23 March 2023: The road to ending tuberculosis

Context:

The G20 presidency of India this year, the StopTB board meeting in Varanasi this week, and the United Nations High-Level Meeting on TB in September this year give the ideal platform for India’s efforts to speak loudly, allowing the world to eradicate TB sooner.

Tuberculosis: 

• Mycobacterium tuberculosis is the bacteria that causes tuberculosis (TB). TB germs often attack the lungs, but they can affect any region of the body, including the kidney, spine, and brain.
• Transmission:
  • Tuberculosis spreads through the air from person to person.  When persons with lung tuberculosis cough, sneeze, or spit, the TB germs are released into the air. 
• Every age group is at risk. More than 80% of illnesses and fatalities occur in low- and middle-income nations.
• Symptoms:
  • A cough with mucus and blood at times, chest pains, weakness, weight loss, fever, and night sweats are all common signs of active lung TB.
• Treatment:
  • Tuberculosis is a treatable and curable illness.  Drug-susceptible tuberculosis is treated with a normal 4-month or 6-month course of four antimicrobial medicines, with patient assistance given by a health worker or certified treatment supporter.
  • Isoniazid and rifampicin are two of the most effective first-line drugs.

Global initiatives:

• End TB strategy:
  • Ending tuberculosis is not only a public health issue, but also a development challenge and opportunity. The World Health Organisation’s post-2015 End TB Strategy, approved by the World Health Assembly in 2014, intends to eliminate the worldwide TB epidemic as part of the newly ratified Sustainable Development Goals.
    • SDG Target 3.3 calls for the TB epidemic to be eradicated by 2030.
  • It is a strategy for countries to follow in order to reduce TB incidence by 80%, TB deaths by 90%, and catastrophic expenses for TB-affected families by 2030. The strategy is not a “one-size-fits-all” strategy, and its effectiveness is dependent on adaptation to different national contexts.
• The global fund:
  • The Worldly Fund to Fight AIDS, Tuberculosis, and Malaria began disbursing the first round of money focused towards the worldwide TB pandemic in 2003.
  • The Global Fund assists nations in incorporating innovation into their care models, such as utilising TB data to enhance care or implementing quality improvement measures to guarantee that persons at risk of or with TB may be diagnosed, get care, and effectively complete their treatment.
• In November 2017, the WHO and the Russian government conducted the first global ministerial meeting on tuberculosis.
• The United Nations (UN) hosted its first-ever high-level conference on tuberculosis (TB) on September 26, 2018, raising debate about the condition of the TB epidemic and how to end it to the level of the heads of state and government.

Stop TB Partnership

• The Stop TB Partnership, founded in 2001, is a United Nations-hosted organization that takes calculated risks to meet the needs and raise the voices of individuals, communities, and nations affected by tuberculosis.
• Its objective is a world free of tuberculosis, but until that time, it will make diagnosis, treatment, and care available to those who require them.

Initiatives are taken by India:

• The National Tuberculosis Elimination Programme (NTEP), formerly known as the Revised National Tuberculosis Control Programme (RNTCP), intends to decrease the TB burden in India by 2025, five years ahead of the SDGs.
• The National Strategic Plan for Tuberculosis Elimination (2017-2025) was launched with the goal of eliminating TB by 2025.  It is a multi-pronged approach aimed at detecting all TB patients, with a focus on TB patients seeking care from private physicians and undiagnosed TB in high-risk areas.
• All TB patients in tribal notified blocks are eligible for a travel grant of 750 rupees.
• Community treatment supporters who support patients during treatment, resulting in a successful outcome, are compensated with:
  • Rs.1000 for Drug Sensitive TB, 
  • Rs.2000 for completion of the Intensive Phase, and 
  • 3000 rupees for completing the Continuation Phase of treatment for Drug-Resistant Tuberculosis.
• Nikshay Poshan Yojana, which began on April 1, 2018, provides 500 rupees per month to all TB patients for nutritional support for the course of their treatment.

Three key underserved areas:

• Development and widespread use of an adult tuberculosis vaccine:
  • The present one, which is provided at birth and is especially important for youngsters, is 100 years old. 
  • Significance: The experience of the COVID-19 vaccine development process teaches us how things can be done if there is a strong collaborative will and activity.
  • India’s initiative: It’s also no surprise that Indian initiatives are prominently included on the list of vaccines in development. 
  • Issue or challenge: The difficulties of equal distribution demonstrated with the COVID-19 vaccinations must be avoided at all costs. This is another area where India’s strengths shine.
• Development of novel treatment medicines for tuberculosis:
  • Following a nearly five-decade development drought, a few novel anti-TB medications are now accessible for general usage, if only pricing and production capacity were no restrictions.
  • Moving to an injection-free, all-oral tablet regimen for tuberculosis (the current norm is at least six months) will enhance patient compliance and minimize patient tiredness.
  • Significance: The effort to develop a slew of newer drugs must be accelerated so that when drug resistance develops to the most recently introduced drugs, we will have newer therapies available.
  • Issue/challenge: Current drug-resistant TB estimations are disheartening at best and worrisome at worst.  Not having a ready pipeline of newer medications is a mistake made in the past.
• Diagnosis:
  • There are significant breakthroughs in the use of AI-assisted portable radiography for diagnosing tuberculosis, with 90-second reporting and 95%+ accuracy. This is a mature technology that should be used widely right now.
  • Another area of progress is the use of sentinels, passive surveillance, and the interpretation of cough sounds to detect tuberculosis. This enables unobstructed home-level screening and monitoring, as well as nudges to seek therapy.
  • Significance: This technology is ready for larger-scale deployment and has the potential to revolutionise the way public places and other air quality indicators are monitored.
  • India’s initiative: For COVID-19, India hosted the InDx diagnostics coalition in Bengaluru. This and other biotech businesses should be rewarded for breaking through the complexity of molecular testing and pricing barriers with low-cost, high-quality technologies. New developments in this area should allow the current money available for the procurement of TB tests to be used twice as much.

Source: The Hindu, WHO, PIB