Tuberculosis Elimination Research Articles

“TB - Mindedness”-the only way to beat “the great mimicker”: A case series with atypical presentation of female genital tuberculosis

BackgroundIncidence of Tuberculosis (TB) cases in India reported in 2019 is 193 per 1 lakh population [National Tuberculosis Elimination Plan (NTEP)]. In India, annual extra pulmonary TB burden is 20–25%, of which 4% of cases are of urogenital origin (Revised National TB Control Programme, 2019; World Health Organization, 2019). The Ministry of Health and Family Welfare has made a target of eliminating tuberculosis by 2025 under the NTEP by the process of identification, notification and treatment of cases. Tuberculosis being a leading cause of infertility in developing countries, employing best clinical practices and being “TB-minded” will also save the patient of enormous anxiety and uncertainity and also decrease the time gap between clinical presentation and diagnosis to optimize fertility outcome. MethodologyA prospective cohort study of cases presenting with unusual findings and ultimately being diagnosed as genital tuberculosis was conducted in the gynaecology OPD, AIIMS, New Delhi, from November 2020 to November 2021 (1 year). Patients were investigated judiciously, diagnosis made and followed up for their response to anti tuberculosis therapy (ATT). ResultsThis data comprises of conglomerate of ten cases with unconventional exhibition of genital tuberculosis. 70% of the cases presented with pain lower abdomen not specifically related to menstrual cycle and often confused with IBD. Tubo ovarian mass (70%) mimicking as simple ovarian cyst, ovarian carcinoma or endometriosis was the most common clinical finding we came across.

Vitamin D signal cascade in macrophages against <i>Mycobacterium tuberculosis</i>

Mycobacterium tuberculosis is the causative agent of human tuberculosis; enabling multilayered mechanisms to evade from immune response along with reactivation of the process with subsequent pathogen dissemination. Modification of immune responses through imbalanced intracellular signaling pathways and reprogramming of differential gene expression is one of such mechanisms. Modification targets for M. tuberculosis are the genes which products are involved in lipid metabolism and apoptosis, a key to eliminate intracellular pathogens. here, we review the current scientific data related to this problem: the results of studies published in domestic and foreign literature from the years 2003 to 2022 were systematized and summarized; data on the role of a number of molecular mechanisms regulating lipid metabolism, autophagy and apoptosis in human TB-infection; discuss contemporary ideas about the importance of the VDR signaling cascade controlled by the vitamin D-axis counteracting M. tuberculosis infection, its course and outcome. In addition, there are provided the data on the main M. tuberculosis genetic lines common in Russia and Siberia and the elements of the pathogen-related genetic structure that are important in the context of the topic. The effects of interplay and interactions of intracellular molecular cascades (VDR, NF-kB, MAPK, NFAT5, AMPK, GR) are considered and analyzed, as well as their role in the differential expression of genes that ensure M. tuberculosis inactivation and elimination. Presenting the data confirming that one of the main strategies of mycobacterium immune evasion counteraction to autophagy and apoptosis is implemented through altered VDR signaling pathway, including the epigenetic mechanisms occurring in the pathogen. Based on results of the analysis and summarized literature data (60 articles retrieved from eLIBRARY, PubMed), it is demonstrated that during the thousand-year history of co-evolution with human, M. tuberculosis acquired unique features of genetic organization and mastered the pathways of immune evasion using non-genomic and genomic mechanisms. Available publications confirm that one of the main strategies for M. tuberculosis survival in macrophages is to modify a balance between intracellular signaling cascades controlling the differential expression of genes that provide a proper immune response to infection, followed by pathogen elimination.

Rapid Detection of Mycobacterium Tuberculosis Using a Novel Point-of-Care BZ TB/NTM NALF Assay: Integrating LAMP and LFIA Technologies

Tuberculosis (TB) is one of the leading causes of infectious mortality from a single infectious agent, Mycobacterium tuberculosis (MTB). This study evaluated the performance of the newly developed BZ TB/NTM NALF assay, which integrated loop-mediated isothermal amplification and lateral flow immunochromatographic assay technologies, for the detection of MTB. A total of 80 MTB-positive samples and 115 MTB-negative samples were collected, all of which were confirmed by TB real-time PCR (RT-PCR) using either AdvanSureTM TB/NTM RT-PCR Kit or Xpert® MTB/RIF Assay. The performance of the BZ TB/NTM NALF assay was evaluated by calculating its sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in comparison to those of the RT-PCR methods. Compared to the RT-PCR, the sensitivity, specificity, PPV, and NPV of BZ TB/NTM NALF assay were 98.7%, 99.1%, 98.7%, and 99.1%, respectively. The concordance rate between BZ TB/NTM NALF and RT-PCR was 99.0%. Rapid and simple detection of MTB is essential for global case detection and further elimination of TB. The performance of the BZ TB/NTM NALF Assay is acceptable with a high concordance with RT-PCR, indicating that it is reliable for use in a low-resource environment.

