Syllabus
GS Paper 2 – Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources
Applications where to apply?
When asked about
– Communicable diseases
– TB Elimination Programme
– Antimicrobial resistance
– Technology in health-care
Context
India is regarded as ‘Tuberculosis hotspot’, there is urgent need to address issues in our TB strategy.
Source
The Hindu | Editorial dated 25th March 2024
The TB fight
Tuberculosis (TB) remains a significant global public health challenge, affecting millions of lives annually, with India bearing a substantial burden of the disease. Despite concerted efforts and ambitious goals set by health authorities, progress in TB control has been slower than anticipated.
Tuberculosis (TB)
Tuberculosis (TB) is a contagious disease caused by the bacteria Mycobacterium tuberculosis (MTB). While primarily affecting the lungs, MTB can disseminate to other parts of the body.
Data Point
- TB Impact Globally – WHO estimates:
- Every day, 3,500 people worldwide lose their lives to tuberculosis (TB).
- Around 30,000 people become infected with TB bacilli daily.
- TB Impact in India:
- India alone accounts for 27% of global TB cases.
- TB incidence reduced by 16% from 2015 to 2022 in India.
- TB mortality reduced by 18% from 2015 to 2022 in India.
- TB Diagnosis:
- Globally, 7.5 million patients were diagnosed with TB in 2022.
A gap of approximately 3.1 million people existed who likely had TB but were not diagnosed and reported to national TB programs.
Challenges in combating TB
- Access to Efficient and Quality Care: Despite ambitious goals, access to efficient and high-quality care, including diagnosis, treatment, and support, remains limited.
- Many individuals suspected to have TB or diagnosed with the disease lack access to necessary care, exacerbating the challenge.
- Lack of Person-Centered Approach: There’s a need for a paradigm shift towards a person-centered approach, prioritizing the needs and interests of patients and communities within the healthcare system.
- The lived experiences of TB patients are often overlooked, leading to gaps in understanding their needs and challenges.
- Medicalization of TB: TB is sometimes over-medicalized, neglecting its broader implications as a human, gendered, economic, social, and environmental crisis.
- Efforts to address stigma, gender responsiveness, and mental health support are crucial but insufficient.
- Limited Access to Diagnosis and Treatment: India needs targeted interventions to improve and expand access to TB diagnosis and treatment, especially in rural and underserved areas.
- Molecular testing, the gold standard, remains inaccessible to a significant portion of symptomatic patients.
- Humanitarian Care: There’s a necessity to make TB care more humane, including mental health support and gender-responsive care.
- Strengthening community-based care models can address not only treatment but also social, economic, and mental health needs.
- Socioeconomic Determinants: TB disproportionately affects marginalized communities, exacerbating economic challenges and perpetuating poverty.
- Addressing socioeconomic determinants such as poverty, malnutrition, and housing conditions is essential for TB control.
- Drug Resistance and Treatment Adherence: Controlling antibiotic resistance and ensuring treatment adherence are significant challenges in TB management.
10-Point Agenda Towards Ending TB in India
- Early Detection: Implement compulsory screening for family and contacts of each index case to ensure early detection.
- Strengthen laboratory facilities and establish efficient follow-up mechanisms within health systems to minimize delays in reporting.
- Precise Treatment Categorization: Enhance efforts to determine resistance status at the time of diagnosis to assign appropriate treatment regimens promptly, especially with the rise of drug-resistant TB strains.
- Treatment Adherence and Follow-up: Utilize technology to monitor treatment adherence and follow-up, addressing challenges such as non-compliance due to long treatment durations and mobility of patients.
- Zero Mortality: Prioritize strategies to mitigate mortality associated with TB, including improving access to quality care and treatment for both drug-resistant and non-pulmonary TB cases.
- Controlling Drug Resistance: Implement measures to control the emergence of drug-resistant TB, focusing on regulating antibiotic use and enhancing compliance with treatment regimens.
- Assessing Extent of Drug-Resistant TB: Collect data on the prevalence of rifampicin-resistant TB and multidrug-resistant TB to inform targeted interventions and resource allocation.
