People who have spent their lives in working on TB research and management can tell how the disease has has a devastating grip on global health. Dr K S Sachdeva, Deputy Director General at Central TB Division shares some experiences and insight on India’s battle against TB
What drew you to the work on the TB response programme in India?
I am primarily a chest and TB specialist by profession. When I moved from clinical work, my first obvious choice was something related to my field of study. The challenge of TB elimination was huge but important and hence, I thought this would be the best fit for me.
TB has always been there. We have never been close to eradication. What are the biggest challenges for TB eradication in India – what are the gaps, and how do we fix them?
TB is a disease which exist almost for over 20,000 years. The fact that in this time, we are thinking that it is within the realm of possible elimination, will be a formidable achievement in itself. All challenges can be overcome once we have set ourselves to achieve this.
However, a few challenges that we need to address include the high rate of transmission and the number of patients who are not on the programme radar. This coupled with a huge population base and disease burden in India along with mounting drug resistance needs a concerted effort. Besides that, there are social determinants of TB, like poverty, overcrowding, under-nutrition, which can only be addressed by interventions from departments and ministries outside of health. Behaviour change towards early care seeking and preventing transmission to others along with management of latent TB need to be addressed on an urgent basis.
Having said that, strategies to address all these challenges are already in place and are being scaled up. The very fact that there is a commitment to elimination- is a testimony to the fact that even the policymakers are hell bent on eliminating TB.
Is there a real reason to panic about Drug-resistant TB?
No. The rates of DR-TB in India are not that high. It is mostly a problem in eastern Europe or some countries in Africa where the rates are almost 50 per cent of new patients of DR-TB, and 80-90 per cent of previously treated patients. In our country, these rates for treatment naïve patients are less than three per cent and for treatment experiences around 10 per cent. However, if translated into absolute numbers, the number of population seems high as compared to other countries. But we must take cognizance of the fact that the programme has been set up over the years with the largest network of laboratories to diagnose such cases, better drugs interventions and improved outcomes.
Do you think there have been issues related to drug resistance in terms of treatment regimens not being as effective as you would like them to be?
That was the case a few years ago when newer drugs were not available. We now have treatment that is quite effective and the success rate has improved to 70-80%, which is a huge gain.
Do you think there is a need to re-educate our healthcare workforce and individuals who are being tested on the implications and value of testing?
Of course. There is a continued need to engage with our healthcare workers on all public health issues. We need to focus with regard to public interest there is a need to connect with them, messaging has to be there.
Do you think the way countries have handled the pandemic in terms of screening and infrastructure etc. can give us a new direction on TB diagnosis, management etc.?
Yes. It already has given us a new direction on TB diagnosis and management. The way the pandemic has been handled; the contribution of TB programme cannot be underscored because of the currently available 2000 labs in the country testing for COVID almost 50% are contributed by TB infrastructure provided by the TB programme. It hugely contributed to the COVID testing load. As a programme, we also have decentralised testing to be as near to the patient as possible and also engaged with private labs. The lab network for our country for TB is the largest in the world. Huge Infrastructure has been created.