Effectiveness of WHO DOTS program on tuberculosis in India

Abstract

India contributes to the maximum number of tuberculosis incidents (27%) and deaths in the worldi . With years of DOTS program and several government measures, India has seen a reduction from 289 incidents per million population in 2000 to 211 in 2017ii. Since 2013, the new cases of tuberculosis have been on the rise in India, attributed to private sector reporting, though debated. This largely ignored global epidemic has become further difficult to treat with the emergence of Multi-Drug Resistance, Extensively Drug-Resistant TB and in the last couple years, Totally Drug-Resistant TB, resulting due to mutations in the bacterial genome to resist the drugs. For these advanced forms of TB, India again is the country with maximum incidences. The Government of India’s policies regarding tuberculosis, mainly the Revised National Tuberculosis Control Program (RNTCP), National Strategic Plans 2012-17 and now revised NSP 2017-25, continue to promise the elimination of TB from the country, but fail to achieve the promised results. India’s National TB Program (NTP) started in 1962iii but is still struggling to make a major impact after more than half a century. The availability of free medicines for TB as per DOTS and free treatment of TB through the government health system is a fact unknown to many, resulting in the information gap for early treatment. This leads to late detection of TB as people defer getting tested until the problem increases. Even when people know of the free government services, the deference gives the likely patients to avoid the high social stigma in India, in both rural as well as urban areas. The spread of tuberculosis is majorly concentrated in rural areas due to lack of hygiene, already existing tuberculosis in many, low levels of immunity, malnutrition and tobacco usage. However, every single incidence in the urban area has a much higher chance to infect others, almost thrice per year as that in the rural areasiv. Also, in the urban areas, the social stigma is even higher regarding TB, as the disease is considered disease of the poor, and is treated discreetly in private, with no reported incidence. Such dynamics make it important to curb both urban and rural incidences in India, although with different strategic approaches. Large scale implementation of DOTS-based RNTCP began in the late 1990sv and later revised in the second phase of the program to include DOTS+ for MDR TB and XDR TB. It is estimated that DOTS saved around 8 million lives since 1997vi , but the continued increase in incidences of TB and related deaths points to either a flawed implementation of the program or the ineffectiveness of the DOTS. This study plans to study the effectiveness of DOTS program in India by comparing it with similar programs in other countries, as well as look at the policy implementation regarding it, and find out whether the tipping point to reverse the TB epidemic can be achieved using the current strategies or whether it needs another catalyst