India has the largest number of multidrug-resistant tuberculosis cases, 27 per cent of the global total, Minister of State for Health Ashwini Choubey has said. However, according to the latest global TB report, India ranks 38th in the number of MDR-TB patients per lakh population (9.6).
“The estimated number of multidrug-resistant/ Rifampicin-resistant TB (MDR/RR TB) patients in India for 2018 is 1,30,000, which contributes to about 27 per cent of the global burden,” Choubey said.
Resistance to anti-TB drugs can occur because of faulty prescriptions which was previously rampant in the private sector, and is now being managed through better engaging the private sector for detection and treatment of TB, he said. Resistance can also occur if the treatment is discontinued before the prescribed time, Choubey explained in a written reply to the Lok Sabha.
To address the issue, the Revised National Tuberculosis Control Programme (RNTCP) conducts information, education and communication (IEC) activities to increase awareness in the public.
The programme recognises that a delay in treatment initiation may cause adverse outcomes.
Hence, since 2016 RNTCP has shifted from notification at treatment initiation to notification at diagnosis. This helps in following up all the patients who are diagnosed and ensure that they are initiated on treatment, the minister said.
The government has taken several other corrective measures like active case finding (ACF) in vulnerable and high risk populations to actively screen symptomatics and detect TB patients, private sector engagement to increase notification and provision of public health action and ensuring availability of free diagnostics and medicines to patients seeking care in the private sector as well.
It has also initiated strengthening of sputum collection and transport mechanisms to ensure early diagnosis. The programme has also tied up with India Post to increase access.
Other mechanisms being strengthened at the local level involve MoUs with courier agencies, human couriers. Measures also include increasing the network of rapid molecular diagnostics to ensure detection of drug resistance at the earliest. The Programme has rolled out universal drug susceptibility testing (UDST) since 2018 as per which resistance testing for Rifampicin is mandatory for all notified TB patients, he said.
Communication campaign aimed at raising levels of awareness, reduction of stigma among community, both through mass and mid media are also being held. Prime Minister had launched ‘TB Free India’ campaign on March 13, 2018 to end TB in India by 2025. To pursue the goal, the government has been implementing National Strategic Plan (NSP) (2017-25) to End TB by 2025.
Active Case Finding is one of the most important strategy being implemented to find the missing cases in the community. In 2017, three rounds were conducted as national campaign, more than 5.5 crore population had been screened and a total of 26,781 additional TB cases were diagnosed.
In 2018, three rounds were conducted as national campaign, more than 18.9 Crore population had been screened and total 47,307 additional TB cases diagnosed.
The health minister also launched the TB Harega Desh Jeetega Campaign on September 25, 2019 in which new sets of IEC material have been launched and disseminated to states.