Tuberculosis in India

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Administrator Green speaks with TB survivors during his trip to Hyderabad, India.  2017. Photo credit: USAID Administrator Green speaks with TB survivors during his trip to Hyderabad, India. November 2017. Photo credit: USAID

At a Glance: TB in India

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    2.79 million

    number of new TB cases

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    deaths from TB

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    multidrug-resistant TB cases

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    treatment success rate for MDR-TB patients

*Source: Estimates of TB and MDR-TB burden are produced by WHO in consultation with countries.

Tuberculosis (TB) is a major public health problem in India. The country has the largest number of TB cases in the world — over a quarter of the global TB and multidrug-resistant TB (MDR-TB) burden. In 2016, 2.79 million people became ill from TB, and 435,000 died from it. India has the greatest number of new cases of MDR-TB (including rifampicin resistance), with an estimated 147,000 cases in 2016.

There are more than 850,000 cases of TB each year in India that are either undetected and untreated or diagnosed and treated by private healthcare providers with potentially substandard drugs and treatment regimens. Such drugs and treatment regimens not only fail to fully eliminate the TB bacteria, but they also contribute to an increasing incidence of drug resistant TB (DR-TB), including both multidrug-resistant TB, and extensively drug-resistant TB (XDR-TB).

U.S. Support for Ending Tuberculosis Epidemic in India

In November 2017, the U.S. Agency for International Development (USAID) announced further action to help India in its fight against Tuberculosis (TB). India has the world's highest incidence of TB, with 2.8 million cases annually, and accounts for more than a quarter of the global TB burden. India also has the largest burden of multi-drug-resistant TB (MDR-TB) among all countries, with almost 150,000 cases every year. TB claims over 435,000 Indian lives each year, which places TB among the top ten causes of death in the country.

In recognition of these alarming statistics, USAID also announced a new $1 million effort to bring greater awareness to TB's stigma – which disproportionately affects women – to support Prime Minister Modi's ultimate goal of securing a TB-free India by 2025. In India, as in many countries around the world, people often fear how others will treat them if they are diagnosed with TB. Women diagnosed with TB report their families, employers and communities shun and discriminate against them.

USAID has supported the TB program of the Government of India (GOI) since 1998, and has invested more than $140 million to strengthen the capacity of national, State, and District-level TB programs. USAID has also introduced new tools and approaches to reach, cure, and prevent TB in India successfully. The current objectives of the USAID/India TB portfolio are to strengthen the detection and treatment of TB, including a focus on drug-resistant strains; assist the GOI to plan and implement evidence-based interventions to reach a TB-Free India; and improve patient-centered TB services in private provider settings.

USAID/India's TB program is achieving its primary objective of strengthening the detection and treatment of TB, including drug-resistant disease. Highlights from the program include supplementing the country's first national TB drug-resistance survey; piloting and scaling-up the use of a rapid diagnostic tool, GeneXpert, to diagnose TB in children, including multi-drug-resistant strains; supporting the introduction of bedaquiline, the first new drug approved to treat TB in more than 40 years; and partnering with the Bill and Melinda Gates Foundation and the India Knowledge Park to assist in the development of the mobile technology, 99 DOTS, to improve adherence treatment among patients.

The U.S. Agency for International Development (USAID) is the lead U.S. Government entity for international TB programming. As the largest bilateral funder of TB efforts worldwide, USAID works in partnership with Ministries of Health, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), the World Health Organization (WHO), the Stop TB Partnership, the private sector and civil society to reach every person with TB, cure those in need of treatment, and prevent new TB infections through a patient-centered approach aimed at alleviating suffering and saving lives.

In December 2014, the U.S. Agency for International Development (USAID) and Janssen Therapeutics, one of the Janssen Pharmaceutical Companies of Johnson & Johnson, entered into a partnership to accelerate progress in the fight against antibiotic-resistant bacteria, specifically MDR-TB. As part of the collaboration, Janssen will donate $30 million worth of the drug SIRTURO® (bedaquiline) over a 4-year period through USAID's programs for the treatment of MDR-TB. The drug donation will enable nearly 100 low- and middle-income eligible countries to access the life-saving drug for free.

