Prime Minister Narendra Modi while addressing the One World TB Summit on March 24, World Tuberculosis Day in Varanasi, launched several initiatives, including the Tuberculosis-Mukt Panchayat, a shorter Tuberculosis Preventive Treatment, and a family-centric care model for Tuberculosis. He also released India’s Annual Tuberculosis Report 2023 and dished out awards to states, Union territories and districts for their progress towards ending Tuberculosis.
“Karnataka and Jammu and Kashmir have been honoured with the Tuberculosis-Free Award. Awards have also been given for the best work at the district level,” said the prime minister.
The Sustainable Development Goal for Tuberculosis requires a 90% reduction in mortality and an 80% reduction in the incidence rate of Tuberculosis cases by 2030 from the 2015 baseline. India had an estimated 2.8 million new cases of Tuberculosis in 2015. India had an estimated 2.9 million new cases of Tuberculosis in 2021, as per the World Health Organization Global Tuberculosis Report 2022.
“To incentivise states/Union territories and districts to continue working towards the Sustainable Development Goal, the Tuberculosis-free award was introduced in 2020. This award is linked with incentives, encouraging states/Union territories and districts to achieve various milestones in a short period of time. This fosters healthy competition among them and keeps them motivated,” said a senior government official in the Central Tuberculosis Division, who did not want to be named.
The Tuberculosis-free award acknowledges accomplishments in decreasing the incidence of Tuberculosis cases through four distinct categories, with 2015 as the base year. Districts and states/Union territories that successfully reduce the incidence of Tuberculosis cases by 80%, meeting the Sustainable Development Goal, are granted the highest level of recognition, which is the Tuberculosis-free status. The other categories comprise the gold medal category, granted for a 60% reduction, the silver medal category for a 40% reduction and the bronze medal category for a 20% reduction in Tuberculosis incidence.
Karnataka received the silver medal, indicating a 40% reduction in incidence of Tuberculosis cases from 2015, while Jammu and Kashmir bagged the bronze medal, indicating a 20% decline in incidence of Tuberculosis cases compared to 2015. Three districts – the Nilgiris (Tamil Nadu), Pulwama (Jammu and Kashmir), Anantnag (Jammu and Kashmir) – received the Tuberculosis-free status as they reduced the incidence of Tuberculosis by 80%.
A national task force of experts from the Indian Council for Medical Research, the National Institute of Epidemiology, the National Institute for Research in Tuberculosis, World Health Organization India and the Indian Association of Preventive and Social Medicine independently verifies districts and states/Union territories under different categories.
The senior government official explained three methods used by the experts for verification of Tuberculosis-free status. The first method is called the Inverse sampling methodology or direct survey, which involves identifying a pre-determined figure of 30 cases based on the prevalence of Tuberculosis in the community and screening of the population to find those cases. The survey is completed in the district either when 5% of the district’s population is covered, or at least 10,000 households are screened, or 30 cases are found, whichever happens first. In addition to the survey, there is a thorough verification of secondary data available in the district.
The second method involves examining the sale of Tuberculosis drugs in the private sector in the district from 2015 onwards, while the third method assesses the district’s performance in terms of key programme indicators, such as the number of people tested and the number of negative tests, etc.
Two of the three methods should show a reduction according to the set criteria for the district to be awarded.
The reason the sale of Tuberculosis drugs is tracked is because often, Tuberculosis cases in the private sector go unreported to the government, and therefore, the sale of Tuberculosis drugs is a better indicator of how widespread the disease is. (That said, private sector notifications have grown over the years.)
Awards and Recognitions
In 2020, Budgam district in Jammu and Kashmir and Lakshadweep became the first district and Union territory, respectively, to attain over an 80% decrease in Tuberculosis incidence. As of now, a total of four districts and one Union territory have received the Tuberculosis-free certification.
Tuberculosis elimination goals
The award is given by India’s National Tuberculosis Elimination Programme, implemented by the government under the National Health Mission. The National Strategic Plan 2017-2025 for Tuberculosis Elimination has set targets to reduce the incidence of new Tuberculosis cases by 80% and to eliminate Tuberculosis by 2025, which is five years ahead of the global timeline. Elimination of Tuberculosis means India would have to reduce the incidence rate of the disease to 44 cases per 100,000 population by 2025.
Notifications refers to cases of Tuberculosis registered with the government. The government mandates that any case of Tuberculosis, whether treated in the private or public sector, be registered with the government.
With 2,420,000 cases and an approximate notification rate of 172 cases per 100,000 population in 2022, Tuberculosis case notification in India increased by 0.6% from 2019. Detecting (and notifying) new Tuberculosis cases in 2020 and 2021 had become harder because of the Covid-19-related lockdowns and the burden on the health system, and notifications had dropped during this period, even as the Tuberculosis case burden was estimated to be the same.
“We are confident in achieving the 2025 target of eliminating Tuberculosis in India because we are currently performing better than other countries. Despite facing challenges, we are focused on expanding prevention measures such as the shorter Tuberculosis Preventive Treatment initiative, which we believe will lead to a significant reduction in new cases next year,” said the senior government official. The shorter Tuberculosis Preventive Treatment initiative includes a weekly regimen of 12 doses for three months, and was announced during the One World TB summit.
But experts point out some challenges that need to be overcome for India to achieve its goals. Blessina Kumar, chief executive officer of the Global Coalition of TB Advocates, a coalition of people affected by Tuberculosis from across the globe, said that the “diagnostic tools are available but uninterrupted supply of commodities like cartridges [used in testing machines] remains a challenge at the ground level”.
Dr Shibu Vijayan, a public health expert working in the field of Tuberculosis for the last 25 years, and currently medical director of Global Health Qure.ai, an AI startup for Chest X-ray interpretation for Tuberculosis triaging, said that within the next six months India needs to roll out the shorter drug regimen for Multidrug-resistant TB (MDR-TB), which will bring down the time to treat from 18-24 months to 6-9 months. He added that, globally, there have to be accelerated innovations in Tuberculosis treatment and vaccinations.
Kumar and Vijayan said that India still needs to implement initiatives faster, and effectively. “India has a significant burden of Tuberculosis, and commitments must be translated into effective implementation on the ground,” said Kumar.
This article first appeared on FactChecker.in, a publication of the data-driven and public-interest journalism non-profit IndiaSpend.