and detect drug-resistance. Early diagnosis is key to successful treatment and disease control. Improving patient outcomes involves rationalising treatment regimens in the private sector and providing support for needy patients to help them complete the full course. Shorter regimens currently being evaluated in research studies have the potential to lower default rates, which will help prevent drug-resistant TB. Perhaps the most critical aspect is a strong public information campaign that will increase awareness, empower patients, reduce stigma and help combat TB effectively.
Other key issues which require attention are infection control and nutrition. Since TB is an air borne disease it spreads quickly in close, densely knit spaces. In the absence of ventilated housing, providing patient, families and communities with sufficient information on preventive strategies can help contain the infection. Also, the government needs to introduce a provision for nutritional supplements to all TB patients. There is a well-established relationship between better nutrition and improved treatment outcomes. Since the majority of TB patients belong to vulnerable sections of society, a nutritional supplement or financial incentive (similar to Janani Suraksha Yojana) during the treatment would go a long way in reducing drop-outs and ensuring completion of therapy.
While we deal with the problem in the present, it is critical to plan for the future. The development of effective TB vaccines is vital. Although the Bacillus Calmette-Guerin vaccine is administered to all newborns, it is only effective for the first few years. There is an urgent need to invest in research and development and focus on indigenous TB vaccines. Public-private partnerships in research can go a long way in converting leads from academic laboratories into useful products. India is considered a pioneer in TB prevention and control. But substantial reductions can only be achieved if appropriate policies are followed, effective clinical and public health management is ensured and strong political commitment guides the effort.
The writer is director at the National Institute of Research in Tuberculosis in Chennai and leads the research programme on TB/HIV
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