A challenge which is puncturing efforts to diagnose TB early and accurately is use of diagnostic tests that are not WHO-approved for active TB disease. A part of private health sector in India has been using tests that are not meant to be used for diagnosing active TB disease: such as antibody blood serology, or QuantiFERON Gold or Platinum. QuantiFERON Gold or Platinum may be a test for diagnosis LATENT TB, but not active TB disease.
The government of India had banned antibody blood serology for TB diagnosis in June 2012. We need WHO-approved standard tools for diagnosing active TB disease.
Private sector is mostly not notifying TB
Government of India made it mandatory in May 2012 that every single private practitioner or private laboratory must notify all TB cases to the RNTCP through its user-friendly electronic portal called NIKSHAY. "But TB notification from private health sector is hardly happening in India" said Dr Pai.
Public health community needs to worry because not only private health sector is not always notifying TB cases but use of non-evidence based tests is still occurring. If ending TB is a goal in sight, then every TB case has to be diagnosed early, treated with drugs that work for her/him, and adherence needs to be ensured too - among other components of TB care and control.
"We have 1 million missing TB cases in India -- we have no idea of what's happening to them - how are they being diagnosed in private (if they are being diagnosed at all!), what drugs are they being treated with, how treatment is being monitored, how adherence is being ensured, etc."
External Quality Assurance is a stepping stone, not a stumbling block!
"If we go around India we see one-room small laboratories --what is the quality of any of the test being done there? RNTCP has a nationwide network of sputum microscopy and has taken it years to develop a strong robust system for External Quality Assurance (EQA). Private sector has very little in terms of EQA. What to talk of quality of sophisticated tests, we cannot even trust the quality of sputum smear microscopy done in a laboratory that does not have EQA."