India focuses on drug resistant TB to meet 2025 deadline

The Indian government on Saturday released the world's largest National Anti-TB Drug Resistance Survey (NDRS) and India TB Report 2018 to help plan a strategy to meet the ambitious goal of eradicating tuberculosis from India by 2025.

"This is a tall order but I am confident that if we all work together, if all the partners combine together and we ensure full treatment is given on regular basis we can show the world this can be achieved. I am confident of this and my confidence is backed by our success in eradicating Polio," said Health Secretary Preeti Sudan at a function on the occasion of 'World TB Day'.

"The Prime Minister has called for 'TB Mukt Bharat' which can only be possible if we ensure our panchayat and blocks are declared TB free. For that Government has adequately provisioned drugs and diagnostic in every part of the country," she said after releasing the two reports.

The anti-TB drug resistance survey, noting India has more new TB patients annually than any other country globally, contributing to 27 per cent of the world's TB burden and about 2.79 million TB patients are estimated to be added annually, says more than a quarter of patients in India have drug resistance to one or the other anti-TB drug.

As per the Global TB Report 2017, worldwide about 4.1 per cent of new TB patients and 19 per cent of previously treated TB patients have multidrug resistant-TB (MDR-TB), which is TB resistant to at least two of the first-line drugs - isoniazid and rifampicin.

The estimated number of MDR-TB in India is 147 000, accounting for one fourth of the global burden of MDR-TB. "The treatment success rate among MDR-TB patients in India is consistently about 46 per cent and the death rate is around 20 per cent, as against the global level of treatment success rate of 52 per cent and death rate of 17 per cent," the survey said.

Extensively drugresistant TB (XDR-TB), defined as MDR-TB with additional resistance to at least one fluoroquinolone and one second line injectable drug, has been reported by 123 countries. The proportion of XDR-TB among MDR-TB patients is 6.2 per cent worldwide.

"In view of the above, the Government of India decided to conduct a National Anti-TB Drug Resistance Survey (NDRS) to know the prevalence of drug resistance among TB patients with particular focus on MDR-TB among both new and previously treated TB patients," it said.

There were wide variations in the state-wise levels of drug resistance, highlighting that national level estimates tends to mask the local and focal epidemics that need to be addressed with specific interventions.

The survey suggested setting up and strengthening drug resistance surveillance including using state of art next generation sequencing.

"This will provide the programme with the trends of drug resistance, transmission patterns and mapping of hot spots in different states for better understanding of molecular epidemiology for TB surveillance," it said.

As per the India TB Report 2018, centrally sponsored Revised National TB Control Programme is scaling up its policy of Universal Drug Susceptibility Testing, whereby all cases diagnosed with TB will get a minimum of rifampicin and isoniazid resistance testing.

"The programme adopted a Direct Benefit Transfer mechanism for transfer of monetary support and incentives to patients," the report said. Further, the programme has modified its diagnostic approach to drug sensitive and drug resistance TB cases.

--IANS

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