The path to tuberculosis elimination: a renewed vision.

Tuberculosis (TB) elimination and pre-elimination, with thresholds of 1 and 10 incident cases per million population, respectively, were considered achievable for low TB incidence countries in the 1990s, when they were conceived. However, it has since become clear that, even in low TB incidence settings with effective programmes and sufficient resources, achieving pre-elimination in the next decade will require a dramatic acceleration of efforts. In this review, we describe the history of the TB elimination concept and existing country experiences, as well as the interventions available to accelerate the progress towards this threshold. We then propose a framework for near-term progress towards the more aspirational goal of TB pre-elimination. This framework consists of five stages (high incidence, moderate incidence, low incidence, nearing pre-elimination and pre-elimination) that are benchmarked to specific levels of TB incidence in each country. Using this framework, countries can set 5-year targets of achieving certain reductions in TB incidence and/or reaching the next stage, through the use of strategies tailored to both local epidemiology and available organisation and infrastructure. TB elimination remains as an aspirational goal in all stages, but certain activities can be prioritised in the short term to make more rapid progress, ensure local-level buy-in and increase accountability. As TB pre-elimination is approached, certain ethical and social concerns are likely to rise in importance; these concerns are also discussed. Our aim in setting this framework is to guide clinicians, public health experts and decision makers in taking actionable next steps in the trajectory towards TB pre-elimination and elimination.

Exploring the tuberculosis medication program in Indonesia as perceived by patients and their families: A qualitative study.

Tuberculosis (TB) remains a significant public health challenge in Indonesia, with the country experiencing one of the highest numbers of lost cases in TB management. Therefore, there is a need to identify the underlying reasons for this problem. This study aimed to explore the experiences of TB-diagnosed patients and their families during the time of diagnosis and while undergoing the TB medication program. This study employed a qualitative descriptive-interpretive approach. The study was conducted in government community health centers (CHC) from May 2022 to July 2022. A total of 22 participants, consisting of 12 TB-diagnosed patients and ten family members, were included in the study. Data were collected through focus group discussions and analyzed thematically. Five themes were developed: (1) Delay in tuberculosis diagnosis, (2) Delay in starting TB treatment, (3) High willingness of patients and their families to recover, (4) Understanding that TB is an infectious disease, and (5) Factors affecting patient recovery. The study findings might contribute to the National TB elimination program. It is recommended that all health workers practicing in the community should be involved in the TB program to improve its management. Collaboration between multiple sectors in the community can also provide an advantage in solving TB problems by increasing new case detection. Additionally, it is suggested that all nurses working with TB patients establish rapport with health cadres and patients' families to enhance medication adherence in patients.

Genomic and geospatial epidemiology of Mycobacterium tuberculosis in Oman: first national insight using whole genome sequencing

Mycobacterium tuberculosis (MTB) is a global public health issue. Although Oman reduced the burden of tuberculosis (TB) by 85% in under 25 years, the annual incidence rate remains stagnant. Whole genome sequencing (WGS) is used to investigate the transmission dynamics of MTB complex. This study aimed to resolve traditional genotype clusters and exploring the geospatial distribution to understand the epidemiology of TB in Oman. Confirmed cases with spoligotyping clusters were randomly selected. WGS of 70 isolates were selected for final analysis. Correlation of epidemiological and geospatial data was conducted. A total of 233 cases were registered in 2021; 169 had confirmed growth, with an incidence rate of 5.2/100,000 population for 2021. A total of 70 genomes were analyzed, and five large clusters and three medium clusters were identified. The lineages L1, L2, L3, and L4 and several sublineages belonging to the Indo-Oceanic family and East African Indian family were identified as predominant in Oman. There were no multidrug-resistant cases identified. There is a considerable genetic variation among the strains in Oman. This predominance could be linked with the high percentage of non-national population, which represents different countries and frequent traveling to high TB burden countries. WGS combined with geospatial investigations of MTB are required to better understand the disease transmission in Oman, which will support TB elimination efforts.

