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The Hindu
2 days ago
- Health
- The Hindu
Small change in MBBS education curriculum can make substantial impact on early detection of TB: study
Tuberculosis (TB) remains one of India's most significant public health challenges, with the country accounting for nearly a quarter of the global TB burden. Despite a robust national programme and the availability of free diagnostic and treatment services under the National Tuberculosis Elimination Programme (NTEP), early detection of the disease continues to fall short. Many individuals with symptoms of TB go undiagnosed for weeks or even months, contributing to continued transmission within communities as well suffering avoidable health complications. The delays in diagnosis are often attributed not just to gaps in health infrastructure but also to a lack of early suspicion at the primary point of care. Patients commonly approach local healthcare providers with symptoms like persistent cough, weight loss, fever, or night sweats. However, these symptoms are frequently misattributed to other conditions or treated symptomatically, without considering TB as a possible cause. This widespread failure to 'suspect TB' -- a critical first step -- has been repeatedly identified as a major reason for missed cases. It is in this context that a community-based screening model was introduced at Bharati Vidyapeeth Medical College in Pune. The goal was to find a sustainable, scalable way to improve TB case detection while simultaneously integrating public health practice into the medical curriculum. The innovation came through the Family Adoption Programme (FAP), a nationwide initiative mandated by the National Medical Commission, which assigns medical students to specific rural or urban communities for continuous engagement throughout their training. The study learnings from integrating TB screening activity into FAP for MBBS students was published in Frontiers in Public Health. The first point of contact and active case finding Swathi Krishna, TB researcher and public health physician based in Pune and key faculty member behind the programme's implementation, explains the rationale, 'In our healthcare system, the first point of contact is often a missed opportunity. Students are the future of that system, so we need to train them not just in hospital-based care but in recognising the realities at the ground level.' Under this initiative, MBBS students visiting households began asking just four simple symptom-based questions related to TB. If any symptom was reported, the case was flagged and referred to the local ASHA (Accredited Social Health Activist) for follow-up and testing. This low-cost, high-reach strategy is referred to as 'active case finding', a method endorsed by the World Health Organization (WHO) and the NTEP, but rarely operationalised at scale in routine community interactions. The results were encouraging: not only did the students identify presumptive TB cases, but they also became more confident in recognising its early signs and engaging with communities on sensitive health issues. The involvement of ASHA workers was crucial. According to Dr. Swathi, 'ASHA workers are already doing so much. When students collect these symptom reports during household visits, it lightens the ASHA worker's load and makes their follow-up more targeted.' In effect, the programme bridged the gap between community-based medical education and primary care outreach, enhancing both the learning experience of students and the reach of public health services. Breaking stigma barriers through continuos awareness Sanjivani Patil, associate professor in the Department of Community Medicine, adds that the model is particularly powerful because of its continuity. 'Unlike a one-off camp, the FAP ensures that students are visiting the same families regularly over three years. This builds rapport. Initially, people are hesitant to talk about TB symptoms because of stigma or fear. But with time, they open up. They trust the students.' Stigma remains a formidable barrier. In many communities, TB is still viewed with fear and shame, leading patients to conceal symptoms or delay care. Awareness about the Nikshay Poshan Yojana—a scheme under the NTEP that provides free treatment, nutritional support, and diagnostics—is also limited. But the presence of students, guided by faculty mentors and supported by local health workers, gradually breaks down these barriers. Community engagement activities such as street plays, awareness rallies, and health talks further reinforce positive messaging and reduce misinformation. From an educational standpoint, the intervention fits seamlessly into the competency-based medical education (CBME) framework. Students are trained to communicate effectively, collect and analyse health data, and understand the social determinants of disease. Their work is assessed through logbooks and field reports, ensuring accountability. As Dr. Patil observes, 'This experience gives students a reality check. In hospitals, they see rare diseases. But in the field, it's about cough, fever, diarrhoea, and skin issues. These are the cases they will encounter as primary care physicians. They learn to think beyond the textbook.' Possibilities of expansion, challenges and further research The programme's design also allows for replication. Every medical college implementing FAP can adapt this TB symptom screening model. Each batch of MBBS students is assigned around 800 households, translating into a wide population base being covered. Urban settings are not excluded -- Urban Health Training Centres (UHTCs) affiliated with medical colleges can deploy the same approach in underserved city neighborhoods, slum areas, or industrial zones. Saibal Adhya, another senior faculty member at the college and co-author of the study, highlights the policy implications. While India's TB programme is well-resourced, he points out that treatment and testing still need to be more accessible at the grassroots level. 'Even though the services are free, the unavailability of drugs or closed diagnostic labs leads people to spend from their own pockets. That's where trust in the system erodes,' he says. He also recommends that regular faculty development sessions and workshops on NTEP guidelines be institutionalised across all medical colleges. 'You cannot expect students to be champions unless their teachers are aligned with national health priorities,' he says. Authors also point out the importance of such TB screening initiatives, as a modest change in routine educational practice can make a substantial impact on both medical training and public health outcomes. Dr Swati says, 'It reinforces the idea that meaningful change does not always require massive infrastructure or funding. Sometimes, it just takes the right questions asked at the right time by the right people.'
