India can eliminate TB just like polio

Despite forty years of programmatic efforts to control tuberculosis, the disease remains a persistent foe for the country and undermines economic progress and development efforts. India’s “National Strategic Plan” on Tuberculosis (TB) for 2012-2017 aims to achieve early detection and treatment of at least 90% of estimated TB cases in the community. But the question is, whether Revised National TB Control Programme (RNTCP) is doing enough to stop transmission to prevent new infections and report new cases faster? To do this, the national TB programme needs to take a proactive approach of early identification of TB cases and design an effective, evidence-based strategy to reach areas with high risk of transmission (or TB hotspots) and where access to health care remains a concern. Should this not be incorporated, it seems unlikely that the target outlined in National TB Strategic Plan can be achieved. 

The other important strategy for RNTCP is to prioritise active case finding (As per WHO definition, active case finding is the systematic identification of people with suspected active TB, in a predetermined target group, using tests, examinations or other procedures that can be applied rapidly) as its core strategy to locate hotspots and reduce the risk of transmission within vulnerable communities as well as ensure that undetected TB is arrested early on. Identifying potential hotspots with systematic door-to-door search approach will not only get those with early signs of the infection to the programme and stop transmission to others vulnerable to it, but also improve quality and reduce treatment costs. 

One untreated case of TB can potentially infect 10 to 15 people around them. Until now the strategy is to test only those who report to the health facilities with symptoms of TB, which is usually after they have ignored persistent cough. This “passive” means to detect has to be replaced with active case finding urgently. The strategic focus on key vulnerable population through active case findings to identify the patient quickly and put them on treatment, requires enormous efforts and preparedness within the health system, which many experts feel is lacking in the current TB programme. Globally evidence from hard-to-reach populations suggests that active case finding works. The approach of not reaching out to vulnerable population group, and instead wait for patients to come to the government system on their own results in delay in diagnosis and treatment, and fuels the spread the disease.

The approaches of active case finding should align with other line departments to ensure infection control in crowded homes of the poor where most TB patients potentially reside. The approach also requires looking into the specific population groups such as prison inmates, diabetes patients,  smokers and those using smoky chulha, among others. In this context, there is a need to analyse the dispersion of TB cases to know the foci of the disease. The profile of risk groups should be clearly defined for each state in India and RNTCP must further refine its definition of risks and vulnerable groups. 

TB can be eliminated just like polio through collective action of awareness, prevention and care. The strategy to reach every person with TB, cure those in need of treatment and prevent new TB infections can be part of a larger campaign that the government can roll out to free India from this curable disease.

The author is an international development practitioner and policy analyst