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(Source – The Hindu, International Edition – Page No. – 8)

The article discusses challenges faced by India in achieving its End TB targets due to high global TB burden, drug-resistant cases, and systemic healthcare gaps.

  • Tuberculosis (TB) remains the leading infectious disease killer globally.
  • The End TB targets, which aim for a 90% reduction in TB deaths, 80% reduction in new cases, and zero catastrophic costs for TB-affected families by 2030, are far from being achieved.
  • India pledged in 2018 to achieve these targets by 2025 but faced setbacks due to the COVID-19 pandemic.
  • According to the WHO Global Tuberculosis Report 2024, India accounts for 26% of global TB cases and remains a hub for drug-resistant TB and TB-related deaths.
  • High-risk groups include individuals exposed to factors like silicosis, undernutrition, overcrowding, and comorbidities such as diabetes.
  • Migrant workers face challenges due to poor access to healthcare and difficulty continuing treatment when moving back to native places.
  • Addressing undernutrition is a priority, but other contributory factors require multisectoral actions tailored to specific regions.
  • India’s National Tuberculosis Elimination Programme (NTEP) offers free and effective drugs, achieving treatment initiation in over 95% of notified cases.
  • However, a supply chain disruption in 2023 led to a shortage of key drugs, causing treatment delays, risk of antibiotic resistance, and catastrophic health expenses.
  • Extrapulmonary TB (EP-TB) affects organs other than the lungs, such as lymph nodes, kidneys, brain, and bones, accounting for 24% of cases.
  • EP-TB is often missed or diagnosed late due to vague symptoms resembling other diseases.
  • General practitioners need better training to detect EP-TB early through simple tests and thorough clinical examinations.
  • Studies indicate that only 35% of private practitioners and 75% of government doctors can correctly diagnose classical TB symptoms.
  • shortage of trained staff and limited access to molecular tests like CBNAAT and Truenat delay diagnosis.
  • Many testing facilities are district-based, and logistical issues like cartridge shortages and technician availability worsen the problem.
  • In Idukki, Kerala, collaboration with Kudumbashree, a women’s self-help network, led to significant community participation and advocacy, helping achieve TB targets.
  • Advocacy by political leaders and cross-learning from successful practices across regions can enhance TB elimination efforts.
  • India achieved a 24% decline in TB deaths compared to 2015, exceeding the global decline rate.
  • Learning from countries like Vietnam, which used active case finding among high-risk groups, could improve interventions.
  • India must adapt its strategies and frameworks to address regional challenges and accelerate progress toward eliminating TB.
  • Achieving the End TB targets by 2025 remains challenging due to systemic issues, but progress in case notification and reduced deaths offers hope.
  • Strengthened healthcare systems and community-driven interventions are crucial to eliminating TB.

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