Micro-RNA: A potential screening marker for latent tuberculosis

An ancient disease, Tuberculosis is one of the most challenging infectious disease contributing to mortality and morbidity worldwide. Tuberculosis elimination globally, by 2050, is a mammoth task as Mycobacterial infections have wide range of presentation, from the clinical to the subclinical or latent and pose a diagnostic and therapeutic challenge. The virulence as well as evading property of Mycobacterium tuberculosisMtb) from the host's immune system confers upon it the ability to remain latent in the host cells. This forms the basis of classification of tuberculosis patient as having latent-TBI or active TB. This review focuses on the role of miRNA as biomarkers of LTBI. The aim is to have an overview of the current knowledge about miRNA, its involvement in TB pathogenesis and its role as a reliable tool for diagnosis of latent tuberculosis.miRNA are non-encoding endogenous RNAs which regulate gene expression by directing their target RNA for degradation or translational repression. Degraded RNA are released in the extracellular milieu, are present in various body fluids, such as blood, saliva, and urine, and are biomarkers for a number of diseases including cancer, Parkinsons’ disease, CAD, liver diseases, TB and other infectious diseases. miRNAs are differentially expressed during active TB and LTBI, and therefore can be used as biomarkers of disease progression and response to anti-TB therapy. This will further permit more specific therapeutic interventions in TB management. A thorough search of available literature resources was performed on online databases such as Google Scholar, NCBI, Nature, Research gate, PubMed, Science Direct. It was found that miRNA are promising biomarkers to identify healthy latent TB individuals for further course of action and can be reliable tools for routine use in current clinical practice for specific therapeutic interventions to limit active TB population. They meet the criteria of ideal biomarkers, such as minimally invasive, accessibility, high specificity, and sensitivity.

Molecular Characterization of katG and inhA Mutations by Genotype MTBDRplus Line Probe Assay To Guide Isoniazid and Ethionamide Use for Drug-Resistant Tuberculosis.

Introduction Drug-resistant tuberculosis (TB) continues to be a global health threat in all its forms. Significant resistance has been observed against isoniazid (INH), one of the most important therapeutic options for treating TB. Molecular testing methods such as line probe assay (LPA) provide rapid diagnosis and early management. Mutations in different genes can be detected, which indicate INH and ethionamide (ETH) drug resistance. We aimed to determine the frequency of these mutations in katG and inhA genes by LPA to guide INH and ETH use for drug-resistant TB. Materials and methods Two consecutive sputum samples were collected from each patient, followed by decontamination by N‑acetyl‑L‑cysteine and sodium hydroxide method. LPA was performed on the decontaminated samples by GenoType MTBDRplus, and the strips were analyzed. Results Out of the 3,398 smear-positive samples tested by LPA, valid results were found in 3,085 (90.79%) samples. Of the 3,085 samples, INH resistance was seen in 295 samples (9.56%), of which mono INH resistance was in 204 samples, and 91 were multidrug resistant. katG S315T was the most common mutation responsible for high-level INH resistance. At the same time, inhA c15t was the most common mutation associated with low-level INH resistance and ETH cross-resistance. The average turnaround time for the processing and reporting of samples was five days. Conclusions The high burden of INH resistance is alarming and can be a major obstacle to TB elimination. Although molecular methods have reduced the reporting time leading to early management of the patients still, a large knowledge gap persists.

The state of tuberculosis surveillance in Canada.

Tuberculosis incidence in Canada has remained essentially unchanged over the past decade. A strategic plan to reduce the burden of disease, underpinned by high-quality surveillance data, is sorely needed. However, tuberculosis surveillance data are lacking in Canada for multiple reasons. There is no single entity responsible for coordinating a tuberculosis response, including strategies for surveillance, thusinhibiting effective solutions. This in turn affects the timeliness and comprehensiveness of national tuberculosis surveillance reporting: between 2000 and 2020, there was an average 25-month delay to publication of annual surveillance data and the comprehensiveness of reports has precipitously fallen over time. Compounding these issues are case report forms for tuberculosis surveillance data which have not been updated since 2011, failing to keep up with the changing tuberculosis epidemiology and to provide information required for strategic planning. Common-sense steps can be taken to vastly improve the utility of collected tuberculosis surveillance data, and the development of a strategic plan for tuberculosis elimination. These include initiating a country-wide consultation on surveillance needs; allocating resources for data collection and analysis and data sharing; setting precise, measurable goals; and, importantly, establishing an oversight committee with representation from all provincial/territorial tuberculosis program leads who are held to account for performance.

