Lok Sabha Question No. 3025 (UNSTARRED), answered on 2019-12-06
Subject: Drug Resistant TB Cases
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Girish Bhalchandra Bapat, Rajan Baburao  Vichare, Devji Mansingram Patel, Janardan Singh Sigriwal

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUEST ION NO. 3025 TO BE ANSWERED ON 6 TH DECEMBER, 2019

## DRUG RESISTANT TB CA SES

## 3025. SHRI GIRISH BHALCHANDRA BAPAT:

SHRI RAJAN VICHARE:

SHRI DEVJI M. PATEL:

SHRI JANARDAN SINGH SIGRIWAL :

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) whether India has the largest number of individuals suffering from drug resistant/mu resistant vers ions of tuberculosis (TB) and if so, the details thereof and the reasons theref
- (b) whether it is a fact that delays in treatment are another major factor for death due so, the corrective measures taken by the Government to overcome this so ial st gma and lack of access to sound and affordable medical care;
- (c)  whether  the  Government  proposes  to  launch  a  mega  campaign  to  eradicate  TB  from  t country by 2025 under which a screening drive will be launched to identify TB patient i and every parts across the country and if so, the details thereof and the a chievement of targets set thereof so far;
- (d) whether the Government proposes to provide medicine facility to the TB patients in homes  through  ASHA  health  workers  keeping  in  view  the  complex  and  lengthy  process  of getting medicine after getting dis charged from the hospitals, if so, the details thereof; and
- (e) if not, the further steps being taken by the Government to provide full course of me the patients easily?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

## (SHRI ASHWINI KUMAR CHOUBEY)

- (a): Yes, in absolute numbers, India has the largest number of individuals suffering fro resistant TB. However, as per the latest global TB report, India ranks 38 th in the number of MDR - TB  patients  per  lakh population  (9.6  per  lakh  population).  The  estimated  number  of Multi  drug  resistant/  Rifampicin  resistant  TB  (MDR/RR  TB)  patients  in  India  for  2018 1,30,000, which contributes to about 27% of the global burden. Further d etails are annexed at Annexure.

Resistance to anti - TB drugs can occur as an outcome of faulty prescriptions which was previously rampant in the private sector, and is now being managed through better engag the private sector for detection and treatment of TB. Resistance can also occu r if the treatment is  discontinued  before  the  prescribed  time.  To  address  this,  the  programme  conducts activities to increase the awareness in the public regarding.

- (b): The Programme recognizes that a delay in treatment initiation may cause adverse outcomes. Hence, since 2016 RNTCP  has shifted from notification at treatment initiation to notific diagnosis. This helps in following up all the patients who are diagnosed and ensure that initiated on treatment. The Govt. has taken severa l oth r corrective measures to address timely diagnosis as well:
- i.Active Case Finding (ACF) in vulnerable and high risk populations to actively sc symptomatics and detect TB patients.
- ii. Private sector engagement to increase notification and provision of public health Ensuring availability of free diagnostics and medicines from the Programme to pati seeking care in the private sector as well.
- iii. Strengthening sputum collection and tr sport mechanisms to ensure early diagnosis. The Programme has also tied up with India Post to increase access. Other mechanisms be strengthened at the local level involve MoUs with courier agencies, human couriers.
- iv.Increasing  the  network  of  rapid  m olecular  diagnostics  to  ensure  detection  of  drug resistance at the earliest. The Programme has rolled out Universal Drug Suscepti Testing (UDST) since 2018 as per which resistance testing for Rifampicin is mandat for all notified TB patients.
- v.Com munication  campaign  aimed  at  raising  levels  of  awareness,  reduction  of  stig among community, both through mass and mid media.
- vi.To  reduce  stigma  of  TB  in  the  community,  National,  state  and  district  level  for have been set up to provide a platform for TB survivors to voice their views. Network of  TB  Champions  have  been  created  from  existing  network  of  4  lakh  treatment supporters and past TB patients and people affected due to TB. With this purpose standardized  curriculum  has  been  developed  to  support  TB Survivors/  to  become effective  Community  TB  Mobilizers/Champions.  More  than  90,000  community members including TB survivors have been sensitized by 305 trained TB Champions in 140 districts in collaboration with REACH (NGO). These TB Champions have also provided patient support services to more than 8000 TB patients.
- vii. Further, all Health & Wellness Centres established under Ayushman Bharat have bee earmarked as sputum collection centres and DOTS centres from where TB medicines can be taken.
- viii. To ensure aff ordable care, the Revised National TB Control Programme provides free treatment  to  all  TB  patients  in  the  country,  irrespective  of  the  sector  from  wh patient is seeking care. The Programme has made provisions under which private sec health centre s can also serve as DOTS Centres and provide RNTCP supplied daily FDC drugs to TB patients.
- (c): Hon'ble Prime Minister had launched 'TB Free India' Campaign on 13 th March 2018 to end TB in India by 2025. To pursue the goal Government has been implemen ting National Strategic Plan (NSP) (2017 - 25) to End TB by 2025. Active Case Finding is one of the most important strategy being implemented to find the missing cases in the community. In 20 three rounds were conducted as national campaign, more than 5.5 crore population had been screened and a total of 26781 additional TB cases were diagnosed. In 2018, three rounds conducted  as  national  campaign,  more  than  18.9  Crore  population  had  been  screened  an total 47307 additional TB cases diagnosed.

