More than 1 in 10 TB patients drop out, develop drug resistant disease

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Radiologist examines chest x-rays
Radiologist examines chest x-rays

Drug resistance has emerged as one of India’s biggest challenges, forcing the landmark decision of making non-notification of TB a criminal offence

As India prepares to end TB five years ahead of the global target of 2030, the annual tuberculosis report has brought some alarming news. India’s first National Drug Resistance Survey results have shown that the rates of multi drug resistant (MDR) TB among new TB patients is 2.84% and that in previously treated it is 11.60 %.

According to the Global TB report 2017, the total burden of TB in India is estimated to be 28,00,000, a quarter of the world’s TB cases.

This means that more than one in ten TB patients drop out of the long regimen before time and go on to develop MDR TB making treatment more difficult.  Multidrug-resistant TB (MDR TB) is caused by an organism that is resistant to at least isoniazid and rifampin, the two most potent TB drugs. These drugs are used to treat all persons with TB. This is one of those statistics that contributed to India’s recent decision to make it a penal offence for doctors and chemists to not report TB cases. The move is expected to better patient compliance.

According to the Global TB report 2017, the total burden of TB in India is estimated to be 28,00,000, a quarter of the world’s TB cases.

Since 2007-08, annually, the Revised National TB Control Programme (RNTCP) which is the national programme for the disease, screens approximately 20 million symptomatic persons by microscopy for TB and initiates about 1.5 million persons on TB treatment. CBNAAT and Line Probe Assay introduced in 2009 and scaled up from 2012 onwards, have ensured that rapid molecular diagnostics are available throughout the country. In 2017, 7,32,449 patients have been tested using these methods and 38,854 Rifampicin resistant/MDR-TB patients have been
diagnosed.

In her foreword, Union health secretary Preeti Sudan talked about India’s initiative towards active case finding that is also designed to ensure that patients who have fallen out of the radar of the TB control network are brought back in time and started once more on the medication. In the Union Budget this year a nutritional support of Rs 500 per month was announced for all TB patients irrespective of their financial status.

The National Strategic Plan is aiming to achieve elimination of TB, by 2025. During the plan period, targets are:
* 80% reduction in TB incidence (i.e. reduction from 211 per lakh to 43 per lakh)
* 90% reduction in TB mortality (i.e. reduction from 32 per lakh to 3 per lakh)
* 0% patient having catastrophic expenditure due to TB