End TB, save lives

Dr Anil Barkul

Every year, March 24 is celebrated as the World TB Day to commemorate the discovery of Tuberculosis bacillus by scientist Robert Koch on this day in 1882. TB is seen in humans as old as 3 millions years old. In India, evidence is there to show the presence of TB since almost 3300 years.

The first TB sanatorium was started in 1906 in India near Ajmer.

Initially, treatment included cod liver oil, vinegar massages and inhaling turpentine. After 1944, streptomycin and other drugs were invented. Different regimens were prescribed to control the disease. As the days went by, the problem of resistance developed so fast that the tuberculosis cases were becoming multi-drug resistant (MDR) cases. In India, the big population, poverty, illiteracy, poor drug compliance, poor health facilities and HIV AIDS were other contributory factors for development of MDR cases which later in became XDR i.e. highly resistant and even XXDR TB cases as the drug resistance advanced at the end of the 20th century.

The United Nations has taken up a campaign End TB by 2030. This means to reduce 95% of deaths and to reduce 90% of the TB incidence in society as compared to 2015. Prime minister Narendra Modi announced a plan to eliminate tuberculosis in India by 2025. At present, there are 5 TB cases per 1000 population in India.

As TB is an ancient illness, it is very difficult to eradicate it but we can control it and treat it efficiently to save lives. That’s why the theme for World TB Day 2022 is ‘Invest to End TB, Save lives.’

Recently, many initiatives have been taken in management of TB. The public has been made more aware about the disease. That is one of the reasons to celebrate World TB Day. Along with government hospitals and doctors, their private counterparts are also actively involved in registering and treatment of TB patients. The app like NICKSCHAY is used for keeping record of patients and each patient is given unique identity number and his treatment is tracked till patient is cured. Also, per month ex gratia amount is given to each patient for healthy diet. Even the doctors are given Rs 500 for detecting a new TB case.

The newer tests like CBNAAT (Cartridge Based Nucleic Acid Amplification Test) are used for detecting resistance to drugs like INH and/or Rifampin so that specific sensitive drug treatment can be started since beginning to avoid drug resistance. To add to it, second line tests like LPA 1 and LPA 2 (Line Probe Assay) are done to know who are resistant to multiple drugs.

It is difficult treating MDR and XDR/ XXDR cases as duration of treatment is prolonged, also the numbers of drugs used can be upto 10 to 12. Recent trials in India have shown promising results for short term course (six months) of newer anti-tuberculous drugs like BPaL regimes comprising costly medicines like Bedaquilin, Pretomanid and Linezolid. Let’s hope the problem of MDR is solved with this.

We have to invest not just money but hard work, determination, emotion, energy and monetary assets required to end TB.

(The author is a TB specialist and former IMA president of Beed Branch).