Why in the News?

• Success of TANSACS: The news highlights the exceptional success of Tamil Nadu’s targeted interventions, which have reduced the HIV prevalence rate to 0.18%, significantly lower than the national average of 0.22% (as per the 2021 NACO report).
• Targeted Elimination Goal: The state is now moving toward the ambitious goal of eliminating HIV-TB co-infection by 2025-26, ahead of the national elimination target of 2030 for AIDS.
• Focus on PMTBMBA: The article draws attention to the state’s active promotion of the Pradhan Mantri TB Mukt Bharat Abhiyan (PMTBMBA), a community-centric initiative to provide support to TB patients, which underscores the crucial role of societal engagement in public health campaigns.

Key Takeaways

1. The Tamil Nadu Model of AIDS Control (TANSACS)

Tamil Nadu was one of the earliest and hardest-hit states by the HIV epidemic in India. Its response, led by the first-of-its-kind State AIDS Control Society (TANSACS), offers a successful blueprint for other states and national health programs.

Pointers:

• Early and Sustained Intervention: TANSACS was registered in 1994, making it the first such society in India, allowing for an early, dedicated, and sustained programmatic approach.
• Focus on High-Risk Groups (HRGs): It adopted a strategy of Targeted Interventions (TIs), focusing on key populations (Female Sex Workers – FSWs, Men who have Sex with Men – MSM, etc.) through Community-Based Organisations (CBOs) and NGOs. This ensured maximum impact with limited resources.
• Comprehensive Service Continuum: TANSACS established a robust ‘prevention-to-care continuum’:
  • Prevention: Widespread awareness campaigns, condom promotion, and Needle Syringe Exchange Programs (NSEP) for Injecting Drug Users (IDUs).
  • Testing: Establishing accessible Integrated Counselling and Testing Centres (ICTCs), branded as Nambikai Maiyam (Centre of Hope), which served as the entry point for diagnosis and care.
  • Treatment & Care: Scaling up Antiretroviral Therapy (ART) centres and providing care, support, and treatment (CST) services.
• Stigma Reduction: Innovative campaigns, like urban art murals, were used to combat stigma and discrimination, promoting social inclusion for People Living with HIV (PLHIV).

2. The Challenge of HIV-TB Co-Infection (The ‘Accursed Duet’)

Tuberculosis (TB) is the most common opportunistic infection among People Living with HIV (PLHIV). The co-infection (known as the ‘Accursed Duet’) poses a significant public health threat, as HIV accelerates the progression of latent TB infection to active disease.

Pointers:

• Bidirectional Relationship:
  • HIV on TB: HIV infection weakens the immune system, increasing the annual risk of developing active TB by 5-15% (compared to 5-10% lifetime risk for an immunocompetent person).
  • TB on HIV: Active TB can worsen the course of HIV-related immunodeficiency.
• Mortality Burden: In India, TB accounts for approximately 25% of deaths among PLHIV.
• Strategy for Elimination (The 3 I’s): India’s National AIDS Control Programme (NACP) and National TB Elimination Programme (NTEP) use a collaborative strategy, including:
  • Intensified TB Case Finding (ICF) at ART centres.
  • Isoniazid Preventive Therapy (IPT) for all eligible PLHIV to prevent the progression of latent TB to active TB.
  • Infection Control (IC) measures at all healthcare facilities.

3. Community-Based Initiatives and Corporate Social Responsibility (CSR)

The focus on the Pradhan Mantri TB Mukt Bharat Abhiyan (PMTBMBA) highlights the shift towards community and multi-stakeholder participation in achieving health targets.

Pointers:

• Objective of PMTBMBA: Launched in 2022 to provide additional support to Persons with TB (PwTB) to accelerate the country’s progress towards TB elimination by 2025.
• The ‘Ni-kshay Mitra’ Model: This is the core component where a donor (Ni-kshay Mitra)—which can be an individual, a private organisation, a corporate, or a political party—adopts consented TB patients to provide nutritional, diagnostic, and vocational support for a minimum of six months.
• Role of CSR: Corporations can fulfill their Corporate Social Responsibility (CSR) mandate by becoming Ni-kshay Mitras, directing resources toward the nutritional support component, which is critical for improving treatment adherence and outcomes.
• Filling the Gaps: PMTBMBA supplements the government’s existing financial support for nutrition, the Ni-kshay Poshan Yojana (NPY) (₹500 per month). The community support addresses the crucial social determinants of health like undernutrition and loss of livelihood, which perpetuate the cycle of disease and poverty.

