Evolutionary journey of programmatic services and treatment outcomes among drug resistant tuberculosis (DR-TB) patients under National TB Elimination Programme in India (2005-2020)

ABSTRACT

Introduction: India, with one-fourth of global burden of tuberculosis as well as multidrug-resistant TB, made bold commitment to end TB by 2025. There is no documented comprehensive review of the evolutionary journey of India’s DRTB service expansion and changes in the treatment outcome so far.

Area Covered: The current document presents evolution and journey of programmatic services and the progress in treatment outcomes among DRTB patients since 2005 with efforts cum challenges in nationwide scale-up of evidence-based policies and services, opportunities and future prospects for universalizing quality care - an essential ingredient to end TB in India. In the era of standardized longer treatment regimen till 2017, only half of the patients were successfully treated. Interventions to address factors associated with access and quality of care introduced since 2018 like universal drug susceptibility testing (UDST) guided treatment with shorter regimen, newer drugs, social protection; accelerated detection and began enhancing survival and success rate in recent DR-TB patient cohorts.

Expert Opinion: Patient-centric care; robust TB/DR-TB surveillance system, shorter effective safer regimens and innovations, a milestone essential to end TB in India by 2025 to accomplish the vision of the Prime Minister of India.

KEYWORDS:

• MDR-TB
• Universal Drug Susceptibility Testing (UDST)
• treatment outcomes
• programmatic management of drug-resistant TB

Article highlights

• India carries one fourth of the global burden of TB and MDR-TB

• DRTB diagnostic and treatment services have evolved over period 2006-2020 and are still evolving.

• Treatment success rates among MDR RR TB patients show intracountry variations and are improving with use of evidence-based diagnosis and DST guided treatment.

• Patient support system, digital case-based surveillance, innovations in patient care and new drugs are expected to bring significant changes in treatment outcome of DRTB patients.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Disclaimer

The authors declare that the views expressed in the submitted article are of their own and not an official position of their respective institutions.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.