Loss-to-follow-up Rate among Tuberculosis Patients Registered at Two Tuberculosis Units of Ballabgarh Block of District Faridabad, Haryana

Introduction: Treatment loss-to-follow-up (LTFU) is a great obstacle to tuberculosis (TB) elimination. Our objective was to estimate its prevalence in district Faridabad, Haryana, and to see its association with selected variables. Materials and Methods: We conducted a desk review of TB notification registers of two TB units under a district TB center, Faridabad. All patients registered between October 1, 2016, and September 30, 2017, were analyzed. Following univariate analysis, factors with P < 0.2 were included in the multivariable logistic regression model. Results: Of 999 eligible patients, 742 (74.2%) had treatment outcomes available. LTFU was estimated to be 3.5%, with cumulative incidence calculated to be 6.63 LTFUs per 100 person-years. LTFU increased with increasing age. LTFU was 5.2% (9.8 LTFUs per 100 person-years) and 0.3% (0.6 LTFUs per 100 person-years) among pulmonary TB (PTB) and extra-PTB (EPTB) patients, respectively. LTFU was higher in patients with previous relapse (9% or 14.2 LTFU per 100 person-years) and previous LTFU (16% or 32 LTFUs per 100 person-years) as compared to only 2.4% (4.7 per 100 person-years) among new patients. PTB patients and patients on treatment after prior LTFU had 12 times and 5 times higher odds of LTFU than EPTB patients and new patients, respectively. Conclusion: The observed LTFU burden is lower than the <5% target set by the National TB Elimination Program. Lack of information on outcomes under the program should be cause for concern. Special attention should be paid under the program on high-risk groups identified to ensure treatment adherence.

FLUORESCENCE MICROSCOPY VS TRUENAT- WHICH METHOD IS BETTER FOR DIAGNOSIS OF TUBERCULOSIS?

Background: Despite the advent of newer drugs, modern diagnostic techniques and improvement in management strategies, India continues to be the leader in tuberculosis burden. Several methods for diagnosis exist, such as light microscopy, fluorescent microscopy, solid culture, liquid culture (Mycobacterium growth indicator tube [MGIT] culture) to molecular methods. However, each of these methods have variable sensitivity and specificity. Very few studies have been done evaluating the role of TrueNAT with fluorescent microscopy, thereby evaluating the performance of a designated microscopy center under the national tuberculosis elimination programme. Methods and Materials: This is a retrospective observational study performed in a designated microscopy center in Santhiram Medical Center, Nandyal. This is to compare the fluorescence microscopy and TrueNAT provided as part of the National Tuberculosis Elimination programme. A total of 342 patients underwent testing at this center and were diagnosed with tuberculosis. Results:Majority of the study participants were males, smokers, in the age groups of 31-40 years. The mean age of males was found to be higher than that of females. (37.64 vs 32.39 years). 89.42% of patients were diagnosed on fluorescent microscopy, while 94.23% were diagnosed with TrueNAT. Sensitivity of TrueNAT was 91.61%, specificity was 87.80% and accuracy was 90.76%. Conclusion: TrueNAT appears to be superior to Fluorescent microscopy in a setting of a designated microscopy center.This can be used for rapid diagnosis, with high sensitivity with specificity when compared to the traditionally accepted fluorescent microscopy.

Knowledge, Attitude, and Practices Among Healthcare Practitioners in the Context of Multidrug Resistance Tuberculosis: An Appraisal to Disease Elimination.

