Gap between estimated number and actual cases of TB closing

The India TB report (2024) which released earlier this week, suggests that the gap between the estimated number and actual cases of tuberculosis (TB) is closing. One of the most significant factors that has contributed to this is the tracking of all TB patients, happening via the government’s Ni-kshay portal. because the tracking helps in containing the number of ‘missing cases’, which denote people who have either not received the treatment or have given it up midway and continue to spread infection to others. As per the official figures mentioned in the report, there were only 2.3 lakh missing cases in 2023, as compared to 3.2 lakh the year before, the report states.

A welcome change this time is the high number of TB cases reported by the private sector (8.4 lakh of the 25.5 lakh cases) even as the majority of the TB cases continue to be reported by public health centres. Last year, only 1.9 lakh cases were reported by the private sector.

As India looks forward to eliminating the disease, it is important to note that the estimated incidence of TB increased to 27.8 lakh in 2023 as against 27.4 lakh in 2022; the mortality resulting from TB though, continues to remain at 3.2 lakh. India has developed and adopted a new methodology to understand the numbers in its bid to tackle tuberculosis in the country. This is crucial because even today, India has the world’s highest tuberculosis (TB) burden, with an estimated 26 lakh people contracting the disease. Yet, over the years, the country has witnessed aggressive detection and reporting of TB cases – In 2022, India reported 2.42 million TB cases, up from 2.13 million in 2021 and 1.80 million in 2020.

The latest report for this year mentions risk factors such as undernourishment, HIV, over alcohol consumption, diabetes and smoking which affect both the infection rate and treatment outcomes. First and foremost of these is a severe lack of “ideal nutrition”—as per the report nearly 7.44 lakh TB patients were undernourished in 2022. In the same year, close to a lakh patients of tuberculosis were living with HIV. As per experts, HIV increases the chances of contracting symptoms of tuberculosis by as much as 20 times. This is primarily because the body’s defence mechanism is at an all-time low due to HIV, and so the chances of contracting infections is much higher.

It’s the same with diabetes; it increases the likelihood of contracting multidrug-resistant TB by manifolds. As per the official estimates, there were 1.02 lakh tuberculosis patients with diabetes in India in 2022. In 2023, nearly 92 per cent of TB patients were screened for diabetes in India, with 7.7 per cent being diagnosed with it. And, nearly 63 per cent of those diagnosed initiating diabetes treatment as per the report. There’s a connection between tuberculosis and alcohol too—a daily intake of more than 50 ml of alcohol increases the risk of TB infection. In 2023, around 75 per cent of TB patients were screened for tobacco use, of whom 11 per cent were identified as tobacco users.

Artificial intelligence is being actively deployed for TB screening and detection. Dr Ashwani Kumar of CSIR-Institute of Microbial Technology works in the area of treatment of tuberculosis, and his lab has been one of the pioneers to address the problem of ‘long duration of TB treatment extending upto six to eight months and as a result people opting out of it midway’. His paper published in 2016 in the journal Nature, became a landmark in the field of biofilms and further enriched the understanding of mycobacterium tuberculosis which causes the TB disease. Kumar and his team were the first to show that biofilms are present in human lungs of which cellulose is a major component. If one can destroy these biofilms, then one can kill mycobacterium tuberculosis faster. “So, we showed that tuberculosis is a chronic biofilm infection and this will go a long way in India’s goal of eradicating TB because it will shorten the treatment and people will also comply with it,” he says.