Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis, primarily affecting the lungs but capable of impacting other body parts if left untreated. This airborne illness spreads when individuals with lung TB cough, sneeze, or spit, releasing germs into the air that can be inhaled by others. TB remains a significant global public health concern, and its burden is particularly pronounced in India, which accounts for a substantial portion of worldwide cases and deaths.
The Scale of the Challenge
India carries the highest global burden of tuberculosis. In 2023, approximately 2.8 million people were newly affected by TB in India, accounting for over one-fourth of the world’s new cases and 26% of global TB cases and deaths.
The human cost of tuberculosis in India is substantial, with an estimated 323,200 deaths in 2023, translating to about 37 citizens dying every hour. The disease also places a considerable strain on the healthcare system, impacting physical, psychological, and economic well-being. Beyond individual suffering, TB has a broader economic impact due to lost workdays, estimated at 100 million annually.
Drivers of the Epidemic
Several factors contribute to the TB epidemic in India. Socio-economic determinants play a considerable role, with poverty, malnutrition, and overcrowding creating environments conducive to disease transmission. These conditions can weaken immune systems, making individuals more susceptible to developing active TB disease from a latent infection.
Challenges within the healthcare system also fuel the epidemic, including issues with timely diagnosis and treatment. The unregulated private healthcare sector can sometimes lead to misdiagnosis or incomplete treatment, contributing to drug resistance. The misuse of anti-tubercular drugs has resulted in the emergence of drug-resistant strains like Multi-Drug Resistant TB (MDR-TB) and Extensively Drug Resistant TB (XDR-TB). India had 1.1 lakh MDR-TB cases in 2022 and accounts for 27% of global multi-drug resistant tuberculosis.
Biological factors, such as co-infection with HIV, exacerbate the TB burden. HIV weakens the immune system, making individuals more vulnerable to TB progression, and TB remains a leading cause of death among people living with HIV. Undernutrition, alcohol use disorders, and smoking also contribute significantly to new TB cases.
India’s Response to Tuberculosis
The Indian government and various stakeholders have implemented several strategies and programs to combat tuberculosis. The National Tuberculosis Elimination Program (NTEP) is a prominent initiative aimed at eliminating TB by 2025, five years ahead of the global target. This program, scaled up nationwide by 2006, is a large-scale TB control effort, placing over 100,000 patients on treatment each month.
NTEP employs various approaches, including active case finding to identify new infections and ensure timely diagnosis. Treatment protocols, such as Directly Observed Treatment, Short-course (DOTS), are central to the strategy, ensuring patients take medication to prevent drug resistance. The program also focuses on public awareness campaigns to reduce stigma, alongside patient support schemes like Nikshay Poshan Yojana, which provides nutritional support.
India’s efforts have yielded some positive outcomes, with a 16% decline in TB incidence and an 18% reduction in mortality since 2015. The incidence rate fell from 237 per lakh population in 2015 to 199 per lakh in 2022, and the mortality rate decreased from 28 to 23 per lakh population during the same period. The notification of TB cases has also improved by over 50% in the past nine years, with nearly 32% of notifications in 2023 coming from the private healthcare sector.
Overcoming Hurdles and Looking Ahead
Despite progress, the fight against TB in India faces persistent challenges. Ensuring treatment adherence remains a hurdle, as incomplete or inconsistent medication intake can lead to drug resistance and treatment failure. Addressing the growing burden of drug-resistant TB, including MDR-TB and XDR-TB, demands specialized and longer treatment regimens, which can be difficult to manage.
Stigma associated with TB can deter individuals from seeking timely diagnosis and treatment, while reaching vulnerable populations poses logistical difficulties. Securing adequate and sustained funding is also an ongoing challenge, impacting the scale and reach of interventions. Domestic funding for TB prevention and treatment increased by 38% in 2023 to $253 million, although it remains lower than pre-COVID figures.
Looking ahead, future strategies for TB elimination in India include the continued integration of new diagnostics, drugs, and vaccines. Innovations in diagnostic technology, such as digital chest X-rays read by teleradiologists, show promise for faster and more accessible diagnosis. Research into the genetic profile of bacterial populations can help adapt treatment regimens to counter bacterial evolution and drug resistance. The long-term vision involves a comprehensive approach that strengthens primary healthcare infrastructure, addresses socio-economic determinants, and fosters community engagement to achieve the goal of TB elimination.