Emerging trends of Drug Resistant TB across India is a definite matter of concern. New innovations and approaches are the need of the hour to tackle the malady.

1. Tuberculosis- Epidemiology
and challenges
DR Abhisek Mishra
Assistant Professor
Dept of CFM, AIIMS, Patna

6. World TB Day-2018

7. Global burden

8. Global burden
• Tuberculosis (TB) is one of the top 10 causes
of death worldwide.
• In total, 10.4 million people infected with TB,
and 1.8 million died
• Seven countries account for 64% of the total
TB cases, with India, Indonesia, China,
Philippines, Pakistan, Nigeria, and South
Africa

9. • 6,00,000 new cases are found to be RRTB, out
of which 4,80,000 are MDR TB
• In 2016, an estimated 1 million children
became ill with TB and 250 000 children died
of TB (including children with HIV associated
TB).
• TB is a leading killer of HIV-positive people:
in 2016, 40% of HIV deaths were due to TB.
Source-global Tuberculosis Report, WHO
Global burden

10. Caseload in SEAR Countries

12. Indian scenario

13. • India had 2.7 million new cases of TB in 2016,
down 3.57% from 2.8 million in 2015, the
WHO report said. Of the 1.8 million TB deaths
globally, 4,23,000 are reported in India
• Deaths due to tuberculosis (TB) in India fell
12%–from 480,000 in 2015 to 4,23,000 in
2016
Indian scenario

14. Drug Resistance TB
• As per the Global TB Report 2017, worldwide
approximately 4.1% of new TB patients
and 19% of previously treated TB patients
have multidrug resistant-TB (MDR-TB)
• The results of the survey showed that MDR-
TB is 6.19% among all TB patients with
2.84% among new and 11.6% among
previously treated TB patients. (DRS survey
GOI)

15. • No in millions and Death is in lakhs
• Children are being affected
• TB HIV Co Infection
• DR TB is in rise-11.6% prevalence of MDR
cases among the previously treated persons
A WORRYING TREND

16. A WORRYING TREND

17. A WORRYING TREND

20. WHO-END TB Strategy

21. National Strategic Plan 2017-2025
• Vision: TB-Free India with zero deaths,
disease and poverty due to tuberculosis
• Goal: To achieve a rapid decline in burden of
TB, morbidity and mortality while working
towards elimination of TB in India by 2025

22. NSP 2017-2025 GOI
• POLITICAL COMMITMENT

23. • DIRECT BENEFIT TRANSFER

24. Nutritional support for patients
with TB
• It has now been announced that patients with
TB will receive R500 ($8) a month for food.
• Finance Minister told parliament in his Feb 1
budget speech

25. Active Case Finding
• Active case finding (ACF) campaign, focusing
on clinically, socially and occupationally
vulnerable populations and shifting from
passive to active case finding along with
passive case finding

26. Private provider incentives
• Rs 250/- on notification of a TB case
diagnosed as per Standards for TB Care in
India (STCI)
• Rs 250/- on completion of every month of
treatment
• Rs 500/- on completion of the entire course of
TB treatment
• For DRTB cases-Rs 2750 and Rs 6750

27. • Scaling-up of Bedaquiline (BDQ) Services
AND Conditional approval for Delamanid to
deal with drug resistance cases.

28. 99 DOTs

29. Introduction of Real-Time Medication Event
Reminder-Monitor Device (RT-MERM)

30. Legislations

32. MISSING CASES
• India has roughly 1.3 million “missing”
tuberculosis (TB) patients, who may either not
have been diagnosed or were lost for follow-up,
and so could potentially spread TB to others
• Considerable proportion of these “missing”
patients are being treated by private sector
including practitioners of Indian medical
traditions
• SOURCE-Subbaraman, R. et al. The tuberculosis cascade of care in India's public
sector: A systematic review and meta-analysis. PLoS Med. 13, e1002149 (2016)
doi: 10.1371/journal.pmed.1002149

33. • The private sector in India could have treated
anything between 1.19 and 5.24 million cases in
2014 (best estimate: 2.2 million cases a year),
according to a 2016 study published in the Lancet,
based on data from the sale of drugs containing
rifampicin.
• In 2016, about 63% of estimated TB cases in
India were registered (called notifications to the
government in medical parlance). The
government is still not aware of a quarter of TB
cases
MISSING CASES

34. Private provider engagement

35. Private provider engagement
• A recent study of private doctors showed that
only 29% of doctors had adequate knowledge
of diagnosis, and only 29% knew a proper
treatment regimen
• Source-To eradicate TB, many doctors must first learn how to diagnose it”,
2018, New Indian Express,
www.newindianexpress.com/thesundaystandard/2018/

36. PRIVATE SECTOR

38. Inability of the system to
address
mental health issues

39. • A study published in the International
Journal of Tuberculosis and Lung
Diseases in 2008 says that the stigma affects
the quality of patients’ lives and the
effectiveness of TB medicines. The overall
stigma index is the highest for India, the study
found

40. Non protocol management
of TB
• Indiscriminate use of anti-TB drugs, especially
outside the RNTCP, has contributed
significantly to the emergence of drug-resistant
TB in India
Source-presentations of Kuldeep Singh Sachdeva, Chief Medical Officer, Central TB Division; and Ashok Kumar,
Deputy Director General and Head, Central TB Division, and Project Director, RNTCP

41. THANK YOU.