Tuberculosis cases increased by 16% in India in 2018

India witnessed 16% increase in the number of tuberculosis cases in 2018 against the previous year’s figure of 18 lakh even though around eight lakh patients went undetected, according to an official report released on Wednesday (September 25).

According to the India TB Report 2019, India accounts for a quarter of the Global TB burden with an estimated 27 lakh new cases in the year 2018.

Of that 21.5 lakh TB cases were notified to the Revised National Tuberculosis Control Programme (RNTCP), compared to 18 lakh in 2017 – an increase of 16% in one year.

Among the notified, treatment was initiated for about 19.1 lakh cases (90%), across both public and private sectors.

“The burden of undetected tuberculosis is large in many settings, especially in high-risk groups which are identified under the country’s National Strategic Plan (2017-25),” the report stated.

According to the report, of the total notifications, 25% (5.4 lakh) cases were reported from the private sector, a 40% increase from last year.

This indicates an increased engagement with private sector providers and patients seeking care from them.

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Besides, 79% of patients notified for TB in 2017 (across both public and private sectors) have successfully completed their treatment, while 49,733 cases were detected due to the efforts of the Active Case Finding Campaign, for which 14.4 crore vulnerable people were screened.

Also, as per the report, 40,761 new patients who were notified in 2017, died.

Special Secretary Sanjeeva Kumar of the Union Ministry of Health, in his message in the report, said the efforts to improve diagnostics has led to a 52% increase in drug-resistant TB detection, along with decentralisation of drug-resistant treatment centres (DR-TB) centres from 197 to 509 in the past one year.

“The largest-ever National Drug Resistance Survey in the world for 13 anti-TB drugs has been completed and it has indicated about 6.2% prevalence of drug-resistant TB in India among all TB patients,” he said.

Free diagnosis and treatment services are available under the RNTCP for all drugs sensitive as well as drug-resistant TB cases and adequate drug stocks have been made available.

According to the report, Uttar Pradesh, with 17% of population of the country, reported the maximum 4.2 lakh cases, accounting to 20% of the total notifications.

Delhi and Chandigarh stand apart from all other states and Union territories with regard to notification rate relative to their resident population, it said.

Their annual notification is 504 cases/lakh population and 496 cases/lakh population. This is because patients residing in many other parts of the country are diagnosed/notified from these two UTs.

The characteristics of the affected population largely remain similar with majority of the affected individuals being in the age group of 15-69 years and 2/3rd being males. HIV co-infection among TB was nearly fifty thousand cases amounting to TB HIV co-infection rate of 3.4%, the report said.

The improved notification is dependent on increased access to TB diagnostic services, the report said.

TB is the leading cause of morbidity and mortality among people living with HIV and HIV co-infection rates among incident TB patients is estimated to be 3% and 86,000 HIV-associated TB patients are emerging annually.

In terms of numbers, India ranks second in the world and accounts for about 9% of the global burden of HIV-associated TB, the report said.

The mortality in this group is very high and 11,000 people with HIV die every year due to TB, it said.

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India is the third-highest HIV burden country in the world, with an adult prevalence of 0.22%, it added.

People living with HIV (PLHIV) are at 21 times higher risk of developing tuberculosis. TB-HIV co-infection results in higher mortality rates.

Nearly 25% of all deaths among people living with HIV are estimated to be due to TB. To mitigate the effect of dual burden of HIV and TB, the RNTCP and the National AIDS Control Programme have developed a collaborative framework.

Since April 2018, over 20.8 lakh beneficiaries have received benefits of ₹427 crore under the Nikshay Poshan Yojana where all such patients are given ₹500 per month for nutritional assistance during the course of treatment, the report said.

The treatment supporters were paid a total of ₹17 crore as honorarium. Patients from tribal areas received a total of ₹1.8 crore as treatment support.

Approximately, ₹1 crore were paid to private providers as incentives for notification.