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India is leading a significant battle against tuberculosis (TB), accounting for 26% of the global TB cases, with over 2.5 million cases diagnosed in 2023. The National Strategic Plan for TB Elimination aims to end TB by 2025. Despite advancements, challenges such as drug resistance and late diagnosis persist, demanding continuous improvement in detection and treatment strategies.

Current Challenges in India’s Fight Against Tuberculosis (TB):

• High Prevalence of Drug-Resistant TB: Drug-resistant TB, including Multidrug-Resistant TB (MDR-TB), poses a significant challenge due to treatment complexities and longer durations.
  For example: In 2023, India reported 63,939 MDR-TB cases, making it harder to achieve treatment success due to the need for more intensive care and monitoring.
• Delayed Diagnosis and Detection: A substantial number of TB cases remain undiagnosed due to limited access to diagnostic facilities and the prevalence of asymptomatic cases.
  For example: According to the National TB Prevalence Survey (2019-21), 42.6% of cases were asymptomatic and would have been missed without chest X-ray screenings.
• Stigma and Social Barriers: Social stigma associated with TB leads to delays in seeking care and non-adherence to treatment, further spreading the disease.
  For example: A study by India TB Research Consortium highlighted that 34% of TB patients delayed seeking treatment due to fear of social ostracism.
• Weak Health Infrastructure in Rural Areas: Inadequate health infrastructure and a shortage of trained healthcare professionals in rural and remote areas hinder effective TB management.
  For example: India’s Rural Health Statistics (2022-23) show a deficit of 28% in the required number of trained lab technicians for TB testing in rural health centres.
• Comorbidities and Risk Factors: Comorbidities such as HIV, diabetes, and malnutrition increase susceptibility to TB and complicate its treatment.
  For example: According to the India HIV Estimation Report 2021, 18% of HIV patients also suffer from TB, necessitating integrated management strategies.

Strategies for Improving Diagnosis of Drug-Resistant TB:

• Enhanced Molecular Diagnostic Tools: Rapid and accurate diagnosis is critical for early detection and appropriate treatment of drug-resistant TB.
• Expanding Access to Genomic Sequencing: Advanced genomic tools can help identify drug-resistant strains more precisely, guiding effective treatment.
• Strengthening Laboratory Infrastructure: Investing in laboratory capabilities ensures accurate diagnosis, especially in regions with high TB burdens.
  For Example: India’s initiative to establish more advanced TB culture and drug sensitivity testing (DST) labs under the Revised National TB Control Programme (RNTCP) has improved diagnostic accuracy.
• Mobile Diagnostic Units: Bringing diagnostic services to remote and underserved areas can greatly improve TB case detection.
• Community-Based Screening: Involving communities in TB screening can lead to earlier detection and better outcomes for drug-resistant cases.

Strategies for Improving Treatment Outcomes for Drug-Resistant TB:

• Personalised Treatment Regimens: Tailoring treatment to individual patient needs based on drug susceptibility testing can improve outcomes.
• Shorter Treatment Regimens: Shortening the duration of treatment can increase patient adherence and improve outcomes for drug-resistant TB.
  For Example: The introduction of the shorter MDR-TB regimen, which lasts 9–12 months, has shown higher treatment success rates in patients compared to the traditional 18-24 month regimens.
• Patient Support and Adherence Programmes: Support systems that help patients adhere to treatment are crucial for managing drug-resistant TB.
  For Example: Providing patients with direct observation of treatment (DOT) and psychosocial support has reduced default rates in MDR-TB patients.
• Access to Newer Medications: Ensuring access to the latest TB medications can improve treatment outcomes, particularly for resistant forms.
  For Example: The inclusion of bedaquiline and delamanid in treatment protocols can improve outcomes for patients with extensively drug-resistant TB (XDR-TB).
• Integrated Care Models: Coordinating care for TB patients with other health services can address multiple health issues simultaneously, improving overall outcomes.
  For Example: In India, integrating TB care with HIV services in high-burden settings can result in better treatment outcomes for co-infected patients by addressing both diseases simultaneously.

To eliminate TB by 2025, India must focus on strengthening its diagnostic capabilities, expanding treatment options, and reducing social stigma. Enhanced community engagement, digital health integration, and robust R&D investments are crucial for combating drug-resistant TB and achieving sustainable health outcomes. With a multi-pronged strategy, India can effectively control TB and move closer to eradication.

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