GS Paper III

News Excerpt:

The Union World Conference on Lung Health 2023 came out with final tools to fast-track work on multiple aspects of TB control.

• The new improved drug regimens will cut treatment time for drug-resistant tuberculosis by up to two-thirds, which is the primary source of this optimism.

What are the issues associated with TB drug resistance?

• The long duration of treatment, and subsequent drug toxicity, resulted in the patients being unable to tolerate the drugs, and also non-compliance with treatment schedules. This ultimately led to drug-resistant TB. 
• While TB do not yet have a viable vaccine that can render prevention possible, TB care duration of treatment- naturally gets spirits up. 
• Hence, the biggest progress in the recent past is the development of shorter regimens for all forms of TB, especially the 6-month all-oral treatments for drug-resistant TB. 

Harder Regimens and the ray of ‘hope’ ahead:

Treatment regimens are hard because firstly, the MDR TB, patients might require up to 14,000 pills and secondly, MDR-TB affects half a million people each year.

• What were the favorable outcomes of the Union World Conference?

• • Three regimens were presented, which had positive outcomes in between 85-90% of participants for treatment of multidrug-resistant tuberculosis or rifampicin-resistant tuberculosis (MDR/RR-TB). 
  • Further, the fourth regimen showed a strong treatment response at 85.6% and represented an alternative for people who cannot tolerate bedaquiline or linezolid.
  • To present, people living with TB faced treatments that lasted up to 24 months and 14,000 pills. Some patients even had to endure months of painful, daily injections.
  • However, the new drug regimens for MDR/RR-TB represent similar efficacy and safety to conventional treatments but have reduced treatment time by up to two-thirds. 

Challenges with the Indian Health Care System:

Although the innovation or research seems a miracle, the WHO report mentions that MDR-TB still remains a major public health issue concerning India because of the following reasons:

• Drug Resistance in India: The most effective first-line drug (i.e., Rifampicin), and its resistance remains a major concern. Only 68% of MDR/RR TB patients completed treatment successfully in 2020.
• Treatment in India: India is not on the regimen line as recommended by WHO instead it goes for a mixed approach. Although in 2019, WHO phased out injectables, over 22,000 Indian MDR/RR-TB patients in 2021 were on treatment regimens that contained injectables. (TB Reports 2023)
• Reluctant to the Old methodology: At the primary diagnosis stage, still 77% of patients in India are investigated. An old diagnosis tool, Sputum smear Microscopy cannot detect drug resistance, and detects only half of all people with these tests.
• Sputum smear microscopy reportedly has about 50% sensitivity and therefore contributes to the huge burden of missed cases in the country.

Need a Multi-pronged approach:

• Need to update the procedures: India is well-placed to scale innovations in tuberculosis diagnostics. 
• Several molecular tests are now endorsed by the WHO, including Xpert MTB/RIF Ultra, TrueNAT MTB, and TrueNAT MTB-RIF Dx, loop-mediated amplification, assay line probe assays, and centralized assays. 
• Some are low-complexity tests, while others are moderate-to-high-complexity assays.
• It is crucial to deploy all these tools to find every person who has the infection.
• Need for AI intervention: The world, today, has X-rays with AI assistance to flag abnormalities, AI-assisted cough diagnosis, new advances in the molecular detection of TB, multiple products built on the faster nucleic acid amplification test (NAAT), and whole-genome sequencing.
• Rapid portable, battery-operated tests could be a new tool for point-of-care TB testing requiring minimal equipment and user expertise. 
• Point-of-care testing does not require specialized clinical or laboratory equipment, making this an invaluable tool in preventing the spread of a disease through early detection.

Mains PYQ

Q. Can overuse and free availability of antibiotics without Doctor’s prescription, be contributors to the emergence of drug-resistant diseases in India? What are the available mechanisms for monitoring and control? Critically discuss the various issues involved. (UPSC 2014)