The Indian Medical Association (IMA) has said that India reported 21,36,418 TB patients as per India TB Report 2022. 79,144 deaths were directly related to TB in 2019, stressing that TB remains the biggest killer amongst infectious diseases after Covid.

The doctors’ body stressed that the resilience with which the National TB Elimination has worked can be seen from the brisk recovery that the programme has made in spite of the disruption during Covid 19 pandemic.

The National TB Elimination programme has reinvented itself with every change in the global strategy. Diagnosis and treatment of Tuberculosis has undergone revolutionary changes in the past two decades.

According to the IMA, to its credit the NTEP has kept pace with all scientific advancement. Molecular Diagnostics and Drug sensitivity Testing (DST) have been implemented in all the districts of the country.  Short-course, fixed dose drugs are available free of cost in both Government and private sectors.

The IMA added that the community has been engaged in a way to fill up the gaps in service delivery to the patient. The National TB elimination programme is one of the best run public health programmes in the whole world. However, the challenges remain.

“DR TB or the drug resistant TB is perhaps man made though a small percentage may be natural. The discovery of Bedaquiline and Delamanid molecules was well in time. Fortunately, the Indian epidemic is by and large drug sensitive and the situation therefore warrants close attention,” the IMA said.

 One important challenge that arose in the last decade of last millennium is co infection with HIV. Significant progress has been made in TB HIV services. Fortunately, the TB epidemic in India is driven by TB itself unlike most African countries where it is driven by HIV. Next to DR TB, TB HIV has emerged as a challenge impacting our efforts to contain TB.

The third major factor that emerged was the Covid 19 pandemic. There was a large global drop in TB notification. The clock was turned back by at least ten years. In 2019 7.1 million new TB patients were notified. It fell to 5.8 million in 2020. In 2021 it recovered partially to 6.4 million. India was affected substantially. However, the fast recovery continues indicating a robust Public Health System and a vigilant Programme.

 However, the unacknowledged blind spot of the Programme and the iceberg of TB elimination is the constituency of Private doctors. The Programme scarcely acknowledged the quantum of patients in the private sector until evidence piled up to show that at least half of the patients were outside the Programme.

 Million cases went missing at some point of time. Private doctors are a conscientious group who are conscious of their duty to the nation. Peer pressure and recognition are the key to their involvement. Even non-financial incentives will have a role.

Large number of patients go to private doctors to protect their confidentiality. In Spite of several outreach initiatives the spell of the private sector is an enigma for the Programme. Stigma and confidentiality are the factors we need to navigate. Private doctors hold the key.

Lot of unlearning is required by the Programme. India remains the first among the High Burden countries. One in four TB patients in the world is an Indian. We need to work together lest we will end up converting a drug sensitive epidemic into a drug resistant epidemic.