At the rate of decline of tuberculosis (TB) prevalence in India over the past 24 years (0.91% per year), it would take India 183 years for the disease to be considered eradicated. The recently released government budget set 2025 as a target for TB elimination from India. Critics have responded by saying that this is a far too optimistic figure despite the recent (all too incremental) increase to the health budget.
TB is often not diagnosed upon the first visit to a doctor, mentions an article published on NDTV’s EveryLifeCounts pointing out one of the major issues affecting the treatment and spread of tuberculosis (TB) in India: diagnosis. This leads to symptoms worsening and the disease being spread to others, sometimes for months.
Key areas of criticism within the article are diagnosis, disparities in diagnosis and care methods between state run and private hospitals as well as mismanagement of medications. All of these combined factors result in an inefficient and failing system that is underperforming government targets of disease eradication by a wide margin.
The government policy has been dismissed as: “A politician’s slogan — full of sound but lacking meaning and impossible to implement in our country” says Dr Zarir Udwadia, a TB activist and consulting chest physician. Despite criticism of this, Dr Udwadia has commended the government’s calls for reduced medication costs as a step in the right direction.
This rate of elimination is unlikely to increase without proper assessment of the limiting factors. Rapid diagnosis should be a priority, particularly in urban environments where the conditions are ideal for infection rates to reach almost exponential levels.
Antibiotic resistance also contributes massively to the spread of the disease. Misdiagnosis as well as a trial and error approach to antibiotic prescription leads to many people with multi-drug resistant TB (MDR-TB) remaining untreated for long periods of time, spreading MDR-TB to others in the process.
Usage of various different antibiotics, as well as unfinished periods of treatment have been shown to increase the rate of antibiotic resistance. With every strain of MDR-TB appearing the number of effective treatments declines, this in the following years may cause considerable issues if the disease is not rapidly eliminated. Recently developed drugs such as bedaquiline have been shown to be effective against MDR-TB, though potential side effects of the drug can be lethal, and so usage is withheld for when all other options are unsuccessful.
In government run hospitals the standard detection method is sputum smear microscopy. Though a simple and rapid detection method, it is inefficient at diagnosis when there are less than 10,000 microorganisms per millilitre of sample. This causes early stage TB to often be dismissed. Modern techniques are often only utilised in private hospitals, where the quality of diagnosis is still highly variable. The implementation of World Health Organization approved method, Xpert MTB/RIF, an automated nucleic acid amplification test, with higher levels of specificity would more accurately diagnose early stage TB.
India is unlikely to reach the goals of TB eradication without implementation of modern detection technology and better management of antibiotic prescription. Until the numerous treatment issues are assessed, the goal of 2025 remains unattainable.