Eight months on, states are still waiting for 3HP TB preventive drugs

Subject : Science and Tech

Section: Health

Context:

Eight months after the Prime Minister launched the pan-India rollout of a shorter TB Preventive Treatment (TPT) in March 2023 called the 3HP — once-weekly isoniazid-rifapentine for 12 weeks — States are yet to receive the 3HP combination drug from the Central TB Division.

Details:

Tamil Nadu and Kerala have already begun using 3HP for TB preventive treatment despite not receiving the drug supply.
Since treatment with 3HP involves only 12 doses, compliance is better, adverse effects of the drugs are less and treatment completion is better compared with 180 doses of isoniazid monotherapy.
Less than 20% of TB infections are due to household contacts being exposed to the index case.
TB preventive therapy can halt the progression of TB disease very effectively for many years.
In India, there are greater chances of getting re-infected after completing the TB preventive therapy. and reinfection may reverse the protection.

Hepatotoxicity:

Hepatotoxicity implies chemical-driven liver damage. Drug-induced liver injury is a cause of acute and chronic liver disease caused specifically by medications and the most common reason for a drug to be withdrawn from the market after approval.
The cases of hepatotoxicity have been reduced with 3HP drug regime.

About TB:

Tuberculosis (TB) is an infectious airborne bacterial disease caused by Mycobacterium tuberculosis.
TB commonly affects the lungs (pulmonary TB) but can also affect other parts (extrapulmonary TB)
Tuberculosis spreads from person to person through the air, when people who are infected with TB infection cough, sneeze or otherwise transmit respiratory fluids through the air.
About 30-40% of the Indian population has latent TB infection, and 5-10% of those with latent infection will develop TB disease over the course of their lives.
Smear microscopy forms the bulk of TB testing (despite its low sensitivity) and molecular testing constitutes just 23%.
India should invest more in TB screening using digital chest X-rays and molecular testing for TB disease confirmation.

Multidrug-Resistant TB (MDR-TB):

In MDR-TB, the bacteria that cause TB develop resistance to antimicrobial drugs used to cure the disease.
MDR-TB does not respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs.
Treatment options for MDR-TB are limited and expensive.
CBNAAT (Cartridges Based Nucleic Acid Amplification Test) is used for early diagnosis of MDR-TB.

Extensively Drug-Resistant TB (XDR-TB):

XDR-TB is a form of multidrug-resistant TB with additional resistance to more anti-TB drugs.
People who are resistant to isoniazid and rifampicin, plus any fluoroquinolone and at least one of three injectable second-line drugs (amikacin, kanamycin, capreomycin) are said to have XDR-TB.

National Strategic Plan for TB Elimination:

It is a framework to guide the activities of all stakeholders whose work is relevant to TB elimination in India.
It provides goals and strategies for the country’s response to the disease during the period 2017 to 2025.
It aims to direct the attention of all stakeholders on the most important interventions or activities that the RNTCP believes will bring about significant changes in the incidence, prevalence and mortality of TB.
It will guide the development of the national project implementation plan (PIP) and state PIPs, as well as district health action plans (DHAP) under the National Health Mission (NHM).