TB in India - picking up their act

Any notion of a public health system in India must be tempered by this piece by the Indian Express. The article relates to MDR-TB in the Indian state of Maharashtra, which is regarded as the richest state in India. With a population of 96.8M any problem in Maharashtra is bound to occur on a large scale.

The Maharashtra Public Health Dept doesn't hold back on their TB work

In 1992, the Government of India, together with the World Health Organization (WHO) and Swedish International Development Agency (SIDA), reviewed the national programme and concluded that it suffered from managerial weakness, inadequate funding, over-reliance on x-ray, non-standard treatment regimens, low rates of treatment completion, and lack of systematic information on treatment outcomes. As a result, a Revised National Tuberculosis Control Programme (RNTCP) was designed.

The RNTCP has established a goal of detecting 70% of TB (via sputum microscopy) and curing 85% of those cases. Maharashtra claim to have some success in that area

With around 600,000 tests undertaken annually the task is enormous. What they are finding is that of those tested 55% are smear positive with 59% of those positives being confirmed by sputum culture and of these new cases 5% are MDR-TB - which should be around 9,700 cases per year.

Extending these detection rates over the entire population of 96.8M gives a sense of the scale of the problem. To that end they are to open 2 new MDR-TB labs, one in Pune and the other in Mumbai.

With active and drug resistant TB remaining to be brought under control it is unlikely that latent TB will be a priority. However, India remains a breeding ground for disease and the potential for both TB and MDR-TB to travel to developed countries remains large.