Sounding tuberculosis alarm

The India TB Report 2020 is a reminder to all the States that next five years will be crucial to make the country tuberculosis free. The COVID-19 pandemic has affected various tuberculosis intervention programmes and has made the target of making India TB free by 2025 more difficult than could be visualised. In 2019, the country notified 24 lakh TB patients including 6.8 lakh patients notified by the private sector hospitals. The number of missing cases decreased to 2.9 lakh in 2019 from 10 lakh in 2017. The report presents the progress made in implementation of the National Strategic Plan over the initial three years and lessons learnt for dealing with the challenges for the remaining five years of the plan period from 2017 to 2025. The Health and Family Welfare departments of the states and other stakeholders, however, cannot lose sight of the disruption caused by the COVID-19 pandemic in the National Tuberculosis Elimination Programme. Though the numbers speak volume about the significant achievement made in TB notifications, the contribution of the private sector fell much below the expectation despite 35 per cent rise over 5.03 lakh private sector TB notifications in 2018. The achievement of private sector in TB notification was estimated at 28 per cent against the target of 54 per cent set in the National Strategic Plan for 2019. Among the North-eastern states, Nagaland accounted for the highest per cent of 34 per cent contribution by private sector in TB notification. In Assam, contribution of the private sector in the year was 23 per cent accounting for 8023 notifications of the total 48669 cases. In Tripura, the private sector contribution was the lowest at 1 per cent while it was only two per cent in Arunachal Pradesh, three per cent in Mizoram, four per cent in Sikkim, 18 per cent in Manipur and 20 per cent in Meghalaya. Contrasted to performance of the states in the region, Delhi accounted for 125 per cent contribution by the private sector accounting for 28,123 of the total 79,859 TB notifications in 2019. As the private sector is not burdened with the COVID-19 treatment, these hospitals can play pro-active roles in implementation of the TB elimination programmes. Most of the doctors and healthcare workers in public sector hospitals have been deployed in COVID-19 duties. The private sectors can play the most critical role at this juncture of bridging this gap and meeting the shortfall of doctors and healthcare professionals in TB elimination programme implementation. The National Strategic Plan underlines the need for early identification of presumptive TB cases, at the first point of care, be it private or public sector, and prompt diagnosis using highly sensitive diagnostic tests to provide universal access to quality TB diagnosis including drug resistant TB in the country. The national programme guidelines say that realtime monitoring of TB patient's treatment adherence is essential to offer on time patient counselling and treatment continuation if the patient missed any dosage. Therefore, physical visit to patients is essential to back up remote and digital monitoring. For early diagnosis of tuberculosis, the cartridge based Nucleic Acid Amplification Test (CB-NAAT) machines are essential. In most of the states, most of these machines in the public sector have been deployed in COVID-19 detection tests. However, government has to ensure that poor and downtrodden are not excluded from special TB notification drive by private sector during the COVID-19 pandemic situation. India accounts for the highest TB cases in the world. The county also shares the highest burden of drug-resistant TB cases in the world. The World Health Organization in its Global Tuberculosis Report 2019 describes tuberculosis as "a communicable disease that is a major cause of ill health, one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent (ranking above HIV/AIDS)." It is spread when an infected person expels the bacteria into the air by coughing. Wearing of masks, therefore, prevents its spread to a great extent. The campaign for wearing masks to prevent spread COVID-19 infections needs to be leveraged to prevent spread of TB infection. Timely diagnosis and treatment of the infected can cure the disease and prevent transmission to other people. More government and community support, social and economic, to TB survivors and TB survivors trained to become TB champions will motivate other survivors to come forward and contribute to eradication of the disease. Streamlining the laboratory support system both in public and private sectors and training of laboratory personnel will go a long way in improving the rapid diagnostic services. Free access of the anti-TB drug to patients seeking treatment in private sector is an important area which needs focused attention of the respective State Governments. The country can least afford the latent risk of TB cases remaining undetected.