The Ho n'ble Health and Family Welfare Minister also launched the TB Harega Desh Jeetega  Campaign  on  25 th September  2019  in  which  new  sets  of  IEC  material  have  been launched and disseminated to states.

An  'Accelerator  to  National  Strategic  Plan'  includes  followi ng  key  components  under 'TB Harega, Desh Jeetega' campaign:

1. Community Engagement
2. Advocacy and Communication
3. Health & Wellness centres and TB
4. Inter - Ministerial collaboration
5. Private health sector engagement
6. Corporate sector engagement
7. Latent TB Infection Management

(d) & (e) : The Govt. offers medicines to TB patients through a decentralized mechanism wherein  medicines  are  provided  by  treatment  supporters  who  may  be  member  of  the community residing in the vicinity of the TB patients, health workers such as  ASHA, or even members  of  the  patients'  family.  The  patient  may  also  choose  to  take  medicine  from  the peripheral  health  facility.  Decision  on  treatment  support  plan  is  decided  by  patien providers, based on patient convenience and choice.

……………….

| Estimated burden of MDRRRTB patients (per 100000 population)   | Estimated burden of MDRRRTB patients (per 100000 population)   | Estimated burden of MDRRRTB patients (per 100000 population)   | Estimated burden of MDRRRTB patients (per 100000 population)   |
|----------------------------------------------------------------|----------------------------------------------------------------|----------------------------------------------------------------|----------------------------------------------------------------|
| Sr. No.                                                        | country                                                        | MDR RR TB Per lakh population                                  | Estimated number of MDR/RR TB                                  |
| 1                                                              | Kyrgyzstan                                                     | 47.6                                                           | 3000                                                           |
| 2                                                              | Lesotho                                                        | 37.9                                                           | 800                                                            |
| 3                                                              | Namibia                                                        | 36.8                                                           | 900                                                            |
| 4                                                              | Republic of Moldova                                            | 34.6                                                           | 1400                                                           |
| 5                                                              | Eswatini                                                       | 31.7                                                           | 360                                                            |
| 6                                                              | Ukraine                                                        | 29.4                                                           | 13000                                                          |
| 7                                                              | Mozambique                                                     | 28.1                                                           | 8300                                                           |
| 8                                                              | Russian Federation                                             | 28.1                                                           | 41000                                                          |
| 9                                                              | Somalia                                                        | 26.7                                                           | 4000                                                           |
| 10                                                             | Kazakhstan                                                     | 26.2                                                           | 4800                                                           |
| 11                                                             | Papua New Guinea                                               | 23.2                                                           | 2000                                                           |
| 12                                                             | Mongolia                                                       | 22.7                                                           | 720                                                            |
| 13                                                             | Gabon                                                          | 21.2                                                           | 450                                                            |
| 14                                                             | Tajikistan                                                     | 20.9                                                           | 1900                                                           |
| 15                                                             | Myanmar                                                        | 20.5                                                           | 11000                                                          |
| 16                                                             | Democratic People's Republic of Korea                          | 20.4                                                           | 5200                                                           |
| 17                                                             | Bhutan                                                         | 19.9                                                           | 150                                                            |
| 18                                                             | South Africa                                                   | 19.0                                                           | 11000                                                          |
| 19                                                             | Timor-Leste                                                    | 18.9                                                           | 240                                                            |
| 20                                                             | Zambia                                                         | 17.9                                                           | 3100                                                           |
| 21                                                             | Philippines                                                    | 16.9                                                           | 18000                                                          |
| 22                                                             | Belarus                                                        | 14.8                                                           | 1400                                                           |
| 23                                                             | Uzbekistan                                                     | 14.5                                                           | 4700                                                           |
| 24                                                             | Georgia                                                        | 14.2                                                           | 570                                                            |
| 25                                                             | Turkmenistan                                                   | 13.7                                                           | 800                                                            |
| 26                                                             | Botswana                                                       | 13.3                                                           | 300                                                            |
| 27                                                             | Pakistan                                                       | 13.2                                                           | 28000                                                          |
| 28                                                             | Azerbaijan                                                     | 13.1                                                           | 1300                                                           |
| 29                                                             | Angola                                                         | 12.7                                                           | 3900                                                           |
| 30                                                             | Djibouti                                                       | 12.5                                                           | 120                                                            |
| 31                                                             | Palau                                                          | 11.2                                                           | 2                                                              |
| 32                                                             | Nigeria                                                        | 10.7                                                           | 21000                                                          |
| 33                                                             | Congo                                                          | 10.7                                                           | 560                                                            |
| 34                                                             | Zimbabwe                                                       | 10.4                                                           | 1500                                                           |
| 35                                                             | Marshall Islands                                               | 10.3                                                           | 6                                                              |
| 36                                                             | Peru                                                           | 10.0                                                           | 3200                                                           |
| 37                                                             | Sao Tome and Principe                                          | 10.0                                                           | 21                                                             |