Eradication of TB remains a distant goal as systemic challenges persist

Survivors Against TB urge India to address TB crisis with expanded efforts, including nutrition support and improved diagnosis.

Ahead of World TB Day on March 24, Survivors Against TB, a community advocacy group of TB survivors, wrote a letter to the Prime Minister “on the urgent and pressing need to expand efforts to address India’s Tuberculosis (TB) crisis.” The letter mentions that despite the government’s commitment to “eliminate high-burden infectious” TB by 2025, ‘we are still far from reaching this goal’ and identifies six key challenges: TB diagnosis and access; lack of access to free, quality treatment and drugs; adequate nutrition and mental health support; stigma-free and gender responsive care; economic support; and high quality care. 

Tuberculosis is a ‘biosocial problem that requires biosocial solutions,” says a commentary in The Lancet. It is a “curable infectious disease linked to inequities. “Socioeconomic conditions create vulnerabilities to the disease and its catastrophic outcomes.”

  India could lead in TB elimination

“India’s efforts are a new model for the global war on TB,” the government says. According to the World TB Report 2023, India recorded an average of 199 new infections in every 100,000 people in 2022. An estimated 13% of treated patients and 2.5% of new cases were multi-drug resistant or resistant to the first-line drug rifampicin. Nearly 400,000 people die of TB each year in the country. 

Current biomedical strategies to reduce new infections include the BCG vaccine, which protects against severe forms of childhood TB; tuberculosis preventive treatment (TPT) which now aims to cover other household contacts and clinical-risk groups apart from children younger than five years and household contacts with HIV; and newer, shorter courses (1–3 months) and effective rifamycin-based regimes. 

Despite the array of interventions, “challenges such as insufficient diagnosis and treatment access, stigma, and socioeconomic barriers continue to impede India’s progress in combating this disease,” says Chapal Mehra, convenor of SATB in the letter. 

Undernutrition is a major risk factor for both the occurrence of new cases and the occurrence of severe TB that can result in TB deaths, Anurag Bhargava, professor at the Yenepoya Medical College, Manipal, and one of the authors of The Lancet report, said. Undernutrition in adults contributes to 34–45% of all new cases annually, while undernutrition in patients with TB is a major risk factor for TB deaths, apart from increasing the risk of drug toxicity and relapse. This is the most important risk in the management of TB. Undernutrition impacts both the occurrence of TB and the outcomes of TB treatment, which include mortality, drug toxicity to patients, and relapse.