Recent statistics indicate that while the overall incidence of tuberculosis (TB) in India has seen a reduction, the prevalence of multidrug-resistant tuberculosis (MDR-TB) continues to present significant public health issues. The World Health Organisation (WHO) reports that India accounts for about 32% of global MDR-TB cases, putting the nation among the top countries struggling with this challenging form of the disease. MDR-TB is resistant to primary anti-TB drugs, including isoniazid and rifampicin, complicating treatment protocols.

Overall Decrease in TB Incidence

Since 2015, the incidence of TB in India has decreased by 21%. The estimated rate for 2024 stands at 187 cases per 100,000 people, a slight improvement from 195 cases per 100,000 in 2023. However, this figure still falls short of the government’s target of achieving a TB incidence rate of 44 cases per 100,000 by 2025. TB is an airborne infectious disease caused by the bacterium Mycobacterium tuberculosis, which predominantly affects the lungs.

Resistance Issues in Tuberculosis

The WHO has identified that the majority of new TB cases arise in 30 high-burden countries, with India contributing approximately 25% of worldwide cases. The India Tuberculosis Report of 2024 recorded 63,939 instances of MDR-TB. The inaugural National Anti-TB Drug Resistance Survey released in 2018 indicated that 6.19% of all TB patients in India were affected by MDR-TB. The survey also discovered a high level of fluoroquinolone resistance. Resistance can arise primarily due to two factors: acquired resistance from improper treatment and direct infection from resistant strains.

Challenges in Managing Drug-Resistant TB

Setting aside typical factors, early testing for drug resistance is vital. Many individuals begin treatment without confirming their specific drug resistance, leading to ineffective therapies. Experts stressed the importance of patient adherence to treatment. Irregular medication and premature treatment discontinuation contribute to the development of stronger, resistant bacteria. Furthermore, the long duration and potential side effects of MDR-TB treatment can hinder patient compliance.

Efforts in Detecting and Treating MDR-TB

Challenges persist in detecting MDR-TB cases, prompting India to implement initiatives under the National TB Elimination Programme. These programs, including active case-finding campaigns and advancements in molecular diagnostics, have resulted in the identification of 63,939 MDR-TB cases. However, interruptions during treatment can lead to XDR-TB, a form even resistant to the latest drugs. Systemic factors, such as delayed diagnoses and fragmented care, also exacerbate drug resistance.

Socio-Economic Factors in TB Control

Several socio-economic barriers hinder efforts to combat drug-resistant TB, including a lack of awareness, associated stigma, and adherence issues. Co-existing medical conditions like diabetes, malnutrition, and HIV contribute to the complexity of TB cases. In certain regions, access to proper diagnostics and specialized care remains limited. Enhanced awareness, early diagnosis, and support systems are essential for improving treatment adherence and curbing TB transmission.

National Strategies for TB Elimination

The National Strategic Plan for 2017–2025 outlines strategies aimed at significantly reducing TB incidence by 2030. This plan aligns with global TB elimination goals and Sustainable Development objectives aimed at achieving a TB-free India, alongside zero deaths and poverty linked to tuberculosis. A focus on efficient healthcare delivery models and continuous patient monitoring is necessary to address the intricacies of managing drug-resistant TB effectively.

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