Tuberculosis (TB) remains one of the leading infectious causes of death worldwide, and India is among the countries with the highest TB burden. TB control is facing several roadblocks in our country with the rapid development of multidrug-resistant (MDR) as well as extensively drug-resistant TB (XDR) and as an after-effect of the global COVID-19 pandemic.With the target of TB elimination by 2025 (National Tuberculosis Elimination Program, NTEP), there is a need that treating physicians in our country be well aware of MDR-TB and be able to diagnose and treat it at an appropriate time. The present study is conducted to explore the knowledge levels, attitudes, and practices concerning MDR-TB amongst healthcare professionals working in different healthcare sectors. A total of 250 allopathic medical practitioners (Bachelor of Medicine and Bachelor of Surgery [MBBS], specialists, and superspecialists) working in any sector (private or government), who are directly involved in managing any form of TB patient and are willing to undertake the assessment, were included in this online questionnaire-based survey that was circulated using various social media platforms like WhatsApp, Facebook, Linked In, and Gmail. Responses to the questionnaires created in Google Forms were analyzed by capturing data in a Microsoft Excel® spreadsheet for further statistical analysis. The data were analyzed using multiple measures of dispersion and cross-tabulations. Among the 250 participants, most of the participants had encountered MDR-TB in their clinical practice, and the majority believe that MDR-TB is a rising problem. Although 88% of the participants did a GeneXpert assay before the start of anti-tubercular therapy (ATT), three-fourths of the participants knew that the assay detects the MTB genome and rifampicin resistance. MDR-TB was suspected in participants after no clinical improvement was observed after 3-6 weeks of a trial of ATT. Two-thirds of the participants knew that linezolid is currently being used as a second-line drug for the treatment of MDR- TB. The respondents in our survey mostly do not themselves treat MDR-TB and refer the patients to an MDR-TB center or a pulmonary medicine specialist. Healthcare practitioners (HCPs) with good knowledge levels can diagnose and treat TB patients appropriately, thus decreasing the rising MDR-TB problem, and they can educate patients and the general population about TB and the emerging MDR-TB situation. With the current level of knowledge about MDR-TB management, there is certainly an urgent need for educational and persuasive measures for the training of doctors in both the public and private sectors so as to achieve TB elimination by 2025.

Incidence, Diagnosis and Treatment of Otorhinolaryngological, Head and Neck Tuberculosis: A Prospective Clinical Study.

Introduction Tuberculosis is a disease of diversified presentation. It affects almost all organs in the body, and otorhinolaryngological, head and neck involvement is not an exception. Objective To increase awareness about the different clinical presentations of otorhinolaryngological, head and neck tuberculosis, the techniques employed to diagnose it, and to assess the response to the treatment. Methods We conducted a prospective study of 114 patients who presented primarily with otorhinolaryngological, head and neck tuberculosis. Routine blood investigations, chest radiographs, the tuberculin test, and sputum examination for the presence of acid-fast bacilli were performed in all cases. Site-specific investigations were performed in relevant cases only. The patients were treated according to the antitubercular treatment (ATT) regimen recommended by the Indian Ministry of Health and Family Welfare's National Tuberculosis Elimination Program (NTEP), and they were followed up clinically two and six months after starting the ATT. Results Tubercular cervical lymphadenopathy was the most common clinical presentation (85.96%), followed by deep neck abscess (5.27%). Fine-needle aspiration cytology proved to be a reliable tool for the diagnosis of tubercular lymphadenopathy. Improvement at the end of 2 and 6 months of the ATT was observed in 90.35% and 96.50% of the cases respectively. Conclusion The diagnosis of otorhinolaryngological, head and neck tuberculosis requires a high index of clinical suspicion, and the ATT proved to be very effective in reducing the severity of the disease.

Baseline Assessments of TB Detection Centres in Selected Public and Private Laboratories in India and Need for Introducing Quality Management Systems

Quality is sine qua non of healthcare services. Laboratory driven Quality Management Systems (QMS) are key to provide quality diagnosis. Missed diagnosis due to laboratory lacunae stymies Tuberculosis (TB) control measures, amplifies morbidity, mortality and, disease transmission. Hence, a pilot was conceptualized with Central TB Division, National TB Elimination Program (NTEP), Ministry of Health and Family Welfare, Government of India and Indian Council of Medical Research (ICMR) to perform baseline assessments for QMS at four laboratories from public and private centers at Delhi and Odisha. Data was collected using a standardized checklist. Scores were compiled for compliance to quality standards for attributes assessed across seven thematic domains. The assessment helped identify current status in terms of performance, processes followed and, areas requiring improvement. TB laboratories were found lacking in human resources and, backup staff that disrupted service delivery. Other gaps included quality aspects in documents, records, process controls in smear microscopy, optimum resource utilization and laboratory safety. Adage for missed TB diagnosis included laboratory errors, failure to document, collect and, test repeat samples for Nucleic Acid Amplification Tests (NAAT), lack of patient centric laboratory signages, equipment handling and, maintenance. Baseline assessments of quality at TB laboratories mainly focused attention on areas of greatest need to ameliorate the health system challenges and, develop roadmaps to accelerate improvement. By adapting to local context, QMS can be enacted through a shared vision in quality care to positively impact TB case finding and, optimize utilization of NAAT for diagnosis thereby setting stage for nationwide adoption and, scaleup.