India is among the countries benefitting from this partnership and will receive drugs for 2,000 patients for the first year of the donation program, with the expectation to reach 10,000 patients by the fourth year of the donation period. Bedaquiline will be supplied through six treatment centers in India with USAID providing technical assistance to ensure the quality delivery of the new drug.


USAID’s Work in India to Address TB and DR-TB

USAID is a strong partner to the Government of India and has supported the country’s Revised National TB Control Program (RNTCP) since 1998, having invested over $100 million to date, mostly through public sector healthcare services. Through collaboration with technical partners, the private sector and a wide range of organizations, our efforts in India have contributed to a nearly 60 percent TB case detection rate and an 87 percent treatment success rate since 1998.

Some highlights of our work in India include:

Wide-scale Implementation of Rapid TB and DR-TB Diagnosis:

A USAID-funded project is helping turn the tide against ‪‎TB in India by accelerating the diagnosis and treatment of patients with TB and DR-TB. Promising results from a new study show an almost 40 percent increase in TB and DR-TB case notification in public health facilities in India that use a high-sensitivity diagnostic test known as Xpert MTB/RIF. USAID is a leading partner in the global implementation of the Xpert diagnostic test, which has the potential to save lives by significantly improving TB diagnosis around the world, especially in places with high rates of drug resistance. USAID is also supporting a project in four urban cities in India (Hyderabad, Kolkata, Chennai and Delhi) using Xpert to successfully transform the way India diagnoses TB in children.

Learn More.

Supporting the First Nationwide Drug Resistance Survey:

USAID is currently supporting the first nationwide drug resistance survey in India. More than 5,000 samples will be tested, including a subset for whole genome sequencing. Once completed, this survey will provide a statistically representative national estimate of the prevalence of drug resistance among new and previously treated patients in India and will contribute to a more accurate estimate of DR-TB globally.

Improving Treatment Outcomes through the Grand Challenges in TB Control Initiative:

Launched in partnership with IKP Knowledge Park, Hyderabad and the Bill & Melinda Gates Foundation, the Grand Challenges in Tuberculosis Control program aims to nurture ideas that are innovative and sustainable and can be scaled. This program supports Indian innovators to improve TB treatment adherence through out-of-the-box innovations. The first round of winners, chosen for their innovative ideas providing technology-driven solutions that will substantially strengthen TB control in India, were announced in 2013. A second round seeking innovative solutions to improve TB diagnostics was recently announced in 2015.

Technical Expertise for Capacity Building:

USAID led the creation of a successful network of consultants to bring technical expertise and much-needed on-the-ground support directly to India’s Central TB Division, states and districts. This network has built capacity in India for two decades and has been the backbone of TB control in India, contributing to the 60 percent case detection rate in the country.

First Large Scale Pilot to Diagnose TB Among People among People with HIV:

In India, deaths in people living with HIV (PLHIV) who also have TB are unacceptably high. Ensuring these patients are quickly identified and put on treatment is critical to saving lives. USAID initiated the first largescale pilot to diagnose TB among PLHIV at 30 antiretroviral therapy centers in five high HIV-burden states in India. This pilot included the use of Xpert as the initial diagnostic and as a daily fixed-dose combination (FDC) treatment. The initial results have led the country to pilot the use of FDCs for all TB patients in 100 districts in India.

A New Portfolio of TB Activities in India

We are building upon our successes in India and mobilizing support quickly and effectively through a new portfolio of TB activities and interventions, including two priority projects:

Call to Action for a TB-Free India

The Call to Action for a TB-Free India is part of the Global Challenge TB project funded by USAID. Launched in April 2015, the campaign will create new partnerships by leveraging Indian political, intellectual, financial and material resources in support of TB control to make joint commitments and bring about change. The Call to Action will increase participation and investment in the national TB control program by promoting national leadership on TB, advancing public understanding of, and reducing social stigma associated with, TB and generating support from research institutions to accelerate progress against TB.

TB Health Action Learning Initiative (THALI)

The THALI project will establish a holistic approach to TB control efforts in up to three major cities in India by helping identify, apply and scale up successful innovative approaches to addressing TB and MDR-TB, especially among under- or inadequately served urban slum dwellers and other low-income populations. THALI will strengthen urban TB control in India with an emphasis on private sector providers and diagnosis and treatment of MDR-TB.

Additional Resources

Last updated: September 18, 2019

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