The road to ending tuberculosis

The road to ending tuberculosis

Subject : Science and technology

Section :Health

Concept :

• The existing target of ending tuberculosis (TB) by 2030 lacks implementation and clarity about definitions of “end”.

Tuberculosis (TB)

• Tuberculosis (TB) is an infectious 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.
• The most common risk factor associated with TB is HIV & other conditions that impair the immune system.
• Common symptoms of tuberculosis are Chronic cough with blood-tinged sputum, Loss of weight, Loss of appetite, Fever and night sweats, Fatigue , etc.

TB Treatment: consists of four drugs:

• Isoniazid (INH)
• Rifampicin
• Pyrazinamide
• Ethambutol

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.
• To achieve goal: To end TB by 2025

Background:

• In 1993, the World Health Organisation (WHO) declared TB a global health emergency.
• Founded in 2001, the Stop TB Partnership (a UN-hosted organisation) takes bold and smart risks to serve the needs and amplify the voices of the people, communities, and countries affected by TB.
• The Stop TB board meets in Varanasi, India, and will coincide with World TB Day 2023 (March 24).
• The Global Fund to Fight AIDS, TB and Malaria (2002) began disbursing money directed towards the global TB epidemic in 2003.
• However,the response has been short on urgency and long on processes.
• For example, The Global Fund remains hostage to the zero-sum games imposed by donors and the champions of the three diseases.

Key areas that remain under-served:

• Development and wide use of an adult TB vaccine: The current vaccine is delivered at birth.
• Getting newer therapeutic agents for TB.
• Moving to an injection-free and shorter all-oral pills regimen for TB (the current standard is for at least six months) will improve compliance and reduce patient fatigue.
• The space of diagnostics:
• There are exciting developments for use of AI-assisted handheld radiology with 90-second reporting and 95% plus accuracy for diagnosing TB.
• This is a mature technology and should be rolled out universally immediately.

Best practices in India:

• The COVID-19 vaccine development process shows what can be done with the help of collective will and action.
• India convened the InDx diagnostics coalition in Bengaluru for COVID-19.
• TN-KET (Tamil Nadu KasanoiErappilaThittam/TB death-free project)

Measures taken by India to eradicate TB

• The National Tuberculosis Elimination Programme(NTEP) – Aims to strategically reduce TB burden in India by 2025.
• It was previously known as Revised National Tuberculosis Control Programme (RNTCP).
• The government reached over a billion people in 632 districts/reporting units.
• The National Strategic Plan for TB Elimination – It was launched to achieve the target of ending TB by 2025 in a mission mode.
• It is a multi-pronged approach which aims to detect all TB patients with an emphasis on reaching TB patients seeking care from private providers and undiagnosed TB in high-risk populations
• Ni-kshay Poshan Yojana(NPY)(Nutritional Support to TB) –  It helps to meet the nutritional requirements of TB patients, especially the underserved
• From 2018 till present, around Rs. 1,707 crore has been disbursed to more than 65 lakh people on TB treatment across the country
• Patient Provider Support Agencies (PPSA) – To engage the private sector, Patient Provider Support Agencies (PPSA) have been rolled out across 250 districts through the domestic setup and JEET initiative
• Universal Drug Susceptibility Testing (UDST) – To ensure every diagnosed TB patient is tested to rule out drug resistance before or at the time of treatment initiation itself.
• Pradhan Mantri TB Mukt Bharat Abhiyaan – To bring together all community stakeholders to support those on TB treatment and accelerate the country’s progress towards TB elimination.
• Ayushman Bharat – Health and Wellness Centres – To decentralize comprehensive primary healthcare including TB care services at the grassroots level.
• Bedaquiline and Delamanid -Newer drugs like Bedaquiline and Delamanid have also been made available for management of DRTB.

What are the global measures to eradicate TB?

• End TB Strategy – by World Health Organization (WHO)
• It serves as a blueprint for countries to reduce TB incidence by 80%, TB deaths by 90%, and to eliminate catastrophic costs for TB-affected households by 2030.
• World Development Report (1993) – Published by the World Health Organization (WHO).
• The 1993 World Development Report labelled TB treatment for adults as the best buy among all developmental interventions.
• The Global Fund – A worldwide movement to defeat HIV, TB and malaria and ensure a healthier, safer, more equitable future for all.
• The Stop TB Partnership – Brings together expertise from a broad spectrum of country, regional, and global partners in our shared mission to revolutionize the TB space and end TB by 2030
• Sustainable Development Goal 3 – To end TB epidemic by 2030

For further notes on Tuberculosis, refer – https://optimizeias.com/global-tb-report-2022/