- Availability of Appropriate Medicines: Address procurement challenges for DR-TB medications and ensure adequate treatment facilities for all DR-TB cases, including in-patient care when necessary.
- Integration into Larger Health Systems: Strengthen referral networks within and between different levels of public and private health systems to ensure comprehensive care and continuity of treatment.
- Dynamic Notification System: Enhance the notification system to capture real-time TB data and facilitate coordination between sectors and practitioners for more effective disease surveillance and response.
- Considering Population Mobility and Migration: Develop policies to enable portability of TB treatment within the country, acknowledging the impact of mobility on healthcare seeking behaviours and treatment outcomes.
Leveraging Technology Solutions to eliminate TB
Leveraging technology and innovation, such as AI and digital health solutions, holds promise in enhancing TB care efforts.
- X-ray Imaging with AI:
- Utilizing portable X-ray devices equipped with AI-driven software for TB detection, enabling rapid and accurate screening at the point of care.
- This technology can detect TB cases, even in individuals without apparent symptoms, improving early detection rates and facilitating timely treatment initiation.
- Molecular Testing and NAAT Machines:
- Scaling up molecular diagnostic capacity through nucleic acid amplification test (NAAT) machines for rapid and accurate detection of TB and drug resistance.
- Despite challenges like cost and accessibility, expanding the deployment of NAAT machines can enhance diagnostic coverage and reduce missed TB cases.
- Alternative Sample Collection Techniques:
- Exploring alternative sample collection methods, such as tongue swabs, to simplify and improve the accessibility of TB testing.
- These innovative approaches can overcome challenges associated with traditional sputum collection, particularly in vulnerable populations like children.
- PCR Machines for Diagnosis:
- Leveraging Polymerase Chain Reaction (PCR) machines, already utilized during the COVID-19 pandemic, for TB diagnosis and expanding their reach to remote areas.
- PCR technology offers rapid and accurate detection of TB bacteria, contributing to improved diagnostic efficiency and patient management.
- Urine LAM Test:
- Implementing rapid urine lipoarabinomannan (LAM) testing for TB screening in both pulmonary and extra-pulmonary cases.
- This point-of-care test provides a quick and convenient diagnostic option, particularly for resource-limited settings, improving access to TB diagnosis.
Conclusion
Tackling the TB epidemic in India requires a multifaceted approach that goes beyond conventional medical interventions. By prioritizing person-centred care, addressing socio-economic disparities, leveraging technology for early diagnosis and treatment monitoring, and strengthening healthcare systems, India can make significant strides towards TB elimination.
Related Topics
Clinical Trials of MTBVAC in India
Bharat Biotech, in collaboration with Spanish biopharmaceutical company Biofabri, is conducting clinical trials of the MTBVAC tuberculosis vaccine in India.
- The vaccine was developed in the laboratory of the University of Zaragoza with Dr. Brigitte Gicquel of the Pasteur Institute, Paris.
- Unique Vaccine Composition:
- MTBVAC is the only vaccine in clinical trials against tuberculosis based on a genetically modified form of Mycobacterium tuberculosis isolated from humans.
- Unlike the BCG vaccine, MTBVAC contains all antigens present in strains infecting humans, potentially enhancing its effectiveness.
- Trial Phases:
- Phase 1 and 2 trials of MTBVAC have been completed in other countries by Biofabri.
- Bharat Biotech will conduct Phase 3 trials in India, focusing on evaluating safety, immunogenicity, and efficacy.
- Importance of India’s Participation:
- India’s involvement in the trials is significant due to its high burden of tuberculosis cases, representing 28% of global TB cases.
- Studying the vaccine’s safety, immunogenicity, and efficacy in India’s diverse population is crucial for its advancement.
- MTBVAC aims to be more effective and longer-lasting than the BCG vaccine, particularly for newborns and prevention of TB in adults and adolescents.
BCG’s limited effectiveness against pulmonary tuberculosis highlights the need for more efficacious vaccines like MTBVAC.
References
The Hindu. Clinical-trials-of-spanish-tuberculosis-vaccine-mtbvac-begin-in-india
Practice Question
Discuss the challenges in achieving TB elimination in India. Highlight innovative strategies and technologies that can accelerate progress towards TB elimination. [250 words]