Conext:
A comprehensive approach is required , integrating system wide and community level actions with a strong focus on individuals affected by TB.
Introduction:
- Tuberculosis is caused by a bacterium called mycobacterium tuberculosis
- People with active TB disease in the lungs or voice box can spread the disease
- Drug resistant TB: Some forms of the TB bacteria have become drug resistant
This happens , in part , because a random genetic change in a bacterium which might give it some quality that makes it more likely to survive the attack of an antibiotic
Progress in TB care in India:
- 17% decline in TB incidence in India ( 2015-2023) and a 21.4% reduction in TB related deaths.
This is because :
- Expansion of molecular testing for rapid TB detection and drug resistance.
- Introduction of an oral BPaLM drug regimen
- Doubling of nutritional support engagement and involvement of TB survivors.
Prevalent issues:
- Higher out of pocket expenditure
- Lack of quality care ensured at primary health centres and wellness centres
- without proper guidance , TB patients may delay diagnosis , face social stigma
- Social stigma can lead to isolation , malnourishment and worsening health conditions
- At a macro level , TB is often neglected due to perception that it primarily affects the poor
Key measures to ensure equitable and decentralized TB care:
Strengthening person centred care approaches:
- Models like Tamli nadu’s TB death free project have shown success in reducing TB mortality by identifying and supporting vulnerable groups.
Addressing systemic barriers:
- Referral pathways between private and public health systems need improvement.
Integration of TB service into primary healthcare:
- Co screening of TB patients for diabetes, COPD and other NCDs can improve early intervention.
Financial protection and UHC approaches :
- minimising out of pocket expenses by providing direct financial support to patients and families.
- Scheme like NPY
Need for public private partnership:
- Provide flexibility in care pathways and access to medicines
- Ensure basic diagnostic and treatment standards are not compromised
- Offer choice and comfort to patients while maintaining treatment outcomes
Patient centric approaches:
- A resilient public health system with trained human resources, an uninterrupted drug supply
- Empowered communities led by TB survivors
- Better point of care testing nutritional support and a universal TB vaccine
- Integration of TB care with social and private insurance schemes for financial protection
- Political commitment and corporate investment
- A media that actively highlights TB challenges to drive awareness and action
Learning from covid experience:
- Equity in access to information
- Addressing misinformation and social stigma
- Expanding surveillance and research
Conclusion:
There is no single path to success. Rethinking partnership, challenging norms and reframing problems can provide more effective strategies and pathways for achieving success in TB control ,fostering innovation and improved outcomes in the fight against the disease
Practice mains question:
“TB is the silent killer of the Indian population “. In light of the above statements , it highlights the TB burden that India faces and indicates the measures which can help eliminate the problem.
