India’s TB decline outpaces global average but high burden remains a concern – Firstpost

The latest data reveals that India’s tuberculosis (TB) incidence has decreased from 237 to 195 cases per 100,000 population between 2015 and 2023—a 17.7% reduction, more than double the global average of 8.3%.

This progress highlights the success of the National TB Elimination Program (NTEP). However, India remains far from its 2025 target of reducing incidence to 10 cases per 100,000 population, five years ahead of the global goal. The high disease burden and other factors continue to pose challenges.

India accounts for 62% of multidrug-resistant TB cases worldwide

Dr. Sushrut Ganpule, Consultant in Chest Medicine at Jupiter Hospital (Pune): India’s significant contribution to the global TB burden. Alongside Russia and China, India accounts for 62% of multidrug-resistant TB (MDR-TB) cases worldwide, bearing 30% of the global TB burden.

“India’s National Strategic Plan (2017–25) aims to reduce TB incidence rapidly, aligning with global targets. Community engagement is vital to educate people, reduce stigma, and address challenges faced by TB patients.”

“Investing in research for new diagnostics, treatments, and healthcare delivery models like telemedicine is crucial. Advances like rapid molecular tests (e.g., Xpert MTB/RIF) and shorter drug-resistant TB regimens have improved outcomes and reduced side effects,” Dr. Ganpule said.

Whole genome sequencing and BPaLM regimen: A game-changers

Dr Niranjan Patil, Scientific Business Head and AVP – Infectious Diseases, Head- Microbiology & Infectious Molecular Biology (Metropolis Healthcare): Advanced molecular diagnostics, such as CBNAAT (Genexpert Ultra, Xpert XDR) and Line Probe Assays are crucial for rapid and precise detection of TB and drug resistance patterns like MDR, Isoniazid monoresistance, and Pre-XDR. Automated TB culture tests (e.g., MGIT) provide insights into resistance to newer drugs like Bedaquiline and high-dose Moxifloxacin, part of the BPAL-M regimen for multi-drug-resistant TB.

“Whole Genome Sequencing (WGS) using Next-Generation Sequencing (NGS) helps resolve discrepancies in test results, identify novel mutations, and detect drug resistance for 18 anti-TB drugs, including newer ones like Bedaquiline and Delamanid. WGS also aids in strain typing, lineage detection, and molecular surveillance to track TB transmission and guide public health measures,” said Dr Patil.

“Government initiatives like the 100-Day TB Elimination Campaign and expanded diagnostic access through Ayushman Aarogya Mandirs and private labs are strengthening India’s fight against TB, aiming for a TB-free future by 2025,”.

New era with personalised, effective therapies

Dr. Ravi Shekhar Jha, Director & HOD, Pulmonology at Fortis Hospital (Faridabad): TB treatment has advanced with shorter, more effective regimens. For drug-sensitive TB, a 4-month regimen combining Rifapentine, Moxifloxacin, Isoniazid, and Pyrazinamide offers similar cure rates to the traditional 6-month treatment but with better adherence and fewer side effects. For drug-resistant TB, the BPaL regimen (Bedaquiline, Pretomanid, Linezolid) has revolutionized care, providing a 6-month, all-oral treatment with high success rates and reduced toxicity. Innovations like therapeutic drug monitoring and molecular diagnostics enable personalized treatment, while research into host-directed therapies and new vaccines aims to enhance immune responses and improve outcomes. These advancements are transforming TB care, aiming for faster cures, lower relapse rates, and better patient quality of life.

Alarming statistics

Data from City X-Ray and Scan Clinic over the past six months shows that 21% of pediatric cases (up to 16 years) and nearly 14% of adults were microbiologically confirmed TB cases, including both pulmonary and extrapulmonary TB. Also, latent TB testing (IGRA) revealed 23% positivity in children and 43% in adults.

Dr. Aakaar Kapoor, CEO and Lead Medical Advisor at City X-Ray and Scan Clinic said “The high TB caseload reflects widespread ignorance and malnutrition, particularly among those with weakened immune systems. While pulmonary TB is widely recognized, extrapulmonary TB—where the infection spreads to other organs—is equally serious and often overlooked.”

