Tuberculosis: current situation, challenges and overview of its control programs in India

Tuberculosis (TB) is one of the most ancient diseases of mankind, with molecular evidence going back to over 17,000 years. In spite of newer modalities for diagnosis and treatment of TB, unfortunately, people are still suffering, and worldwide it is among the top 10 killer infectious diseases, second only to HIV. According to World Health Organization (WHO), TB is a worldwide pandemic. It is a leading cause of death among HIV-infected people. In India, historically speaking, fight against TB can be broadly classified into three periods: early period, before the discoveries of x-ray and chemotherapy; post-independence period, during which nationwide TB control programs were initiated and implemented; and the current period, during which the ongoing WHO-assisted TB control program is in place. Today, India's DOTS (directly observed treatment-short course) program is the fastest-expanding and the largest program in the world in terms of patients initiated on treatment; and the second largest, in terms of population coverage. Major challenges to control TB in India include poor primary health-care infrastructure in rural areas of many states; unregulated private health care leading to widespread irrational use of first-line and second-line anti-TB drugs; spreading HIV infection; lack of political will; and, above all, corrupt administration. Multidrug-resistant TB (MDR-TB) is another emerging threat to TB eradication and is a result of deficient or deteriorating TB control program. WHO with its "STOP TB" strategy has given a vision to eliminate TB as a public health problem from the face of this earth by 2050. For this review article, data available at the official websites of WHO; and from the Ministry of Health, Government of India, were consulted, and search engines PubMed(®) and Google Scholar(®) were used.