Missing TB cases remain a concern in India: Dr. Kuldeep Singh Sachdeva

New Delhi, March 23 (IANS) Missing cases of Tuberculosis (TB) coupled with diagnostic and treatment delays are the major roadblocks in India’s mission to end the deadly infection in the country by 2025, said Dr. Kuldeep Singh Sachdeva, the former head of India’s TB elimination programme at the Ministry of Health and Family Welfare (as Deputy Director General – TB) on Saturday.

According to the latest global research published in The Lancet Infectious Diseases journal, ahead of World Tuberculosis Day on March 24, tuberculosis incidence in India dropped only marginally by 0.5 per cent between 2015 and 2020.

The study reported that in 2020 India’s TB incidence stood at 213 cases per one lakh population, while deaths were between 3.5-5 lakh -- both remain well above the targets.

“Missing TB cases remain an important source of continued TB transmission. Ending TB is not possible without reaching all cases in the community, diagnosing them early and treating and supporting them towards a cure,” Dr. Kuldeep, currently the President and Chief Medical Officer of Goa-based Molbio Diagnostics, told IANS.

Raising public awareness and health-seeking behaviour followed by screening with sensitive tools like ultraportable X-rays, which can be deployed closer to them, are some of the ways to reach such cases, said the public health expert.

“Those who screen positive would need a final confirmation with highly sensitive and specific molecular tests preferably point of care tests as they can be deployed closer to patients even in remote settings. Deployment closer to the cases can save out-of-pocket expenses of the community and does not interrupt the routine day-to-day workflow of the cases and caregivers,” he noted.

Dr. Kuldeep also pointed out the delay between diagnosis and treatment that is increasing the spread of the deadly disease.

“Diagnostic and treatment delays are still being observed. These delays imply continued transmission of infective pools, potential for advanced disease and poor outcomes.

“Universal screening and deployment of point of care rapid diagnostics has the potential to diagnose cases early in the disease process. This coupled with starting treatment within 24-48 hours of diagnosis can interrupt the chain of transmission effectively,” he explained.

Rapid molecular diagnostic tests must be the initial diagnostic test in all persons with signs and symptoms of TB, as per the World Health Organization (WHO) guideline.

While there has been some progress in the use of molecular tests in India, the country “is still to reach its optimal potential,” the expert said.

Even as India aims to achieve the target of eliminating TB by 2025, in 2022, the country accounted for the highest number of TB cases in the world, as per the WHO’s 2023 report. With a whopping 2.8 million TB cases, India “represented 27 per cent of the global burden”.

“India is committed to achieving sustainable development goals for TB by 2025,” Dr. Kuldeep said.

“The country has taken various new initiatives to achieve rapid decline in cases quickly and implementation seems to be on track. The current burden remains high and these efforts need to be sustained for a few years to achieve SDGs,” he added.