Pune: A large-scale tuberculosis survey in Pune has exposed a worrying problem in India’s fight against the disease, detecting recurrent TB in several survivors. In most of these cases, symptoms were back within just six months of treatment completion.
The findings, researchers said, indicate that successful completion of TB treatment does not mean clinical follow-ups should stop. The researchers added that their study also found that home-based screening was significantly better at detecting recurrent TB than telephone-based screening.
“It demonstrates the importance of actively looking for TB recurrences after treatment completion. When recurrent disease goes undetected, patients continue to suffer, and the resulting lung damage can significantly impact their quality of life,” said Dr MS Barthwal, a contributor to the study and a professor of respiratory medicine at DY Patil Medical College, Hospital & Research Centre.
Findings of the study, called TB Aftermath (TBAM), were recently published in Lancet Global Health. Researchers followed 1,076 TB survivors and 3,309 household contacts for 18 months after treatment completion across six government TB clinics in rural and urban Pune, from Jan 21, 2021 to Sept 4, 2023.
They found 75 TB survivors (7% of the surveyed) with recurrent TB during the follow-up period, while 30 household contacts (1%) were newly diagnosed with TB. Tuberculosis can spread through the air among close contacts. The median time to diagnosis was less than six months after treatment completion, highlighting that the post-treatment period was a critical window for active surveillance. Researchers said they now hope the data helps guide policy decisions on post-treatment TB surveillance.
“Completing treatment is a major milestone, but for many people, the journey with TB does not end there,” said lead author Dr Jonathan Golub, from Johns Hopkins University, Baltimore. “Our study offers strong evidence that TB survivors in high-incidence settings like India are a high-risk group that would benefit from recurrence screening. These findings also have important policy implications that extend beyond India,” he added.
The country has made progress against TB. Estimated incidence fell 21%, from 237 per lakh in 2015 to 187 per lakh in 2024. Mortality has declined too – from 28 to 21 per lakh over the same period.
Dr Vidya Mave, director of the Centre for Infectious Diseases in India (CIDI) and principal investigator for the TB Aftermath Study, said: “An interesting finding was the increasing contribution of prior extrapulmonary tuberculosis among people who had altered lung function tests and developed recurrence. Although the route of transmission remains the same, the disease may manifest outside the lungs, emphasizing the need for comprehensive follow-up of all TB survivors.”
