TB Muktt Bharat | TB Free India | Win over Tuberculosis

PMO INDIA with an initiative of the Ministry of Health and Family Welfare (MOHFW) INDIA, has facilitated the country's progress towards TB elimination by 2025 and made India TB-free.

What is Tuberculosis?

Tuberculosis (TB) is an infectious airborne disease caused by Mycobacterium tuberculosis, most commonly affecting the lungs. It is usually transmitted from person to person via droplets of people with active respiratory disease. 

Ways of Transmission: 

1) Airborne – Coughing, Sneezing, 
2) Alimentary (Through the Digestive Tract);
3) Contact;
4) Intrauterine infection with tuberculosis.

Symptoms: Symptoms of active lung TB are 

1)    Cough with sputum ≥ 2 weeks, 
2)    high fever ≥ 2 weeks,
3)     Significant weight loss  > 10%,
4)    Night sweat,
5)    Haemoptysis
6)    Chest pain, 
7)    Shortness of breath, 
8)    Weakness, etc.

Vaccine: BACILLE CALMETTE GUERIN (BCG)

Statistics: 

According to WHO, 33.33% of the world's population is infected with Mycobacterium TB. In 80% of cases, infection occurs in childhood. 20% of the population has an active form of tuberculosis. 

India has the world’s highest burden of TB with six deaths occurring every ten minutes from tuberculosis (TB). India is trying all possible methods to prevent these deaths. With the proper course of treatment and keeping a record of the patients, TB patients can be cured and the nation can come to the elimination phase by 2025.

•    Rate of Incidence of TB: 190 cases/lakh population
•    Estimated TB cases: 26.4 lahks (2019)
•    Reported TB cases - 24 lakhs (2019) 
                                    - 18 lakhs (2020) 
                                    - 12.8 lakhs (So far-Aug’21)

What is Pradhan Mantri TB Mukt Bharat Abhiyaan?

To galvanize community participation and ownership, Her Excellency, Smt. Droupadi Murmu, Hon’ble President of India on 9th September 2022 launched the “Pradhan Mantri TB Mukt Bharat Abhiyaan (PMTBMBA)” to provide persons affected with TB and their families additional nutritional, diagnostic, and vocational support, delivered by the community. Enormous participation from all States/UTs has been seen with Political leaders, Ministers, MPs, Elected Representatives, Government officials, NGOs and big associations coming forward and conducting multiple events to spread awareness about the PMTBMBA initiative. 

NATIONAL STRATEGIC PLAN.

1) DETECT

Actively searching and reaching every TB patient in the private sector.

•    Decentralize TB screening to AB-HWC levels,
•    Scale up Improved Diagnostics to the PHC  Levels,
•    Early Detection of Drug-Resistant TB,
•    Vulnerability Mapping & Active case finding,
•    Private Sector Engagement.

2) TREAT

Treat all TB cases with high-quality anti-TB drugs.

•    Daily regimen –Fixed Dose Combination
•    Increase Treatment Success Rate > 90%
•    Injection-free treatment regimens
•    Scale up of Newer drugs/regimens
•    >4 lakh ASHA & Community Volunteer as DOT provider

3) PREVENT

Prevent the emergence of TB in susceptible populations and stop catastrophic expenditure due to TB by all.

•    Sustaining COVID-appropriate behaviour,
•    Contact tracing and screening of all household contact and TB

Preventive Treatment

•    Control airborne infections in community & Health Facilities,
•    Community Mobilization & People’s Movement.

4) BUILD

Build & strengthen supportive systems including enabling policies, empowered institutions & human resources.

•    National Training on Tuberculosis at NIRT.
•    Digital Interventions - 
•    Multisectoral Collaboration Digital Intervention.
•    Procurement & Supply Chain Management
•    Surveillance 

5) VERIFICATION:

•    A community survey of incidence & under-reporting
•    Interviews with private doctors & chemists to verify drug sales in the community. 
•    Verification of the TB score of an individual and review of records.

TB Arogya Saathi App

NIKSHAY (Case-based, web-based surveillance for TB)
Nikshay Mitra Initiative: It is to take care of Nutrition, additional diagnostic, and provide support to those on TB treatment.

