Private players hold the key to map TB cases misse­d by health system?

New Delhi: When a medical student of Banaras Hindu University, (BHU), Varanasi, hanged herself in her hostel room a couple of months ago,  it set alarm bells ringing. What made it more traumatic and painful was when it was discovered that she took this extreme step because she was suffering from pulmonary TB.  It seems the number of TB patients in India refuses to go down despite the government upping the ante to defeat this debilitating disease by the year 2025. The wider picture of the missing millions, who are vulnerable to this dreaded disease, is a cause for grave concern.

The government is committed to make India TB free, five years before the UN mandated deadline of 2030 under its Sustainable Development Goals (SDGs). According to health specialists and policy makers, there is a need for a multi-pronged approach involving the government, private players and pathological laboratories, if this goal is to be achieved.

Out of 10 million cases reported globally every year, 2.7 million (27%) cases are reported from India. Statistics reveal that 40 per cent of TB cases are missed by the health delivery system which is very alarming as mortality due to TB is the third leading cause for loss of lives in the country.

Now, the bigger question is how to address this huge challenge? “India can be TB free by 2025 by ensuring that all suspects are first diagnosed,  and those tested positive for TB, are brought under the treatment regime, be it in the government or private sector,” says NextGen Invitro Diagnostics Ltd, (NGIVD) Chief Executive Officer Vivek Chandra.

Quick detection

Laboratory diagnosis of TB cases for treatment, notification, and prevention of spread, holds the key to arrest the disease and stop it from spreading. “TB Lamp is an economical option which is WHO endorsed to quickly detect active TB cases, that too in less than an hour’s time in Pulmonary TB cases. Labs play a crucial role in giving acceptable evidence of active TB on the basis of which treatment/DBT will be initiated,” says Dr Shalabh Malik, National Head of Microbiology and Serology, Dr Lal Path lab.

This is the only molecular test which is robust, accurate and fast with high sensitivity and specificity. It can be performed with minimal training and without any special lab infrastructure. The instrument can be operated with a battery and solar panel.

In India, complex conditions like Multi-Drug Resistance TB (MDR-TB) make treatment more difficult. Sadly, India has the highest burden of TB and MDR-TB in the world.

Role of private players

NGIVD founder Chandra stresses that diagnosis is the key that can lead us to the path of ending TB. “A diagnostic tool which is available in close proximity to  the patient, even in remote location, will ensure that none of these TB suspects are left undiagnosed. Coupled with diagnostic tools like GeneXpert, which enables fast Drug Sensitivity testing, the right medication and programs like 99dots, there is a comprehensive eco-system which is being created to tackle the disease. Major emphasis has to be now on how to increase cooperation from the private sector, which accounts for almost half of the total disease incidence.”

The social stigma attached to the disease needs to be tackled by on-ground social workers so that more patients are encouraged to talk openly and access the government program. “Mandatory notification is a welcome step, however, many view it as a carrot and stick approach. To enable the right motivation, NGOs, philanthropists, big industrial houses & private practitioners need to come together and institute large-scale screening campaigns to bring more suspects into the treatment regime,” he says.

 “Through our reach to small labs, low cost and ease of use, we are training even less trained technicians to use TB LAMP and thus provide a highly accurate diagnostic test at the peripheral level. Our ongoing validation in peripheral settings will enable it to be part of National program and thus be accessible to town and rural population,” he says.