'Quick evaluation key to fighting TB in India'

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, a new study suggests.
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 said.
Approximately 8.6 million people worldwide develop active TB each year, and 1.4 million die from it. Twenty-five per cent of all diagnosed TB patients are in India alone.

Although treatment for TB is freely available and highly effective, the disease continues to kill hundreds of thousands of people every year in India, and vast numbers of cases go undetected.
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," said study's lead author Henrik Salje from the Johns Hopkins Bloomberg School of Public Health.
"Private providers often use the wrong tests for TB, and without getting the right diagnosis, patients move between providers with long diagnostic delays," said Salje.

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 per cent 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 multi-drug-resistant tuberculosis (MDR-TB).

Researchers explored the impact of six different roll-out 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 per cent of all individuals seeking care for TB symptoms could reduce new TB cases by 14.1 per cent over 5 years, while the "high-risk-only," public-sector strategy currently being implemented might only reduce TB cases by 0.2 per cent.
However, achieving this result required substantially more resources and appropriate TB treatment.
The research was published in the journal PLOS Medicine.