Early TB detection, higher testing after Goa switches from microscopy to molecular

“Prior to Covid, the extent of testing for TB or the presumptive TB examination rate was 1330/lakh population which dipped to 780. However there was a sharp rise due to the introduction of upfront molecular tests,” Gaunekar said.

Molecular testing of samples for detecting TB at Ponda PHC

Many challenges

For health officials in Goa the challenges were numerous. Microscopy, a century old test with modest sensitivity and requires at least two smears to complete the testing process was the standard method to diagnose TB across its 24 designated centres. The drop in testing rates and how the staff would cope with virtual training about newer technology apart from the Covid scare were concerns that they had to address. As per the algorithm a rifampicin (drug used to treat TB) resistance test would be done within 15 days of being detected with TB. However primary health centres’ staff and nodal officers were sensitized about how to perform molecular tests. “Initially we had 5 Truenat testing sites and now there are 17,” Dr Gaunekar said.

Ensuring uninterrupted availability of Truenat test kits

WHO has recommended molecular testing as the preferred frontline testing for TB and as part of its flagship initiative to ‘Find. Treat. All’ (first launched in 2018) had called for replacing microscopy with upfront rapid molecular diagnostic test by 2027. This is mainly as microscopy underperforms in diagnosing TB and hence cases of TB can be missed. Worldwide almost 7 out of every 10 people with presumptive TB were not diagnosed by a molecular test in 2021.

Goa is among the two states in the country with 100 per cent molecular tests upfront as per the India TB report 2023 and at Ponda, Dr Govind Desai , District TB officer (South Goa) says microscopy is now relegated only to two or six months post treatment.

At a distance of 34 kms from Panjim, ensuring an uninterrupted availability of Truenat test kits is healthcare firm Molbio Diagnostics’s manufacturing unit–spread across 1.35 lakh sq ft at Verna, Goa. WHO has endorsed several upfront molecular tests for TB including Xpert MTB/RIF Ultra (Cepheid Inc, USA) and TrueNAT MTB-RIF Dx (Molbio Diagnostics, India).

Says Sriram Natarjan, CEO and co-founder , Molbio Diagnostics, “The Indian Council of Medical Research took three and a half years to validate this platform for diagnosing TB. Our Truenat machines were not only important during Covid-19 pandemic years but has shown how it is a multi disease diagnostic platform. From TB, HIV, hepatitis and so on, testing kits are a true point of care molecular diagnostic platform.”

Team at Ponda PHC with District Tuberculosis Officer Dr Govind Desai.

Tongue swabs next?

With a production capacity of more than 3.5 lakh units per day, the firm is also working on tongue swabs to detect TB. “We have taken multiple efforts to even take the lab to the people by using digital X-ray systems with the Truenat machine that can be deployed in areas to screen the population and test for TB. That is the level of efficiency we are trying to achieve,” Natarjan adds and appeals if TB has to be eliminated then tools have to be effectively deployed.

Bring labs to people

Formally launching the global call to Find TB to Stop TB at the conference, key activists Shobha Shukla, Coordinator , Asia Pacific Media Alliance for Health and Development , founder – CNS along with Dr Ishwar Gilada, Secretary General, People’s Health Organisation, Dr Tara Singh Bam, Board director (APCAT) and several others said that early and accurate TB diagnosis was a critical gateway to TB care pathway. Most other states are at different stages of replacing microscopy with molecular tests. Goa has shown the way and is among the two states in the country with 100 per cent molecular tests upfront. Bringing `lab to the people’ and not people to the lab is the first vital step towards finding TB, failing which despite the best tools, we will keep missing TB cases, experts said

 Risk factors and rise in death rate

Close to 700 TB deaths have been reported from 2018 till date in Goa. While officials admit that the death rate has risen from 4 to 6 per cent to nearly 10 per cent the concern remains risk factors like diabetes and alcohol. The prevalence of diabetes in Goa is 26.4 per cent as per the ICMR-INDIAB report and according to NFHS 5 data the intake of alcohol above the age of 15 is 59.1 per cent in males and 4.8 per cent in females.
Approximately 2,200 cases of TB are detected every year and at least 9-10 per cent deaths are registered , the state TB officer admits. In 2022 there were 174 deaths and 183 in 2021. We are addressing the situation by stepping up awareness and counselling sessions,” Dr Gaunekar said.
According to Dr Desai though the alcoholics proportion is high, most patients deny consumption. “Also on an average we detect between 55 to 60 cases of multi drug resistant TB. Also at the TB sanatorium at Margao, alcoholic patients are sent for regular counselling therapy. It has an average occupancy of 30 to 35 patients who are mainly homeless and are admitted for social reasons,” Dr Desai adds.