Progress in Tuberculosis (TB) Care in India
India has made significant strides in TB care through the adoption of innovative strategies to detect, treat, and prevent TB.
- Molecular Testing: Expansion of molecular testing for rapid detection of TB and drug resistance.
- BPaLM Regimen: Introduction of the shorter, all-oral regimen using Bedaquiline, Pretomanid, Linezolid, and Moxifloxacin.
- Ni-kshay Poshan Yojana (NPY): Doubling of nutrition support entitlement to ₹1,000 a month.
- Community Involvement: Expanded role for TB survivors and Champions in community-level efforts.
Impact on TB Incidence and Deaths
These strategies have led to a 17.7% decline in TB incidence from 237 per 100,000 in 2015 to 195 in 2023, and a 21.4% reduction in TB-related deaths.
Integration with the Public Health System
Integration of TB services into the broader health system is crucial for equitable and universal health coverage (UHC).
- The Ayushman Bharat National Health Protection Scheme (2018) integrates TB services within its components.
- Ayushman Arogya Mandirs (AAMs): These centers provide comprehensive primary health-care services, including TB diagnostics and treatment.
Challenges and Solutions in TB Care
Despite free TB services, over 50% seek private care, resulting in uneven standards and significant out-of-pocket expenses. Strengthening referrals from private to public systems and ensuring insurance coverage is crucial.
Road to Equitable TB Care
To accelerate progress towards TB elimination and UHC, several steps need to be taken:
- Strengthening Person-Centred Care: Model interventions in states like Tamil Nadu have reduced TB mortality.
- Recognizing Intersectionalities: Addressing gender, age, caste, and socio-economic factors is essential for equitable TB outcomes.
- Integrated Care: Implementing integrated general health screening to identify and treat TB alongside other conditions.
- Minimizing Out-of-Pocket Expenditure (OOPE): Strengthening social protection schemes to reduce financial burdens during TB treatment.
- Access to Information: Enhancing public understanding of TB to combat stigma and ensure early detection and treatment.
Concluding Remarks
An equitable TB programme ensures the highest quality of person-centred care, essential for TB elimination and achieving UHC. India’s approach is poised to set global standards, with equity as a foundational principle.