At the start of 2020 the central government has renamed the RNTCP the National Tuberculosis Elimination Program (NTEP). In a letter to all the State Chief Secretaries of states and UTs, the commitment is emphasised of the Union government achieving the sustainable development goal of ending TB by 2025, five years ahead of the global targets.
a) Management of Drug sensitive and resistant tuberculosis.
Drug-resistant TB has been known from the time anti-TB drugs were first introduced for the treatment of TB. Currently, the WHO estimated incidence of Rifampicin (R) and MDR TB in India is estimated to be around 135 000. This translates to around 10 patients per 100 000 population annually as per the Global TB Report, 2018Drug-resistant TB has been known from the time anti-TB drugs were first introduced for the treatment of TB. Currently, the WHO estimated incidence of Rifampicin (R) and MDR TB in India is estimated to be around 135 000. This translates to around 10 patients per 100 000 population annually as per the Global TB Report, 2018 (source: “Global TB Report,” World Health Organization, Geneva, 2018).
b) Management of Non-tuberculosis mycobacteria
Though NTM are widely distributed in the environment, they rarely cause disease. They may be falsely recovered from clinical specimens due to laboratory contamination or contamination of medical instruments. Chronic pulmonary infection due to M. avium complex and M. Kansasii generally occurs in elderly persons especially males who are smokers or who have preexisting lung lesions.
Clinical, radiological and microbiological criteria are equally important and all must be met to make a diagnosis of NTM lung disease. We go for HRCT scan as well as microbiology tests such as AFB analysis and MGIT for diagnosing and treating them.
c) Pretreatment evaluation
History and physical examination, Weight and height (BMI), Random blood sugar, Chest X ray and HIV testing.
-In DS-TB (Drug sensitive TB): LFT, KFT, CBC
-In DR-TB (Drug resistant TB): Apart from above mentioned testing we also go for baseline ECG, TSH, Urine pregnancy test (in women of reproductive age group), Audiometry and Fundus evaluation by ophthalmologist
d) Management of LTBI (Latent TB Infection)
LTBI screening must be restricted to specific high-risk populations in India, where the benefits of LTBI treatment outweigh any risks. Although either TST (Tuberculin skin testing) or IGRA(Interferon gamma release assay) can be used for LTBI screening, it is important to make sure that these tests are not used for active TB diagnosis
By IPT (Isoniazid prophylactic therapy), we are actively involved in diagnosing and treating patients who are having LTBI and risk of getting active TB in future. IPT is given in HIV patients, patients who are planning to receive immunosuppressive medications or monoclonal antibodies (e.g: Anti-TNF blockers).