At a Glance: TB in India
2.1 million
number of new TB cases
240,000
deaths from TB
99,000
multidrug-resistant TB cases
171/100k
national incidence of TB
120,000
TB/HIV prevalence
50%
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. Each year, more than 2 million people in India get TB, and over 300,000 people die from it. India has the greatest number of new cases of MDR-TB, with an estimated 99,000 cases in 2014.
There are nearly 1 million 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).
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.
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.
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