Why in News?
Drug-resistant tuberculosis (DR-TB) is a huge challenge that demands our urgent attention. With a quarter of the world’s DR-TB cases, India’s response can shape how other countries deal with this growing threat.
 
Tuberculosis: 
It is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs.
Transmission: TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air.
Symptoms: Cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats.
Treatment: TB is treatable and curable disease. It is treated with a standard 6 month course of 4 antimicrobial drugs that are provided with information, supervision and support to the patient by a health worker or trained volunteer.
TB Treatment: consists of four drugs:
·         Isoniazid (INH)
·         Rifampicin
·         Pyrazinamide
·         Ethambutol

Multidrug-Resistant TB (MDR-TB)  
·         In MDR-TB, the bacteria that cause TB develop resistance to antimicrobial drugs used to cure the disease.
·         MDR-TB does not respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs.
·         Treatment options for MDR-TB are limited and expensive. CBNAAT (Cartridges Based Nucleic Acid Amplification Test) is used for early diagnosis of MDR-TB.
 
Extensively Drug-Resistant TB (XDR-TB) 
·         XDR-TB is a form of multidrug-resistant TB with additional resistance to more anti-TB drugs.
·         People who are resistant to isoniazid and rifampicin, plus any fluoroquinolone and at least one of three injectable second-line drugs (amikacin, kanamycin, capreomycin) are said to have XDR-TB.
 
Current Scenario in India: 
The WHO estimates that 119,000 new cases of multidrug/rifampicin resistant TB (MDR/RR-TB) emerge in India each year. However, the Indian TB programme has notified only a little over half the estimate — 64,000 MDR/RR-TB cases — in 2022.
 
Background: 
·         In 1993, the World Health Organisation (WHO) declared TB a global health emergency.
·         Founded in 2001, the Stop TB Partnership (a UN-hosted organisation) takes bold and smart risks to serve the needs and amplify the voices of the people, communities, and countries affected by TB.
·         The Stop TB board meets in Varanasi, India, and will coincide with World TB Day 2023 (March 24).
·         The Global Fund to Fight AIDS, TB and Malaria (2002) began disbursing money directed towards the global TB epidemic in 2003.
·         However,the response has been short on urgency and long on processes.
·         For example, The Global Fund remains hostage to the zero-sum games imposed by donors and the champions of the three diseases.
 
Key areas that remain under-served: 
·         Development and wide use of an adult TB vaccine: The current vaccine is delivered at birth.
·         Getting newer therapeutic agents for TB.
·         Moving to an injection-free and shorter all-oral pills regimen for TB (the current standard is for at least six months) will improve compliance and reduce patient fatigue.
 
The space of diagnostics: 
·         There are exciting developments for use of AI-assisted handheld radiology with 90-second reporting and 95% plus accuracy for diagnosing TB.
·         This is a mature technology and should be rolled out universally immediately.
 
Best practices in India: 
·         The COVID-19 vaccine development process shows what can be done with the help of collective will and action.
·         India convened the InDx diagnostics coalition in Bengaluru for COVID-19.
·         TN-KET (Tamil Nadu KasanoiErappilaThittam/TB death-free project)
 
Measures taken by India to eradicate TB :
·         The National Tuberculosis Elimination Programme (NTEP) – Aims to strategically reduce TB burden in India by 2025.
·         It was previously known as Revised National Tuberculosis Control Programme (RNTCP).
·         The government reached over a billion people in 632 districts/reporting units.
·         The National Strategic Plan for TB Elimination – It was launched to achieve the target of ending TB by 2025 in a mission mode.
·         It is a multi-pronged approach which aims to detect all TB patients with an emphasis on reaching TB patients seeking care from private providers and undiagnosed TB in high-risk populations
·         Ni-kshay Poshan Yojana(NPY)(Nutritional Support to TB) –  It helps to meet the nutritional requirements of TB patients, especially the underserved
·         From 2018 till present, around Rs. 1,707 crore has been disbursed to more than 65 lakh people on TB treatment across the country
·         Patient Provider Support Agencies (PPSA) – To engage the private sector, Patient Provider Support Agencies (PPSA) have been rolled out across 250 districts through the domestic setup and JEET initiative
·         Universal Drug Susceptibility Testing (UDST) – To ensure every diagnosed TB patient is tested to rule out drug resistance before or at the time of treatment initiation itself.
·         Pradhan Mantri TB Mukt Bharat Abhiyaan – To bring together all community stakeholders to support those on TB treatment and accelerate the country’s progress towards TB elimination.
·         Ayushman Bharat – Health and Wellness Centres – To decentralize comprehensive primary healthcare including TB care services at the grassroots level.
·         Bedaquiline and Delamanid -Newer drugs like Bedaquiline and Delamanid have also been made available for management of DRTB.

Global measures to eradicate TB:  
·         End TB Strategy – by World Health Organization (WHO)
·         It serves as a blueprint for countries to reduce TB incidence by 80%, TB deaths by 90%, and to eliminate catastrophic costs for TB-affected households by 2030.
·         World Development Report (1993) – Published by the World Health Organization (WHO).
·         The 1993 World Development Report labelled TB treatment for adults as the best buy among all developmental interventions.
·         The Global Fund – A worldwide movement to defeat HIV, TB and malaria and ensure a healthier, safer, more equitable future for all.
·         The Stop TB Partnership – Brings together expertise from a broad spectrum of country, regional, and global partners in our shared mission to revolutionize the TB space and end TB by 2030
·         Sustainable Development Goal 3 – To end TB epidemic by 2030
In December 2022, WHO recommended the use of the BPaLM/BPaL regimen for DR-TB patients, which offers a s much higher success rate of 89 per cent, reduces the pill burden to only three to four pills a day and shortens the treatment duration. Studies estimate an annual saving of $740 million globally because of transition to BPaLM/BPaL. With India accounting for a third of the global MDR/RR-TB treated patients this could mean a saving of nearly $250 million per year for the country.
 
Way Forward: 
Focus should be on understanding the key determinants like poverty, under- nutrition and tobacco smoking. This is so that prevention is the approach and not cure. 
In addition to this the gaps in the public healthcare system must be addressed as this is the main medium through which millions of Indians seek treatment. 
Although the Revised National Tuberculosis Control Program has worked toward improving the diagnosis of patients with free tests, free TB drugs, extended adherence support to increase rates of TB treatment, completion and involvement of private healthcare providers, there is more that can be done.
The Government of India aims to eradicate tuberculosis in India by 2025 by involving the private sector, NGOs and caregivers to improve earlydiagnosis, treatment adherence and outcomes for TB patients, and intersectional collaboration between different platforms that promote access to healthcare with regard to tuberculosis.
 
Mains Question:
  Q:  Despite many efforts taken by GOI, India continues to be worst affected by tuberculosis- Analyse