At 6.2%, Karnataka has recorded the highest tuberculosis (TB) death rate in the country in 2018. This is higher than the national TB death rate of 4% in public sector.
Doctors see this as a worrisome trend, especially when the success rate of treatment in the public sector is 80% is the State. Karnataka is followed by Gujarat, Puducherry, and Tripura that have recorded 6%, 5.5%, and 5.2%, respectively.
Attributing this to the high prevalence of TB-HIV co-infection, health officials said among those tested for TB in the last one year in the State, 10.3% were HIV positive patients and 70% of patients with TB have a known HIV status. “This is one of the reasons why the TB death rate in Karnataka is the highest,” Seenappa, State Joint Director (Tuberculosis), told The Hindu .
Nearly 40% of the over 16,000 new HIV cases detected in the State are reported to have TB as a co-infection. “Several districts in north Karnataka — Kalaburagi, Yadgir, Bagalkot, and Belagavi — have high prevalence of HIV cases. And, over 25% of HIV deaths are due to TB. This explains the high TB death rate in the State,” Dr. Seenappa said.
Concerned over the high death rate, the State Health Department is now prioritising TB comorbidities, especially HIV, diabetes and tobacco addiction. The single window delivery of TB and HIV services for all People Living with HIV (PLHIV) receiving care in the ART centres has been streamlined with improved coverage, he said.
Comorbidities an issue
According to India TB Report, 2019, over 90% of PLHIV are being screened in ART centres for TB symptoms, and nearly 6 lakh PLHIV have been given access to rapid molecular testing via CBNAAT (cartridge based nucleic acid amplification test) for TB diagnosis.
The report that was released recently said that nearly one lakh TB/HIV patients were initiated on daily drug regimen and nearly 5 lakh PLHIV were initiated on TB preventive therapy across the country till December 2018. The Revised National Tuberculosis Control Programme (RNTCP) has expanded its collaboration with Diabetes and Tobacco Control Programmes and is being further strengthened with cross linkage of services. Nearly 36% and 27% of the TB patients in public sector have been screened for diabetes and tobacco usage, respectively, and linked to appropriate services through the Non-Communicable Disease Programme and the Tobacco Control Programme, the report stated.
Private sector notifications poor
TB is a notifiable disease in the country since May 2012, for which the government has set up a web-based, case-based notification network called NIKSHAY. Despite awareness regarding mandatory TB notification, a significant number of private practitioners do not report cases and this has led to cases being missed out of government data.
According to the India TB Report, 2019 that was released recently, of the 83,094 patients who were notified for TB in Karnataka in 2018, only 17.38% amount for private sector notification. The private sector notifications increased by 20% in 2018 (14,437 in 2018 as against 11,988 in 2017).
In 2018, the total TB case notifications (83,094) increased by 2.34% over last year of which public sector notifications amount to 82.62%.
In fact, while over half of all TB patients in India seek care in the private sector, the case notifications from the private sector are way behind those in government hospitals across the country. Although the Union Health Ministry had set a target to reach 15 lakh case notifications from the private sector in 2018, only 5.4 lakh cases have been notified from across the country.
However, justifying the low rate of TB notification from the private sector in Karnataka, Seenappa, State Joint Director (Tuberculosis), said this is because most private doctors tend to refer a TB patient to a government facility rather than notifying it themselves on the NIKSHAY portal.
