India contributes nearly a quarter of the global burden of tuberculosis (TB) and continues to be a significant public health challenge in the country. Fortunately, the past two decades have witnessed innovations in diagnosis and treatment that are changing the TB care landscape and providing a stepping stone for TB control and eventual elimination in India. Advancements in TB Diagnosis A timely diagnosis is the first step for controlling TB. Conventional diagnostic tools like sputum smear microscopy have limited sensitivity and do not capture drug-resistant strains. India has responded to these challenges by adopting a range of novel diagnostic tools:
Truenat: Truenat, an invention of the Goa-based Molbio Diagnostics, is a point-of-care, chip-based molecular test for TB and rifampicin resistance. Truenat can be used to give an output within an hour helping in timely treatment decisions, and was approved by the World Health Organisation (WHO) in 2020. Because it does not require much infrastructure and is portable, it is particularly useful in remote or resource-poor settings. eCompliance: This system, which is based on biometrics, is used to ensure compliance with TB treatment protocols. eCompliance, for example, is a concept that employs a fingerprint or iris scan to track patients as they arrive to take their medications and is implemented by organizations like Operation ASHA. It improves the effectiveness of TB programs by reducing default rates and ensuring supervised treatment.
Innovations in TB treatment
As new strains of drug-resistant TB have come into play, new measures of approach to infection are required:
Bedaquiline: Developed by an international team of researchers including Indian scientist Anil Koul, Bedaquiline is an effective treatment for multi-drug-resistant TB (MDR-TB). It has conditional marketing authorisation in several countries including India and is included in the national TB elimination plans. India is using it since 2019, when it was made available through over 500 drug-resistant TB centers to ensure the #EndTB program by the Health Ministry. Shorter Treatment Regimens: Shorter and simpler TB treatment regimens are being explored, led by researchers including Dr. Zarir Udwadia. Work has been done in developing these regimens for better compliance and results in the present patients.
Community: Based Approaches Building community engagement is critical for TB programs to work:
Operation ASHA: This non-profit organization provides TB treatment via the DOTS (Directly Observed Therapy, Short-Course) approach, offering clinics in easily accessible and familiar locations (shop, temple, etc.) which decreases stigma and increases access to care. This model, which can be replicated in other countries, has been proven to be effective. Challenges and the Road Ahead Yet, such strides do not come without hurdles:
Awareness and Stigma: More is still needed for informing communities about symptoms of TB and alleviating the stigma associated with it. Healthcare infrastructure: In order to support the rapid scaling of new diagnostic and clinical tools, healthcare systems need to be strengthened.
Funding and resources: Motorised investments are needed for survival and growth of TB control programs. Take home lesson for India is that TB diagnosis and treatment innovations are changing the face of battle against a disease from ancient time. The country is a nation with high rate of TB (ceasing to be a public health problem) with marked utilisation of newer technologies as well as community approaches.
(The author, Dr. Sameer Bhati, Director of Star Imaging and Path Lab Pvt. Ltd.)
