From DOTS to DOST: a new framework for TB elimination in India

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Health Policy

Background:

• India shoulders a substantial global burden of tuberculosis (TB), accounting for a quarter of cases and a third of deaths.
• Significant regional variations in TB prevalence necessitate localized and tailored elimination strategies.

Purpose of the Study:

• To introduce the Dual-phase Operational Strategy for Tuberculosis elimination (DOST), a novel roadmap for TB elimination in India.
• To address TB as both an infectious disease and a complex structural challenge requiring integrated interventions.

Main Methods:

• Phase 1: Intensified case-finding, rapid molecular diagnosis, and enhanced treatment to reduce transmission, exemplified by India's 100-Day TB Campaign.
• Phase 2: Scaling up TB preventive treatment and addressing co-morbidities (undernutrition, HIV, diabetes) to prevent disease progression.
• Subnational adaptation of strategies based on regional TB incidence and burden.

Main Results:

• The DOST strategy integrates medical interventions with social support, emphasizing a person-centered, compassionate approach.
• Sequencing and localization of proven interventions provide a pragmatic pathway from TB response to elimination.
• The strategy acknowledges the need for both rapid disease reduction in high-burden areas and sustained progress in low-incidence regions.

Conclusions:

• The DOST strategy offers a comprehensive and adaptable framework for TB elimination in India.
• Addressing structural determinants alongside medical management is crucial for successful TB elimination.
• A dual-phase, person-centered approach is essential for overcoming India's TB challenge.