14 C
New Delhi
Sunday 19 January 2020

Rollout strategy is key to battling India’s TB epidemic

A new study led by Johns Hopkins Bloomberg School of Public Health researchers suggests that getting patients in India quickly evaluated by the right doctors can be just as effective at curbing tuberculosis (TB) as a new, highly accurate screening test.

While ideally all suspected TB cases would be evaluated with the new test, it is primarily being used only on the highest-risk populations and only in public health clinics, partly because of its cost and the complexity of the nation’s health care system. This slows diagnosis of a disease that must be caught early, the researchers say.

A report on the research, conducted in conjunction with researchers at McGill University and others, is published July 15 in the journal PLOS Medicine.

Approximately 8.6 million people worldwide develop active TB each year, and 1.4 million die from it; 25% of all diagnosed TB patients are in India alone. Although treatment for TB is freely available and highly effective, TB continues to kill hundreds of thousands of people every year in India, and vast numbers of cases go undetected. Public TB clinics are better equipped to quickly diagnose and begin treatment for the disease, but patients are often reluctant to utilize them. The researchers say that for better TB tests to make a major difference they must be made available to the private health care providers where patients first seek care.

“Most people in India with underlying TB initially seek care for cough from the private health care sector,” notes the study’s lead author Henrik Salje, PhD, a postdoctoral fellow in the School’s Department of Epidemiology. “Private providers often use the wrong tests for TB, and without getting the right diagnosis, patients move between providers with long diagnostic delays.”

Often, patients with symptoms start with convenient and more trusted private sector physicians and informal health care providers, but ultimately public sector physicians diagnose and treat more than half of the TB cases in India. They have long used sputum smear microscopy, which may miss up to half of all active cases.

The new test for TB, Xpert MTB/RIF, can diagnose TB in 90 minutes, capture 70% of cases missed by microscopy and can also determine if the strain is resistant to rifampin, the most important anti-TB drug. India has begun rolling out this new technology, but since Xpert MTB/RIF is much more expensive than traditional tests, it is currently being implemented mainly in public clinics to test HIV-positive patients who may also have TB or those at high risk of having multidrug-resistant tuberculosis (MDR-TB).

For their study, the researchers explored the impact of six different rollout strategies by developing a mathematical model of TB transmission, care-seeking and diagnostic and treatment practices in India. They found that providing access to Xpert for 20 percent of all individuals seeking care for TB symptoms could reduce new TB cases by 14.1% over 5 years, while the “high-risk-only,” public-sector strategy currently being implemented might only reduce TB cases by 0.2%. However, achieving this result required substantially more resources and appropriate TB treatment. The authors also found that simply improving the referral network of informal providers to the public sector  without any new testing at all  could have as much of an effect on TB as scaling up the new Xpert test.

“The impact of better TB diagnosis depends not only on the accuracy of the test, but also on the behavior of both patients and providers, good access to validated new tools, and quality TB treatment following diagnosis,” says the study’s senior author David W. Dowdy, MD, PhD, an assistant professor in the Department of Epidemiology. “To achieve maximum impact of novel diagnostics, India should engage the private sector, improve quality of care across all sectors, and dramatically increase the resources used to fight TB.”


Story Source:

The above story is based on materials provided by Johns Hopkins Bloomberg School of Public Health. Note: Materials may be edited for content and length.


Journal Reference:

  1. Henrik Salje, Jason R. Andrews, Sarang Deo, Srinath Satyanarayana, Amanda Y. Sun, Madhukar Pai, David W. Dowdy. The Importance of Implementation Strategy in Scaling Up Xpert MTB/RIF for Diagnosis of Tuberculosis in the Indian Health-Care System: A Transmission Model. PLoS Medicine, 2014; 11 (7): e1001674 DOI: 10.1371/journal.pmed.1001674

Stay on top - Get daily news in your email inbox

Sirf Views

Fear-Mongering In The Times Of CAA

No one lived in this country with so much fear before,” asserted a friend while dealing with India's newly amended citizenship...

CAA: Never Let A Good Crisis Go To Waste

So said Winston Churchill, a lesson for sure for Prime Miniter Narendra Modi who will use the opposition's calumny over CAA to his advantage

Archbishop Of Bangalore Spreading Canards About CAA

The letter of Archbishop Peter Machado to Prime Minister Narendra Modi, published in The Indian Express, is ridden with factual inaccuracies

Sabarimala: Why Even 7 Judges Weren’t Deemed Enough

For an answer, the reader will have to go through a history of cases similar to the Sabarimala dispute heard in the Supreme Court

Tanhaji: An Unabashed Celebration Of Hindutva

Tanhaji: The Unsung Warrior Film Review | Featuring Ajay Devgn, Saif Ali Khan, Kajol, Sharad Kelkar, Luke Kenny and Neha Sharma

Related Stories

Leave a Reply

For fearless journalism

%d bloggers like this: