Context

• The article highlights the positive progress India has made in reducing Tuberculosis (TB) incidence and mortality since 2015, exceeding global decline rates.
• Despite this success, achieving the ambitious goal of TB elimination by 2025 seems unlikely due to several existing challenges.

Key challenges in eliminating TB

Detection gaps: 

• Testing majority of patients (77%) through less accurate smear microscopy, which has an accuracy of 22-43 per cent and cannot detect resistance to anti-TB drugs. 
• Inefficient current testing rate of 1.2 percent.
• Heavy reliance on symptomatic screening tends to miss out on asymptomatic patients.

Drug shortages

• Recent reports of drug shortages across states hinders treatment completion.
• Decentralization of drug procurement might put states at a disadvantage in negotiating prices due to local constraints and a lower volume required as compared to the central government.

Treatment Adherence:

• Ensuring adherence to the treatment remains a challenge to prevent drug resistance and transmission.

Lack of Vaccine

• BCG vaccine used in infants is insufficient for complete protection and it necessitates development of a new vaccine for long-term elimination.

Government efforts

• Ni-kshay portal

• • NI-KSHAY-(Ni=End, Kshay=TB) is the web enabled patient management system for TB control under the National Tuberculosis Elimination Programme (NTEP). 
  • It is developed and maintained by the Central TB Division (CTD), Ministry of Health and Family Welfare, Government of India, in collaboration with the National Informatics Centre (NIC), and the World Health Organization Country office for India.
  • Ni-kshay is used by health functionaries at various levels across the country both in the public and private sector, to register cases under their care, order various types of tests from Labs across the country, record treatment details, monitor treatment adherence and to transfer cases between care providers. 
  • It also functions as the National TB Surveillance System and enables reporting of various surveillance data to the Government of India.
• Transformative policies were introduced by the government including universal nutritional support for patients, effective engagement with the private sector, to the first-of-its-kind crowd sourcing programme to help patients complete treatment.
• Enhanced government funding also plays a role in effective elimination of TB.

Way forward

Strengthen testing: 

• Prioritize widespread adoption of molecular diagnostics for accurate and efficient diagnosis. Increase testing rate to 4 to 5% from the current 1 to 2%.
• Consider alternative screening tools like portable AI-enabled X-rays which can be efficient and affordable.

Address drug shortages

• Reassess the decentralization policy and explore alternative models for affordable drug procurement.
• Consider less toxic treatment options and ensure its availability like the WHO-recommended BPaL(M) (Bedaquiline, Pretomanid, and Linezolid)regimen for drug-resistant patients.

Develop a vaccine

• Support and accelerate research efforts towards developing a new and effective TB vaccine.