Time of India
14-05-2025
- Health
- Time of India
PM Modi chairs meeting with Nadda to review TB elimination campaign progress
New Delhi: Prime Minister Narendra Modi convened a meeting on Tuesday to assess the progress of the tuberculosis elimination campaign. Union Health Minister JP Nadda and other leaders attended. The Government of India has implemented various focused strategies under its National Tuberculosis Elimination Programme (NTEP) to tackle this significant burden. These key initiatives under NTEP aim to strengthen diagnosis, treatment, and prevention efforts, accelerating progress toward a TB-free India. In 2020, the Government of India renamed the Revised National Tuberculosis Control Program (RNTCP) the National TB Elimination Program (NTEP). This reflects India's goal to eliminate tuberculosis (TB) by 2025, five years before the global target of 2030, according to the release. According to WHO's Global TB Report, India has made significant progress in fighting tuberculosis. Under the National Tuberculosis Elimination Programme (NTEP), the incidence rate of TB cases has dropped by nearly 17.7 per cent, from 237 cases per 1 lakh people in 2015 to 195 in 2023. TB-related deaths have also reduced, falling from 28 to 22 per 1 lakh people during the same period, as stated in the release earlier. The NTEP follows the National Strategic Plan (2017-2025), focusing on four key actions: Detect - Treat - Prevent - Build (DTPB) to control and eliminate TB in India. To eliminate TB by 2025, the NTEP programme achieved the highest-ever number of case notifications , reporting 25.5 lakh TB cases in 2023 and 26.07 lakh cases in 2024. It is the first-ever Indigenous TB burden mathematical model that estimates state-wise TB. The programme also provided incentives for ASHAS, TB Champions & Caregivers, thus strengthening patient support systems. The programme focused on the high-risk group and found 3 lakh additional cases via house-to-house screening. 560 colleges supported TB detection & research, also regular surveys, drug sales tracking, and under-reporting assessments conducted, also collaboration with ministries, industries, NGOS & technical bodies also done, as stated in a press release.
