Equip private doctors to curb TB in India: Study

Although treatment for tuberculosis (TB) is freely available and highly effective, it continues to kill hundreds of thousands of people every year in India. A vast numbers of cases go undetected, owing primarily to the ill-equipped private health care providers, says a study.

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, the researchers said.

"Most people in India with underlying TB initially seek care for cough from the private health care sector," said the study's lead author Henrik Salje from Johns Hopkins Bloomberg School of Public Health in the US.

Public TB clinics are better equipped to quickly diagnose and begin treatment for the disease, but patients are often reluctant to utilise them, the study said.

"Private providers often use the wrong tests for TB, and without getting the right diagnosis, patients move between providers with long diagnostic delays," Salje added.

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 percent 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 currently Xpert MTB/RIF is 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 percent over five years, while the "high-risk-only", public-sector strategy currently being implemented might only reduce TB cases by 0.2 percent.

The researchers 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.

Approximately 8.6 million people worldwide develop active TB each year, and 1.4 million die from it. Twenty-five percent of all diagnosed TB patients are in India alone.

The study appeared in the journal PLOS Medicine.