TUBERCULOSIS - THE CONTINUING SCOURGE OF INDIA

Epidemiological picture of tuberculosis in India is complex with wide variation in the annual risk of infection and prevalence of disease. T he concentration of the disease among younger age groups makes tubercu losis a major socio-economic burden in India. The disability adjusted life years (DALYS) is estimated to be around 63 and 46 lakhs of years of life lost in men and women respectively. The burden is likely to in crease with HIV epidemic with an increase of cases with dual infection , increase in morbidity and mortality due to tuberculosis. Management of drug resistant tuberculosis is a major hurdle in tuberculosis contr ol and is a major step in cutting the chain of transmission to those w ith HIV infection, AIDS and Immunodeficiency. Development of new thera peutic modalities to address this problem are also urgently required. Poor patient compliance has been the reason for failure of many contro l programmes. Operational research studies conducted by the TRC have r esulted in elucidation of socio-behavioural aspects of patients which need further investigation for remedial measures. Studies to improve d rug delivery and to measure the impact of health education and mass me dia on compliance are areas which need to be concentrated. Newer techn iques such a's DNA fingerprinting need to employed to improve knowledg e of the patterns of transmission in communities. The impact of HIV in fection on tuberculosis and the role of chemoprophylaxis in HIV infect ed individuals in high risk populations, children in close contact wit h newly diagnosed patients and HIV infected individuals need to be urg ently explored. Improved methods for diagnosis of Mycobacterium tuberc ulosis infection must await considerable advance in the understanding of basic immunology, mycobacterial antigenic structure and host-parasi tic interaction.