UPSC EDITORIAL ANALYSIS : Actionable ideas for TB control

Source: The Hindu, The Hindu

• Prelims: Current events of national importance(AMR,TB, National TB Elimination Programme, Covid-19, Mission COVID Suraksha etc

• Mains GS Paper II: Government policies and interventions for development in various sectors and issues arising out of their design and implementations etc

ARTICLE HIGHLIGHTS

• Every day, 3,500 people worldwide lose their lives to tuberculosis (TB), and around 30,000 people become infected with TB bacilli(WHO) estimates.

• India accounts for 27% of global TB cases

• The theme for World TB Day 2024 (March 24):‘Yes! We can end TB!’

INSIGHTS ON THE ISSUE

Context

Tuberculosis:

• TB is caused by a bacterium called *Mycobacterium tuberculosis, belonging to the Mycobacteriaceae* family consisting of about 200 members.

• Some of Mycobacteria cause diseases like TB and Leprosy in humans and others infect a wide range of animals.

• In humans, TB most commonly affects the lungs (pulmonary TB), but it can also affect other organs (extra-pulmonary TB).

• TB is a treatable and curable disease.

• TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air.

• Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats.

What steps need to be taken to control TB?

• Nutritional support: It is an important step towards healthy development of TB patients.

• The growing focus on patient support, addressing stigma, and gendered aspects of TB is important.

• Bridge the gap between policy intent and on-the-ground realities. For instance, India needs to prioritize targeted interventions aimed at improving and expanding access to TB diagnosis and treatment.

• For instance, India needs to prioritize targeted interventions aimed at improving and expanding access to TB diagnosis and treatment.

• Expand the reach of TB testing facilities, particularly in rural and underserved areas

• Ensure the availability of free, affordable and quality-assured TB drugs.

• Molecular testing is the gold standard and less than a quarter of symptomatic patients are getting that as their first test.

• Focus on efforts to make care more humane. Mental health support and gender responsive care become critically important.

• Mental health support and gender responsive care become critically important.

• Efforts are needed to strengthen community-based TB care models, empowering frontline health-care workers to deliver comprehensive care which addresses treatment and social, economic and mental health needs It is closer to where patients live.

• It is closer to where patients live.

• By supporting frontline TB workers, strengthening supply chains and procurement mechanisms, decentralizing TB services and empowering local communities India can reduce stigma, overcome barriers to access and enhance treatment outcomes.

• India can reduce stigma, overcome barriers to access and enhance treatment outcomes.

• Addressing the socio-economic determinants of TB requires a multi-sectoral approach.

• Poverty alleviation, improvement in nutritional status, well-ventilated housing and better air quality will all contribute towards reducing TB.

• Recent research: It has shown that nutritional supplementation reduced TB incidence substantially in household contacts of adults with microbiologically confirmed pulmonary TB.

• By tackling the underlying root causes of TB, India can make significant strides towards eliminating the disease and improving the overall health and well-being of its population.

Variants of TB:

• Drug-resistant (DR-TB)

• Totally drug-resistant (TDR-TB)

• Extensively drug-resistant (XDR-TB)

• Pulmonary TB (P-TB)

• Non-pulmonary TB

10-point agenda towards ‘ending TB’:

• Early detection: Given TB’s etiology, early detection is the key. Compulsory screening for family and contacts of each index case is essential necessitating availability of laboratory facilities and efficient follow-up mechanisms within health systems.

• Compulsory screening for family and contacts of each index case is essential

• necessitating availability of laboratory facilities and efficient follow-up mechanisms within health systems.

• Precise treatment categorisation: With increasing DR-TB, it is imperative to know the resistance status at the time of diagnosis to assign appropriate treatment regimens as per their phenotypic susceptibility.

• Treatment adherence and follow-up: TB requires a long period of sustained treatment. This leads to non-compliance, which could be due to observable improvement in health status, or change of residence, movement across States and districts. The TB control programme has a built-in follow-up system, But compliance to complete treatment is not 100%. Leveraging technology to monitor compliance needs focus.

• This leads to non-compliance, which could be due to observable improvement in health status, or change of residence, movement across States and districts.

• The TB control programme has a built-in follow-up system, But compliance to complete treatment is not 100%.

• But compliance to complete treatment is not 100%.

• Leveraging technology to monitor compliance needs focus.

• Zero mortality: Mitigating mortality due to TB, be it DR-TB or non-pulmonary TB, is necessary.

• Controlling drug resistance: Poor regulatory mechanisms for drug control and non-compliance with treatment regimens are the main reasons for such a high degree of drug resistance.

• Assessing the extent of drug-resistant TB: There needs to be data on the proportion of people diagnosed with TB who have rifampicin-resistant TB (RR-TB) and multidrug-resistant TB (MDR-TB) This is resistance to both rifampicin and isoniazid, collectively referred to as MDR/RR-TB. It helps in better plan and design of the control programme resource allocation for diagnosis the treatment regime as well as availability of trained staff mandated for DR-TB. Availability of appropriate medicines: Assured medical supply is mandated under the TB control programme. The procurement challenges for DR-TB medications such as bedaquiline and delamanid must be addressed Ascertaining treatment facilities for all DR-TB cases which require in-patient care. Integration into larger health systems: Strengthening referral networks within and between different levels of public health systems and private health systems is vital to ensure no symptomatic cases are lost no patients miss their dosages and are non-compliant the screening of contacts for all positive cases of pulmonary TB cases (DR or non-DR). Dynamic notification system: A robust notification system will ease the burden of health system personnel. While Ni-kshay has evolved ‘Ni-Kshay-(Ni=End, Kshay=TB) is the web enabled patient management system for TB control under the National Tuberculosis Elimination Programme (NTEP)’ It requires improvements to capture real-time TB data between sectors, practitioners, time, and locations. Considering population mobility and migration: Portability of TB treatment within the country is crucial at the policy level.

• This is resistance to both rifampicin and isoniazid, collectively referred to as MDR/RR-TB.

• It helps in better plan and design of the control programme resource allocation for diagnosis the treatment regime as well as availability of trained staff mandated for DR-TB.

• plan and design of the control programme

• resource allocation for diagnosis

• the treatment regime as well as availability of trained staff mandated for DR-TB.

• Availability of appropriate medicines: Assured medical supply is mandated under the TB control programme. The procurement challenges for DR-TB medications such as bedaquiline and delamanid must be addressed Ascertaining treatment facilities for all DR-TB cases which require in-patient care.

• The procurement challenges for DR-TB medications such as bedaquiline and delamanid must be addressed

• Ascertaining treatment facilities for all DR-TB cases which require in-patient care.

• Integration into larger health systems: Strengthening referral networks within and between different levels of public health systems and private health systems is vital to ensure no symptomatic cases are lost no patients miss their dosages and are non-compliant the screening of contacts for all positive cases of pulmonary TB cases (DR or non-DR).

• no symptomatic cases are lost

• no patients miss their dosages and are non-compliant

• the screening of contacts for all positive cases of pulmonary TB cases (DR or non-DR).

• Dynamic notification system: A robust notification system will ease the burden of health system personnel. While Ni-kshay has evolved ‘Ni-Kshay-(Ni=End, Kshay=TB) is the web enabled patient management system for TB control under the National Tuberculosis Elimination Programme (NTEP)’ It requires improvements to capture real-time TB data between sectors, practitioners, time, and locations.

• ‘Ni-Kshay-(Ni=End, Kshay=TB) is the web enabled patient management system for TB control under the National Tuberculosis Elimination Programme (NTEP)’

• It requires improvements to capture real-time TB data between sectors, practitioners, time, and locations.

• Considering population mobility and migration: Portability of TB treatment within the country is crucial at the policy level.

Initiatives:

Way Forward.

• The needs and the interests of patients and communities must be prioritized within the care paradigm and the health-care system. This principle, echoed by survivors, communities, health experts and policymakers, underscores the need for a person-centered approach to TB care and management.

• This principle, echoed by survivors, communities, health experts and policymakers, underscores the need for a person-centered approach to TB care and management.

• Leveraging technology and innovation holds promise in enhancing TB care efforts in India.

• The adoption of AI and digital health solutions for TB diagnosis, adherence and surveillance can revolutionize the way TB care is delivered and accessed in the country.

• By investing in developing better vaccines, we can hope to ultimately eliminate this airborne disease.

• The path to TB elimination in India requires a concerted effort to prioritize person-centered care, address social determinants of health, and embrace innovation.

• By adopting a holistic and person-centered approach, India can overcome the barriers that stand in the way of TB control and create a healthier future for all its citizens.

QUESTION FOR PRACTICE

Critically examine the role of WHO in providing global health security during the COVID-19 Pandemic.(UPSC 2020) (200 WORDS, 10 MARKS)

Editorial Analysis – 25 March 2024