With the Central government setting a target to eliminate Tuberculosis (TB) by 2025, five years ahead of the Global Sustainable Development Goal (SDG) End TB Target of 2030, the Nagaland State National TB Elimination Programme (NTEP) is racing to fulfil this ambitious target and achieve “TB-Free Nagaland” goal by 2025.
Dr Vezokholu Theyo, state TB officer of NTEP under Health & Family Welfare department, admitted that the target timeline appeared to be “ambitious”, but said several policy decisions, and strategies and newer initiatives had been taken to scale up elimination efforts. In a communiqué, she said: “Along with the rest of the country, Nagaland is pacing for the End TB efforts towards achieving the target in line with the strategic plan.” She explained that the target of 2025 was set taking 2015 as the baseline, where one of the main goals was to “reduce in TB incidence rate by 80%”.
On TB prevalence in Nagaland, Theyo disclosed that there were 4,284 active TB cases in 2023, while the TB cases notified in 2023 was 86% against the allotted target of 5,000, which translated to notification rate of about 204 per lakh population. Of all the TB cases notified that year, she said the burden of TB cases in Dimapur was the highest, comprising 48% with a notification rate of 508 per lakh population, while Longleng had the lowest burden district with 1.14% against the total TB cases notified in the state with a notification rate of 91 per lakh population. She said private healthcare sectors notified about 15% of the TBs cases annually.
She revealed that men (age 15-45 years) were mostly infected by TB, comprising 60% of total notified cases in Nagaland in 2023. Further, out 4,361 notified cases currently, 412 were TB-HIV coinfected cases– 9.4% of total notified cases in 2023.
She revealed that there was an increase in TB notifications pre-Covid, which declined during the Covid phase and was now on an upward trend. (See table)
“There was both an increasing and a declining trend in the last five years. Following the Covid year of 2020, the TB cases have shown an upward trend, but was yet to reach the pre-Covid level of 2019,” she disclosed.
The state TB officer said there was an increase in trend in the TB cases notified from 2014, reaching a peak of 4,845 in 2019. Similarly, there was an increasing trend in notification rate, which reached a peak of 235 per lakh population in 2019.
Explaining the increase and decline trend, she said the peak TB cases in 2019 and the increasing trend following the Covid could not be solely concluded as saturation of TB cases in the state.
She stressed identification of all presumptive TB cases, including the missing cases, to reach a saturation point through quality screening and testing with new diagnostic tools.
Dr Theyo attributed the decline in 2020 (as shown in the graph) to Covid. Though mitigation measures were undertaken to address the issues and challenges, she said some implementation efforts were hampered due to reasons such as sample transportation from the collection site to the testing facility faced challenges due to lack of transport or minimal HR presence at the testing lab, and minimal cooperation from the public due to fear or stigma where regular cases finding activities were minimised or halted.
She attributed the increased cases to increased case detection through active-case finding, intensified case finding efforts, decentralisation of presumptive cases finding with active involvement of health & wellness centres and partner NGOs, introduction of newer diagnostic tools such as Truenat and CBNAAT machines, expansion of testing capacities in all TB units, increased awareness among the public through regular meetings and sensitisation programmes, improved di-directional referrals between programmes, better engagement with private sector, etc.
Assuring that the state was working and implementing key strategies to become TB-Free by 2025 based on National Strategic Plan (NSP), Theyo said initiatives such as Sub-National Certification (SNC) and TB-free districts, TB Mukt Panchayat, community support to TB patients/Nikshay Mitra/PMTBMBA, newer initiative launches, proposal with MoTA, scaling and optimal utilisation of molecular diagnostics, dedicated sample collection and transport, TB screening through cough powered artificial intelligence and Viksit Bharat Sankalp Yatra were taken.