image.pngThe launch of Bedaquiline â€“ a new anti-TB drug for Drug Resistant TB as part of the Revised National Tuberculosis Control Programme â€“ is part of governmentâ€™s new strategies towards achieving the Sustainable Development Goals (SDGs) and the End TB Strategy. This new class of drug is a diarylquinoline that specifically targets Mycobacterial ATP synthase, an enzyme essential for supply of energy to Mycobacterium tuberculosis and most other mycobacteria. This drug is indicated for use in the treatment of drug-resistant TB. Bedaquiline is being introduced at six identified tertiary care centres across India. These sites have advanced facilities for laboratory testing and intensive care for patients. Bedaquiline will be given to multi-drug resistant TB patients with resistance to either all fluoroquinolone and/or all second line injectables and extensive drug resistant TB.
India also has a large number of drug resistance cases and drug resistance is a major cause for concern because of lack of adherence to medicines and the availability of TB drugs over the counter. Tuberculosis remains a major public health problem despite noteworthy socio-economic development and availability of technology. It was made a notifiable disease in 2012. India is a signatory to “”The End TB Strategy“” that calls for a world free of tuberculosis, with measurable aims of a 50 per cent and 75 per cent reduction in incidence and related deaths, respectively by 2050, and corresponding reductions of 90 per cent and 95 per cent by 2035. The SDGs which came into effect from January 1, 2016 require that all three dimensions of development â€“ economic, social and environmentalâ€”are addressed in an integrated manner to ensure that “”no one is left behind.””
Though India is the second most populous country in the world, one fourth of the global TB cases occur in India annually. As per WHO Global TB Report 2015, of the estimated global incidence of 9.6 million TB cases, 2.2 million were estimated to have occurred in India. As per the current WHO estimates, Indiaâ€™s TB control programme is on track as far as reduction in disease burden is concerned. There is 58 per cent reduction in TB mortality rate as compared to 1990 level as there is 55 per cent reduction in TB prevalence rate by 2014 as compared to 1990 level with the trend declining steadily. Tuberculosis prevalence per lakh population has reduced from 465 in year 1990 to 195 in 2013 which in terms of numbers means the prevalence has reduced from 40 lakh to 15 lakh annually.
Tuberculosis incidence per lakh population has further reduced to 167 in 2014 and TB mortality per lakh population has come down to 17 in 2012 as against 38 in 1990. In absolute numbers, mortality due to TB has reduced from 3.3 lakh to 2.2 lakh annually. The Union Health and Family Welfare Minister J.P.Nadda said that India was committed to fighting Tb and resources would not be a constraint. He also inducted over 500 Cartridge Based Nucleic Acid Amplification Test (CBNAAT) machines in the programme. The CBNAAT is a revolutionary rapid molecular test which detects Mycobacterium tuberculosis and rifampicin drug resistance, simultaneously. This test is fully automated and provides results within two hours. It is a highly sensitive diagnostic tool and can be used in remote and rural areas without sophisticated infrastructure or specialized training.
Until 2015, 121 CBNAAT sites are functional in the country largely providing decentralized testing for detection of DR TB. With the availability of these additional 500 machines, access to rapid quality assured diagnosis of DR TB and TB will be ensured in all the districts of India either directly or through a linkage by specimen transport mechanism. Additionally, the programme will be able to use this highly sensitive state-of-art technology for diagnosis of TB among key populations like children, PLHIV and extra pulmonary TB patients. India has also launched the â€˜Third line ART programme for People Living with HIVâ€™. The life-saving third line ART costs nearly Rs. 1.18 lakh per patient per year. Providing these free would not only safe lives but improve socioeconomic conditions of the patients. This initiative brings Indiaâ€™s ART programme at par with programmes in the developed countries. “