An increase in the number of tuberculosis (TB) cases notified in India in 2023 over 2022 underscores the rigour of the efforts to shrink the pool escaping the TB control programme’s radar. The better capture of cases can be credited to the private sector’s impressive jump in performance, as well as states like Uttar Pradesh and Bihar bettering their record. With such success, a larger number of patients than earlier can be monitored for effective treatment, which, in turn, can curb the spread and prevent any uptick in mortality and the evolution of more menacing forms of the pathogen.
India’s TB notification success and the general trend of decline in incidence and mortality are certainly encouraging. Even as this momentum is preserved, drug-resistant TB needs urgent focus. Though WHO data showed that the incidence of multi-drug resistant (MDR) TB in the country was on a slow-decline trajectory before the pandemic, an increase was recorded in 2021. India’s own data bears out this trend. The country reports the highest incidence of MDR TB globally. Its stance on patent applications for bedaquiline, a last resort drug, might have made it easier to produce the drug locally, but bedaquiline coverage is estimated to be much smaller than needed.
Non-lung TB is another challenging facet of India’s TB burden. This is more common in women, and manifests very differently from pulmonary TB, whose symptoms are more widely recognised in comparison — and therefore, is often missed. The problem is exacerbated by the access barriers that women face when it comes to timely care. Against such a backdrop, the TB control programme needs to adopt a multi-focal approach.
