Syllabus: Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources.
Global TB Report
- Global and National Status
- WHO Global TB Report 2025 presents a mixed scenario for India.
- India recorded a 21% decline in TB incidence, from 237/lakh (2015) to 187/lakh (2024).
- Despite progress, India still bears 25% of the global TB burden, the highest worldwide.
- Uttar Pradesh reports the maximum cases, followed by Maharashtra, Bihar and Madhya Pradesh.
- Delhi has the highest TB infection prevalence rate despite lower absolute numbers.
- Drug-Resistant TB Challenge
- India recorded the highest MDR-TB and RR-TB cases globally in 2024, accounting for 32% of global burden.
- Treatment success stands at 90% for new cases but only 77% for MDR-/RR-TB patients.
- Mortality Trends
- TB mortality reduced from 28/lakh (2015) to 21/lakh (2024).
- Despite improvement, mortality remains three times higher than the government’s elimination target.
- Missed Elimination Target
- India missed its TB-free 2025 target, set ahead of the global 2030 goal.
- Gains have saved millions of lives but remain insufficient to achieve elimination.
Key Drivers of Progress
- Use of AI, molecular diagnostics, and rapid resistance detection.
- Nutritional support to vulnerable groups.
- Schemes for drug-resistant TB and adoption of newer therapies such as BPaLM.
- Strengthening under the National TB Elimination Programme.
Persistent Challenges
- Diagnostic gaps, especially in rural regions.
- Socio-economic disparities affecting care-seeking.
- High MDR-/RR-TB burden and frequent drug shortages.
- Malnutrition worsening susceptibility and treatment outcomes.
About Tuberculosis
- TB is an infectious disease caused by Mycobacterium tuberculosis.
- Primarily affects lungs (pulmonary TB) but can also involve other organs (extrapulmonary TB).
- Pulmonary TB may present as chronic disease or acute pneumonia affecting alveoli.
- TB spreads through airborne droplets when infected individuals cough or sneeze.
- HIV and weakened immunity are major risk factors.
Standard Treatment Regimen
- Treatment lasts 6 months, with:
- Intensive Phase (2 months): Isoniazid, Rifampicin, Pyrazinamide, Ethambutol.
- Continuation Phase (4 months): Key drugs continued.
- Previously treated cases receive 12-week IP with Streptomycin.
Drug-Resistant TB
- MDR-TB
- Diagnosed early using Cartridge Based Nucleic Acid Amplification Tests (CBNAAT).
- MDR-TB resists both Isoniazid and Rifampicin.
- Cure rates remain low and treatment costly.
- XDR-TB
- MDR-TB with additional resistance to fluoroquinolones and injectable second-line drugs.
- Requires long-term treatment with up to eight drugs; success depends on severity and immunity.
Pretomanid: Promising New Drug
- FDA-approved, developed by TB Alliance.
- Forms BPaL regimen (Bedaquiline–Pretomanid–Linezolid).
- Reduces treatment duration to 6–9 months; fully oral; effective in HIV-positive patients.
- Beneficial for XDR-TB and selected MDR-TB cases.
India’s TB Elimination Strategy
- Goal: TB elimination by 2025 under NTEP.
- National strategic plan for tuberculosis elimination (NSP) 2017–2025 built on Detect–Treat–Prevent–Build (DTPB).
- Key tools: NIKSHAY portal, microscopy centres, CBNAAT, Line Probe Assay (LPA), Truenat.
- Prevention: IPT for child contacts, BCG vaccination.
- Strengthening via improved policies, HR capacity and integrated health systems.
Q- “Despite progress, India’s TB elimination efforts remain constrained by socio-economic and systemic challenges.” Discuss. (15 Marks)