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. 2022 Jul 28;12(7):e060197.
doi: 10.1136/bmjopen-2021-060197.

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

Kathiresan Jeyashree #  1 , Jeromie Thangaraj #  1 , Kiran Rade  2 , Bhavesh Modi  3 , Sriram Selvaraju  4 , Saravanakumar Velusamy  1 , Sasidharan Akhil  1 , Mathavaswami Vijayageetha  1 , Dhanapal Sudha Rani  1 , Ramasamy Sabarinathan  1 , Sakthivel Manikandanesan  1 , Rajalakshmi Elumalai  1 , Meenakumari Natarajan  1 , Bency Joseph  1 , Amarendra Mahapatra  5 , Almas Shamim  6 , Amar Shah  7 , Ashok Bhardwaj  8 , Anil Purty  9 , Bhavin Vadera  10 , Anand Sridhar  6 , Aniket Chowdhury  6 , Asif Shafie  11 , Avijit Choudhury  2 , Deka Dhrubjyoti  6 , Hardik Solanki  6 , Krushna Sirmanwar  12 , Kshitij Khaparde  6 , Malik Parmar  2 , Nisha Dahiya  11 , Parija Debdutta  6 , Quazi Ahmed  13 , Ranjani Ramachandran  2 , Ranjeet Prasad  11 , Rohini Shinde  11 , Rupali Baruah  14 , Sandeep Chauhan  6 , Sandip Bharaswadkar  6 , Shanta Achanta  6 , Burugina Nagaraja Sharath  15 , Shibu Balakrishnan  6 , Shivani Chandra  6 , Sophia Khumukcham  6 , Sudarsan Mandal  11 , Sumitha Chalil  6 , Vaibhav Shah  6 , Venkatesh Roddawar  12 , Raghuram Rao  11 , Kuldeep Sachdeva  11 , Manoj Murhekar  16 ; Subnational TB claims verification group
Collaborators, Affiliations

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

Kathiresan Jeyashree et al. BMJ Open. .

Abstract

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.

Keywords: Epidemiology; Public health; Tuberculosis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Comparison of baseline tuberculosis (TB) incidence with direct, indirect and drug data based TB incidence for subnational verification of TB claims in India, 2020.
Figure 2
Figure 2
Estimates of tuberculosis (TB) incidence per 100 000 population by three methods, India, 2020.
See this image and copyright information in PMC

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References

    1. National strategic plan for tuberculosis elimination 2017–2025, 2017. New Delhi. Available: https://tbcindia.gov.in/WriteReadData/NSPDraft20.02.20171.pdf
    1. India TB report 2020, 2020. New Delhi. Available: www.tbcindia.gov.in [Accessed 19 Apr 2021].
    1. Pardeshi G, Wang W, Kim J, et al. . TB notification rates across parliamentary constituencies in India: a step towards data-driven political engagement. Trop Med Int Health 2021;26:730–42. 10.1111/tmi.13574 - DOI - PMC - PubMed
    1. Golandaj JA, Naikar SK, Hallad JS. Trends and sub-national disparities in TB notifications in India: insights from HMIS data. Indian J Tuberc. 10.1016/J.IJTB.2021.04.005 - DOI - PubMed
    1. Aggarwal A, Pandey A. Inverse sampling to study disease burden of leprosy. Indian J Med Res 2010;132:438. - PubMed

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