Addressing undernutrition to end TB: evidence from the RATIONS cluster randomised trial in India

Anurag is an internist/epidemiologist who has worked at various levels of care over the past 33 years with a focus on tuberculosis care and prevention, acute febrile illnesses, and access to essential medicines. He is a member of STAG-TB, WHO, Geneva and loves teaching clinical medical students. Madhavi was a surgeon and now teaches community medicine. Her focus is primary care, social determinants, adolescent and maternal nutrition. She loves mentoring students in research and socially relevant pursuits. Anurag and Madhavi were PI and Co-PI of the RATIONS trial of nutritional support in TB prevention and care.

Topic: Undernutrition is the leading risk factor for TB incidence in India contributing to an estimated 0.75-0.9 million of the 3 million new cases annually. It is highly prevalent in persons with TB (PWTB), often severe, and is a leading risk factor for deaths. RATIONS was the first trial (supported by ICMR) globally to aim for a reduction of TB incidence by improving the nutritional status of those at risk. It was also the largest cohort study of 2800 patients with TB who were given nutritional support to improve TB treatment outcomes. The presentation will provide the rationale for RATIONS from the background research on TB and nutrition of the researchers, highlight the operational aspects of this cluster-randomized trial, discuss the results and the way forward.