TB is a curable disease. Yet lakhs of patients die of TB in India and across the globe. This is most often because they are either diagnosed inaccurately, late or treated inappropriately. Since TB is airborne, an incorrectly diagnosed person can infect others. Further, inappropriate treatment perpetuates suffering and drug-resistance. Most often the challenges associated with TB diagnosis and treatment are attributed to economic, social and physical limitations in accessing diagnostics, continuing and completing treatment. We cannot address the global TB crisis until we improve TB diagnosis and treatment to ensure all those infected with TB get detected and treated early!

TB remains undiagnosed and hence untreated for several reasons. These include, use of outdated tools for TB diagnosis, misuse of existing TB tests for the detection of active TB as well as inadequate uptake of World Health Organisation (WHO) endorsed rapid diagnostic TB tests. However, often a key reason for delayed diagnosis is poor awareness and inability to access health services. Often by the time TB is diagnosed it is either in advanced stages or drug resistant.

Even when someone is diagnosed with TB, patients often receive inappropriate treatment especially in the private sector. This can lead to increased suffering, illness, drug resistance, and sometimes death. Most TB affected lack adequate information on effective TB diagnosis and treatment.

Patient literacy on treatment specifically remains extremely poor and limited. This combined with deep seated stigma and discrimination is a critical challenge for TB treatment.

WHAT NEEDS TO BE DONE?

• Create public awareness on TB ensuring prevention and reduction of stigma: India needs to urgently address issues of public awareness, prevention, community engagement and stigma reduction. Survivors and TB affected communities remain passive recipients of care often fearful of accessing treatment or speaking out about TB due to wide spread discrimination. Our fight to combat TB must begin with empowering individuals and communities with information and reducing stigma.

• Create a comprehensive multimedia awareness campaign to ensure awareness Focus on creating awareness of Extra Pulmonary TB which remains neglected Strengthen community and institutional infection control measures to act as a strong preventive tool.

• Ensure mandatory counseling for TB affected individuals and families to ensure prevention and family support for TB affected.

Early and accurate diagnosis for every Indian:

• Substitute sputum smear microscopy with WHO-endorsed, highly sensitive molecular diagnostics by 2017, while simultaneously scaling up capacity for liquid cultures and DST.

• Scale-up implementation of new diagnostic tests, and offers universal drug-susceptibility testing (DST) to all TB patients to ensure rapid detection of all forms of TB.

• Create mechanisms to ensure every Indian seeking care in both the public and private sectors can easily access accurate TB tests for free whenever needed. 

• Prevent the use or entry of sub-optimal tests by making sure that all new diagnostics for TB undergo rigorous validation before approval.

Prioritize changes in treatment of TB: 

• Create partnership with the private sector to ensure alignment between the public and private sector guidelines on treatment and diagnosis.

• Provide quality assured drugs for the entire treatment period for each patient through accredited public and private outlets/pharmacies.

• Ensure access to free drugs to all patients irrespective of whether they seek care in the public or private sector.

• Ensure quick access to new transformative drugs such as Bedaquiline and Delaminid through the government system to patients who need them the most.

• Provide drug susceptibility testing guided treatment as a norm to all suspected drug resistant TB cases to ensure appropriate treatment and prevent MDR TB cases from becoming XDR TB.