India may have achieved a success rate of 88 per cent in treatment of tuberculosis — higher than the global treatment success rate of 85 per cent — but HIV-TB co-infection continues to be a cause of major concern, as the percentage of people infected with the twin infection increased substantially between 2010 and 2011. The percentage of TB patients tested for HIV increased nationally from 32 per cent to 45 per cent.
It is estimated that there are around 2.4 million HIV patients in India. Recent country- level data show that about 6 per cent of TB patients are HIV-positive. National surveillance has shown that the distribution of HIV among TB patients is highly heterogeneous, and is closely correlated with the distribution of HIV infection.
As per estimates of the World Health Organisation, released on the eve of the World TB Day, prevalence and incidence rates of all forms of TB were 249 and 181 per 100000 people respectively in 2011. However, the estimates have not yet been officially approved by the Ministry of Health and Family Welfare.
The report puts the multi drug-resistant tuberculosis (MDR-TB) prevalence at 2.1 per cent among new cases and 15 per cent among retreatment cases, which is based on sub-national surveys conducted in three States between 2006 and 2009.
Meanwhile, India is planning a national Drug Resistance Survey for 2013.
Despite the low MDR-TB prevalence, India ranks first among the 27 MDR-TB high burden countries. The Revised National TB Control Programme (RNTCP) has developed a plan to scale up the services considerably in order to treat at least 40,000 MDR-TB patients annually by 2017, supported by the Global Fund Round Single Stream Funding, Unitaid and domestic funds.
Ineffective and delayed diagnosis in both private and public sectors and failure to notify and register patients in the private sector diagnosed with TB, in addition to patients accessing private providers not linked with the RNTCP, have been identified as some of the major challenges faced by India in controlling the dreaded disease that claims 24 lives of every 100,000 people infected.Achieving universal access, including marginalised and high risk groups, while maintaining and continuing to improve the quality of services across the country; introducing newer diagnostics and their positioning at various levels of health care, and ensuring adequate staffing at all levels — through improved human resource development — to reduce reliance on a limited pool of dedicated TB staff are some more issues that need to be tackled, the ‘Stop TB in South-East Asia — zero death to zero infection’ says.
Enforcing regulations for prescription and sale of anti-TB drugs; promoting rational use of first and second line drugs outside the programme to prevent MDR and extensively drug resistant TB (XDR TB), developing and implementing airborne infection control measures in health facilities and effectively promoting operational research to address local challenges are among the issues flagged in the report.
As on September 2012, all 28 States and seven Union Territories are providing MDR-TB diagnostic and treatment services. A cumulative total of 1,08,792 MDR-TB suspects were tested and 16,825 MDR-TB cases and 92 XDR-TB cases started on second-line standard treatment.
A limited number of TB mortality studies based on vital registration, and verification of the cause of death through verbal autopsies, have also been carried out in the region. A study in Chennai revealed that the TB mortality rate is 152 deaths per 100,000 population among men and 43 per 100,000 among women. A State-level study in Andhra Pradesh revealed that 5 per cent of deaths among men and 3 per cent among females were caused by TB.
Since its inception in 1997, the RNTCP has initiated almost 17 million patients on treatment.
