, “WHO’s post-2015 TB strategy, now the ‘End TB strategy’, has a goal to end the global epidemic of the disease.”
“... It means the incidence of TB becomes so low that it is no longer a significant public health problem (less than one case per million population). The ‘End TB strategy’ has set targets for 2035 and immediate milestones for 2025,” she said.
By 2025, WHO’s milestones, Ms. Menabde said, would be a 75 per cent reduction in TB deaths (compared with 2015) besides, bringing down the TB incidence rate by 50 per cent (less than 55 TB cases per 100,000 population).
And by 2035, the reduction in TB deaths should be 95 per cent (compared with 2015) with a 90 per cent reduction in TB incidence rate and to see that no affected families face catastrophic costs due to the disease, she stated.
On whether a global eradication of the disease could be possible or not, the WHO official said, “Ending the global TB epidemic is feasible with dramatic decline in TB deaths and cases, and elimination of economic and social burden of TB.
Failure to do so will have serious individual and global public health consequences.”
Regarding countering TB in the country, Ms. Menabde pointed out that WHO has been providing technical guidance and support to India’s TB control programme.
“It (WHO) has been supporting the government in development of quality standards, treatment protocols, operational research, piloting innovations, validation of new tools, etc. The recently developed, ‘Standards for TB care in India’, is an important tool for achieving the goal of universal access to quality TB care,” she said.
Ms. Menabde said there were a number of key strategic documents such as the ‘End TB strategy’ of WHO Global TB programme which provide strategic directions for TB elimination which is the more immediate goal.
“The Standards for TB Care in India (STCI) is a useful technical guideline for all health care providers in India for practicing good diagnosis, treatment, public health and social standards for TB care. India’s national TB control programme has developed strategies for intensified TB control efforts, named TB Mission India 2020, and this too can act as an effective roadmap for TB control in India,” she said.
Meanwhile, on a U.N. Habitat report which claimed that overcrowding and poor ventilation in slums was conducive to the spread of the disease worldwide, she said, “Airborne infection control measures need to be prioritised in all health care settings.”
“To address the urban TB problem, active case finding strategies and use of sensitive diagnostic tools needs to be pursued. Further, every TB patient diagnosed should be placed on treatment as quickly as possible to prevent further transmission.
“Awareness programmes on cough hygiene also need to be prioritised. Every person living with HIV needs to be actively screened for TB and if not affected, then TB preventing therapy with isoniasid should be given,” she said.
