Burden of DR-TB in India

There are currently five categories of drug-resistant TB treated under the National TB Elimination Programme (NTEP) at present: Isoniazid (INH)-Resistant TB, Rifampicin (R) Resistant-TB , Multi- Drug Resistant TB (MDR-TB), Pre-Extensively Drug Resistant TB (pre-XDR-TB) and Extensively Drug Resistant TB (XDR-TB). 

DR-TB scenario in India

• In Global TB report 2022, India reported the MDR/RR-TB prevalence rate of 316 per 1 lakh population and incidence rate of 8.5 per 1 lakh population. 

• The proportion of bacteriologically confirmed TB cases tested for rifampicin resistance among new cases (pulmonary) was 76% and for the previously treated was 73%. 

• Total 58837 MDR/ RR TB cases were laboratory confirmed of which 53037 (90%) initiated treatment and 10935 pre-XDR-TB/XDR-TB cases were laboratory confirmed of which 9780 (89%) were initiated on treatment. Further 19752 MDR/RR-TB cases tested for resistance to any fluoroquinolones

• The treatment success rate for MDR/RR-TB cases who were started on second-line treatment in 2019 was 57% and for Pre-XDR-TB/XDR-TB cases was 55%, whereas the death rate was in the range of 13-14% for DR-TB patient

• In 2021, there was also a 9% reduction in the number of MDR-TB patients put on treatment as compared to the pre-pandemic % (2019). 

• India accounts to more than a quarter of the global DR-TB burden which makes it one of the top contributing countries for the world’s total DR-TB cases. 

Significance

• The high death rate, long duration of treatment and average treatment outcome of DR-TB poses a threat to effectively managing the disease in the country. 

• Given the catastrophic expenditure that occurs due to TB, more so when it is DR-TB, the economic impact these rising DR-TB numbers may cause in a developing economy like India are very alarming. 

• Additionally more than 50% of the country’s population are in the age group of 15-54 years and this is also the population which is most affected by DR-TB and thereby impacting the overall growth of the country. Therefore as a country it is extremely crucial to address both bio-medical as well as psycho social aspects of TB.

Resources:

• India TB Report, 2022.
• Global Tuberculosis Report, 2022
• National TB Prevalence Survey (2019-2021), ICMR, India

Assessment: