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The three major problems of the Revised TB Control TB Program need to be addressed
Tuberculosis is one of the worst diseases in the world, killing 1.5 million people every year (WHO). TB affects older people in their very productive years and thus deprives them of family and nation. In India, the capital of TB worldwide, the disease kills about 1,400 people every day. These are perfect measurements, because our health management system does not have a system for calculating exact numbers.
In the 1950s and 1960s, India was a world leader in epidemiology research, infection and local TB treatment. The National TB Control Program of 1962 was based on regional and participatory districts. However, model upgrades were unsuccessful and the system failed to control TB. So we lost confidence and started to do what the WHO told us to do under the Revised Tuberculosis Control Program (RNTCP). WHO experts, in addition to distinguishing between the TB of poor and rich countries, use the hypothetical framework for TB control to design RNTCP. In 2018, India realized that light at the end of the tunnel was still difficult.
There are obvious flaws in the RNTCP. First, in a highly funded system, there is no prescriptive method for monitoring TB control. Compare this with the National AIDS Control Program. Prior to the establishment of the National AIDS Control Agency, the Indian Council of Medical Research-managed AIDS Control Task Force had a unique mechanism for monitoring the control process, known as ‘guard surveillance’. With it, we have data about the spread of infection that can be compared throughout the years, from 1986 to the present. There has been pressure from WHO experts to stop it, but it should be given to Drs. Sriram P Tripathy, then Director General of ICMR at the time, politely but firmly refused.
India recently faced WHO estimates of COVID-19 deaths in India. That the government can publicly oppose the WHO is a good sign. Now we must boldly point out the flaws of the RNTCP designed by WHO and build our complete strategy.
Second, the idea that treating patients with pulmonary TB alone could control TB was delusional in India. The goal of the theory is to ‘reduce the source’. If one patient is the closest source of infection and infection to another in the community, early diagnosis and treatment can serve as a reduction in the source. India is a country with a huge responsibility. Large numbers of adults carry TB infection in the lungs in a state of lifelong sleepiness (latent TB). Some of them deteriorate and have tuberculosis (TB). HIV infection, diabetes, malnutrition, lung damage due to contamination, smoking, inability to function due to chronic illness, alcoholism, etc. accelerates TB regeneration.
Third, the RNTCP failed to find human relationships in controlling TB. In India’s AIDS Control Program, public education was given priority. Red ribbon clubs in schools and colleges are their heritage. Without informed public participation, discrimination and delays in seeking help will continue.
Recognizing that TB was uncontrollable, the WHO requested another system review through World Health Assembly Resolution in 2014 to eradicate TB by 2035. Strengthened by the promise of an effective strategy, the Prime Minister announced in 2018 that India will eradicate TB by 2025. .
According to Epidemiologically, human power over viruses includes control, elimination and elimination. Control refers to the reduction of the burden of disease by specific interventions to a predetermined level over a predetermined period. Evidence will have to show that the decline was due to those intervention measures and not to ‘national policy’. Diseases with social symptoms often decrease over time with better housing, better nutrition, education and income – this is the ‘trend of the world’. Globally, with this ‘national trend’, TB burden has been declining by 1% or 1.5% per year.
Termination means gaining a fair share of new cases. As we have a serious backlog of latent TB, we cannot eradicate TB, but we should aim for a high level of control (reducing from 200 lakh per year to 50 lakh per year) and record it at a rate. That will do justice to the Prime Minister’s vision. Higher control is achievable as we have larger assets in the form of RNTCP. Qualified Provincial and Regional TB officials are already on duty and we have a comprehensive network of TB clinics and a community of civil servants and staff. Once the deficiencies listed above have been corrected, we can control TB.
T. Jacob John is the Chairman, Rotary Club of the Vellore TB Control Society, and Sushil Mathew John is the Professor of Public Health, Christian Medical College, Vellore