Open Journal Systems

National Tuberculosis Elimination Program: India’s Goals and Challenges

Sunitha C Srinivas, Gokul Dharani, Mahesh Padukudru Anand, Seeprarani Rath, Raj Vaidya, Rohit O Agarwal, Krishna Kumar

Abstract


Objectives

Tuberculosis (TB), despite being a preventable and curable disease, has remained a consistent public health challenge in India. Before the additional challenges of the COVID pandemic started, India set out with the National Tuberculosis Elimination Program (NTEP). While combating COVID, the healthcare system has not been able to cope with the stringent requirements of NTEP. Therefore, this article highlights the current situation of TB in India while providing a snapshot of the evidence-based patient-centric approaches that could be adopted to work towards the goals of NTEP by 2025. 

Findings

The main challenges identified with NTEP were continued lack of awareness about TB, prevalence of stigma and tracking of the “missing cases”. Collaboration between Civil Society Organizations and local and national governments could greatly enhance development outcomes by conducting outreach activities. Integration of community-based TB activities with other community-based healthcare activities is necessary to improve synergy and impact. 

Summary

Based on our key findings, it is evident that India has to adopt multisectoral responses and evidence-based pathways such as current digitalization of the programme to address the complex and layered nuances, subsequently facilitating health system strengthening. The article culminates by emphasizing the importance of how community engagement and community champions can contribute to reduced catastrophic costs for patients and towards the intended elimination goals. Attention is drawn towards the role of pharmacy practice professionals in enhancing TB prevention and in supporting those who are being treated, to complete their therapy successfully.


Keywords


Tuberculosis (TB); Digitalization; National TB Elimination Programme (NTEP); Community Engagement; TB Champions; Pharmacy Practice

References


Tuberculosis. Published 2021. Accessed June 22, 2022. https://www.who.int/news-room/fact-sheets/detail/tuberculosis

Rapid Communication: Key Changes to the Treatment of Drug-Resistant Tuberculosis.; 2022. Accessed June 22, 2022. https://apps.who.int/iris/bitstream/handle/10665/353743/WHO-UCN-TB-2022.2-eng.pdf?sequence=1

Global Tuberculosis Report.; 2021. https://www.who.int/publications/i/item/9789240037021

WHO Consolidated Guidelines on Tuberculosis, Module 4: Treatment - Drug-Susceptible Tuberculosis Treatment.; 2022. https://www.who.int/publications/i/item/9789240048126

The End TB Strategy: Brochure.; 2015. https://cdn.who.int/media/docs/default-source/documents/tuberculosis/end-tb-brochure22cf78c9-ddf7-47df-9261-b999e8df83ba.pdf?sfvrsn=4160919c_1&download=true

Centers for Disease Control and Prevention. Tuberculosis. Published 2014. Accessed June 22, 2022. https://www.cdc.gov/tb/publications/factsheets/general/ltbiandactivetb.htm#:~:text=Persons with latent TB infection are not infectious and cannot,first two years of infection

Huddart S, Svadzian A, Nafade V, Satyanarayana S, Pai M. Tuberculosis case fatality in India: a systematic review and meta-analysis. BMJ Glob Heal. 2020;5(1):e002080.

Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2020. Accessed August 12, 2022. https://vizhub.healthdata.org/gbd-compare/india

Annabel Kanabus. TB Statistics India. GHE. Accessed June 22, 2022. https://tbfacts.org/tb-statistics-india/

Jimenez-Corona ME, Garcia-Garcia L, DeRiemer K, et al. Gender differentials of pulmonary tuberculosis transmission and reactivation in an endemic area. Thorax. 2006;61(4):348-353.

Horton KC, MacPherson P, Houben RMGJ, White RG, Corbett EL. Sex Differences in Tuberculosis Burden and Notifications in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. PLoS Med. 2016;13(9):e1002119. doi:10.1371/journal.pmed.1002119

Wingfield T, Cuevas LE, MacPherson P, Millington KA, Squire SB. Tackling two pandemics: a plea on World Tuberculosis Day. Lancet Respir Med. 2020;8(6):536-538. doi:10.1016/S2213-2600(20)30151-X

Silva DR, Muñoz-Torrico M, Duarte R, et al. Risk factors for tuberculosis: diabetes, smoking, alcohol use, and the use of other drugs. J Bras Pneumol publicacao Of da Soc Bras Pneumol e Tisilogia. 2018;44(2):145-152. doi:10.1590/s1806-37562017000000443

Household air pollution and health. Published 2022. Accessed August 8, 2022. https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health

National Strategic Plan for Tuberculosis Elimination 2017-25.; 2017. https://tbcindia.gov.in/WriteReadData/NSP Draft 20.02.2017 1.pdf

Satyanarayana S, Subbaraman R, Shete P, et al. Quality of tuberculosis care in India: a systematic review. Int J Tuberc lung Dis Off J Int Union against Tuberc Lung Dis. 2015;19(7):751-763. doi:10.5588/ijtld.15.0186

Daftary A, Jha N, Pai M. Enhancing the role of pharmacists in the cascade of tuberculosis care. J Epidemiol Glob Health. 2017;7(1):1-4. doi:10.1016/j.jegh.2016.05.001

Miller R, Goodman C. Quality of tuberculosis care by pharmacies in low- and middle-income countries: Gaps and opportunities. J Clin Tuberc other Mycobact Dis. 2020;18:100135. doi:10.1016/j.jctube.2019.100135

National Tuberculosis Elimination Programme. Published 2021. https://www.nhp.gov.in/revised-national-tuberculosis-control-programme_pg

Datta KK. TB control programme in India. Health Millions. 1995;21(1):4-7.

Khatri GR. National tuberculosis control programme. J Indian Med Assoc. 1996;94(10):372-375,384.

Maher D, Mikulencak M. What Is DOTS? - A Guide to Understanding the WHO-Recommended TB Control Strategy Known as DOTS.; 1999. https://apps.who.int/iris/bitstream/handle/10665/65979/WHO_CDS_CPC_TB_99.270.pdf;jsessio

Revised National Tuberculosis Control Programme. https://dghs.gov.in/content/1358_3_RevisedNationalTuberculosisControlProgramme.aspx

Khawbung JL, Nath D, Chakraborty S. Drug resistant Tuberculosis: A review. Comp Immunol Microbiol Infect Dis. 2021;74:101574. doi:https://doi.org/10.1016/j.cimid.2020.101574

National TB Prevalence Survey in India (2019 - 2021). https://tbcindia.gov.in/showfile.php?lid=3659

Yadav S, Rawal G. SWOT analysis of the Directly Observed Treatment Short-course (DOTS) strategy under the revised national tuberculosis control program at a large center in west Delhi. Published online 2020.

Gopinath R, Bhatia R, Khetrapal S, Ra S, Babu GR. Tuberculosis Control Measures in Urban India Strengthening Delivery of Comprehensive Primary Health Services.; 2020.

Wingfield T, Karmadwala F, MacPherson P, et al. Challenges and opportunities to end tuberculosis in the COVID-19 era. Lancet Respir Med. 2021;9(6):556-558.

Hogan AB, Jewell BL, Sherrard-Smith E, et al. Potential impact of the COVID-19 pandemic on HIV, tuberculosis, and malaria in low-income and middle-income countries: a modelling study. Lancet Glob Heal. 2020;8(9):e1132-e1141.

New data shows COVID-19 combined with funding shortfalls are devastating efforts to end TB by 2030. StopTBPartnership. https://www.stoptb.org/news/new-data-shows-covid-19-combined-with-funding-shortfalls-are-devastating-efforts-to-end-tb-2030. Published September 28, 2021.

Alagna R, Besozzi G, Codecasa LR, et al. Celebrating World Tuberculosis Day at the time of COVID-19. Eur Respir J. 2020;55(4).

Khan MS, Rego S, Rajal JB, et al. Mitigating the impact of COVID-19 on tuberculosis and HIV services: A cross-sectional survey of 669 health professionals in 64 low and middle-income countries. PLoS One. 2021;16(2):e0244936. doi:10.1371/journal.pone.0244936

PredictTB. Accessed June 25, 2022. https://predict-tb.com/

MERM: A device to aid patient treatment adherence. Published 2021. Accessed June 25, 2022. https://predict-tb.com/news-events/article/merm-a-device-to-aid-patient-treatment-adherence/

99DOTS Deployments. Accessed June 25, 2022. https://www.99dots.org/About.html

Introduction to Nikshay. https://nikshay.zendesk.com/hc/en-us/articles/360038581631-Introduction-to-Nikshay-

Global Health Expenditure Database. Accessed June 24, 2022. https://apps.who.int/nha/database/country_profile/Index/en

Prasanna T, Jeyashree K, Chinnakali P, Bahurupi Y, Vasudevan K, Das M. Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India. Glob Health Action. 2018;11(1):1477493. doi:10.1080/16549716.2018.1477493

Sarin R, Vohra V, Singla N, Thomas B, Krishnan R, Muniyandi M. Identifying costs contributing to catastrophic expenditure among TB patients registered under RNTCP in Delhi metro city in India. Indian J Tuberc. 2019;66(1):150-157. doi:10.1016/j.ijtb.2018.10.009

SDG – 8.5 UHC {71ST Session WHO SEARO}. https://main.mohfw.gov.in/sites/default/files/Itemy_0.pdf

