BMJ Open (Jul 2022)

Estimation of tuberculosis incidence at subnational level using three methods to monitor progress towards ending TB in India, 2015–2020

  • ,
  • Swati Mahajan,
  • Amar Shah,
  • Sarit Sharma,
  • Rituparna Das,
  • Kathiresan Jeyashree,
  • Mathavaswami Vijayageetha,
  • Bhavesh Modi,
  • Burugina Nagaraja Sharath,
  • Vijay Singh,
  • Shamim Mannan,
  • Sairu Philip,
  • Jasleen Kaur,
  • Ranjani Ramachandran,
  • Raghuram Rao,
  • Sriram Selvaraju,
  • Bency Joseph,
  • Vaibhav Shah,
  • Kiran Rade,
  • Lalit Sankhe,
  • Surinder Singh,
  • Sandeep Chauhan,
  • Anupam Banerjee,
  • Devender Kumar,
  • Ganapathy Kalaiselvan,
  • Bhavin Vadera,
  • Paras Mehta,
  • Meenakumari Natarajan,
  • Manoj Murhekar,
  • Aswathy Sreedevi,
  • Jeromie Thangaraj,
  • Saravanakumar Velusamy,
  • Sasidharan Akhil,
  • Dhanapal Sudha Rani,
  • Ramasamy Sabarinathan,
  • Sakthivel Manikandanesan,
  • Rajalakshmi Elumalai,
  • Amarendra Mahapatra,
  • Almas Shamim,
  • Ashok Bhardwaj,
  • Anil Purty,
  • Anand Sridhar,
  • Aniket Chowdhury,
  • Asif Shafie,
  • Avijit Choudhury,
  • Deka Dhrubjyoti,
  • Hardik Solanki,
  • Krushna Sirmanwar,
  • Kshitij Khaparde,
  • Malik Parmar,
  • Nisha Dahiya,
  • Parija Debdutta,
  • Quazi Ahmed,
  • Ranjeet Prasad,
  • Rohini Shinde,
  • Rupali Baruah,
  • Sandip Bharaswadkar,
  • Shanta Achanta,
  • Shibu Balakrishnan,
  • Shivani Chandra,
  • Sophia Khumukcham,
  • Sudarsan Mandal,
  • Sumitha Chalil,
  • Venkatesh Roddawar,
  • Kuldeep Sachdeva,
  • Jayakrishna Kurada,
  • Mayank Sharma,
  • Debajyoti Mohapatra,
  • Yogesh Patel,
  • Sapna Thekkepat,
  • Karthikeyan Kumaraswamy,
  • Mallika Tharakan,
  • Shramana Majumdar,
  • Vrinda Manocha,
  • Sukriti Chauhan,
  • Shekhar Waikar,
  • Puja Ambule,
  • Krithika Murali,
  • Devi Madhavi Bhimarasetty,
  • Tulika Goswami,
  • Darshan Mahyavanshi,
  • Krutarth Bhrahmbhatt,
  • Bhautik Modi,
  • Anmol Gupta,
  • Sunil Raina,
  • Rajiv Kumar Gupta,
  • Ratnesh Sinha,
  • Manju Toppo,
  • Gajen Medhi,
  • Swati M Patki,
  • Bishnu Ram Das,
  • Lisa Sarangi,
  • Afsal Hakim,
  • Suresh Balan,
  • Baer Philip Ravikumar,
  • Subrata Baidya,
  • Abhik Sinha,
  • Boddepalli Nagendra Naidu,
  • Bikash Chandra Nayak,
  • Anoop Dev,
  • Pallavi Boro,
  • Debarshi Paul,
  • Amrita Sarkar,
  • Bhavesh Bariya,
  • Jatin Chhaya,
  • Dixit Chauhan,
  • Mithun Sanghavi,
  • Nilesh Thakor,
  • Rohit Ram,
  • Hinal Baria,
  • Abhilash Sood,
  • Anupam Parashar,
  • Yangchen Dolma,
  • Rakesh Bahl,
  • Dilip Kumar,
  • Mohammad Salim Khan,
  • A K Jayasree,
  • Zinia Nujum,
  • Sheela P Haveri,
  • Dinesh Bhatnagar,
  • Subrata Kumar Palo,
  • Priyesh Marskole,
  • Prashant Verma,
  • Dinesh Kumar Pal,
  • Neelam Toppo,
  • Sanjay R Quraishi,
  • Sunil Panigrahi,
  • Rambadan Chauhan,
  • Jayashree Gothankar,
  • Swapnali S Kadam,
  • Dasi Rao,
  • Sudhir Wanje,
  • Pallavi Uplap,
  • Ningombam Joenna Devi,
  • Rikrak Ch Marak,
  • Markordor Lyngdoh,
  • Manoj B Patki,
  • Satyajit Sundar Ray,
  • Kavita Vasudevan,
  • Mahesh Satija,
  • Mahesh Choudhary,
  • Mitin Parmar,
  • Venkatesh Govindasamy,
  • Karlapudi Nitesh Kumar,
  • Goutham Thumari,
  • Amar Tripura,
  • Chanda Mog,
  • Shampa Das,
  • Ritesh Singh,
  • Chandra Shekar Maity,
  • Mamta Gehlawat

DOI
https://doi.org/10.1136/bmjopen-2021-060197
Journal volume & issue
Vol. 12, no. 7

Abstract

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Objectives We verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India.Design A community-based survey, analysis of programme data and anti-TB drug sales and utilisation data.Setting National TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status.Participants Each district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district.Outcome measures We calculated a direct estimate of TB incidence based on incident cases identified in the survey. We calculated an under-reporting factor by matching these cases within the TB notification system. The TB notification adjusted for this factor was the estimate by the indirect method. We also calculated TB incidence from drug sale data in the private sector and drug utilisation data in the public sector. We compared the three estimates of TB incidence in 2020 with TB incidence in 2015.Results The estimated direct incidence ranged from 19 (Purba Medinipur, West Bengal) to 1457 (Jaintia Hills, Meghalaya) per 100 000 population. Indirect estimates of incidence ranged between 19 (Diu, Dadra and Nagar Haveli) and 788 (Dumka, Jharkhand) per 100 000 population. The incidence using drug sale data ranged from 19 per 100 000 population in Diu, Dadra and Nagar Haveli to 651 per 100 000 population in Centenary, Maharashtra.Conclusion TB incidence in 1 state, 2 UTs and 35 districts had declined by at least 20% since 2015. Two districts in India were declared TB free in 2020.