TimesLIVE
14-05-2025
- Health
- TimesLIVE
US aid freeze leaves TB survivors in India ‘high and dry'
By Sudeshwar Singh, a tuberculosis survivor and health activist, used to co-ordinate and mentor about 800 advocates in India's eastern state of Bihar, part of a grassroots network that plays a pivotal part in global efforts to end the epidemic by 2030. However, since the US suspended foreign assistance earlier this year, Singh had to drop his work ensuring patients get treatment and instead search for a new job as the sole breadwinner in his family of four. 'Most of us ourselves are affected by TB and committed to the TB community, but when our own income is affected, how do we support others?' he said. Singh, 48, is the founder of TB Mukt Vahini (TMV), which roughly translates as the Army for a TB-Free Community, one of two dozen community-led health organisations in India whose funding has dried up since US President Donald Trump dismantled the US Agency for International Development, or USAID, under his 'America first' foreign policy. Singh and other survivors of tuberculosis who were trained as 'TB champions' are on the front line of India's response to the disease, working in their communities to raise awareness, reduce stigma and support patients in a country with the highest number of infections in the world. USAID has spent more than $140m (R2.5bn) since 1998 to fight TB in India, where an estimated 2.8-million people have the disease, more than a quarter of cases worldwide. Without groups like TMV, public health experts in India are warning of a spike in infections and deaths from tuberculosis, an infectious disease caused by a bacteria that can kill half of patients who do not receive treatment. 'It is with great difficulty that we found TB survivors who were trained to be TB champions. How can they work without support?' asked Blessina Kumar, who is based in New Delhi and is CEO of the Global Coalition of TB Advocates, an organisation with 540 members in 76 countries. 'The TB community is left high and dry due to the USAID funding problems, and their work (is) left incomplete.' Bihar, where TMV worked with TB patients, is one of the country's most impoverished and populous states, with an annual per capita income of less than $500 (R9,115). 'With the recent freeze we are unable to sustain our operations,' said Singh. The TB champions working with Singh co-ordinate with government health centres and guide patients through treatment to make sure they receive medication. The survivor-led networks also provide patients with emotional support amid the challenges of treatment while facing potential discrimination in the community. India's National Tuberculosis Elimination Programme (NTEP), which has an annual budget of $492m (R8.9bn), is almost entirely funded by the government to procure drugs and provide diagnostics. USAID awarded grants and contracts to government agencies, non-governmental organisations and the private sector, whose work on controlling TB has helped shape the Indian government's policies on fighting the disease. However, the agency's annual investment of $100,000 (R1.8m) in community-based organisations ensured that vulnerable populations, including the urban poor, miners and migrants, were reached. Across the world, foreign funding accounts for about a fifth of the money spent fighting TB, and the US previously contributed more than 55% of the funds, according to the Geneva-based Stop TB Partnership administered by the UN. Subrat Mohanty, a board member with Stop TB Partnership, said shelters for destitute patients in India and other small organisations were specially hard hit by the collapse in US aid. 'They are not getting any money, neither are any activities happening, including healthcare screening, taking TB patients to the diagnostic facilities or follow-up for further treatment,' he said. Mohanty fears India's goal of ending TB this year is in jeopardy. 'At the end of the day, it is the community that has to use the diagnostic tools and has to come for screening. If they are not going to be sensitised or empowered, how will the (national) programme see results?' A Stop TB Partnership study showed USAID's funding cuts could lead to as much as a 36% rise in cases and a 68% jump in deaths to 2.24-million by 2030 in 26 high burden countries. 'The withdrawal of US support threatens essential TB services, including diagnostics, treatment, TB-HIV co-infection interventions and research initiatives critical to achieving TB eradication,' the study said. Mohanty said India must devote more of its own money to curbing tuberculosis and seek assistance from non-traditional TB donors such as Denmark, Sweden, South Korea and Japan. India is the world's third-biggest producer of pharmaceuticals, putting it in a better position than other countries, specially in Africa, that have relied on USAID to purchase life-saving medication to treat tuberculosis. However, experts said the Indian government has not publicly acknowledged the impact of the loss in USAID assistance. Urvashi Singh, deputy director-general of the NTEP, did not respond to questions sent by text message and e-mail. Kumar said: 'India has enough resources to meet the gap through government and private funding, but it needs to act now.'
