Mismanagement of tuberculosis in India: Causes, consequences, and the way forward

Introduction Tuberculosis in India: magnitude of the problem india, a country with over 1.21 billion people, has the highest burden of tuberculosis (TB) in the world, accounting for 20% of the global incidence of TB, and an even higher share of global incidence of multi–drug resistant (MDR) TB (1). Thus the success of any global effort to control TB and MDR–TB is critically dependent on the success of such an effort in India. The Indian National TB programme (NTP) was launched in 1962, but suffered from inadequate program funding, managerial weaknesses, irregular drug supply and multiplicity of treatment regimens (2). With low rates of case detection and treatment completion (30%), high rates of default (40–60%), and continuing high mortality (50 per 100,000) the NTP failed (2). Acknowledging this reality, a Revised National Tuberculosis Control Programme (RNTCP) was launched by the Government of India in 1997, based on the global DOTS (Directly Observed Treatment, Short course) strategy which aimed to have an epidemiologic impact by achieving 70% case detection and 85% cure rates. By 2006, 100% of the Indian population was covered by the DOTS programme, making this scale–up one of India’s most significant public health accomplishments. The RNTCP has resulted in impressive improvements in cure rates (currently >80% in new infectious cases), substantial decline in death rates with low rates of default (<10%) (3, 4).