Providing subsidised tuberculosis tests can help India save 80 lakh lives in 30 years, finds Lancet study

By providing subsidised tests for patients suffering from tuberculosis (TB) and assisting them to complete the entire course of their treatment, India can save up to 80 lakh lives over the next 30 years, a new Lancet Commission report released on Thursday says. These 80 lakh lives saved would account for 28 percent of the total deaths that occur due to the disease. The report, put together by a commission headed by Eric Goosby from the University of California, San Francisco, makes policy and investment recommendations to countries with high occurrence of TB cases. India has the highest number of TB patients in the world, with a share of one-fourth of the global cases. A big reduction in TB cases in India will also help control the spread of the disease worldwide. [caption id=“attachment_522086” align=“alignleft” width=“380”] File image of a tuberculosis patient in India. AP[/caption] The Lancet report, which includes inputs from 13 countries, details how countries can address challenges such as handling TB treatment in the private sector as well as treating people with an HIV co-infection and drug-resistant TB. “People affected by tuberculosis are often among the most poor, marginalised and stigmatised in their communities, and it is hard to escape the conclusion that the chronic underfunding and under-appreciation of tuberculosis are reflections of their social and economic status,” write Elizabeth Zuccala and Richard Horton, editors at The Lancet, in the series. For India, the report recommends scaling up access to TB services and providing universal availability to drug susceptibility testing and second-line TB drugs. It adds that India must increase domestic expenditures on health and research on TB and also provide universal TB care to eliminate catastrophic costs for people with the ailment.​ Union Health Minister JP Nadda writes in the report that TB in India keeps people from climbing out of poverty for seven years after they complete their treatment. According to the estimates of the Lancet Commission, India loses Rs 3,200 crore with TB mortality every year. To improve TB treatment, it would cost the country Rs 29 crore per year, which is far less than what it loses currently. In 2018, India spent Rs 58 crore on the national TB programme. Keeping in mind how a large part of the treatment for TB in India is sought from the private healthcare sector, the report adds that the country needs enhanced engagement of private sector providers. To this, Nadda adds that 25 percent of the national TB budget was used in the private sector to provide financial incentives to private providers for installing case-based web and mobile-based TB notification systems as well as technology for treatment adherence.

“India now notifies more than 5,40,000 tuberculosis cases annually from the private sector alone, an increase of 35 percent compared with 2017,” the health minister writes.

An initiative to find active cases was taken up under the national TB programme, where more than 14.4 crore people who are at risk of acquiring the disease were screened in 447 districts across the country. More than 50,000 additional TB cases were detected through this surveillance. “In 2018 alone, there were 2.15 million new TB case notifications in India, an increase of 3 lakh (16 percent) cases in a single year, for the first time in the history of the National Tuberculosis Programme,” Nadda writes. The findings of the commission further establish that the government’s participation in controlling one of the toughest communicable diseases has paid off, and continued efforts can further bring the burden of the disease down in India. In 2017, TB killed 16 lakh people worldwide, more than any other infectious disease. Of these, 4.21 lakh were Indians. The same year, around a quarter of the world’s population was living with a TB infection, and in India alone, 27.4 lakh new TB cases were detected. The Sustainable Development Goals include targets to reduce TB deaths by 90 percent and incidence by 80 percent compared with 2015 levels by 2030. The World Health Organization’s End TB strategy aims to reduce deaths by 95 percent and occurrence by 90 percent between 2015 and 2035. But at the current rate of decline, a 90 percent reduction in TB incidence in India can only be achieved by 2124, the report notes.