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Integrate TB services with primary health system: Lancet

Integrate TB services with primary health system: Lancet

According to The Lancet Global Health article based on modelling for three high-burden countries, including India, compared with 2015 data, 57% reduction in incidence and 72% reduction in mortality will been seen only by 2035.

Key findings

  • Of the 10 million new tuberculosis (TB) cases reported globally in 2017 by the World Health Organisation, 2.74 million were from India, showing a marginal reduction from 2.79 million in 2016.
  • Compared with 2015 data, 57% reduction in incidence and 72% reduction in mortality will been seen only by 2035 in three countries including India.
  • Modelling suggests that lives of eight million (28%) people with TB can be saved over the next 30 years if tests are subsidised and patients are supported to complete the treatment.

TB in India

India has set an ambitious goal of eliminating TB by 2025, but integration of TB services with the primary health system to reduce diagnostic delays is not happening. Patients are not diagnosed and treated at the primary level, which is the first point of contact.

India’s National Strategic Plan for TB Elimination (2017–25) has called for a six-time increase in private notifications to two million patients per year by 2020.

With 1,35,000 cases in 2017, India has the highest number of multidrug-resistant TB (MDR-TB) cases in the world.

According to the report, in India, only 14% of people with MDR-TB completed treatment and just 11% remained disease-free at the end of one year.

The Lancet Commission recommends that India should scale up access to TB services for all those seeking them, optimise engagement of private sector providers and guarantee universal access to drug susceptibility testing and second line TB drugs.

What is TB?

Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable.

TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.

How to prevent it?

To prevent TB -  

  • Avoid exposing yourself to people with active TB.
  • Know if you are "at-risk"
  • Lead a healthy lifestyle.
  • Get the BCG vaccination to prevent TB.
  • Schedule a TB test if you have been exposed to someone with tuberculosis.

Diagnostic tests for TB disease include – Rapid molecular test, Sputum smear microscopy, Culture-based methods

What is Primary Health Care?

At its heart, primary health care is about caring for people, rather than simply treating specific diseases or conditions. 

PHC is made up of three main areas: empowered people and communities; multisectoral policy and action; and primary care and essential public health functions as the core of integrated health services. 

This includes a spectrum of services from prevention (i.e. vaccinations and family planning) to management of chronic health conditions and palliative care. PHC can meet the majority of an individual’s health needs over the course of their life.

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