India’s pursuit of eradicating tuberculosis (TB) by 2025, a goal set by Prime Minister Narendra Modi, faces significant hurdles. Despite the launch of the National Strategic Plan (NSP) in 2017, followed by a revised plan in 2020, the country remains far from meeting its diagnostic targets.

Struggling Diagnostics Landscape

The NSP 2017-2025 aimed to reduce the use of sputum smear microscopy for TB detection and increase the utilization of molecular tests. However, as of 2022, India fell short of these aspirations. Only 23% of presumptive TB cases were detected using molecular tests, while smear microscopy accounted for the majority, detecting 77% of cases. The revised NSP introduced even more stringent diagnostic requirements, emphasizing precision tests for initial diagnosis.

Revised NSP’s Ambitious Goals

The revised NSP prioritizes early detection of presumptive TB cases, advocating for “prompt diagnosis” through sensitive tests at the first point of contact, whether in the private or public sector. Furthermore, the plan emphasizes universal access to high-quality TB diagnosis, including drug-resistant TB. It aims to scale up advanced diagnostic services and TB surveillance capacity, replacing smear microscopy with molecular tests.

Implementation Challenges

Despite the NSP’s vision, India faces obstacles in transitioning to molecular testing. Even though the revised plan mandates the replacement of smear microscopy with molecular tests in all TB diagnostic centers, this transition remains unrealized. While the revised NSP highlights the need for rapid transition, progress has been slow.

Bacteriological Confirmation and Drug Resistance

Another concern lies in the proportion of bacteriologically confirmed cases. In 2022, only 59% of notified TB patients in the public sector had confirmed cases, indicating a reliance on X-rays and clinical evaluation without bacteriological confirmation. Additionally, the percentage of confirmed cases with tested rifampicin resistance was just 77%, falling short of universal drug-susceptibility testing goals.

External Recommendations

In 2019, WHO and the Joint Monitoring Mission assessed India’s TB program and recommended urgent measures to achieve the 2025 goal. One vital suggestion was replacing smear microscopy with molecular tests nationwide. To accelerate molecular testing, the WHO-JMM team proposed utilizing private sector capacity for 20 million molecular tests annually.

Challenges in Implementation

Challenges persist in terms of both resources and infrastructure. Limited availability of molecular testing machines, scarcity of trained personnel, and shortage of molecular tests hinder progress. The revised NSP acknowledges difficulties in accessing NAAT-based molecular tests at peripheral health institutions for active case finding.

Outsourcing to the Private Sector

Given the constraints, outsourcing molecular tests to the private sector becomes a necessity. This approach can improve case detection at the initial point of contact while awaiting universal access to molecular tests in the public sector.

In conclusion, India’s pursuit of eliminating TB by 2025 is facing formidable challenges in the realm of diagnostics. Despite ambitious goals and revised strategies, the transition from smear microscopy to molecular tests remains sluggish. The need for rapid action, collaboration with the private sector, and overcoming resource constraints are pivotal to achieving this vital health objective.

Source: The Hindu

Frequently Asked Questions (FAQs) About India’s TB Detection Goals

1. What are India’s goals for TB eradication?

India aims to eliminate tuberculosis (TB) by 2025, as set by Prime Minister Narendra Modi. This ambitious goal was established to combat the widespread impact of TB in the country.

2. What is the National Strategic Plan (NSP) for TB?

The National Strategic Plan (NSP) is a comprehensive framework developed by India’s Health Ministry to guide efforts in achieving the goal of TB elimination. The NSP outlines strategies, approaches, and targets for TB detection, treatment, and prevention.

3. How has India’s progress been in meeting its TB detection targets?

As of 2022, India has faced challenges in meeting its TB detection targets. Despite efforts outlined in the NSP, the utilization of molecular tests for TB detection remains lower than desired, with smear microscopy still being the predominant method of diagnosis.

4. What is the role of the revised NSP in addressing TB detection challenges?

The revised NSP introduced in 2020 emphasizes precision tests for early TB diagnosis and underscores the need for scaling up advanced diagnostic services. It aims to replace smear microscopy with molecular tests for more accurate and efficient detection.

5. What percentage of presumptive TB cases were detected using molecular tests in 2022?

In 2022, only 23% of presumptive TB cases were detected using molecular tests, highlighting the gap between the target set by the NSP and the current reality.

6. How has the private sector been involved in TB detection?

To accelerate TB detection and reach the 2025 goal, the revised NSP proposes leveraging the private sector’s capacity for molecular testing. This collaboration can help increase the availability of advanced tests across the country.

7. What challenges hinder the transition to molecular testing?

India faces challenges in implementing molecular testing due to limited availability of machines, shortage of trained personnel, and a scarcity of molecular tests. These constraints slow down the transition process.

8. What are the consequences of not achieving diagnostic goals?

Failure to meet diagnostic goals could hinder the timely detection of TB cases, potentially leading to delayed treatment and continued transmission. This underscores the urgency of addressing these challenges.

9. How important is bacteriological confirmation in TB diagnosis?

Bacteriological confirmation is crucial for accurate TB diagnosis. In 2022, only 59% of notified TB patients in the public sector had bacteriologically confirmed cases, suggesting a reliance on other diagnostic methods.

10. What is the significance of drug resistance testing in TB management?

Universal drug-susceptibility testing is vital for identifying drug-resistant TB cases early, enabling appropriate treatment and preventing further spread of drug-resistant strains.

In summary, India’s journey toward TB elimination by 2025 is marked by challenges in achieving TB detection targets, transitioning to molecular testing, and ensuring widespread access to accurate diagnostic tools. Collaboration with the private sector and overcoming resource limitations are essential steps to successfully address these obstacles.