Controlling the drug-resistant tuberculosis epidemic in India: challenges and implications

Abstract

India is highest Tuberculosis (TB) burden country accounting for an estimated one-fourth of the global burden. Drug resistant TB (DR-TB) represents major public health problem in India.Patients with DR-TB may often require profound changes in their drug regimen which are invariably linked to poor adherence and sub-optimal treatment outcomes compared to drug sensitive TB. The challenge of addressing DR-TB is critical for India, as it accounts for over 27% of the global DR cases. In recent decade, India has been upfront in its battle against TB and even set up revised National Strategic plan (NSP) to eliminate TB by 2025. However, to achieve this ambitious goal, country will need multifaceted approach with respect to management of DR-TB.Despite concerted efforts driven by National TB elimination program, India faces substantial challenges with respect to DR-TB care especially in peripheral and resource limited endemic zones. The current article, describes some of the major challenges along with its implications associated with reducing the growing DR-TB epidemic in India.

Double trouble: compounding effects of COVID-19 pandemic and antimicrobial resistance on drug resistant TB epidemiology in India

“…In 2017, India launched its revised national strategic plan (NSP) with the ambitious goal of ending TB by 2025. Under its revised NSP (2017–25), the Government of India introduced several aggressive steps, such as decentralization of DR-TB services for better accessibility under the private sector, universal drug susceptibility testing (U-DST) for presumptive patients from MDR-TB hotspots, and scaling up diagnostic services of CBNAAT, True NAT, and line probe assays in low-resource settings for better surveillance and diagnosis ( 28 ).…”

Snapshot of Mycobacterium tuberculosis Phylogenetics from an Indian State of Arunachal Pradesh Bordering China

“…Patients with DR-TB often require profound changes in their drug regimens, which are invariably linked to poor treatment adherence and sub-optimal treatment outcomes compared to drug-sensitive TB. Higher drug-resistant TB cases remain a challenge for clinicians and National Tuberculosis Elimination Programme (NTEP) for accurate and effective TB treatment in India [ 3 , 4 ]. In India, the paucity of rapid diagnosis in locations having low resources and high endemicity areas where access to health care centers is difficult, remains a major constraint in treating DR-TB cases.…”

“…In India, the paucity of rapid diagnosis in locations having low resources and high endemicity areas where access to health care centers is difficult, remains a major constraint in treating DR-TB cases. It is estimated that around 56% of MDR-TB cases in India remain undiagnosed [ 4 ]. Arunachal Pradesh, one of the states in the northeastern region of India bordering China with 80% area covered with forest, mostly with hilly terrains, has awakened consciousness of NTEPs due to the high prevalence of around 78.8% MDR-TB cases [ 5 ].…”

Snapshot of <em>Mycobacterium tuberculosis</em> Phylogenetics from an Indian State of Arunachal Pradesh Bordering China

“…Patients with DR-TB often require profound changes in their drug regimens, which are invariably linked to poor treatment adherence and sub-optimal treatment outcomes compared to drug-sensitive TB. Higher drug resistant TB cases remains a challenge for clinicians and National Tuberculosis Elimination Programme (NTEP) for accurate and effective TB treatment in India [3,4]. In India, the paucity of rapid diagnosis in locations having low resources and difficult to reach areas with high endemicity present a major constraint on DR-TB treatment.…”

“…In India, the paucity of rapid diagnosis in locations having low resources and difficult to reach areas with high endemicity present a major constraint on DR-TB treatment. It is estimated that around 56% of MDR-TB cases in India remain un-diagnosed [4]. Arunachal Pradesh, one of the states in the northeastern region of India bordering China with 80% area covered with forest, mostly with hilly terrains, has awakened consciousness of NTEPs due to high prevalence of around 78.8% MDR-TB cases [5].…”