Tuberculosis (TB)

Why in the News?

Recent studies have indicated that nutritional deficiency has led to an increase in TB cases in India, which has been compounded by drug shortages recently.

• Shortage of Rifampicin, a medicine used for treating drug sensitive TB was not available in many parts of India since last year.
• Since June 2023, three important medicines used for treating drug resistant TB — Linezolid, Clofazimine, and Cycloserine have faced a stock out.

TB and Nutritional deficit:

1. Severe undernutrition is one of the contributing causes of deaths in TB patients.
2. Undernutrition as a risk factor accounts for over 40% of new TB cases every year.

Key highlights of the study:

1. Nutritional support led to 39% reduction in all forms TB disease (pulmonary and extra-pulmonary) and 48% reduction in microbiologically confirmed pulmonary TB.
2. Early weight gain in the first two months was associated with 60% lower risk of TB mortality.
3. Treatment w successful in 94% of TB patients and only 4% of mortality was reported during the trial period.

About:

Tuberculosis:

1. An infectious bacterial disease caused by Mycobacterium tuberculosis that commonly affect the lungs.
2. Mode of transmission: A communicable disease transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease.
3. Tuberculosis is preventable and curable.
4. Those who are infected but not (yet) ill with the disease cannot transmit it.
5. TB disease is usually treated with antibiotics and can be fatal without treatment.
6. Symptoms: prolonged cough, chest pain, weakness, fatigue, weight loss, fever and night sweats.

Incidence if TB cases globally and in India:

1. Global TB Report 2021: The estimated mortality rate among all forms of TB was 37 per 100,000 population in 2020.
2. India has the highest burden of TB with two deaths occuring every three minutes from tuberculosis (TB).
3. TB is the 13th leading cause of death and the second leading infectious killer after COVID-19 (above HIV and AIDS).
4. The Covid-19 pandemic led to setbacks in the fight against TB in decades of gain achieved.
5. Of the total number of people who develop TB each year, about 90% are adults, with more cases among men than women

Efforts taken so far:

1. National Tuberculosis Elimination Programme (NTEP)
   • Free of cost laboratory services to patients attending public health facilities and those referred from the private sector.
   • Special campaign to identify Active Case finding among risk groups: diabetes, chronic kidney and liver disease, patients on immuno-suppressants, etc.,

1. • Adoption and adaptation of newer drugs and treatment modalities for TB control.
     • • For instance, an injection-free treatment regimen for Drug-sensitive TB has been implemented across the country.
   • Decentralised TB services to the Ayushman Bharat – Health and Wellness Centres (AB-HWC) to offer last-mile service delivery to TB patients.
   • Access to drugs including newer drugs to patients seeking care in the private sector has been given for free.
2. National Strategic Plan for Elimination of Tuberculosis (NSP 2017- 25)
   • Four critical pillars of NSP 2017-25 includes
     1. Detect
     2. Treat
     3. Prevent – implementation of TB Preventive therapy to all household contacts.
     4. Build

3. 18 States have committed to Ending TB by 2025 by formally implementing
   • State-specific Strategic Plans and
   • District-specific Strategic Plan
4. TB comorbidities handling:

1. Malnutrition
   1. Nutrition-TB App (N-TB App):
      1. Under Ministry of Women and Child Development (MoWCD).
      2. facilitates the implementation of the technical aspects of the nutritional assessment and appropriate supplementation
2. Tobacco smoking and alcohol
   1. Support through de-addiction centres
   2. Social Support systems to people struggling with alcoholism.
3. HIV
   1. Provider Initiated Testing and Counselling (PITC) initiative for early detection of HIV among presumptive TB patients.
   2. Single-window TB and HIV services implementation

5. TB Aarogya Sathi application
   • For people with TB with multi-language support
   • TB screening tool
   • Self-reporting bank account and treatment adherence feature.