India’s TB Report 2023: Men More Affected Than Women, Urgent Need for Equitable Care

Tuberculosis (TB) continues to be a significant public health challenge in India. The India TB Report 2023 has revealed that men are more affected by TB compared to women, highlighting a concerning gender disparity in the disease burden. While India's ambitious TB treatment programs under the National Tuberculosis Elimination Program (NTEP) have made significant progress, the report underscores the need for a more inclusive and equitable healthcare approach to effectively combat the disease.

Gender Disparity in TB Cases: A Deep-Rooted Concern

According to the India TB Report 2023, nearly 65% of TB cases in India were reported among men, while women accounted for only about 35%. Several factors contribute to this gender disparity. Occupational exposure, higher prevalence of smoking and alcohol consumption among men, delayed healthcare-seeking behavior, and biological susceptibility are some of the key reasons why men are disproportionately affected by TB. Additionally, men working in labor-intensive sectors, such as construction and mining, are more exposed to risk factors that contribute to TB transmission.

On the other hand, women, despite having a lower reported TB burden, face unique challenges. Social stigma, lack of awareness, and inadequate access to healthcare prevent many women from seeking timely treatment. In many cases, women diagnosed with TB experience discrimination within their families and communities, further exacerbating the problem.

India’s TB Treatment Program: Progress and Challenges

The Government of India has been at the forefront of TB elimination efforts through its National Tuberculosis Elimination Program (NTEP), previously known as the Revised National Tuberculosis Control Program (RNTCP). NTEP aims to achieve a TB-free India by 2025, five years ahead of the global target set by the World Health Organization (WHO). Some of the key initiatives under this program include:

• Nikshay Poshan Yojana (NPY): A direct benefit transfer (DBT) scheme providing ₹500 per month to TB patients for nutritional support.
• Active Case Finding (ACF) Strategy: Regular screenings in high-risk populations to ensure early detection.
• Free TB Diagnosis and Treatment: The government provides free TB medication through DOTS (Directly Observed Treatment, Short-course) centers across the country.
• Newer Diagnostic Tools and Treatments: India has adopted advanced diagnostic techniques such as CBNAAT (Cartridge-Based Nucleic Acid Amplification Test) and newer drugs like Bedaquiline and Delamanid for drug-resistant TB (DR-TB) cases.

Despite these efforts, challenges persist. Drug resistance remains a major concern, with a rising number of multi-drug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) cases. Treatment adherence is another critical issue, as many patients discontinue medication after initial recovery, leading to relapse and increased resistance.

Vertical Health Programs: India’s Approach to Disease Control

India follows a vertical health program approach for major diseases, including TB, malaria, HIV/AIDS, and polio. These programs operate independently with their own infrastructure, funding, and administration. While vertical programs allow for focused intervention, they also come with limitations:

• Lack of Integration: Vertical health programs often work in silos, making it difficult for patients with co-morbidities (such as TB-HIV) to receive holistic care.
• Resource Allocation Issues: Funding is often skewed towards one disease at a time, leading to gaps in healthcare services for other illnesses.
• Burden on Healthcare Workforce: With multiple parallel programs, healthcare workers often face excessive workload and administrative challenges.

Experts argue that while vertical programs have been successful in addressing specific diseases, a more integrated healthcare approach is needed for long-term sustainability. A comprehensive primary healthcare system that addresses multiple diseases simultaneously can improve efficiency and patient outcomes.

Need for Equitable TB Care: Bridging the Gaps

While India's TB elimination program has made remarkable progress, ensuring equitable care for all sections of society remains a pressing challenge. The gender disparity highlighted in the India TB Report 2023 further emphasizes the need for a more inclusive and gender-sensitive approach to TB care.

Key Recommendations for Equitable TB Care

1. Gender-Sensitive Policies: Special focus should be given to increasing TB awareness among women and ensuring their access to timely diagnosis and treatment.
2. Community-Based Interventions: Strengthening community engagement can help reduce stigma and encourage people to seek early treatment.
3. Strengthening Primary Healthcare: Integrating TB services with primary healthcare centers can provide a holistic approach to disease management.
4. Private Sector Collaboration: Public-private partnerships can enhance TB detection and treatment, especially in urban and underserved areas.
5. Improved Nutritional Support: Expanding the scope of the Nikshay Poshan Yojana to provide more comprehensive nutritional support can help improve treatment adherence and outcomes.
6. Focus on High-Risk Groups: Special attention should be given to vulnerable populations such as migrant workers, slum dwellers, prisoners, and HIV-positive individuals, who are at higher risk of TB.

Conclusion

The India TB Report 2023 provides crucial insights into the country’s fight against tuberculosis, particularly in highlighting the disproportionate impact of TB on men. While India’s TB elimination strategy has made substantial progress, gaps in equitable care need urgent attention. Moving forward, a comprehensive, patient-centered, and gender-sensitive approach will be critical in ensuring that no one is left behind in the battle against TB.

With continued investment, innovation, and an inclusive healthcare strategy, India has the potential to not only meet but exceed its TB elimination targets, setting an example for the world in the fight against this deadly disease.

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