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Towards a TB free India: It cannot be a lone battle

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Shobha Shukla, Citizen News Service - CNS (CNS): India carries the highest global burden of TB - a curable disease that kills one Indian every 90 seconds. There are 2.2 million new cases of TB in the country every year, out of which an estimated 71,000 cases are of multi-drug resistant TB (MDR-TB). This curable disease kills 110,000 HIV-associated TB cases also emerging annually in India, second only to South Africa, and the country accounts for 10% of the global TB/HIV burden. Between 2006 and 2014, TB cost the Indian economy a staggering $340 billion.

A TB Free India is not possible without support of civil society organizations (CSOs) working in the field of maternal, child and adolescent health, nutrition, anti-tobacco use, diabetes and HIV/AIDS. Recently a 'Civil Society Conclave: Towards a TB Free India' was hosted in New Delhi by The International Union against TB and Lung Disease (The Union), The Central TB Division (CTD), Ministry of Health and Family Welfare (MoHFW) and The US Agency for International Development (USAID) to discuss the growing problem of TB in vulnerable populations--PLHIV, those suffering from diabetes, tobacco users, migrants, tribals, poor and malnourished people-- and the need for collaborations to address the challenges. The government representatives from MoHFW felt the need of public private partnerships, in addition to synergies between various public health programmes, in order to achieve the goal of universal access to TB care and control--including those 1 million TB patients who seek treatment in the private sector.


During the conclave, The Delhi Network of Positive People (DNP+) raised the issue of non-availability of Rifabutin in Baghpat town of UP for a TB/HIV co-infected patient on 2nd line ART. She was advised by her treating doctor on 5th May to continue ATT with Rifabutin. Despite adequate stock of Rifabutin capsules available in the state as on 30th April 2016, she could get the medicine only on May 11, 2016 and that too after DNP+ relentlessly followed the matter with Central TB Division for over 3 weeks. An earlier report from Bihar said that patients there have to wait for 3-4 months to get initiated on 2nd line ART, and then collect the drugs from Patna. They have to go to Varanasi to get their viral load testing done as there is reportedly no centre in Bihar where this is done free.

Acknowledging that these systemic issues need to be addressed, Dr Jagdish Prasad, Director General Health Services, blamed political apathy (in states like UP and Bihar), and lack of monitoring for improper implementation of the Revised national TB Control Programme (RNTCP). He said that one cannot rely wholly on state governments to implement the national programme, and CSOs will have to step in to reduce this gap and also help government to reach the unreached and marginalised populations.


Prasad also listed some recent policy changes made in the RNTCP:

(i) introduction of rapid diagnostic CB-NAAT test in all districts;

(ii) daily TB drug regimen for TB/HIV co-infected patients; and

(iii) introduction of Bedaquline under conditional access programme. He also mentioned that a robust IT system is now being developed for quality monitoring of the programme at district, state and central level.

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