DTBE in India
Capital City: New Delhi
Area*:3.29 million sq. km. (1.27 million sq. mi.)
Population (est.), 2010*: 1.17 billion (urban 29%)
Estimated TB Incidence, 2010**: 185/100,000
Estimated TB Prevalence, 2010**: 256/100,000
Adult HIV Prevalence Rate, 2009***: 0.3%
Number of people living with HIV (PLHIV), 2009***:2,400,000
Percent of tested TB patients who were HIV+, 2010**: 9%
**Source: WHO Global TB Control Report 2011
***Source: UNAIDS, Report on the Global AIDS Epidemic, 2010
India has the highest burden of both drug-susceptible and drug-resistant tuberculosis (TB) in the world, with an estimated 3 million prevalent TB cases, of which 75,000 are multidrug-resistant TB (MDR TB). Since 1997, the Centers for Disease Control and Prevention’s Division of Tuberculosis Elimination (CDC/DTBE) has provided technical assistance for TB control efforts in India in collaboration with the U.S. Agency for International Development (USAID), the Southeast Asia Regional Office (SEARO) of the World Health Organization (WHO), and the Government of India. CDC/DTBE’s technical officer based in India works for WHO/SEARO and provides technical support to the Indian national TB program regarding TB/HIV integration, strengthening Directly Observed Therapy Short-course (DOTS) programs, epidemiological impact assessments, development of laboratory capacity, implementation of integrated MDR TB diagnosis and treatment programs, and enhancement of public-private partnerships.
Recent Accomplishments & Ongoing Collaborations
Program Strengthening and Epidemiology
Operational Research Protocols Developed: CDC/DTBE facilitated a series of three operational research workshops, organized by WHO, CDC, and the International Union Against TB and Lung Disease (IUATLD) in Bangalore. The workshops aimed to develop operational research capacity for 26 public health experts associated with the TB Program by taking participants through all phases of operational research, including protocol development, data analysis, and report writing.
TB Infection Control: CDC/DTBE organized a national steering body for infection control, helped the national TB program develop the first National Guidelines on Airborne Infection Control, created a standard curriculum, and trained public health professionals at national and state levels for pilot testing national guidelines.
Implementation and evaluation of rapid diagnostics: CDC/DTBE and WHO will support a large scale demonstration project for deployment of new high-sensitivity TB diagnostics tests and innovative new delivery mechanisms to achieve the national target of universal access to quality TB diagnosis and treatment.
Multidrug-Resistant TB (MDR TB), TB/HIV, and Other At-Risk Populations
Scale-Up of MDR TB diagnosis and treatment: The Indian Revised National Tuberculosis Control Program (RNTCP) plans to escalate treatment for MDR TB from 500 patients in 2009 to 30,000 patients per year in 2013. This is the largest number of MDR TB patients started on treatment in a single country. CDC/DTBE and partners developed a national plan for scaling up treatment services during this period, including drug supply chain management, trainings, laboratory service preparation, and implementation activities on a state-by-state basis.
TB Laboratory Scale-Up for diagnosis of MDR TB: CDC/DTBE facilitated the adoption by the National TB Program of a new diagnostic algorithm for MDR TB based on rapid diagnosis using molecular line probe assays. CDC/DTBE also developed national scale up plans and developed a framework for training laboratory staff and monitoring laboratory performance.
Scale-Up of TB/HIV activities: CDC/DTBE and the Ministry of Health will be working to scale-up recently adopted policies for comprehensive TB/HIV services. This includes technical support for the development of TB/HIV implementation plan for high-HIV prevalence states, development of revised training material for TB/HIV for health care workers, counselors and program staff. CDC/DTBE has facilitated train-the- trainer workshops for four states in India. CDC/DTBE provided comprehensive technical support at the national level for TB/HIV collaboration, including facilitation of four national TB/HIV technical working group meetings.