India is the country with the highest TB burden in the world, contributing 28% of the global TB burden. The country has recently published the findings of the National TB Prevalence survey (NPS) which was conducted from 2019-2021 to know the actual disease burden at a national level. The NPS has revealed that prevalence of TB infection among the population who are 15 years old and over is 31.4%.
The UN High Level Meeting on TB in 2018 reiterated that giving TB preventive treatment to people at highest risk of progressing from TB infection to disease remains a critical activity to achieve the global targets of the End TB Strategy.
The introduction of TB preventive therapy (TPT) in the National TB Elimination Program (NTEP) has marked a paradigm shift in TB care in India. Epidemiological modelling studies show that effective implementation of TPT alone in South-East Asia region can result in an annual TB incidence decline of 8.3%, independent of other background interventions.
Since April 2021, The Union has been implementing the Project Axshya Plus with the support from the Global Fund. The project is aligned with two of the four strategic pillars of India’s National Strategic Plan-2020-2025 - “Prevent” by contact tracing and management of Latent TB Infection, and “Build” by providing technical assistance to the NTEP.
Project Axshya Plus is attempting to implement a comprehensive package of interventions, including: identifying individuals at highest risk, testing for infection, excluding active TB, choosing the treatment option that is best suited to an individual, managing adverse events, supporting medication adherence and monitoring programmatic performance.
Despite the challenges posed by the COVID-19 pandemic, the project team and field staff continue to reach household contacts of people with pulmonary TB, providing testing services and initiating TPT where appropriate. Since the inception of the project last year, nearly 350,000 contacts have been screened and nearly 200,000 initiated on TB preventive treatment.
The lessons learned from this project implementation will add a wealth of knowledge to further update the guidelines and strategies for TB prevention in India.