how do we find TB?

 The right diagnosis for tuberculosis

We can detect TB largely by 

• leveraging the systems already in place, 
• quickly deploying newer proven technologies

our target 

 Ending the TB by 2030 is among the health targets of the United Nations’ Sustainable Development Goals.

 Last year, Prime Minister Narendra Modi said that India is working towards eliminating TB five years ahead of the global 2030 target.

 How well-positioned is India to achieve this?

 In fact, in November 2023, the World Health Organization (WHO) acknowledged India’s success on two major fronts:

 in reducing TB incidence by 16% from 2015 to 2022 (close to double the pace at which global TB incidence is declining) 

and in reducing TB mortality by 18% during the same period

The weakest aspect

However, as Dr. Madhukar Pai, Dr. Puneet K. Dewan, and Dr. Soumya Swaminathan pointed out in ‘Transforming tuberculosis diagnosis’ in Nature, globally, diagnosis continues to be the “weakest aspect of TB care”

 WHO’s ‘Global Tuberculosis Report 2023’

 globally, 7.5 million patients were diagnosed with TB in 2022; 

 some 3.1 million people who probably fell ill with TB but were not diagnosed and reported to national TB programmes.

 “If we cannot find TB, we cannot treat TB. And if we cannot treat TB, we cannot end TB”.

So, how do we find TB? 

1  newer proven technologies and our system 

We can detect it largely by leveraging and optimising the systems and processes already in place, as well as by quickly deploying newer proven technologies that take diagnosis as close to the point of care as possible.

2  first step of screening patients: 

India regularly conducts active case-finding drives across the country. 

 3 reassess the screening procedures in place.

 Lancet study as well as the Indian Council of Medical Research’s ‘National TB Prevalence Survey in India’ showed that while screening people for symptoms is good, it is not substantive. 

Studies also show that in many cases, despite not showing any apparent symptoms, people may have infectious TB and may even be transmitting it.

4 X-ray imaging is a quick and efficient way to find these patients

Now, we not only have portable hand-held devices, but also software driven by Artificial Intelligence that can read digital X-ray images and detect possible TB with a high degree of certainty. 

While X-rays are good screening tools, it is imperative to detect TB bacteria in the patient with absolute certainty. 

5 The age-old sputum microscopy test and  newer molecular tests

has its limitations which are addressed by the newer molecular tests that are rapid, accurate, and even detect resistance against drugs. 

To be sure, India has scaled up molecular diagnostic capacity significantly. The NAAT (nucleic acid amplification test) machines in India have gone up from 651 in 2017 to more than 5,000 in 2022. 

ये तरीके कितने सफल 

१ But the utility of these tests is limited due to their high costs and issues with accessibility. 

२ Moreover, a large number of existing technologies including molecular testing are reliant on sputum collection and testing.

 ३ it may not be as easy for everyone, especially young children, to produce sputum /' थूक . 

४ , sample transportation, especially in remote and hilly districts, remains a challenge.

5 During the COVID-19 pandemic, when an alternative to nasopharyngeal swabs was introduced in the form of simpler nasal swabs, saliva, and self-collection, the testing coverage greatly increased.

Other collection techniques

1 other collection techniques such as tongue swabs 

which can be a true game changer. Here, the sample is extracted by simply rubbing the swab in the oral cavity.

 This augments our point-of-care testing abilities and also reduces the costs for overall diagnosis of TB.

 2 PCR machines

 which served us well during the COVID-19 pandemic. 

These are already fitted with the right diagnostic technology and can get to the last mile across the country effectively.

3 urine LAM test 

can also be used to detect cases in the general population effectively. This is a rapid test which is easily performed. It can help in screening for both pulmonary TB (lungs) and extra-pulmonary TB (organs other than the lungs).

Summary 

The TB diagnostics pipeline is rich with several new innovative tests on the anvil. However, to maximise these tests, their rapid validation and adoption under the programme is critical. 

To ensure we truly reach the last mile, point-of-care testing and diagnosis is imperative. 

The good news is we already have a diagnostic framework that is forward-looking. 

We need to simply improve implementation and be more proactive in deploying new technologies.

 We need to ensure that new technologies are streamlined and rolled out faster and build capacity at the sub-district level to conduct such tests as needed. Minor re-adjustments will make a major contribution to India’s TB elimination drive.

source the hindu