Bhargava A, Bhargava M, Juneja A. Social determinants of tuberculosis: context, framework, and the way forward to ending TB in India. Expert Rev Respir Med. 2021;15(7):867-883. doi:10.1080/17476348.2021.1832469

Sinha P, Carwile M, Bhargava A, et al. How much do Indians pay for tuberculosis treatment? A cost analysis. Public Heal action. 2020;10(3):110-117. doi:10.5588/pha.20.0017

Barter DM, Agboola SO, Murray MB, Bärnighausen T. Tuberculosis and poverty: the contribution of patient costs in sub-Saharan Africa – a systematic review. BMC Public Health. 2012;12(1):980. doi:10.1186/1471-2458-12-980

Muniyandi M, Thomas BE, Karikalan N, et al. Association of Tuberculosis With Household Catastrophic Expenditure in South India. JAMA Netw open. 2020;3(2):e1920973. doi:10.1001/jamanetworkopen.2019.20973

Prasad BM, Tripathy JP, Muraleedharan VR, Tonsing J. Rising Catastrophic Expenditure on Households Due to Tuberculosis: Is India Moving Away From the END-TB Goal? . Front Public Heal . 2021;9. https://www.frontiersin.org/article/10.3389/fpubh.2021.614466

Tanimura T, Jaramillo E, Weil D, Raviglione M, Lönnroth K. Financial burden for tuberculosis patients in low- and middle-income countries: a systematic review. Eur Respir J. 2014;43(6):1763 LP - 1775. doi:10.1183/09031936.00193413

Chandra A, Kumar R, Kant S, Parthasarathy R, Krishnan A. Direct and indirect patient costs of tuberculosis care in India. Trop Med Int Heal. 2020;25(7):803-812. doi:https://doi.org/10.1111/tmi.13402

Ghazy RM, El Saeh HM, Abdulaziz S, et al. A systematic review and meta-analysis of the catastrophic costs incurred by tuberculosis patients. Sci Rep. 2022;12(1):558. doi:10.1038/s41598-021-04345-x

Singh S, Kumar S. Tuberculosis in India: Road to elimination. Int J Prev Med. 2019;10(1):114. doi:10.4103/ijpvm.IJPVM_492_17

Getahun H, Raviglione M. Transforming the global tuberculosis response through effective engagement of civil society organizations: the role of the World Health Organization. Bull World Health Organ. 89(8):616-618.

Jareg P, Kaseje DC. Growth of civil society in developing countries: implications for health. Lancet (London, England). 1998;351(9105):819-822. doi:10.1016/S0140-6736(97)11454-4

From TB Survivors to TB Champions: A Training Curriculum.; 2019. https://tbcindia.gov.in/WriteReadData/Reach Curriculum Draft 24-09-19.pdf

Community Systems Strengthening Framework.; 2014. https://www.theglobalfund.org/media/6428/core_css_framework_en.pdf

Community engagement to support universal access to diagnosis, care and treatment of drug-resistant TB. In: Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-Resistant Tuberculosis. World Health Organization; 2014. https://www.ncbi.nlm.nih.gov/books/NBK247407/

Shrivastava JP, Shrivastava A. Scenario of Tuberculosis in India. J Lung Pulm Respir Res. 2021;8(2):24-25.

TB Champion helps eliminate TB in India’s Tribal Communities -- A Ray of Hope on a Motorcycle. USAID From the American people. Published 2021. Accessed June 29, 2022. https://www.usaid.gov/india/success-stories/aug-2021-tb-champion-helps-eliminate-tb-india-tribal-communities-ray-hope-motorcycle

Mullan Z. Reaching the unreached and expecting the unexpected. Lancet Glob Heal. 2014;2(4):e182. doi:10.1016/S2214-109X(14)70214-1

Purty AJ. Detect-Treat-Prevent-Build: Strategy for TB Elimination in India by 2025. Indian J community Med Off Publ Indian Assoc Prev Soc Med. 2018;43(1):1-4. doi:10.4103/ijcm.IJCM_321_17

Kaur B. Health Ministry Report Disagrees With Minister’s Claim That India Will End TB by 2025. The Wire. https://thewire.in/health/health-ministry-report-disagrees-with-ministers-claim-that-india-will-end-tb-by-2025. Published March 27, 2022.

Bhat J, Rao R, Kumar R, et al. TB free India: Reaching the unreached tribal population under National Tuberculosis Elimination Programme. Indian J Tuberc. 2022;69(1):4-7. doi:https://doi.org/10.1016/j.ijtb.2021.04.009

Sheel V. National TB Elimination Programme: Overview - Key Priorities. In: National Health Mission; 2019. https://nhm.gov.in/New_Updates_2018/Presentation/ACS_PS_SEC_ MD_Orientation/NTEP.pptx


Full Text: PDF

Article Level Metrics

Refbacks

  • There are currently no refbacks.
x
Message