In a recent report released by the World Health Organization (WHO) on Tuesday, it was disclosed that more than a quarter of the world’s tuberculosis (TB) patients are located in India.
The staggering statistic reveals that India recorded a substantial 28 lakh cases in 2022. However, amidst the concerning numbers, the report also sheds light on some optimistic trends, notably the reduction in TB mortality and incidence over the past eight years.
One key area of improvement highlighted in the report is the enhancement of India’s case detection system. The report underscores the importance of timely diagnosis, not only for the patients but also to mitigate the risk of infection for their contacts.
Despite the challenges posed by the COVID-19 pandemic, the country’s TB reporting has rebounded to 2019 levels, indicating a positive trajectory in surveillance programs.
Nevertheless, the WHO report comes with a cautionary note, suggesting that some of the “new cases” reported may, in fact, be undiagnosed patients from the pandemic years, emphasizing the need for continued vigilance.
Challenges and Progress in Tuberculosis Management
The report emphasizes that the greatest medical challenge lies in addressing the multi-drug resistant (MDR) variant of TB. The WHO estimates a staggering 1,19,000 new cases of MDR TB emerging in India each year.
However, the country’s TB program reports just over half of this figure. The discrepancy is attributed to factors such as inappropriate prescription, incorrect dosage, poor drug quality, and failure to complete medications.
A noteworthy recommendation from experts is the adoption of molecular diagnostics for TB, similar to those extensively used for COVID-19 detection. Despite WHO’s endorsement of molecular tests, the latest India-TB report indicates that the traditional sputum smear test remains the predominant method in most parts of the country. This method, however, can only detect half of the MDR TB cases, potentially contributing to a high percentage of patients going undiagnosed.
Treatment Challenges and the Road Ahead
TB treatment poses significant challenges for patients, caregivers, and physicians alike. The medication, known for its demanding nature, often leads to side effects ranging from nausea to jaundice. The report highlights the importance of supportive physicians to guide patients through the demanding therapy. Unfortunately, such supportive care is reportedly a rarity in India’s healthcare system.
Notably, less than 68 percent of MDR TB patients who initiated treatment in 2020 completed it a year later. Furthermore, less than 50 percent of drug-resistant TB patients were administered bedaquiline, a shorter-duration drug recommended by WHO since 2019.
With the current trends, it appears that India may miss its target of eliminating TB by 2025. The report calls for policymakers to draw insights from recent studies, including the WHO report, to address the challenges and work towards more effective TB management strategies.
Conclusion
The WHO’s recent report on tuberculosis in India underscores both the progress made and the challenges that persist in the country’s fight against this pervasive disease. While there is cause for optimism in the reduction of TB mortality and incidence over the past eight years, the alarming number of cases and the prevalence of the multi-drug resistant variant necessitate urgent attention.
The report highlights the resilience of India’s case detection system, rebounding to pre-pandemic levels despite the disruptions caused by COVID-19. However, the cautionary note about the possibility of undiagnosed cases from the pandemic years underscores the importance of continued vigilance and robust surveillance.
As India strives to meet its target of eliminating TB by 2025, policymakers must heed the lessons from this report and prioritize the implementation of effective strategies. Support for patients, caregivers, and physicians, along with the widespread adoption of modern diagnostic tools, is crucial to overcoming the hurdles in TB management.
In the face of persistent challenges, the WHO report serves as a call to action—a reminder that the battle against tuberculosis requires unwavering commitment, innovative solutions, and a united effort from the healthcare community and policymakers alike.
