Tuberculosis in India
Interventions in this program include major investment in health care, providing supplemental nutrition credit through the Nikshay Poshan Yojana, organizing a national epidemiological survey for tuberculosis, and organizing a national campaign to tie together the Indian government and private health infrastructure for the goal of eliminating the disease.
This issue of drug resistance began with MDR-TB, moved to XDR-TB and, as of 2021, has grown to embrace the most dangerous form, TDR-TB.
A report by Zarir Udwadia, originating from studies at the Hinduja Hospital in Mumbai, discusses the drug-resistant effects and results.
[10] On March 24, 2019, TB Day, the Ministry of Health & Family Welfare of India notified that 2.15 million new tuberculosis patients were discovered only in 2018.
Although the TB bacteria can infect any organ (e.g., kidney, lymph nodes, bones, joints) in the body, the disease commonly occurs in the lungs.
Coughing, sneezing, and even talking to someone can release the mycobacterium into the air, and a person's chances of becoming infected are higher in countries where TB is common and where there is a big proportion of homeless people.
Local decreases in the incidence of tuberculosis in India correlate with improvements in social and economic determinants of health more than with access to quality treatment.
That leaves patients who seek treatment in India's growing private sector to buy drugs for themselves, and most struggle to do that, government officials say.”[10] Although the latest phase of the state-run tuberculosis eradication program, the Revised National Tuberculosis Control Program (RNTCP), has focused on increasing access to TB care for poor people,[13] the majority of poor people still cannot access TB care financially.
[10] While RNTCP has created schemes to offer free or subsidized, high quality TB care, less than 1% of private practitioners have become fully involved.
[17] This is exacerbated by a lack of education and background information which practitioners and professionals hold for prescribing drugs, or those private therapy sessions.
A study conducted in Mumbai by Udwadia, Amale, Ajbani, and Rodrigues, showed that only 5 of 106 private practitioners practicing in a crowded area called Dharavi could prescribe a correct prescription for a hypothetical patient with MDR-TB.
[17] Poverty and a lack of financial resources are also associated with malnutrition, poor housing conditions, substance misuse, and HIV/AIDS incidence.
The antibiotics most commonly used include isoniazid, rifampin, pyrazinamide, and ethambutol.The treatment under the National TB Elimination Program (NTEP) in India consists of a 2 (HRZE)/4(HRE) anti-TB regime wherein INH, Rifampicin, Pyrazinamide, and ethambutol are given for an initial two months(intensive phase) followed by four months of INH, Rifampicin and Ethambutol.
This vaccine is generally used in countries or communities where the risk of TB infection is greater than 1% each year,[9] which includes parts of India.
In recent years, as smartphone usage and accessibility to low-cost internet services have gained traction in India, perceptions of alternative services such as SMS reminders, voice calls and video DOT (vDOT) have been explored and shown to be acceptable to a variety of patient population thus saving time and money.
[25] Treatment recommendations from Udwadia, et al. suggest that patients with TDR-TB only be treated “within the confines of government-sanctioned DOTS-Plus Programs to prevent the emergence of this untreatable form of tuberculosis”.
[18] Given this conclusion by Udawadai, et al., it is considered certain, as of 2012, that the new Indian government program will insist on providing drugs free of charge to TB patients of India, for the first time ever.
To counteract disempowerment, some countries have engaged patients in the process of implementing the DOTS and in creating other treatment regimens that give more attention to their nonclinical needs.
[33] Pro-poor strategies, including wage compensation for time lost to treatment, working with civil society organizations to link low income patients to social services, nutritional support, and offering local NGOs and committees a platform for engagement with the work done by private providers may reduce the burden of TB[34] and lead to greater patient autonomy.
[35] India has a large burden of the world's TB, with an estimated economic cost of US$100 million lost annually due to this disease.
