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Early diagnosis of drug resistance is crucial to ending TB

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Shobha Shukla, Citizen News Service - CNS

Despite being treatable, TB remains a major global public health problem. As Dr Mario Raviglione, Director

Strong evidence to detect MDR at time of TB diagnosis
Strong evidence to detect MDR at time of TB diagnosis
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Global Tuberculosis Programme of WHO, informed, in 2013, 9 million people fell ill with TB in; 1.5 million men, women and children died from it; 480,000 people developed multi drug resistant TB (MDR-TB), with 210,000 associated deaths. Also, 60% of all MDR-TB cases can be attributed to India, China, Russia, Pakistan and Ukraine.

With an estimated 26% of the global TB cases, India holds the dubious distinction of having the highest incidence of drug sensitive TB and multi MDR-TB cases globally. In 2014, an estimated 61000 MDR-TB cases were notified under the government's Revised National TB Control programme (RNTCP) with another approximately 30000 cases in the private sector.

Early and improved case detection of TB, including MDR-TB, is therefore one of the global priorities for TB control. A recent multi centric demonstration study titled 'Use of Xpert MTB/RIF in Decentralized Public Health Settings and Its Effect on Pulmonary TB and DR-TB Case Finding in India', assessed the impact of up-front Xpert MTB/RIF (the first automated molecular test for diagnosing pulmonary TB and rifampicin-resistant pulmonary TB) testing in India.

Dr KS Sachdeva, Additional Deputy Director General, Central TB Division Ministry of Health & Family Welfare, Government of India, and lead author of the study informed that the key aim of this pilot study was to have an impact assessment of upfront testing for all TB presumptive cases, including those of MDR-TB, with Xpert MTB/RIF (instead of smear microscopy). The study was done at 18 decentralized Xpert MTB/RIF laboratories established at existing public sector microscopy centres in diverse geographic and demographic settings (8 in rural, 6 in urban and 4 in hard to reach tribal and hilly areas) covering a population of 8.8 million. A baseline phase in 14 centres captured programmatic baseline data, and an intervention phase in 18 centres offered Xpert MTB/RIF to all presumptive TB patients.

Results of the study

The study data shows that upfront Xpert MTB/RIF testing resulted in:

(i) An increment of 6-7% on TB detection rates-- baseline phase that tested on microscopy, showed a positivity of around 14%, whereas intervention phase that tested by Xpert showed a positivity of more than 20%. Thus an additional 7% were diagnosed due to Xpert.

(ii) An overall increase of 11% in TB case notification for all forms of pulmonary TB and an increase of 39% for bacteriologically confirmed TB cases.

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