Tuberculosis (TB) and National Strategic Plan for TB Elimination - Testbook

What is Tuberculosis (TB)?

Tuberculosis (TB) is a severe bacterial infectious disease primarily caused by Mycobacterium tuberculosis. It usually affects the lungs but can also spread to other parts of the body.

Types of Tuberculosis (TB)

• Pulmonary Tuberculosis.
• Extrapulmonary Tuberculosis.

Causes of Tuberculosis

• Tuberculosis is a contagious airborne disease, which can be acquired from close contact with an infected person.
• Mycobacterium Tuberculosis is one of the main causes of this dreadful infectious disease.
• Infants and aged people are at a greater risk of catching TB infections.
• Individuals with a weak immune system due to HIV, diabetes are quickly exposed to this infectious disease.
• Mycobacterium Tuberculosis is a pathogenic bacterial species and mainly comprises of four other types of TB-causing bacteria namely:

Diagnosis of Tuberculosis

In addition to physical tests, other tests are available to diagnose the presence of the infectious bacteria. These tests include certain body fluids test – blood and sputum, skin test and chest X-rays.

• Blood Test: In this procedure, blood samples are collected and are tested in the laboratories for the presence or absence of TB germs in the blood cells.
• Skin Test: It is the most common type of test. In this procedure, a small sample of Tuberculin – a purified protein is injected under the patient’s skin. If the skin around the site of the injection gets swollen more than five millimetres then it is a clear indication of TB infection. This test is called the Mantoux tuberculin skin test (TST).

Symptoms of Tuberculosis

TB bacteria or Mycobacterium tuberculosis most commonly grow in the lungs and can cause severe symptoms such as:

Treatment for Tuberculosis

1. Drug treatment is one of the most effective ways to treat this infectious disease.
2. For patients with Latent TB infections, doctors generally prescribe an antibiotic called isoniazid to prevent the latent infection from becoming active.
3. Active TB Diseases will be deadly if it is left untreated.
   • The treatment involves taking a combination of ethambutol, INH, priftin and pyrazinamide for a term of three months followed by a mix of INH and pyrazinamide for 12 months.

Drug-Resistant TB

There is a global concern about the Multi-Drug Resistant TB (MDR-TB) which emerges in the host body due to lack of treatment drug; and the bacteria is not eradicated completely from the body due to interrupted course of antibiotic medicine.

• Since the bacteria are resistant to the first-line anti-TB drugs, the host is treated with second-line anti-TB drugs.

There exists an Extensively Drug resistance TB (XDR-TB) which is developed in the host body due to the high concentration of TB in an area making it very difficult to control. The XDR-TB bacteria strain is resistant to one or two medicines in the second-line antibiotic treatment.

Poor management at this state may lead to further mutation in bacteria leading to complete drug resistance known as Total Drug Resistance TB (TDR-TB).

India and Tuberculosis

Prime minister Narendra Modi will address the One World TB summit and is expected to announce various initiatives to achieve the 2025 TB elimination target on World TB day (24 March).

TB Cases in India:

• According to the Global TB report 2022 released by WHO, India is the largest contributor to global TB cases in the world and accounts for 28% of all TB cases in the world.
• TB incidence in India for the year 2021 is 210 per 100,000 population – compared to the baseline year of 2015 (incidence was 256 per lakh of population in India).
• According to the Global TB report the number of cases in India declined in 2021 and the reporting of cases is yet to reach pre-pandemic levels.
• According to the Ni-kshay portal of the government which helps in real-time reporting of new TB cases, there were 21.3 lakh cases detected in 2021 as compared to 18.05 lakh cases in 2020.
• The number of drug-resistant TB detected also went down by 20% during the period from 1.49 lakh cases in 2015 to 1.19 lakh cases in 2021.

What are the TB Elimination Targets set by India?

• The world target of elimination of TB under sustainable development goals is in the year 2030 but India has set a target five years in advance i.e., by 2025.
• The national strategic plan 2017-2025 sets the target of India reporting no more than 44 new TB cases or 65 total cases per lakh population by 2025.
• The national strategic plan also aimed to achieve a target of incidences of only 77 per lakh population in 2023 which is a challenging task.
• The TB mortality for the year 2020 was 37 per lakh population and the plan aims to reduce the TB mortality to 3 per lakh population.

Actions taken to achieve this Target:

• The government has stepped up actions to identify TB cases among vulnerable and co-morbid populations and also asked the private sector to report TB cases.
• Since the occurrence of the pandemic, a number of molecular test kits such as CB-NAAT and TureNat were made available in all districts in India.
• The government also implemented universal drug susceptibility tests to identify incidences of drug-resistant TB and initiate appropriate treatment. There were community engagement programs involving Ni-Kshay Mitras to provide nutritional support to TB patients.
• Bedaquiline and Delamanid are newer varieties of drugs included in the national list of essential medicines and also provided for free by the government for the treatment of TB.
• The researchers are testing new vaccines called Immuvac and VPM 1002 for an effective fight against the spread of TB.

Government Schemes for Tuberculosis

The Government of India has set a target of zero tuberculosis deaths by the year 2025. To fulfill this commitment, the Ministry of Health and Family Welfare has formulated the National Strategic Plan (NSP) for TB Elimination in 2017. The National Strategic Plan will guide the development of the national project implementation plan (PIP) and state PIPs, as well as district health action plans (DHAP) under the National Health Mission (NHM).

National Strategic Plan (NSP) for TB Elimination

The National Strategic Plan (NSP) for TB Elimination serves as a framework to guide all stakeholders, including national and state governments, developmental partners, civil society organizations, international agencies, research institutions, the private sector, and others whose work is relevant to the elimination of TB in India. This program operates on four strategic pillars: Detect – Treat – Prevent – Build [DTPB].

VISION: TB-Free India with zero deaths, disease, and poverty due to tuberculosis.

GOAL: To achieve a rapid decline in the burden of TB, morbidity, and mortality while working towards the elimination of TB in India by 2025.

Pillars of NSP for TB Elimination: Detect – Treat – Prevent – Build [DTPB]

Features of the National Strategic Plan for TB Elimination

1. Complete detection of TB cases by 2020 followed by 100% elimination of TB by 2025.
2. The Conditional Access Program (CAP) has introduced an Anti-TB Drug named Bedaqualine.
3. Under the Make in India program, development of a first-line anti-TB drug was proposed in the public sector.
4. A corpus fund for TB to be maintained under the Bharat Kshay Niyantran Pratishthan (BKNP) which is also known as the India TB control Foundation, is one of the visions of this NSP.
5. It aims at creating synergy through a shift from a regulatory approach to a partnership approach to streamline the services in the largely unorganized and unregulated private sector.
6. Technological implementation by creating a user-friendly online platform E-Nikshay to let doctors notify the cases as soon as they come across the infected patient.
7. Awareness about TB and its prevention among masses is important. Media campaigns are planned under this program to promote TB Preventive measures. Swasth E- Gurukul is one such initiative of the World Health Organization.

The biggest challenge facing TB control in India is delayed diagnosis and inadequate treatment, particularly among patients seeking care from private providers. The plan aims to detect and treat 100% of the TB cases and at the same time prevent further spread of the disease by building & strengthening the policies in this direction.

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