March 2019 digital v1

NOTIFY ON NIKSHAY:
INDIAN MEDICAL
ASSOCIATION
E
ven though India declared TB a
notifiable disease in the year 2012,
the level of notification has not risen to
expectations. All medical practitioners
in the country have to notify their TB
patients to the government registry.
However, a review of the state-wise
notification data from 2018 showed
that the percentage of notification from
the private health sector in the Indian
states of Uttar Pradesh, Maharashtra,
Bihar Rajasthan, Gujarat, Madhya
Pradesh is a mere 28%. Among these
six states, Bihar is leading in private
notification at 40%, according to the
Indian Medical Association (IMA), which
carried out the survey.
IMA, the umbrella organisation
of Indian clinicians, has recently
urged private doctors to notify every
tuberculosis patient and register them
on Nikshay, a web-enabled application
developed by India’s health ministry.
Nikshay is an online tool which aims
to create a database of all TB patients
for monitoring and research purposes.
Notification allows access to free drugs
and diagnostic tests, nutritional and
patient-centric support that ensures
patients adhere to the treatment and
incentives.
Doctors in the private sector have a
huge role to play in reporting TB cases
and adhering to the Standards for TB
Care in India (STCI). STCI needs to be
followed uniformly across the private
sector.
With the largest burden of
tuberculosis in the world, the Indian
government is working towards a TBfree
India by 2025. Notification of every
TB patient is the single most important
intervention to meet the government’s
vision of a TB-free India.
India accounts for
a quarter of the 8.6
million cases of TB
that occur worldwide.
India also accounts for
a third of the ‘missing
3 million TB cases’ that
do not get diagnosed or
notified.
Leading pulmonologists like Dr George are sceptical
whether India would be able to bring down its numbers
within the stipulated timelines, considering the slow pace
of diagnosis and unusually protracted treatment regimens
practiced in India’s TB hotspots.
Treating latent TB: A daunting task
Also, at 40%, the proportion of people with latent TB is
higher in India owing to poor diagnosis and ineffective
treatment. People with latent TB infection (LTBI) do not
show any symptoms nor do they infect others. The infection,
however, won’t go away unless treated along the lines of
active TB.
The WHO recommends treating only those with active
diseases in high-burden countries like India, a stand criticised
by many TB experts. Targeting LTBI, along with the active
disease, is important to eliminate TB, they assert.
Recent reports indicate that the government is
considering to bring all LTBI patients too under the purview
of treatment. Treating asymptomatic TB patients would
be a daunting task in India as the numbers can be huge.
Policymakers plan to tackle the enormous LTBI population in
a phased manner, targeting the high-risk group with priority
to achieve the goal.
Among those included in the high-risk group and
identified to receive LTBI treatment by the NSP are those
on long-term corticosteroids, immunosuppressants, the HIVinfected
and juvenile contacts of sputum-positive index cases.
Since children are more susceptible to develop severe
forms of disseminated TB, those above six years of age, who
are in close contact of TB patients, will be evaluated. After
excluding active TB cases, they will be given 10 mg/kg of
isoniazid (INH) administered daily for a minimum period of six
months irrespective of their BCG or nutritional status.
INH preventive therapy will also be considered for all HIV
infected children, all tuberculin skin test (TST) positives who
24 / FUTURE MEDICINE / March 2019