Quantum of Stress Hyperglycemia at the Time of Initial Diagnosis of Tuberculosis.

Background India has a high burden of both tuberculosis (TB) and diabetes mellitus (DM). The National TB Elimination Program recommends testing for glycemic status at the initiation of therapy; however, some individuals with elevated sugar levels might have stress hyperglycemia (SH) instead of true DM. Our aim was to perform a longitudinal glycemic assessment of individuals with TB to identify those with true newly diagnosed DM and those with SH. Methods We identified newly diagnosed adults with TB and abstracted information about demography, co-morbidities, disease severity, and glucose-lowering agents. A glycemic assessment was performed at baseline and at the end of six months. Results We included 150 patients with TB, and based on their initial HbA1c values, 82 (54.6%, 95% CI: 46-62%) had dysglycemia (30% had HbA1c levels above 6.4% and 24.6% had values between 5.9% and 6.4%) and 31 (20.7%, 95% CI: 14-18%) had SH. Among individuals with both baseline and follow-up glycemic values, 30% of the individuals previously defined as DM were characterized as SH. The proportion of true SH was 43% (95% CI: 33-60%). Conclusion Most individuals who have dysglycemia at the time of their TB diagnosis have SH. A close follow-up of such individuals will identify those who really require long-term glucose-lowering therapy.

Medicinal Plants as Therapeutic Alternatives to Combat Mycobacterium tuberculosis: A Comprehensive Review

Tuberculosis (TB) is a serious infectious disease caused by Mycobacterium tuberculosis (MTB) and a significant health concern worldwide. The main threat to the elimination of TB is the development of resistance by MTB to the currently used antibiotics and more extended treatment methods, which is a massive burden on the health care system. As a result, there is an urgent need to identify new, effective therapeutic strategies with fewer adverse effects. The traditional medicines found in South Asia and Africa have a reservoir of medicinal plants and plant-based compounds that are considered another reliable option for human beings to treat various diseases. Abundant research is available for the biotherapeutic potential of naturally occurring compounds in various diseases but has been lagging in the area of TB. Plant-based compounds, or phytoproducts, are being investigated as potential anti-mycobacterial agents by reducing bacterial burden or modulating the immune system, thereby minimizing adverse effects. The efficacy of these phytochemicals has been evaluated through drug delivery using nanoformulations. This review aims to emphasize the value of anti-TB compounds derived from plants and provide a summary of current research on phytochemicals with potential anti-mycobacterial activity against MTB. This article aims to inform readers about the numerous potential herbal treatment options available for combatting TB.

A cross-sectional study of extent and causes of interruption of treatment of tuberculosis in a tuberculosis unit of Purba Bardhaman district of West Bengal, India

Background: Tuberculosis (TB) is a communicable disease which requires prolonged treatment and having both medical and social dimensions. Adherence to treatment is very important issue in successful treatment of TB. Directly observed therapy was a key strategy in The Revised National TB Control Program. However, treatment interruption is very common. Aims and Objectives: The objective of this study is to assess the nature, extent, and reasons for interruption of treatment in Bhatar TB Unit (TU) of Purba Bardhaman district of West Bengal. Materials and Methods: The study was a descriptive and cross-sectional study with two components. The study was conducted in the area covered under Bhatar TU of Burdwan district of West Bengal. Complete enumeration technique was followed in the study. In the first component of the study, 231 study subjects were found by complete enumeration, out of which 26 were discarded due to incomplete records. In the other component, 90 study subjects were interviewed at the beginning of treatment and after treatment interruption, if any. Data were analyzed using RStudio. Results: Out of the group with only record review, 205 subjects were included in the study, out of which 160 (78.05%) were male and 45 (21.95%) were female. In the other group with both record review and interview, out of 90 subjects, 64 (71.1%) were male and 26 (28.9%) were female. Out of 295 cases, 270 (91.5%) were new and 25 (8.5%) were previously treated. Out of 295 subjects, 36 (12.2%) had interrupted treatment. Seven persons out of 36 had interrupted more than once. Thirty-four persons had interrupted in intensive phase of treatment. Thirty-two persons had taken 10–20 days before interruption of treatment. The most common reason for interruption of treatment was “Not willing to take tablets.” Among the other reasons were “Side effects,” “Hospitalization,” “Away from home,” etc. Conclusion: Non-compliance to anti-tubercular drugs remains an important issue in the elimination of TB.

