Saturday, March 24, 2018

It is time to revisit the ‘GTN’ approach to end TB

Dr KK Aggarwal
Padma Shri Awardee

TB is a preventable and curable disease and yet despite advances in TB care, India continues to have the highest burden of both TB and MDR TB patients and accounts for about a quarter of the global TB burden. An estimated 1.3 lakh incident multi-drug resistant TB patients emerge annually in India, which includes 79000 MDR-TB Patients estimates among notified pulmonary cases. India bears second highest number of estimated HIV associated TB in the world (TB India 2017).

Globally, the incidence of TB has been declining at about 2% per year. But, this decline is not enough to achieve the first 2020 milestone of the End TB Strategy and the target of ending the TB epidemic by 2030 under the Sustainable Development Goals (SDG 3). TB cases have to decline by 4-5% to achieve this target.

India also has the dubious distinction of being among the top three countries, where the gap between estimated TB incidence and reported cases is the highest: India (25%), Indonesia (16%) and Nigeria (8%). Ten countries accounted for 75% of the incidence-treatment enrolment gap for drug-resistant TB; again India along with China accounted for 39% of the global gap.

This wide gap in the incidence of TB and the reported cases highlights the IMA End TB Strategy of “GTN”, where G stands for GeneXpert test (sputum diagnosis), T for Trace (contacts) and Treat. N is to Notify the disease at Nikshay (mandatory).

India has set 2025 as deadline to be free of TB. Although preventing and controlling TB is a collaborative effort, doctors are major stakeholders in the control of TB.

Control of TB depends on early detection, which means early and better treatment to prevent further spread of TB. Contact tracing interrupts the chain of transmission of the disease by early diagnosis of cases as well as timely and complete treatment.

All household and close contacts of patients with infectious TB should be traced, screened and treated with a full course of ATT if found to have TB.

A household contact is a person who has shared the same enclosed living space for one or more nights or for frequent or extended periods during the day with the index case during the 3 months before starting the current treatment. A close contact is a person who is not in the household but has shared an enclosed space, such as a social gathering place, workplace or facility, for extended periods during the day with the index case during the 3 months before initiation of the current treatment episode (WHO 2012).

Most of us regularly treat many patients of TB. And, there can be no time better than today, World TB Day, to reiterate our commitment to ‘GTN’ and file our returns.

Ask yourself, how many GeneXpert tests you have ordered… how many contacts you have traced and screened for TB…and how many TB patients you have notified at Nikshay.

You can notify even today, if not done earlier. It is not necessary to notify the day you diagnose the patient as having TB.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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