• The RNTCP is scaling up the number of culture and DST laboratories nationwide, along with treatment services, including DOTS-Plus.
  • Despite these achievements, India’s efforts to control TB and MDR TB still suffer from too few laboratories, slow diagnostic tools, inadequate management of treatment, insufficient supplies of second-line drugs, and shortages of trained personnel.
  • Community-based MDR TB treatment is being implemented as an alternative model of treatment.
  • Data from the RNTCP from 2007 to 2010 indicate that the majority of MDR TB cases were undiagnosed in India.

Drug-resistant TB has existed in India virtually since anti-TB drugs were introduced into the country. ICMR carried out state-of-the-art surveys for drug-resistant TB more than 40 years ago (ICMR, 1968, 1969), and surveys have continued since then (Paramasivan and Venkataraman, 2004). Resistance to rifampicin, streptomycin, and other anti-TB drugs has been detected for decades, and MDR TB also was seen in early surveys, although at different levels depending on the place, time, and testing parameters. However, the increasing burden of drug-resistant TB introduces new challenges to TB control and treatment. Ashok Kumar, Deputy Director General and Head, Central TB Division, and Project Director, RNTCP; Kuldeep Singh Sachdeva, Chief Medical Officer, Central TB Division; S. K. Sharma, Chair, Department of Medicine, All India Institute of Medical Sciences (AIIMS); Rohit Sarin, Senior Consultant, Lala Ram Sarup (LRS) Institute of Tuberculosis and Respiratory Diseases; and Aleyamma Thomas, Scientist G and Director-in-Charge, National Institute for Research in Tuberculosis, described the current status of TB and MDR TB in India and the actions taken by government at various levels to combat the disease.

THE BURDEN OF TB AND MDR TB IN INDIA2

India has the highest TB burden of any country in the world, accounting for an estimated one-fifth of global TB cases worldwide (Figure 2-1). It has an estimated prevalence of 3 million TB cases, with 2 million new cases

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2 This section is based on the presentation of Kuldeep Singh Sachdeva, Chief Medical Officer, Central TB Division.



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