Diabetes & TB: A complex and deadly combination

Dr. Anupam Biswas, Senior Consultant- Diabetology/Endocrinology, Fortis Hospital (Noida): Diabetes and tuberculosis (TB) are two major global health concerns that interact in complex ways. While TB is an infectious disease caused by Mycobacterium tuberculosis, diabetes is a chronic metabolic disorder characterized by high blood glucose levels. When occurring together, they present significant public health challenges. The intersection of these conditions is particularly concerning in low- and middle-income countries, where both diseases are prevalent. Understanding the link between diabetes and tuberculosis, identifying hidden health threats, and implementing effective prevention and management strategies are crucial steps toward mitigating their combined impact.

Link between diabetes and tuberculosis

Individuals with diabetes are at a higher risk of developing active TB compared to those without diabetes. This increased susceptibility is primarily due to the compromised immune system associated with chronic hyperglycemia, which impairs the body’s ability to combat infections. Studies have shown that diabetes can increase the risk of active TB disease by two to three times. Additionally, diabetes causes chronic inflammation and reduces the body’s ability to control bacterial infections, increasing the likelihood of latent TB becoming active.

Conversely, TB can adversely affect glycemic control in individuals with diabetes, creating a bidirectional relationship that complicates the management of both diseases. The inflammatory response triggered by TB can lead to insulin resistance, making blood sugar levels harder to control. It can also trigger the release of stress hormones like cortisol, which may impair blood glucose levels.

Hidden health threats

Delayed Diagnosis: The symptoms of TB and poorly controlled diabetes can overlap, leading to delays in the diagnosis of both conditions. For instance, weight loss and fatigue are common in both diseases, which may result in misdiagnosis or delayed treatment.

Increased Severity of TB: Diabetes can lead to more severe manifestations of TB, including a higher bacterial load and more extensive lung damage. This severity can result in prolonged infectiousness and increased transmission rates.

Drug Interactions: The concurrent treatment of TB and diabetes requires careful consideration of potential drug interactions. For example, rifampicin, a key TB medication, can reduce the effectiveness of certain oral hypoglycemic agents, necessitating adjustments in diabetes management.

Multidrug-Resistant TB (MDR-TB): Diabetes has been associated with an increased risk of developing MDR-TB. The exact mechanisms are not fully understood, but factors such as impaired immune response and potential delays in TB diagnosis and treatment among diabetic patients may contribute to this risk.

The World Health Organization (WHO) recommends a collaborative approach where TB patients are screened for diabetes and vice versa. Healthcare providers should be trained to recognise and manage both diseases together. Early detection, proper treatment, and integrated healthcare approaches are essential for managing both conditions. Addressing this dual epidemic requires a multidisciplinary approach.

Call for early detection and prevention

Health experts stress the importance of early diagnosis and stronger preventive measures.

Dr. Vikas Mittal, Director – Pulmonologist, CK Birla Hospital (Delhi): TB remains a global public health challenge, primarily affecting the lungs. Early symptoms include a persistent cough (with or without blood), low-grade fever, weight loss, and chest pain. Advanced stages can cause severe respiratory distress. Despite global efforts, drug-resistant strains and challenges like inadequate healthcare access, stigma, and long treatment durations hinder progress. The WHO emphasises early diagnosis, improved treatment regimens and vaccination programs. Strengthening public awareness, ensuring timely treatment, and investing in research are critical to reducing the global TB burden and achieving elimination goals.

Dr. Ravi Kapoor, Founder and Senior Consultant Radiologist at City X-Ray and Scan Clinic, said: “Early detection is crucial to prevent complications and curb transmission. Accurate diagnosis is half the battle won. This requires enhanced surveillance, improved screening, and more accredited labs for reliable testing.”

Role of private players in TB elimination

Experts highlight the critical role of private healthcare providers in supporting NTEP to combat TB. Dr. Aakaar Kapoor said “India has outperformed many high-burden countries, but preventive care, early diagnosis, and public-private collaboration need urgent attention. Integrating private diagnostic centers with advanced technology, involving them in policymaking, and leveraging their expertise can accelerate progress. Labs with robust infrastructure should also assist others in capacity building.”

“Mandatory accreditation for diagnostic labs and a triple-layer verification system for TB detection can enhance accuracy. Schools should run awareness programs to detect extrapulmonary TB in children early.”