Despite being the most populous district of Himalayan state of Himachal Pradesh in India, Kangra has also led from the front in caring for largest number of people with TB in the state. Compared to the national average in India, Kangra offers TB tests to 3-4 times more people per 100,000 population.

Good news is that TB rates have been consistently declining in the past three years. More importantly, Kangra has made the steepest stride in making the greatest number of village-panchayats’ TB free in the state (81 out of 559 panchayats are declared TB free already).

Indian government has made a radical shift in finding, treating, and preventing more TB recently. It launched a 100-days campaign last month to focus on those who have a higher TB risk and offer them state-of-the-art artificial intelligence enabled and computer-aided TB detection by an ultraportable handheld X-ray and offer WHO recommended upfront molecular test to those who are presumptive for TB.

Another policy change is to screen everyone and not just those with TB symptoms (as almost half of TB patients were asymptomatic and could be found early only through an X-ray in national and sub-national TB prevalence surveys of Indian government). Finding people with TB (early and accurately) and offering them effective TB treatment also stops further spread of pulmonary TB, so treatment is prevention too.

Also, those found without active TB disease in high TB risk populations are to be tested for latent TB – and if found positive for it they are being offered TB preventive therapy (TPT).

As part of its fifteen years old End TB Dialogues series, CNS spoke to Dr Rajesh Kumar Sood, who has served in government health services in Dharamshala, Kangra for three decades now and has been making stellar contribution towards strengthening people-centred health responses. He serves as District TB officer of Kangra for National TB Elimination Programme (NTEP) and as the District Programme Officer of National Health Mission in Kangra.

Dr Sood agrees that the 100 days campaign has accelerated efforts to find more people with TB, treat more of them and prevent TB too.

It is estimated that almost one third of the population may have latent TB in India – which means they have the TB bacteria but not active TB disease. People with latent TB cannot spread it to others (latent TB is not infectious). But there is a risk of latent TB to progress into active TB disease. Every case of active TB disease (and infectious lung TB) comes from this big pool of people with latent TB.

“100 days campaign is the biggest campaign in the history of India to find, treat and prevent TB among high-risk populations. We are not only finding more people with active TB disease and linking them to care but also those who have latent TB and offering them TB preventive therapy. This is a real game changer,” said Dr Sood. “It is like turning the tap off while we find and treat those with the disease.”

Dr Sood’s team in Dharamshala Kangra identified those who are at a higher TB risk. These included those who are malnourished; use tobacco or alcohol; have diabetes or HIV; those who have suffered from TB and completed treatment in last five years (as there could be relapse........

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