Nikshay Poshan Yojana:

•Rs. 500/- per month given to every TB patient through DBT for the duration of treatment 
•Scheme rolled out from April 2018 

Global Efforts:

The WHO (World Health Organisation) has launched a “#EndTB” with the Global Fund and Stop TB Partnership.
 The global TB report is maintained and recorded by WHO.

India’s Efforts:

India’s National TB Elimination Programme is enhanced to achieve the goal of ending the TB epidemic by 2025 from the country.

National Strategic Plan (NSP) for Tuberculosis Elimination (2017-2025), The Nikshay Ecosystem (National TB information system), Nikshay Poshan Yojana (NPY- financial support), TB Harega Desh Jeetega Campaign.

Two vaccines have been developed for TB, and are under Phase-3 clinical trial. (Vaccine Projekt Management) 1002 and MIP (Mycobacterium Indicus Pranii)

Ni-kshay Poshan Yojana:  Rs 500 per month is provided in support to the patient through direct benefit transfer.
Ayushman Bharat Digital Health Mission: Ensure proper diagnostics and treatment and keep the records of the patient by creating digital health IDs for TB patients

Impact of COVID-19 on TB elimination efforts:

Compared to district hospitals PHCs (Primary health centres) were more affected, both in the aspect of initial steps (drop in TB cases notified at the start of COVID-19) and with the decline in recovery after the initial phase of the COVID-19 epidemic. Reasons for the difference in reporting rates could include District hospitals being prioritized for PPE and other medical needs, thus remaining more functional than healthcare centres; in addition, patients with TB diagnosed at community health centres tend to have more severe illness and potentially were unable to delay seeking healthcare.

Conclusion

The effects of unattended or delayed TB diagnoses likely were severe for the patient and family members. However, the initial COVID-19–related were reduced in TB case notifications. National TB Programme had a relatively fast recovery after the first wave of COVID-19. However, Public health and healthcare officials should seek opportunities to combine resources to deal with both COVID-19 and TB cases simultaneously. Through better infection prevention and control at health facilities, Improved laboratory infrastructure, community engagement and providing information about both diseases, communities can improve universal health coverage.

India has been leading Public health conversations for many years and is fully committed to ensuring the elimination of TB from India. National TB Elimination Programme (NTEP) has done a commendable job in eliminating TB in India, despite the nation being hit by the epidemic COVID 19. Beyond focusing on patients only, MOHFW has successfully ensured the "TB VIJETAS" to empower the patient and community so that they can help raise disease awareness further and enhance the overall health literacy of the community. The essence of community support has been captured effectively by the Hon’ble PM's Vision of Pradhan Mantri TB Mukt Bharat Abhiyaan. This initiative helps a range of individuals, corporates, elected representatives and organisations to consider adopting TB patients- thereby providing support to districts and blocks across states and UTs in India. 

Digital tools like NIKSHAY Portal – supported community engagement and gave granular data on TB, In addition, The NIKSHAY 2.0, apart from enabling the linkages of the Ni-kshay Mitras with persons affected by TB, helps in real-time monitoring of the progress of flagship scheme PM TB Mukt Bharat Abhiyaan.

The NTEP has been working diligently to prevent TB disease and consistently improve time-to-diagnosis and treatment initiation, adherence, and outcomes. Significant advances have been made in India in 2022 in providing accurate TB diagnostics and effective treatment. India is well on its way to achieving our ambitious goal of Ending TB and the NTEP continues the relentless efforts towards a TB Free India.

TB Harega, Desh Jeetega!

Compiled by Dr. Rakesh Kumavat MBBS - Team Proceed Fit  

References:  https://pib.gov.in/

Disclaimer : The information provided in this article is for general informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment. If you have any concerns about your health or are experiencing symptoms, it is important to consult with a healthcare professional. They will be able to assess your specific situation and provide you with personalised advice and treatment based on your symptoms, body type, allergies (if any), existing medical conditions etc. It is always a good idea to consult with a healthcare professional before making any decisions about your health.