1. RATIONALE: India has efficient TB testing methods (such as, WHO recommended laboratory-independent, point-of-care and de-centralised molecular test) for TB infection, but we need to make sure that everyone has access to them as per the WHO guidelines. Molecular test must be the first initial test for every person with presumptive TB upfront because microscopy underperforms to detect TB. Currently, there is limited access (only 23% of people with presumptive TB were tested using a TB molecular test in 2022 as per India TB Report).
FIRST ACTION POINT: We need to ensure that TB tests that underperforms like smear microscopy is 100% replaced by laboratory-independent, point-of-care and decentralised molecular test at the earliest, and communities are made aware about their existence and demand for them.
2. RATIONALE: India has enough financial resources to end TB by 2030, but investments and funds should be more efficiently allocated.
SECOND ACTION POINT: To end TB, it is essential to scale up and ensure that everyone with TB has access to WHO recommended laboratory-independent, point-of-care and de-centralised molecular test, is treated with best of WHO recommended regimens (1 month regimen for latent TB, 4 months for drug-sensitive TB, and 6-months for drug-resistant TB). More importantly, investment in community engagement and capacity building remains critical.
3. RATIONALE: Greater community engagement is needed. UNHLM and the adoption of a Political Declaration is a top-bottom strategy, but also bottom-up strategies are needed: communities must be engaged in the effort to eradicate TB.
THIRD ACTION POINT: Communities must be engaged in policy, programmes and actions, at every level of TB response, from block level to the national level. Community-led monitoring must be recognised and fully invested in to improve TB programme performance and effectiveness.
4. RATIONALE:
Despite evidence that ending TB is a human rights imperative, progress is far off the mark. Despite evidence that every US$ 1 invested in TB yields a return of US$ 46, investment remains sub-optimal.
FOURTH ACTION POINT: Stronger advocacy efforts are needed, also from the communities, civil society networks and other stakeholders: we must make our voices heard to pressure and influence politicians to take action in this regard.
5. RATIONALE: TB is a social disease, and merely a medical response is not enough. We need a socially just response to end TB. Major risk factors that put people at risk of TB warrant multi-stakeholder collaborative activities (in India 5 top risk factors include malnutrition, tobacco, alcohol, diabetes and HIV). Intersectoral response is also key to encourage the 'missing million of TB cases' to get tested for TB, adhere to the therapy, and access to the care and support.
FIFTH ACTION POINT: Call for more effective integration of health sector to end TB: TB screening and diagnosis, as well as treatment should be integrated in other health departments. This will yield major public health gains as well as more value for the health spending as molecular tests are multi-disease platforms (proven to diagnose TB, HIV viral load, malaria, dengue, STIs, hepatitis (HBV, HCV), HPV/cervical cancer, etc), and must be fully utilised.
COMMUNITY DECLARATION BY BLOSSOM TRUST
As a result of the conference, Blossom Trust has decided to take charge of drafting a Community Declaration summarizing the discussed key asks. This declaration will be share among civil societies to gain support and will be submitted to politicians and other key stakeholders.
