India TB Report 2024

Introduction

The India TB Report 2024 was released in March 2024 under the National TB Elimination Programme (NTEP) by the Central TB Division, which is a part of the Ministry of Health and Family Welfare. This report highlights the existent control activities for Tuberculosis (TB), new policies, and the implementation of programme, along with performance indicators at district and state levels in the country.

First published in 2001, this annual report presents the policy updates, implementation programmes, district-and state-wise performance indicators, and so on.

The NTEP is a public health initiative of the Indian government. Started in 2020, NTEP was formerly known as the Revised National Tuberculosis Control Programme (RNTCP). It envisions to better organise and strengthen anti-TB efforts across the country and eliminate TB from India by 2025 with its two significant initiatives—the Ni-Kshay Mitra Initiative (which provides additional diagnostic, nutritional, and vocational support to TB patients) and the Ni-Kshay Digital Portal (a platform for community support for persons with TB).

Status of TB in India

The cases of TB in India have shown a decline of 16 per cent since the year 2015, i.e., in 2015, it was 237 per lakh population; while in 2022, it was 199 per lakh population. Similarly, The mortality rate owing to TB has also reduced by 18 percent, i.e., it was 28 per lakh population in 2015; while in 2022, it was 23 per lakh population.

However, in 2023, the private healthcare sector had recorded almost 32 per cent of TB notifications. This shows an increment of 17 per cent as compared to the previous year. Considering the last nine years, there has been an improvement in the overall notification of TB cases by more than 50 per cent annually. The highest number of TB notifications came from Uttar Pradesh, with an increase of 21 per cent from the last year. The second highest rate was in Bihar with 15 per cent increase.

Tuberculosis: Some Dimensions

Tuberculosis is a contagious disease caused by a bacterium named Mycobacterium tuberculosis. The disease infects those people who are either often malnourished or have low immunity levels and mainly affects the lungs. However, other body parts, particularly intestines, spine, brain, lymph nodes and pleura (lining around the lungs) can also be affected by this disease.

Transmission of TB It is an air-borne disease, i.e., it can spread from person to person through air particles whenever an infected person speaks, coughs, sneezes, or spits. It spreads rapidly in places having dense population and inadequate ventilation. In today's times, the disease can be cured as well as prevented. According to the scientists around the world, it is estimated that almost one-fourth of the global population has TB infection. However, it cannot be transmitted through the people who are not yet ill but only infected, i.e., the ones who have no symptoms of TB. Such TB is called latent tuberculosis.  

Symptoms Weakness, coughing with sputum and blood, fever, chest pain, weight loss, and night sweats are some of the most common symptoms of this disease.  

Prevalence According to this report, around 10 million people get infected with TB every year. Although the disease is curable and preventable, it is one of the top infectious diseases around the world. This is because almost 1.5 million people out of 10 million die of this disease every year. In fact, the major cause of death of people infected with Human Immunodeficiency Virus (HIV) is TB. Besides, it is the main reason for antimicrobial resistance. The majority of the TB patients belong to underdeveloped and developing countries such as Bangladesh, Nigeria, India, South Africa, Pakistan, and the Philippines.

Global Scenario

The largest number of TB cases occurred in the Southeast Asia and the Western Pacific regions (62 per cent new cases) followed by the African region (25 per cent new cases). Two-thirds of new TB cases occurred in India, China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh, and South Africa. As per the 2018 Global TB Report by the WHO, about half of the world’s multi-drug resistant tuberculosis (MDR-TB) cases are in India, China, and Russia with 24 per cent, 13 per cent, and 10 per cent, respectively.

Global TB statistics

• A dormant form of Mycobacterium tuberculosis (M.ts) is found in about two billion people across the world.
• Around 10 million people fall ill with TB annually since 2000.
• About 5–10 per cent of newly infected people are predisposed to developing active TB in their lifespan.
• Some one million people succumb to death from TB every year since 2000.
• HIV co-infection enhances the risk of TB reactivation by 18 times.

About the National Strategic Plan for TB (2017–25)

The Ministry for Health and Family Welfare initiated the National Strategic Plan (NSP) for TB (2017–25). The plan is aimed at obtaining the sustainable development goal (SDG) targets associated with TB by the end of 2025, which is ahead of the global target by almost five years. That is, under Goal 3 of the SDGs of the United Nations, the TB epidemic should cease to exist by 2030.

Besides, a number of strategies have been taken up by the NSP for Tuberculosis based on four important pillars, i.e., ‘Detect’, ‘Treat’, ‘Prevent’, and ‘Build’.

