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According to the Lancet paper, a nutritional intervention in the form of food baskets (1200 kcal for patients with TB and 750 kcal for household contacts) and micronutrient supplements distributed to adults for TB treatment is cost-effective and could substantially decrease rates of TB deaths and infections if introduced across India.

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In 2013, the World Health Organisation recommended nutritional assessment, counselling, and support in selected groups as integral components of TB care. The study researchers estimate that if 50% of adults in TB-affected households in India received nutritional support it would protect nearly 900,000 people from developing TB and prevent more than 350,000 deaths by 2035. In case of 80% coverage, these numbers are predicted to be as high as around 1.4 million and 570,000, respectively. To ensure maximal uptake, authors suggest that food baskets should be designed through community-engaged research, incorporating dietary practices, preferences, and cultural norms of the target population.

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The study— Estimating the epidemiological and economic impact of providing nutritional care for tuberculosis-affected households across India: A modelling study — also highlighted a prior trial on Reducing Activation of Tuberculosis by Improvement of Nutritional Status (RATIONS) from the state of Jharkhand that provided evidence on the effectiveness of nutritional support intervention in reducing TB incidence in the household contacts of adult patients with TB as well as improving treatment outcomes for the patients themselves.

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“The new study models the effects of scaling up such an intervention nationally, to estimate the potential impact of the intervention on TB incidence and mortality in the longer term, as well as looking at if such an intervention would be cost-effective,” read the paper. The researchers estimate that this type of intervention is cost-effective and is highly likely to bring health benefits beyond TB management, thereby improving population-level equity.

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TB is a leading infectious disease worldwide and in India nearly 2.6 million new patients were notified last year. The Indian government has been proactive in providing nutritional support to TB patients under its Ni-Kshay Poshan Yojana. The need to meet the nutritional needs of TB patients was understood quite early on by the experts involved in implementing the Centre’s TB elimination programme.

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“The government has also decided to introduce energy dense nutrition supplementation for all patients with BMI<18.5 and to permit expansion of scope and coverage of Ni-Kshay Mitra initiative under Pradhan Mantri TB Mukt Bharat Abhiyaan to the family members (household contacts) of TB patients,” said Union health minister JP Nadda, last year. With India aiming to eliminate TB by this year, this could well be a key intervention.