India: India Accounted For Almost Quarter Of The World's Cases Of MDR/RR-TB: WHO Report

WHO calls for urgent action to end Tuberculosis (TB) as it estimates that a quarter of the world's population has TB infection

On September 18, 2018, World Health Organization (WHO) published a 'Global TB Report 20181' in the lead up to the UN high-level meeting on TB. This 2018 edition of global report on TB provides a comprehensive and up-to-date assessment of the TB epidemic, and of progress in the response to the epidemic, at global, regional and country levels2.

TB is one of the top 10 causes of death and the leading fatal cause from a single infectious agent. Millions of people continue to fall sick with TB each year. Although global efforts have averted an estimated 54 million TB deaths since 2000, TB remains the world's deadliest infectious disease. This report calls for an unprecedented mobilization of national and international commitments. It urged political leaders who gathered for the first-ever United Nations High-level Meeting on September 26, 2018, to take decisive action towards ending the TB epidemic3.

The highlights of Global TB Report 2018 briefing India status

Reporting new TB cases: Worldwide in 2017, 6.4 million new cases of TB were officially notified to national authorities and then reported to WHO. From 5.7-5.8 million cases reported in 2013, this number has increased to 6.4 million mainly due to increased reporting of cases detected by the private sector in India and Indonesia.

The severity of national epidemics varies widely among countries. In 2017, there were fewer than 10 new cases per 100 000 population in most high-income countries, 150–400 in most of the 30 high TB burden countries, and above 500 in a few countries including Mozambique, the Philippines and South Africa.

Notification of TB: Globally in 2017, 60% of notified TB patients had a documented HIV test result, up from 58% in 2016. Despite increases in notifications of TB, progress in closing detection and treatment gaps is slow and large gaps remain. India accounts 26% of this global gap, and the total gap with Indonesia (11%), Nigeria (9%) and the Philippines (7%) accounts for more than half of the global total.

Drug resistant TB: Drug-resistant TB continues to be a public health crisis. Worldwide in 2017, 558 000 people developed TB that was resistant to rifampicin (RR-TB), the most effective first line drug, and of these, 82% had multidrug-resistant TB (MDR-TB). Three countries together accounted for almost half of the world's cases of MDR/RR-TB - India (24%), China (13%) and the Russian Federation (10%).

Globally, the 139 114 patients starting second-line MDR-TB treatment in 2017, represented 25% of the 558 000 estimated MDR/RR-TB incident cases for the same year. China and India together accounted for 40% of the total gap between enrolments in MDR-TB treatment in 2017 and the estimated number of incident MDR/RR-TB cases in 2017.

Treatment Success Rate: Among the six WHO regions, the highest treatment success rate in 2016 was in the WHO Eastern Mediterranean Region (92%). The lowest treatment success rate (at 75%) was in the WHO South-East Asia Region (due to high proportions of unevaluated cases, especially in India).

A total of 292 182 children aged under 5 years were reported to have been initiated on TB preventive treatment in 2017, an increase of 79% from 163 720 in 2016. At country level, India reported the largest number (38 745), followed by South Africa (32 104).

TB mortality in 2017: TB is the tenth leading cause of death worldwide, and since 2011 it has been the leading cause of death from a single infectious agent, ranking above HIV/AIDS. Globally, there were an estimated 1.3 million deaths from TB among HIV-negative people in 2017 and an additional 300 000 (range, 266 000–335 000) deaths from TB among HIV-positive people. India accounted for 32% of global TB deaths among HIV-negative people, and for 27% of the combined total TB deaths in HIV-negative and HIV-positive people. 

Financing for TB prevention, diagnosis and treatment: Funding for the provision of TB prevention, diagnosis and treatment services has more than doubled since 2006. As in previous years, most of the funding (86%) available in 2018 is from domestic sources. However, this global aggregate figure is strongly influenced by BRICS, in which 96% of funding is from domestic sources. In India, domestic funding more than tripled between 2016 and 2018.

TB case-finding among people attending HIV care in India: For the past year, the Revised National TB Control Programme (RNTCP) and National AIDS Control Organization (NACO) in India have been capturing data to evaluate TB case-finding activities among people attending ART centres.

According to data reported by the RNTCP for 2017, an estimated 58% (n = 49 000) of people with HIV-associated TB were not reported to have reached TB care. Reasons for missing people with TB include poor access to services, weaknesses in service delivery, and gaps in recording and reporting, and limited engagement of the private sector.

Note – For the matter of this report, the estimates of TB incidence and mortality for India are interim, pending results from the national TB prevalence survey planned for 2019/2020.

Footnotes

1 http://apps.who.int/iris/bitstream/handle/10665/274453/9789241565646-eng.pdf

2 http://www.who.int/tb/publications/global_report/Exec_summary_17Sept2018.pdf

3 http://www.who.int/news-room/detail/18-09-2018-who-calls-for-urgent-action-to-end-tb-

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