India had an estimated 63,000 cases of notified multi-drug resistant tuberculosis (MDR-TB) in 2010, the highest in the South East Asia region, the World Health Organisation (WHO) has said.
The MDR-TB prevalence is estimated to be 2.3 per cent among new cases and 12-17 per cent among re-treatment cases. However, due to the size of the population and the number of TB cases reported annually, India ranks second among the 27 MDR-TB high-burden countries worldwide after China.
Extensively drug-resistant TB (XDR-TB) cases have also been reported from India, Bangladesh, Indonesia, Nepal and Thailand from the region. Considerable efforts are required to expand capacity for quality-assured drug susceptibility testing in the region in order to more accurately estimate the extent of drug-resistant TB. Given the widespread availability and use of second-line drugs, and as laboratory capacity to conduct second-line drug susceptibility testing increases, additional number of patients with XDR-TB are likely to be identified, the report warns.
The estimated percentage of the MDR in new TB cases in India is 2.1 (1.7- 2.5) per cent, while the percentage of MDR among previously treated cases was 15 (13 -17) per cent. By the end of 2009, treatment services for the MDR-TB patients were available in sites of 10 States.
Enforcement of regulations for prescription and sale of anti-TB drugs, promoting rational use of first-and second-line anti-TB drugs outside the programme to prevent MDR and XDR-TB are some of the major challenges for India, it says.
The Revised National Tuberculosis Control Programme has developed a plan to scale up considerably MDR-TB services in order to treat annually at least 30,000 MDR-TB patients in the country, supported by the Global Fund Round 9 and the UNITAID to enable a rapid expansion of MDR-TB services in the next few years. As on September 2011, 34 States are providing MDR-TB diagnostic and treatment services and a cumulative total of 5810 MDR-TB cases have been started on treatment, according to the report.
The report “Tuberculosis Control in the South East Asia Region 2012,” says that the region registered an estimated 5 million prevalent and about 3.5 million incident TB cases in 2010. Though the death rates in the region have declined due to successful implementation of the DOTS (directly observed treatment, short course), the disease still claims about half a million lives a year in the region.
With a population of about 1.2 billion, India is the largest country in the region and the largest TB burden country in the world in terms of absolute numbers of incident cases that emerge each year and it contributed one-fourth of the estimated global TB cases in 2010.
As on July 2011 in India, the revised estimated prevalence and incidence rates of all forms of tuberculosis were respectively 256 and 185 per 1,00,000 population in 2010. However, current WHO estimates for TB incidence, prevalence and mortality have not yet been officially approved by the Ministry of Health and Family Welfare, Government of India, and should, therefore, be considered provisional, the report said. The notification rate of all forms of TB and new smear-positive cases were respectively 109 and 51 in 2010.
“Functional national TB control programmes in the Region achieving high treatment-success rates have resulted in maintaining the slow but steady decline in TB incidence rates during the past decade. This has also led to low levels (2.1, range: 1.7- 2.5 per cent) of multidrug-resistance (MDR) among newly detected cases. Among previously treated cases in the region, MDR-TB rate is estimated to be higher at around 17 per cent (range: 17-18 per cent).
However, given the large number of TB cases in the region, this translates to 1,05,000 MDR-TB cases (85,000-1,25 000), accounting for nearly one fourth of the world's MDR-TB cases that were estimated to exist among notified cases in 2010.
It is estimated that around 2.4 million Indians are currently living with HIV.
Recent country-level data shows that about 5 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.