Opinion TB in India: A fight to the end

More than a fourth of the world’s TB patients live in India, according to the WHO report released on Tuesday. The country recorded a staggering 28 lakh cases in 2022. Nevertheless, the report finds cause for optimism in the reduction in TB mortality and incidence in the past eight years. It also acknowledges the improvements made by the country’s case detection system — remaining undiagnosed doesn’t just delay treatment for those with bacterial disease but also puts their contacts at risk of infection. The positive score on TB reporting is reassuring, given that surveillance programmes had taken a hit during the Covid years — case detection levels have rebounded to 2019 levels. However, the global health agency has also put in a caveat — it has not ruled out the possibility of several “new cases” being actually undiagnosed patients from the pandemic years.

Medically, the greatest challenge is posed by the multi-drug resistant (MDR) variant of the disease. The WHO estimates that 1,19,000 new cases of this extremely virulent variety of TB emerge in India each year. However, the Indian TB programme manages to report a little over half of this. A growing body of scholarship testifies that inappropriate prescription, wrong dosage, poor quality of drugs and failure to complete the medications have precipitated India’s MDR TB epidemic. In recent times, experts have advocated the use of molecular diagnostics to treat contagious diseases such as TB. These tests were extensively used for Covid detection and they can be repurposed for TB diagnostics. The WHO, too, recommends molecular tests. However, the latest India-TB report shows that the traditional sputum smear test continues to be the predominant testing method in most parts of the country. Microscopy can at best detect half of MDR TB cases — that explains the high percentage of patients falling under the radar in the country.

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TB treatment is demanding on patients, their caregivers and physicians. The medication takes its toll on the already weak patient, with effects ranging from nausea and loss of appetite to jaundice. Treatment requires an assuring and caring physician to handhold the patient through the difficult period of therapy — a relative rarity in India’s healthcare system. That’s one reason that less than 68 per cent of MDR TB patients who began treatment in 2020 completed it a year later. Moreover, last year, less than 50 per cent of drug-resistant TB patients were put on bedaquiline, the shorter-duration drug recommended by the WHO since 2019. By all accounts, the country will miss its target of eliminating TB by 2025. Policymakers must take their cues from recent reports, including WHO’s study.