Comparative Framework: Health Programmes in India

Feature	TANSACS (State-Level HIV/AIDS Control)	PMTBMBA (National TB Control)
Objective	Reduce new HIV infections; provide care & treatment; eliminate Mother-to-Child Transmission (EMTCT).	Eliminate TB in India by 2025.
Primary Strategy	Targeted Interventions for HRGs; Prevention-to-Care Continuum (ICTC-ART).	Community support and supplemental care through Ni-kshay Mitra (Donor).
Funding & Oversight	NACO (National AIDS Control Organisation) under the Ministry of Health and Family Welfare (MoHFW).	NTEP (National TB Elimination Programme) under MoHFW, with community/CSR funding for supplemental support.
Key Lesson	Sustained, evidence-based, and targeted programmatic approach is vital for epidemic control.	Multi-stakeholder ownership and addressing social determinants (e.g., nutrition) are necessary for elimination.

Challenges

• Sustaining Momentum: As HIV prevalence falls, there is a risk of donor fatigue and reduced political priority, which could lead to a resurgence.
• Hidden Epidemics: Reaching hidden populations (like certain HRGs, migrants, and remote rural communities) with testing and care remains a logistical challenge.
• Integration Gaps: Despite the joint efforts (like the 3 I’s), better programmatic integration between AIDS (NACP) and TB (NTEP) is needed to ensure seamless diagnosis and treatment for co-infected patients across all healthcare levels.
• Adherence and Stigma: Treatment adherence, particularly for the long duration of TB treatment, is complicated by persistent stigma and discrimination against both diseases.

Way Forward (Recommendations)

• Decentralized Empowerment: Empowering District-level AIDS Prevention and Control Units (DAPCUs) and local health institutions to tailor interventions to local needs, replicating the TANSACS model.
• Leveraging Technology: Using technology for better supply chain management of medicines (ART/TB drugs) and a centralized patient tracking system (Ni-kshay is a step in this direction) to ensure continuity of care.
• Focus on ‘One Health’: Extending the elimination concept to other comorbidities, such as HIV-Hepatitis B/C co-infection, which also pose a significant health threat.
• Mainstreaming Public Health: Making health education a core part of the curriculum and using mass media to continuously normalize and destigmatize conditions like HIV and TB.

Source: AIDS and TB fight — Tamil Nadu shows the way again – The Hindu

UPSC CSE PYQ

Year	Question
2013	Identify the Millennium Development Goals (MDGs) that are related to health. Discuss the success of the actions taken by the Government for achieving the same.
2015	Public health system has limitations in providing universal health coverage. Do you think that the private sector could help in bridging the gap? What other viable alternatives would you suggest?
2015	Professor Amartya Sen has advocated important reforms in the realms of primary education and primary health care. What are your suggestions to improve their quality and efficiency?
2018	Appropriate local community level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Discuss.
2019	In the context of the diversity of India’s health-care system, analyze the role of Panchayati Raj Institutions in ensuring equitable access to health services.
2021	COVID-19 pandemic accelerated class inequalities and poverty in India. Comment.
2022	In order to enhance the prospects of social development, sound and adequate health care policies are needed, particularly in the fields of geriatric and maternal health care. Discuss.
2022	Besides the welfare schemes, India needs deft management of inflation and unemployment to serve the poor and the underprivileged sections of the society. Discuss.
2023	Faster economic growth requires increased share of the manufacturing sector in GDP, particularly of MSMEs. Comment on the present policies of the Government in this regard.
2024	In a crucial domain like the public healthcare system, the Indian State should play a vital role in containing the adverse impact of marketization of the system. Discuss.