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Business Standard
14-05-2025
- Health
- Business Standard
PM Modi calls for scaling up early detection to eliminate TB by 2025
Prime Minister Narendra Modi on Tuesday called for scaling up targeted interventions and successful strategies in early detection to eliminate tuberculosis (TB), while chairing a high-level meeting to review progress under the National TB Elimination Programme (NTEP). This comes even as India has set 2025 as its target year for TB elimination—five years ahead of the Sustainable Development Goals (SDG) target of 2030. The Prime Minister highlighted the need to analyse the trends of TB patients based on urban or rural areas and their occupations. 'This will help identify groups that need early testing and treatment, especially workers in construction, mining, textile mills, and similar fields,' he said. Emphasising the improvement of technology in healthcare, PM Modi called upon Ni-kshay Mitras, or volunteers who support TB patients, to use technology to connect with patients and help them understand the disease and its treatment using interactive and easy-to-use methods. According to the World Health Organization's (WHO's) Global Tuberculosis Report 2024, India tops the list of 30 high-burden TB countries, accounting for 26 per cent of the global TB burden. The same report, however, also points to an 18 per cent reduction in TB incidence in India—from 237 to 195 per 100,000 population—between 2015 and 2023, which is nearly double the global pace of around 9 per cent. It also indicates that TB mortality in India fell by 21 per cent, while treatment coverage rose to 85 per cent. The PM also reviewed key infrastructure enhancements under the NTEP, which included the expansion of the TB diagnostic network to 8,540 Nucleic Acid Amplification Testing (NAAT) labs, 87 culture and drug susceptibility labs, and over 26,700 X-ray units. These include 500 AI-enabled handheld X-ray devices, with another 1,000 in the pipeline. Officials also presented updates on new initiatives such as a shorter treatment regimen for drug-resistant TB, newer indigenous molecular diagnostics, and nutrition interventions under the PM Ni-kshay scheme. Launched in 2018, the scheme provides financial support to TB patients through direct benefit payments of Rs 1,000 per month to help them afford nutritious food during their treatment. 'Under the initiative, 2.94 million food baskets have been distributed by 255,000 Ni-kshay Mitras,' a statement by the Prime Minister's Office said. The recently concluded 100-day TB Mukt Bharat Abhiyaan, which screened 129.7 million people in 445 high-focus and aspirational districts across India, was also discussed in the meeting. According to data from the Union Health Ministry, the campaign led to the detection of around 719,000 new TB cases, of which 285,000 were asymptomatic.
Indian Express
13-05-2025
- Health
- Indian Express
Need ‘whole of govt, society' approach to eliminate TB: PM Modi
Reaffirming India's commitment to eliminate tuberculosis, PM Narendra Modi Tuesday called for a 'whole-of-government' and 'whole-of-society' approach to scaling up the successful strategies nationwide. Chairing a meeting to review status of National TB Elimination Programme (NTEP), the PM stressed the need to analyse the trends of TB cases in urban or rural areas and based on people's occupations. This, he said, will help identify groups that need early testing and treatment, especially workers in construction, mining, textile mills and similar fields. The PM also highlighted the importance of cleanliness through Jan Bhagidari (community participation) as a key step in eliminating the disease. India has set a target for eliminating TB by 2025-end, five years ahead of the global goal. The global End TB Strategy for 2030 says that countries must reduce the number of TB deaths by 90% and new cases by 80% as compared to the levels in 2015. Towards this goal, the Centre last December launched a 100-day TB Mukt Bharat Abhiyaan in 347 priority districts. Under this campaign, health workers looked for TB cases among vulnerable individuals such as household contacts of TB patients, under-nourished individuals, those living with HIV, diabetics, smokers and alcoholics, among others. Over 12.9 crore vulnerable individuals were screened and 7.19 lakh new TB cases detected, including 2.85 lakh asymptomatic patients. The 100-day campaign would further close the gap between the estimated number of TB patients and reported cases. According to the latest available Global TB report, in 2023, of its estimated 28 lakh cases, India reported 25.2 lakh cases. According to officials in the know of the matter, several technologies and methods tried out during the campaign would be implemented across the country. Training was underway, they said. One of the key innovations utilised during the campaign — which helped in detecting several of the asymptomatic patients — was the AI driven hand-held X-ray machines. These machines used AI to read the X-rays without a doctor, meaning these tests could be done by minimally trained health workers. Another key method was Jan Bhagidari — the participation of parliamentarians, Assembly members, local government representatives, officials and members of the public. During the meeting, Modi was informed that over 1 lakh new Nikshay Mitras — who provide nutritional support to TB patients during treatment — had augmented the campaign, along with `1,000 support from government.
