Why in News?

• According to the World Health Organization’s (WHO) Global TB report 2023, India accounted for the highest number of tuberculosis (TB) cases in the world in 2022, representing a staggering 27% of the global burden.
• Overall, 30 high burden TB countries [like Indonesia (10%), China (7.1%), the Philippines (7.0%), Pakistan (5.7%)] accounted for 87% of the world’s TB cases in 2022.

What’s in Today’s Article?

• About Tuberculosis (TB)
• Highlights of the Global TB Report 2023
• Status of TB in India - Findings of the Global TB Report 2023
• Areas where India made Tremendous Progress
• The Key Initiatives Launched and Scaled up by the GoI
• Way Ahead Recommended in the Global TB Report 2023

About Tuberculosis (TB):

• It is an infectious disease (world’s deadliest infectious killer) usually caused by Mycobacterium tuberculosis (MTB) bacteria, which generally affects the lungs (Pulmonary TB), but can also affect other parts of the body (Extrapulmonary).
• It is spread from one person to the next through the air when people who have active TB in their lungs cough, spit, speak or sneeze.
• Most infections show no symptoms, which is also known as latent tuberculosis. People with latent TB do not spread the disease.
• Prevention of TB:
  • It involves screening those at high risk, early detection and treatment of cases and vaccination with the Bacillus Calmette-Guérin (BCG) vaccine.
  • Treatment of TB requires the use of multiple antibiotics over a long period of time.
• Drug resistant TB:
  • A person has drug resistant TB if the TB bacteria that the person is infected with, will not respond to (or resistant to), at least one of the main TB drugs.
  • There are two main types of drug resistant TB - MDR (multidrug-resistant) TB and XDR (extensively drug-resistant) TB.
    • MDR TB is when the bacteria that are causing it are resistant to at least isoniazid and rifampicin, two of the most effective TB drugs.
    • XDR TB is defined as strains resistant to isoniazid and rifampin, plus any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin).
• WHO’s END TB Strategy:
  • It was adopted in 2014 with the aim to end the TB epidemic globally by 2035.
  • It aims at 95% reduction by 2035 in the number of TB deaths compared with 2015, 90% reduction by 2035 in the TB incidence rate compared with 2015 and Zero TB-affected families facing catastrophic costs due to TB by 2035.
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Highlights of the Global TB Report 2023:

• Featuring data from 192 countries and areas, the report reveals that 7.5 million people were diagnosed with TB in 2022, marking the highest figure recorded since WHO began global TB monitoring in 1995.
• The TB incidence rate (new cases per 100,000 population per year) rose by 3.9% between 2020 and 2022, reversing declines of about 2% per year for most of the past two decades.
• The WHO pointed out a major global recovery in the number of people diagnosed with TB and treated in 2022, after two years of COVID-related disruptions.
  • The increase is attributed to a good recovery in access to and the provision of health services in many countries.
  • India, Indonesia, and the Philippines, which together accounted for over 60% of the global reductions in the number of people newly diagnosed with TB in 2020 and 2021, all recovered to beyond pre-pandemic levels in 2022.
  • It shows an encouraging trend starting to reverse the detrimental effects of COVID-19 disruptions on TB services.

Status of TB in India - Findings of the Global TB Report 2023:

• India recorded 2.8 million (28.2 lakh) TB cases in 2022, with a case fatality ratio of 12%.
• The best estimate of the number of deaths in India from TB was 3,42,000 (3,31,000 among HIV-negative people and 11,000 among those with HIV).
• The report highlights that MDR-TB remains a public health crisis, with 1.1 lakh cases recorded in India in 2022. 

Areas where India made Tremendous Progress:

• India has made tremendous progress in improving case detection and reversed the impact of COVID-19 on the TB programme.
  • The case detection strategies have resulted in the highest ever notification of cases in 2022 - over 24.22 lakh TB cases were notified, surpassing the pre-COVID levels.
• The treatment coverage has improved to 80% of the estimated TB cases, an increase of 19% over the previous year.
• India’s efforts have resulted in reduction of TB incidence by 16% in 2022 (from 2015) almost double the pace at which global TB incidence is declining (which is 8.7%).
• The mortality of TB has also reduced by 18% during the same period in India and globally. 

The Key Initiatives Launched and Scaled up by the GoI:

• What has resulted in significantly bridging the gap in missing cases?
  • Specialised active case finding drives,
  • Scaling up of molecular diagnostics to block levels,
  • Decentralisation of screening services through Ayushman Bharat Health & Wellness Centres and
  • Private sector engagement.
• The PM TB Mukt Bharat Abhiyan: This has received a tremendous response across the country with over 1 lakh Ni-kshay Mitras from all walks of life coming forward to adopt over 11 lakh TB patients.
• Ni-kshay Poshan Yojana: Under this, about Rs 2613 Cr have been disbursed to over 95 lakh TB patients since its launch in 2018.
• Newer patient centric initiatives: Like Family Caregiver Model and Differentiated Care have been introduced to ensure further reduction in mortality and improvement in treatment success rates.
• National TB Elimination Programme: India has prioritised TB elimination efforts with investing additional resources to the Programme, which is being implemented under the aegis of the National Health Mission.

Way Ahead Recommended in the Global TB Report 2023:

• TB preventive treatment: For people living with HIV, household contacts of those with bacteriologically confirmed pulmonary TB, and clinical risk groups (e.g., those receiving dialysis).
• Addressing the co-epidemics of TB and HIV: Among all incident cases of TB in 2022, 6.3% were people living with HIV; this proportion has been steadily declining for several years.
• Increasing access to early and accurate diagnosis: Using a molecular WHO-recommended rapid diagnostic test is one of the main components of TB laboratory-strengthening efforts under the End TB Strategy.
• Research and innovation: The diagnostic pipeline has expanded considerably in terms of the number of tests, products or methods in development.
• Progress towards universal health coverage (UHC): UHC along with better levels of social protection and multisectoral action on broader TB determinants are all essential to reduce the burden of TB disease.
• Augmenting TB Finance: There was a decline in global funding available on essential TB services from US$ 6.5 billion in 2019 to US$ 5.8 billion in 2022, which is less than half of the global target.