RNTCP Annual Report 2012 - TBC India

Burden of TB-HIV:
TB and HIV act in deadly synergy. HIV infection increases
the risk of TB infection on exposure, progression from
latent infection to active TB, risk of death if not timely
treated for both TB and HIV and risk of recurrence
even if successfully treated. Correspondingly, TB is the
most common opportunistic infection and cause of
mortality among people living with HIV (PLHIV),
difficult to diagnose and treat owing to challenges related
to co-morbidity, pill burden, co-toxicity and drug
interactions. Though only 5% of TB patients are HIVinfected,
in absolute terms it ranks 2nd in the world and
accounts for about 10% of the global burden of HIVassociated
TB. This coupled with heterogenous
distribution within country is a challenge for joint delivery
of integrated services. National and international studies
indicate that an integrated approach to TB and HIV
services can be extremely effective in managing the
epidemic. A modelling study by Williams et al predicts
that that RNTCP should be able to reverse the increase
in TB burden due to HIV, but to reduce mortality by
50% or more by 2015, universal access to coordinated
TB and HIV care is essential. Studies also indicate that
emphasis needs to be on early diagnosis linked to TB
and HIV treatment.
Global estimation of burden of HIV positive incident
TB cases is 10,00,000 (11,00,000-12,00,000) while the
estimates of HIV positive incident TB cases in India is
75,000 (1,10,000 - 1,60,000). As per WHO's Global TB
Report of 2011, HIV prevalence amongst incident TB
cases is estimated to be 3.3% (5%-7.1%).
Burden of paediatric TB in the country:
The actual burden of pediatric TB is not known due to
diagnostic difficulties but has been assumed that 10% of
total TB load is found in children. Globally, about 1 million
cases of pediatric TB are estimated to occur every year
accounting for 10-15% of all TB; with more than 100,000
estimated deaths every year, it is one of the top 10 causes
of childhood mortality. Though MDR-TB and XDR-
TB is documented among pediatric age group, there are
no estimates of overall burden, chiefly because of
diagnostic difficulties and exclusion of children in most
of the drug resistance surveys.
Socio-economic impact:
Tuberculosis Epidemiology - India
11
Besides the disease burden, TB also causes an enormous
socio-economic burden to India. TB primarily affects
people in their most productive years of life with important
socio-economic consequences for the household and the
disease is even more common among the poorest and
marginalized sections of the community. Almost 70% of
TB patients are aged between the ages of 15 and 54 years
of age. While two thirds of the cases are male, TB takes a
disproportionately larger toll among young females, with
more than 50% of female cases occurring before 34 years
of age. The direct and indirect cost of TB to India amounts
to an estimated $23.7 billion annually. Studies suggest that
on an average 3 to 4 months of work time is lost as result
of TB, resulting in an average lost potential earning of 20-
30% of the annual household income. This leads to
increased debt burden, particularly for the poor and
marginalized sections of the population. The vast majority
(more than 90%) of the economic burden of TB in India
is caused by the loss of life rather than by morbidity. This
is due to the fact that TB mortality incurs a greater loss in
the number of life-years per event than does TB morbidity
- despite the fact that there are many more prevalent cases
than deaths. A study on the economic impact of scaling
up of RNTCP in India in 2008 shows that on average
each TB case incurs an economic burden of around US$
12,235 and a health burden of around 4.1 DALYs.
Similarly, a death from TB in India incurs an average burden
of around US$ 67,305 and around 21.3 DALYs. A total
of 6.3 million patients have been treated under the RNTCP
from 1997-2006. This has led to a total health benefit of
29.2 million DALYs gained including a total of 1.3 million
deaths averted. In 2006, the health burden of TB in India
would have risen to around 14.4 million DALYs or have
been 1.8 times higher in the absence of the programme.
The RNTCP has also led to a gain of US$ 88.1 billion in
economic wellbeing over the scale-up period. In 2006, the
gain in economic wellbeing is estimated at US$ 19.7 billion
per annum - equivalent on a population basis to US$ 17.1
per capita. In terms of TB patients, each case treated under
DOTS in India results in an average gain to patients of 4.6
DALYs and US$ 13,935 in economic wellbeing.