The number of privately treated tuberculosis cases in India: an estimation from drug sales data

Abstract

SummaryBackgroundUnderstanding the amount of tuberculosis managed by the private sector in India is crucial to understanding the true burden of the disease in the country, and thus globally. In the absence of quality surveillance data on privately treated patients, commercial drug sales data offer an empirical foundation for disease burden estimation.MethodsWe used a large, nationally representative commercial dataset on sales of 189 anti-tuberculosis products available in India to calculate the amount of anti-tuberculosis treatment in the private sector in 2013–14. We corrected estimates using validation studies that audited prescriptions against tuberculosis diagnosis, and estimated uncertainty using Monte Carlo simulation. To address implications for numbers of patients with tuberculosis, we explored varying assumptions for average duration of tuberculosis treatment and accuracy of private diagnosis.FindingsThere were 17·793 million patient-months (95% credible interval 16·709 million to 19·841 million) of anti-tuberculosis treatment in the private sector in 2014, twice as many as the public sector. If 40–60% of private-sector tuberculosis diagnoses are correct, and if private-sector tuberculosis treatment lasts on average 2–6 months, this implies that 1·19–5·34 million tuberculosis cases were treated in the private sector in 2014 alone. The midpoint of these ranges yields an estimate of 2·2 million cases, two to three times higher than currently assumed.InterpretationIndia's private sector is treating an enormous number of patients for tuberculosis, appreciably higher than has been previously recognised. Accordingly, there is a re-doubled need to address this burden and to strengthen surveillance. Tuberculosis burden estimates in India and worldwide require revision.FundingBill & Melinda Gates Foundation.

Exploiting the synthetic lethality between terminal respiratory oxidases to kill Mycobacterium tuberculosis and clear host infection

“…Tuberculosis (TB) continues to cause 1.4 million deaths in HIVnegative individuals and 10.4 million new cases in 2015 (1). It was recently evaluated that the number of TB cases in India is two to three times higher than previously estimated (2), suggesting that the global number of TB cases may be largely underestimated. Despite progress in public health management and the use of fixed-dose combinations, the number of multi-and extensively drug-resistant (M-XDR) TB cases continues to rise (1).…”

Tuberculosis-Associated Chylothorax: Case Report and Systematic Review of the Literature

“…India has the highest TB burden and accounts for approximately more than one-fifth (21%) of the global disease burden, with recently revised higher estimates of disease burden [1, 2]. Chylothorax is characterized by the presence of chyle in the pleural space due to thoracic duct disruption [3, 4].…”

How we ensured 100% TB notification: experiences from a private tertiary care hospital in India

“…1 Undernotification of TB by the private sector remains a major issue in India 4 years after mandatory TB notification was declared by the Government of India. 2,3 Amrita Institute of Medical Sciences (AIMS), Kerala, is a tertiary care hospital with an annual patient turnover of 800 000 out-patients and 50 000 in-patients.…”