Some Highlights of the Report

• Declining missing cases According to the report, the ‘missing cases’ have been considerably reduced. ‘Missing cases’ are those individuals who are yet unaware that they have TB and, thus, might spread the infection unknowingly. The number of such cases was reduced from 3.2 lakh in 2022 to 2.3 lakh in 2023.
  This became possible due to an important government initiative, namely the Ni-kshay portal. Apart from identifying the TB patients, Ni-kshay performs various other roles, such as ensuring adequate care for the patients, monitoring their progress, and spotting possible issues in advance. With this efficient approach, ‘missing cases’ can be easily tracked and treated before the infection spreads.  
• Giving more accurate figure of TB cases As per the report, the gap between the actual number of cases diagnosed and estimated number of cases is reducing. This is a positive aspect, as it is feared that ‘missing cases’ can transmit TB in the absence of treatment. The gap is narrowing due to the use of advanced detection methods and surveillance techniques.
• Contribution by the private sector Though the maximum number of TB cases is reported by the government healthcare centres (the number of cases reported in a year went down from 29.4 lakh in 2021 to 27.4 lakh in 2022), the private sector has more important role to play. In 2023, the private sector reported considerable number of TB cases, i.e., 8.4 lakh out of the total 25.5 lakh cases reported, i.e., about 33 per cent. In 2015, it was merely 1.9 lakh cases.
  This can be regarded as advantageous, as private sector will contribute more to end TB in the country by enhancing diagnosis and treatment facility throughout the country.
• Risk of TB and mortality It is a cause of concern that there are still a large number of estimated TB cases, i.e., 27.8 lakh cases in 2023, in spite of the positive shift. Besides, the number of deaths due to TB is the same, i.e., 3.2 lakh, as it was in 2022. With these figures, the considerable TB burden in the country is highlighted. However, the mortality rate of TB was reduced from 4.94 lakh in 2021 to 3.31 lakh in 2022. Still, greater continuous efforts are required to further reduce the incidences and mortality.

TB Cases in India over the Years

• Achieving targets of treatment In 2023, the healthcare centres in the country were able to start treating 95 per cent of TB patients who were diagnosed with the infection. This implies that the healthcare system in the country is functioning properly. The healthcare personnel ensure that drug resistance is tested in more and more patients so that most effective medical treatment can be given to them. In 2015, such patients were merely 25 per cent, while in 2023, around 58 per cent patients were tested.  
• Drug susceptibility testing (DST) As per the report, drug susceptibility testing is mandatory so that drug-resistant TB can be recognised in time. With timely detection, apt treatment can be commenced quickly, which will in turn prevent the failure of treatment. Besides, drug-resistant strains can also be prevented from transmitting further.  
• Challenges India aims to eradicate TB by 2025. However, there are several challenges in completing the target. In 2023, India could not meet its target, as the number of TB cases and deaths was still higher. Moreover, the incidence and treatment of TB is associated with several risk factors, i.e., undernourishment, alcohol, and tobacco use, diabetes, and HIV.

Undernourishment In 2022, it was found that almost 7.44 lakh TB patients were suffering from undernourishment. To deal with this, Rs 500 is given to around one crore beneficiaries every month by the government. Besides, under the Ni-kshay Mitra programme, it is appealed to the general public to donate food baskets.

Alcohol and tobacco use Consuming over 50 ml of alcohol everyday poses more risk of getting infected with TB and recurring infection. In 2023, almost 74 per cent of TB patients were tested for alcohol use and 7.1 per cent of these were detected to consume alcohol. Similarly, 75 per cent of TB patients were tested for tobacco use and 11 per cent of these were detected to consume tobacco.

Diabetes According to the estimates, almost 1.02 lakh out of 3.7 lakh TB patients who were diabetic around the world lived in India in 2022. Owing to diabetes, the risk of getting TB infection increases manifold. This, in turn, may lead to greater risk of multi-drug resistant TB. Besides, the treatment of TB becomes complicated in diabetic patients.

In 2023, around 7.7 per cent out of 92 per cent of TB patients were diagnosed with diabetes. According to the TB report, diabetes treatment was commenced in almost 63 per cent of the diagnosed cases.

HIV In comparison to the normal population, people having HIV are at a greater risk of getting infected with TB, i.e., almost 20-times more risk. In 2022, HIV was present in around 94,000 TB patients.

Worldwide Initiatives to Eliminate TB

Several initiatives have been taken by the international organisations to fight against TB. Some of them are mentioned below:

• Along with the Global Fund and Stop TB Partnership, the World Health Organisation (WHO) has launched a joint initiative called ‘Find. Treat. All. #EndTB’.
• The Global Tuberculosis Report is published by the WHO from time to time.
• All member states of the United Nations and the WHO have determined a goal to eliminate TB, namely, ‘The Global Plan to End TB, 2023–2030’. This plan includes a draft related to the important measures to be taken and a thorough estimation of the monetary requirement for this purpose. It is a public health challenge to end TB by 2030.  

Indian Initiatives to Combat TB

The Indian government has implemented several policies to end TB. Some of them are as follows:

1. Pradhan Mantri TB Mukt Bharat Abhiyaan
2. National Strategic Plan (NSP) for Tuberculosis Elimination (2017–2025)
3. TB Harega Desh Jeetega Campaign
4. Ni-kshay Poshan Yojana
5. The Regional Prospective Observational Research for Tuberculosis (RePORT) India was founded in 2013 under the Indo-US Vaccine Action Program (VAP). This is a joint, bilateral, and multi-organisational initiative. Its main objective is to deal with TB and eliminate it from the country and the world.

Conclusion

TB can be eradicated from India only with a determined effort. This requires ensuring patient-centred care, adopting innovative techniques, and tackling social health determinants. A comprehensive and patient-centred approach is vital for India to control TB from spreading and build a healthier and safer tomorrow for all its citizens.

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