Implementation of a tuberculosis elimination project, India 2018-2019.

To describe the changes in tuberculosis case notifications by the private sector after implementation of the Joint Effort for Elimination of Tuberculosis project in India in 2018. We retrieved data from the project recorded in India's national tuberculosis surveillance system. We analysed data on 95 project districts in six states (Andhra Pradesh, Himachal Pradesh, Karnataka, Punjab including Chandigarh, Telangana and West Bengal) to assess changes in the number of tuberculosis notifications, private provider notifiers and microbiological confirmations of cases from 2017 (baseline) to 2019. We compared case notification rates in districts where the project was implemented with the rates in districts where it was not. From 2017 to 2019, tuberculosis notifications increased by 138.1% (from 44 695 to 106 404), and case notification rates more than doubled from 20 to 44 per 100 000 population. The number of private notifiers increased by over threefold, from 2912 to 9525, during this period. The number of microbiologically confirmed pulmonary and extra-pulmonary tuberculosis cases notified increased by more than two times (from 10 780 to 25 384) and nearly three times (from 1477 to 4096), respectively. The districts where the project was implemented showed a 150.3% increase in case notification rates per 100 000 population from 2017 to 2019 (from 16.8 to 41.9) while in non-project districts, this increase was only 89.8% (from 6.1 to 11.6). The substantial increase in tuberculosis notifications demonstrate the value of the project in engaging the private sector. Scaling up these interventions is important to consolidate and extend these gains towards tuberculosis elimination.

National TB elimination programme - What has changed.

Before the start of Coronavirus (COVID-19) pandemic, TB was the leading cause of death due to a single infectious agent, ranking well above HIV/AIDS. Almost one-fourth of the world's population is infected with M.tuberculosis. TB is curable and preventable. About 85% of people who develop TB can be successfully treated with drug regimens of 6 months. Universal health coverage (UHC) is necessary to ensure that all those with the disease can access these treatments. Research breakthroughs (e.g., newer rapid diagnostic techniques, drugs, newer vaccine) are needed to rapidly reduce the number of new cases each year (TB incidence) worldwide. Changes in the National TB Elimination Programme since its inception. The Government of India launched the "National TB Programme" in 1962 as District TB Centre model involved with BCG vaccination and TB treatment to fight tuberculosis, a major public health problem. The tuberculosis control programme has come a long way since then and has undergone major changes over the past few years The Ministry of Health and Family Welfare has developed the "National Strategic Plan" for Tuberculosis Elimination (2017-25) which encapsulates the bold and innovative steps required to eliminate TB in India by 2025, five years ahead of the global targets. By 2020 it was clear that the NSP- 2017-25 will not be able to meet these objectives, so another new NSP India 2025 had been launched in 2020. India has been actively involved in TB control activities for more than 50 years now. TB still continues to be a severe health problem in India. The country is now better prepared to tackle TB than before. It now has advanced and effective interventions and technologies for diagnosis, treatment and care of TB cases.

Local government stewardship for TB elimination in Kerala, India.

The southern Indian state of Kerala has implemented 'Kerala Tuberculosis Elimination Mission' as 'People's Movement against TB' under the stewardship of local governments (LGs). The state has been certified by the Government of India for being on track to attain the UN Sustainable Development Goals related to TB elimination. To document the role of LG stewardship in the successful implementation of the TB elimination activities in Kerala. 1) Key informant interviews with four state officials, 2) desk review of available documents, 3) in-depth interviews with seven LG leaders, three mid-level programme managers and three health department field staff. LG involvement led to the establishment of solutions based on local problems, enhanced outreach of services to the socially vulnerable individuals, improved treatment support to patients with TB, increased community ownership of TB elimination activities, reduced TB-related stigma and social determinants being addressed. Institutional mechanisms such as LG TB elimination task forces, formal guidance in planning interventions and appreciation of their performance in the form of awards were facilitators for LG involvement. LG stewardship can accelerate TB elimination. A good plan for engagement and institutional mechanisms are crucial for LG involvement.