Monday, September 24, 2018

Early detection and timely treatment are the prerequisites to end TB by 2025

 The World Health Organization (WHO) has published its latest edition of the global TB report for this year. As per the report, globally, 10 million people developed TB disease in 2017; of these, 5.8 million were men, 3.2 million women and 1.0 million children. About 1.7 billion people, 23% of the world’s population, are estimated to have a latent TB infection, which puts them at risk of developing active TB disease. Also, drug-resistant TB continues to be a public health crisis. In 2017, 558 000 people developed rifampicin-resistant (RR)-TB); of these, 82% had multidrug-resistant TB (MDR-TB).
 The disease burden caused by TB is declining in most countries, but not fast enough to reach the first (2020) milestones of the End TB Strategy.
 By 2020, the TB incidence rate needs to be falling at 4–5% per year, and the proportion of people with TB who die from the disease (the case fatality ratio, CFR) needs to fall to 10%. But, worldwide, the TB incidence rate is falling at about 2% per year and the TB mortality rate is falling at about 3% per year.
 So, clearly much more needs to be done if the goal of ending the TB epidemic by 2030 is to be met with.
 TB remains the leading cause of death from a single infectious agent (above HIV/AIDS).
 Specific targets for 2030 are a 90% reduction in the absolute number of TB deaths and an 80% reduction in TB incidence (new cases per 100 000 population per year), compared with levels in 2015. Underreporting of detected cases and underdiagnosis remain major challenges to achieving these targets.

In 2017, India accounted for highest number of TB cases globally at 27%; India along with China and the Russian Federation accounted for almost half of the world’s cases of MDR/RR-TB: India (24%), China (13%) and the Russian Federation (10%).

India (26%) was the top country accounting for the global gap in diagnosis and treatment followed by Indonesia (11%) and Nigeria (9%).

India has not fared well as is evident from this latest global TB report. TB is a preventable and curable disease. Despite advances in TB care, India continues to have the highest burden of both TB and MDR TB patients globally.

India has set an ambitious target for itself – to be free of TB by 2025 - five years before the global target in the Delhi End TB Summit held in March this year. To achieve these targets, the Government has rolled out new “National Strategic Plan (NSP) to end TB by 2025”.

Control of TB should therefore be of immediate priority for all stakeholders including health care providers and policy makers.

When I was president of IMA, we had started a campaign “IMA TB Initiative: GTN”. The latest TB statistics for India bring this strategy to the forefront in the battle against TB.

l G: GeneXpert test (diagnose)
l T: Treat (patients) & Trace (contacts)
l N: Notify (mandatory)

Early diagnosis translating to early treatment is the basis of controlling TB. 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. Contact tracing interrupts the chain of transmission of the disease by early detection and timely and complete treatment. TB is a notifiable disease. Every case of TB has to be notified to the concerned authorities.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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