By Shrutika Mathur

While we are struggling to get back on our feet after the paralyzing effects of an ever-changing virus, what has not changed is the fatality of one of the oldest-known diseases: Tuberculosis. In fact, its severity has worsened.¹ 2021 witnessed 19% increase in the cases notifications from the year 2020 according to the National Tuberculosis Elimination Programme (NTEP) in India.² Even more sobering data is presented with the worldwide figures according to which TB is one of the leading causes of death and the second most infectious disease after COVID-19 (more than HIV/AIDS).³

The Stealth of TB

According to the WHO, among many other diseases, TB services were disrupted by the COVID-19 pandemic in 2021, but its impact on the TB response has been particularly severe. The lag in the essential services led to more people going undiagnosed and untreated. This ultimately has resulted in more deaths and more community transmissions of the infection. Furthermore, the number of people provided with treatment declined from 2019 to 2020.

The viciousness of this infectious disease cuts deeper than what the numbers inform us. The active TB spores spread person to person when an infected person coughs or sneezes out the bacteria through the air breathed by others. Healthy individuals may contract latent TB, but the disease may not become active until months or years later. TB attacks when the immune system becomes weaker. The TB bacteria may also hide inside individuals for a long time before it expresses itself. It can be several months after the initial infection before the disease is evident in lab tests; meanwhile, it spreads to other people. India has the highest burden of TB and multidrug resistant TB in the world.⁴ Drug-resistant TB can occur when the drugs used to treat TB are misused or mismanaged. Treating and curing drug-resistant TB is complicated. It can be avoided by taking the drugs as prescribed by the expert and avoiding contact with patients with drug-resistant TB.

TB Affects the Most Vulnerable

TB tends to affect the most marginalised groups heavily. People who live in poorly ventilated and overcrowded conditions, suffer from malnutrition and diseases (particularly HIV) and have limited access to healthcare are most at risk. The disease reciprocally can push the people with TB into a downward spiral of poverty. The sufferers lose productivity and the ability to earn a living. The associated cost of treatment of TB can be draining too. Even when it is free, the cost of traveling to clinics and the nutrition required to heal can be a back-breaking expense for the vulnerable. Besides the physical and mental health suffering, the economic repercussions of the disease, there is a social stigma attached to contracting TB. Recovered individuals can be left isolated from society, excluded from future employment opportunities, women may be divorced or considered unworthy of marriage.

HPPI’s Fight for Ending TB in India 

Cognizant of the severity of the situation, HPPI since 2013 has integrated TB detection and care in its many community-development and health projects. In 2016, HPPI with its partnership with the International Union Against Tuberculosis and Lung Disease to implement Project Axshya, reached many households in slums of Delhi with information about TB and referred people to government clinics if detected with TB symptoms. Furthermore, HPPI has established  Axshya Kiosks with Flexi DOT services for provision of treatment to TB patients before and after normal work hours.

A major challenge of TB control in the homeless population is their high rate of dropping out from the treatment. In 2017–18, a special action was conducted in the Homeless Resource and Service Centre, reaching out to homeless citizens in four districts of Delhi with TB awareness, detection, testing and treatment. Additionally, HPPI conducted information dissemination sessions about TB for people living in slums of Delhi. The intervention focused on household sensitisation through outreach activities, identification and linkage of people with TB symptoms to TB services. HPPI has integrated TB awareness activities in more than 20 projects in Delhi, Haryana, Rajasthan, UP, MP and Bihar.

In 2022 Taloja , Maharashtra, under its Tuberculosis Awareness and Control Project, HPPI in partnership with Dow Chemical International Private Limited is spreading awareness, screening for TB, initiating treatments along with treatment-adherence counseling of new TB patients and their family members. Nutritional support is also provided and TB patients are linked to the government’s Nikshya Poshan Yojna. There is a growing recognition that impacted communities―TB survivors, people with TB and their families―must play a greater role in the recovery. Trained TB Champions can not only support people with TB but also help identify people with symptoms of TB and guide them to the nearest facility.

India has 26% of the world’s TB cases and 34% of the deaths. While India has improved TB treatment success rate from 78% in 2016 to 84% in 2022,⁵ we need to make-up for the lost momentum in our fight towards eliminating TB due to COVID-19. With experience from working on the field towards alleviating TB, HPPI has understood the importance of applying a holistic approach for developing a sustainable process for fighting and eliminating the disease. HPPI actively partners with the Government of India (GoI) to raise and complement its country-wide mass-awareness movement on TB (Jan Andolan). HPPI is committed to support the Government of India (GoI) to achieve the national target of eliminating TB by 2025.