Future goals include the programme’s integration with health services and expansion of diagnostics services
Tuberculosis (TB) has always existed as an unprecedented silent pandemic worldwide. Globally, 10 million people, with a sizeable number from India, are affected by the deadly and infectious disease. Large-scale, sustainable efforts to eliminate TB are thus the need of the hour.
We observed the World TB Day on March 24 under the committed leadership of Prime Minister Narendra Modi and Union Health Minister Mansukh Mandaviya, who addressed the nation with the challenges and roadmap to attain the TB elimination goal. While India has been making consistent efforts to ramp up its services by treating more than 10 million TB patients under the national programme, we are still far from the 2030 Sustainable Development Goals (SDGs) and the 2035 End TB targets.
Owing to the Covid-19 crisis, TB care suffered a major collateral damage in the last two years. The first two waves of the pandemic severely impacted TB diagnosis and treatment services. Wewitnessed approximately 25 per cent reduction in the annual notification of TB cases between 2019 and 2020. Furthermore, it impacted operational support and services with hindrance to easy access to diagnostic services, treatments, and support services for the disease during this period.
Elimination of TB is an ongoing strategic mission, persistently requiring augmented testing capacity, active screening and implementation of strategies for easy identification of TB hotspots. We have state-of-the art tools to tackle the challenge of TB diagnostics in the form of field-based TB detection machines and kits. We now need to ramp up the response to further increase detection and ensure that all those who are in need of treatment can access it.
In this post-Covid-era, TB diagnostic services need pandemic preparedness by leveraging technology to enable door-to-door testing. With a mindset coupled with innovation, self-testing kits like in COVID diagnostics would serve as a big boon in active and early detection. To achieve this, a greater number of accredited private laboratories need to be involved for state-of-the-art testing.
This year’s theme for World TB Day was “Invest to End TB, Save Lives”. Innovation in TB diagnostics can transform public health screening in a big way. Utilizing Artificial Intelligence (AI) to decode scans and X-Rays can transform screening workflows and deliver improved outcomes while enabling substantial cost savings. Rapid and reliable results and reporting also ensure that suspected patients can be educated on-the-spot and cases are not lost for follow-up.
Regulating and monitoring the spread of TB, especially in this era and particularly in a densely populated country like ours, is a Herculean task. Channelisation of the huge resources and manpower in the last two years caused damage to the very fragile gains we have had in TB care.
We have capacity building for TB pandemic like case notification, promotion of active surveillance, contact tracing, and effective infection control measures and there is continued requirement for further research and strengthening of faster and reliable notification and extensive contact tracing of both TB and COVID cases. Promotion of virtual media for information, education and communication in order to create health awareness among community as well as health care workers is an important and desirable strategy to achieve this goal.
One of the most limiting factors in the TB roadmap is to have intact procurement and supply management systems to ensure adequate supplies of TB medications and timely ordering of new drugs to avoid stock-outs. The Government has provided directives under NTEP to continue uninterrupted services across all states and union territories and support patients on DOTS treatment by ensuring adherence, monitoring of side effects from the medications, health education, and providing psychosocial support.
Difficult times require a more intensive approach. To achieve this, we need to focus on virtual OPD or video-observed therapy, smart pill boxes, and other mobile phone-supported adherence strategies. 99 DOTS is a remarkable initiative in our programme to achieve this and it needs continuous heightened reinforcement and regulation. The frontline health-care workers as well as community volunteers may be appointed for awareness raising, prevention, and ensuring adherence. The strategic pillars of our programme are ‘Detect-Treat-Prevent-Build”. Over the last National Strategic Plan period, we did make significant gains in strengthening the support structures, program architecture, and implementation environment for TB control.
Integration of the program with the health services, expansion of diagnostics services, programmatic management of drug-resistant TB(PMDT) service expansion, and single-window service for TB-HIV cases along with drug resistance surveillance are near future goals and further building blocks to achieve a “TB-Mukt Bharat”.
(The writer is a Consultant,Infectious Diseases, Fortis Memorial Research Institute, Gurugram. The views expressed are personal.)