Dr Kuldeep Singh Sachdeva opines ‘Home to test and Home to treat’ through hand-held devices like X-Ray machines, and active case finding in communities may be instrumental towards TB elimination in India

One of the infectious diseases taking away the lives of 1.5 million people every year is Tuberculosis (TB), which has been existing with the evolution of human civilisation for almost 10000 years. But the bigger challenge lies in breaking the chain of its transmission because of its infectious nature. Recently, since COVID, the two decades of a slow decline in the number of deaths due to TB has been reversed.

Throwing light on the problems standing tall in TB elimination, Dr (Prof) Guy B Marks, Interim Executive Director, The Union, says, “TB is a public disease and not private because of being infectious. If you are a diabetic, it’s your problem because you can’t spread it to the community, but if you have TB, you can spread it across unknowingly because it is easily transmitted. Thus, this is the responsibility of society as a whole to work towards its elimination. In the Indian setting, the government should invest in a) active TB case finding, (b) screening everyone, (c) extending financial and medical support to the communities to eliminate TB.”

Talking about the solution and adding his viewpoint towards TB elimination in India, Dr Kuldeep Singh Sachdeva, Regional Director – The Union South-East Asia observes, “What is missing in India is the process of ‘Home to test and Home to treat’, which can be carried out through hand-held devices like X-Ray machines. And the active case finding in communities, and identifying the pockets where the number of cases is high, also may be instrumental towards the elimination of TB in India. Active case finding is very important as it helps in breaking the chain of transmission.”

Talking about the barriers to TB elimination, Prof Marks added “There are so many barriers to TB elimination such as community and political barriers in high-burden settings, the stigma of TB, and insufficient recognition of the communal nature of airborne infectious diseases. As TB is a hidden disease and infects the entire community, so we need to screen everyone as we don’t know who is infected and who is not. Active TB case finding is a major challenge, so government and people have to come together in this expedition.”

Elaborating on the causes of TB elimination, Dr Sachdeva, says, “Those who are malnourished, have 2-3 times more chances of being infected with TB. Also, people with comorbidities like diabetes, and damaged lung HIV infection are vulnerable to TB infection. Likewise, indoor air pollution and smoking increase 2-4 times chances of TB infection. These aspects also need to be addressed while talking about TB elimination.”

Talking about the solutions to TB elimination, especially in high-burden countries, Prof Marks suggests, “To stop TB, it is necessary to interrupt the chain of transmission by finding and treating all people who are living in the community with undiagnosed and untreated active TB affecting the lungs. For this, the most effective strategy is to focus on active, community-wide screening, along with effective treatment, and include point-of-care testing. Also, to achieve this goal, we need to address the stigma of TB through community-wide education involving local thought leaders because people need to be aware that they are not only helping themselves but also helping their family, neighbours, workmates and community by preventing TB infection in others.” 

Talking about the Indian perspective of TB, Dr Sachdeva says, “According to the World Health Organisation (WHO) over 4100 people lose their lives to TB every day and the Global TB Report 2021 estimates that with nearly 26 lakh TB cases, India has 26 per cent of all global and multi-drug resistant TB cases. We have come a long way towards TB elimination in India as we have the tools of a drug, and diagnosis to eliminate TB, and over 90 per cent of treatment for TB has been done. Till 2009, it took 2-3 years for TB treatment, but now it takes only 6-9 months for the treatment. We have success stories of TB elimination in India as Lakshadweep (UT) and the district of Budgam (J&K) were declared TB-free last year.”