• Target Audience [A] People of India, who keep themselves updated on current affairs. [B] Government of India, who makes, implements and evaluates policies. • Message to convey  Tuberculosis (TB) is an ancient infectious disease that is second largest killer across the globe after HIV/AIDS.  India carries maximum burden of the disease.  Daily, 1000 Indians die due to TB.  Though Indian government is running program called DOTS, patient adherence to therapy is a great concern which results in drug resistance.  What steps to be taken by society, community, government and international community – are suggested in my presentation.

1. ANCIENT ENEMY, MODERN IMPERATIVE:
A TIME FOR GREATER ACTION AGAINST
T U B E R C U L O S I S

2. Tuberculosis (TB) is the second-biggest single infectious killer—after
HIV/AIDS—on earth, causing the death of 1.3m people in 2012 (the latest year for which figures
are available). This toll—2% of global mortality—continues despite a cure existing for nearly 70
years and heightened global efforts against TB going back two decades.

3. • In low- and middle-income countries, TB is fuelled by poverty, population
increase and infection with human immunodeficiency virus (HIV) and
acquired immunodeficiency syndrome (AIDS), thought globally, trend is
reductive.
• South East Asia Region carries about 40% of the global TB burden. India is
the highest TB burden country in the world and accounts for more than
25% of the world's incident cases.#
#WHO. Tuberculosis control in South-
East Asia Region. Regional Report. 2012

4. Not only Government [DOTS THERAPY], Private
healthcare is also very much prevalent in INDIA
for treating TB

5. Even though,
More than
1000 Indians
die of TB
every day
USAID-India. Health overview. 2011

6. Though the DOTS(directly observed treatment short course) is
successful strategy worldwide, & based on DOTS strategy, India's
revised national tuberculosis control program (RNTCP) is doing well.
Also, treatment at private clinics is quite common in India.
However, the concern is too high for emergence of
MULTI DRUG RESISTANCE (MDR) & EXTENSIVELY DRUG
RESISTANT (XDR) STRAINS of TB bacillus.
The major reason for drug
resistance is
INCOMPLETE
anti tuberculosis
treatment(ATT)

7. Poor adherence to ATT may lead to treatment failure while strict
adherence to ATT help to achieve desired treatment success and
help to minimize emergence of drug resistant strains
Treatment adherence is influenced by many factors such as
Socio -
cultural
Economic
Background
Subjective
Experience of
Illness
Perceived
Health
Benefits
Central TB Division. TB India2012; RNTCP Annual Status Report. New Delhi: Central TB
Division, Directorate General Health Services, Government Of India; 2012. pp. 21–6.
Thus, treatment adherence by TB patients is a complex
and multifaceted behavioral issue that needs to be
understood better

8. Society & Community – Role to ensure
TB eradication
1
•Though TB is infectious disease, stigma should not prevent patient from taking treatment.
2
•Patient’s family members should ensure that patient completes the therapy. They also ensure
health and hygiene of surroundings, food items and drinking water.
3
•Communities like nearby residents of patients, relatives, friends etc should encourage patient to
stay healthy and away from bad habits like smoking or tobacco chewing. They should also
help/guide him/her in ensuring hygiene of surroundings, food items and drinking water.
4
•Children in schools should be taught to stay away from bad habits, keep their surroundings clean,
take necessary vaccines on time and medical treatment must be taken whenever required.

9. Government – Role to Ensure TB eradication
1
• Designing Campaigns through social media
2
• Designing Campaigns with the help of celebrities
3
• Designing incentives for patients to ensure completing therapy
4
• Designing incentives for health workers to ensure effective implementation of DOTS
5
• Encouraging private healthcare sector to help eradicating TB
6
• Ensuring better quality of basic amenities like food and drinking water
7
• Ensuring effective policy making & implementation on pollution control

10. Proposed ways to ensure Patient Adherence
TAKE YOUR MEDICINES DAILY, LIVEHAPPILY
 People in India have more than 600 million active mobile
connections, more than half of them are internet compatible.
Therefore campaigns on social media with messages from
celebrities, videos etc can be very useful.
 An app can be created which can track patient’s medicine uptake
and can give feedback to his/her doctor, his/her family members
and his/her pharmacist/health worker – as the case may be.
 This approach can significantly improve patient adherence.
Campaigns through Social Media

11. Proposed ways to ensure Patient Adherence
TAKE YOUR MEDICINES DAILY, LIVEHAPPILY
 Classic example of success of such campaigns is UNICEFs campaign of POLIO
ERADICATION namely “Do Boond Jindagi Ki”, in which Indian Superstar Amitabh
Bachchan took part. He shooted for lot of videos, he attended several polio drop
booths and gave polio vaccines to children from his hands.
 TODAY INDIA IS PROUD COUNTRY WITH 100% POLIO ERADICATION.
 In a recent tweet, the legendary actor wrote: Polio eradicated from India..an 8 year
campaign with UNICEF ambassadorship ! Feel such accomplishment and joy !
[https://tweeter.com/SrBachchan/status/490595730294206464]
 This kind of campaign can be designed with celebrities whose major focus should
be on insisting patients to complete TB treatment without any break.
Campaigns through Celebrities

12. Proposed ways to ensure Patient Adherence
TAKE YOUR MEDICINES DAILY, LIVEHAPPILY
Incentives can be designed to ensure patients complete
treatment.
They can be lucrative and achievable so that patients go
for it and completes therapy.
It will help government also to evaluate execution of
campaign and if required, government can take
corrective measures to ensure patient adherence.
Designing incentives for patients

13. Proposed ways to ensure Patient Adherence
TAKE YOUR MEDICINES DAILY, LIVEHAPPILY
 Incentives can be designed for health workers who are
working in DOTS centers so that they do their job with more
involvement, vigilantly and effectively. Also such incentives
can give them a great motivation to do their job in better way.
 These health workers play a vital role in making the campaign
a grand success. Proper and desired execution of campaign
can help in eradicating the dreaded disease. Therefore, if
required, they can be given an intense training program on
various aspects of DOTS process.
Designing incentives for health workers

14. Role of International community to
help India to eradicate TB
1
• International communities can insist Indian government to make regional
policies to eradicate TB because India is having diverse culture across country.
2
• International communities should put pressure on Government of India to
improve basic infrastructure of country, to improve quality of basic amenities
like food and water, to improve overall hygiene, to run vigorous campaigns to
create awareness for TB, to execute TB eradication campaigns effectively.
3
• Indian government must be compelled to provide data on progress of TB
eradication campaigns on regular intervals to international authorities like
WHO.

15. TB
Killing people across
the globe
Can be
treated with
combined
efforts
Patient Adherence to
therapy is major
concern
India has
maximum
burden of
disease

16. References
• WHO. Global Tuberculosis report 2013
• WHO. Tuberculosis control in South-East Asia Region. Regional Report.
2012.
• USAID-India. Health overview. 2011
• Central TB Division. TB India2012; RNTCP Annual Status Report. New Delhi:
Central TB Division, Directorate General Health Services, Government Of
India; 2012. pp. 21–6.
• Ann Med Health Sci Res. 2013 Jan-Mar; 3(1): 67–74.
• Coghlan A. Totally drug-resistant TB at large in India. New Scientist
Health. 2012. Jan 12, Available
at:http://www.newscientist.com/article/dn21350-totally-drugresistant-
tbat-large-in-india.html