Improve TB treatment outcomes with redesigned programs

TB in India: A Social Disease
• TB is a major public health issue in India, with an estimated three million new patients and 3,00,000 TB deaths annually.
• The Ministry of Health and Family Welfare has announced a doubling of the direct benefit transfer from ₹500 to ₹1,000 per month in the Nikshay Poshan Yojana (NPY).
• The scheme includes energy-dense nutritional supplements for underweight patients for two months and extends nutritional and social support to families.

TB’s Causes and Outcomes
• TB is a social disease with social factors like poverty increasing the risk of TB.
• Undernutrition contributes to more than a third to nearly half of new TB cases in India.
• Poor access to primary care, poor quality of care, and poor adherence lead to severe disease and risk of death in the poor.

Nutritional Support in TB Patients
• The Nikshay Poshan Yojana is crucial due to severe undernutrition common in TB patients.
• Nutritional support with food baskets can improve treatment adherence, weight gain, and reduce mortality risk.
• The RATIONS trial showed that early weight gain in patients provided with a 10 kg per month food basket was associated with over 50% reduced risk of death.

Challenges and Future Directions
• The TB programme staff feel overburdened by the processes of facilitating the direct benefit transfer.
• The most vulnerable communities cannot access the benefit due to lack of proof of identity, residence, bank accounts, or distances involved.
• There is a need for dedicated human resources for NPY activities, locally contextualised counseling material, and energy-dense supplements.
• The coverage of the most vulnerable is inadequate in Nikshay Mitra and an explicit advisory against pictures of patients and families receiving food baskets is needed.