Drug-resistant tuberculosis (DR-TB) poses a significant global health challenge that demands immediate attention. With India accounting for a quarter of the world’s DR-TB cases, the country’s response holds the potential to shape strategies for other nations facing this escalating threat.
About Drug-Resistant Tuberculosis
DR-TB occurs when bacteria develop resistance to the drugs used to treat tuberculosis (TB), rendering these drugs ineffective in killing the TB bacteria. This type of TB spreads in the same way as drug-susceptible TB and can result from misuse or mismanagement of TB drugs. Examples of mismanagement include incomplete treatment courses, incorrect prescriptions, unavailability of proper medications, and substandard drug quality.
DR-TB is more prevalent in individuals who fail to adhere to their TB drug regimen, those who have recurrent TB disease, individuals from regions with high DR-TB prevalence, and those who have been in contact with DR-TB patients.
The DR-TB Situation in India
India’s battle against DR-TB is substantial, with the World Health Organization (WHO) estimating around 119,000 new cases of multidrug/rifampicin resistant TB (MDR/RR-TB) emerging annually. However, the Indian TB program’s reported cases for 2022, which stood at 64,000 MDR/RR-TB cases, indicate a discrepancy in numbers.
India’s TB Elimination Program
India’s aspiration to eliminate tuberculosis aligns with global sustainable development targets by aiming to achieve this feat by 2025. The national strategic plan for 2017-2025 envisions reducing the number of new TB cases, mortality rates, and catastrophic costs for affected families. While progress is evident, challenges persist in terms of catastrophic costs for patients with drug-resistant TB.
Challenges Hindering India’s TB Elimination Program
- MDR-TB Resistance to Rifampicin: Resistance to rifampicin, a crucial first-line drug, poses a significant challenge. DR-TB remains a public health threat due to this resistance in India.
- India’s Treatment Approach: Despite WHO recommendations for the BPaL regimen, India continues to use a mix of treatment options, many of which are challenging to adhere to.
- Detection Methods: India’s reliance on traditional sputum smear microscopy hinders accurate detection and drug-resistance assessment. Molecular diagnostics offer superior accuracy and cost-effectiveness but are underutilized.
- Socioeconomic Factors: Undernutrition, limited resources, and financial constraints contribute to incomplete treatment and exacerbate the TB epidemic.
Strategies for Addressing DR-TB in India
- Adoption of WHO-Recommended BPaL Regimen: India should transition to the BPaL regimen, which boasts higher success rates, fewer pills, and shorter treatment duration, leading to significant savings.
- Improved Diagnostic Tools Accessibility: India must ensure access to accurate diagnostic tools, expediting diagnosis and treatment, especially for DR-TB cases.
UPSC Mains Questions
- How might the underutilization of molecular diagnostics for TB detection impact India’s ability to manage and control the DR-TB epidemic effectively?
- Analyze the potential benefits and challenges associated with transitioning to the WHO-recommended BPaL regimen for DR-TB treatment in India.
- How might socioeconomic factors such as undernutrition and financial constraints contribute to the persistence of TB and DR-TB cases in the country, and what strategies could be implemented to address these issues?
