Govt’s low-cost solutions are helping eliminate TB, say officials

A list of affordable solutions introduced by the unification ministry of wellness and fellowship welfare as part of the National Tuberculosis Elimination Programme has ensured that cases are identified and put on treatment in time, especially in remote areas of the country, bringing India closer to the elimination target, officials familiar with the matter said on Sunday.India has set a TB elimination target for 2025 — five years ahead of the global target of 2030.Among the new Innovations rolled out under the programme the Indian Council of Medical Research (ICMR) has validated three indigenous handheld X-ray devices, which made it possible to reach vulnerable population groups for TB screening conveniently. Hand-held devices offer advantages of low weight, portability, and low radiation exposure and are being used in the health ministry’s 100-day accelerated programme that was launched in December, last year.The biomedical research regulator also partnered with the Institute of Plasma Research, Ahmedabad, to develop DeepCXR, a tool for artificial intelligence-based reporting chest X ray films, and AI tools, said the health ministry, are expected to be a gamechanger in detecting presumptive TB patients and quick initiation of treatment. Among diagnostic measures, ICMR also validated CyTb skin test for detection of latent TB infection.“Health Technology Assessment India under Department of Health Research has assessed the TB health Technologies like Truenat for TB diagnosis, BPAL/BPALM regime for MDR TB, Techo plus for tracking and managing TB health services, AI enabled chest X-ray diagnosis and TMEAD an adherence monitoring device for TB treatment,” said Anupriya Patel, minister of state for health, during the inauguration of India Innovation Summit – Pioneering Solutions to End TB, last week.She added: “Use of digital health, artificial intelligence, data collection and health promotion will also play a critical role in reaching the “missing millions” of people with TB who go undiagnosed, and therefore untreated, each year. All innovators should continue their endeavour to develop useful tools for introduction into the programme and help achieve the goal of TB elimination.”The CyTb skin test has been developed by Serum Institute of India against interferon gamma release assay (IGRA), which is the preferred test for latent TB detection. Overall performance of CyTb was better than the currently used tuberculin skin test; however, IGRA is expensive and it may not be feasible to be introduced in resource limited countries, according to experts in the government.ICMR also conducted a multicentric validation of PathoDetectTM— an indigenous molecular diagnostic NAAT test which can perform 32 tests simultaneously, detects MTB complex and first line drug resistance to rifampicin (RIF) and Isoniazid (INH) simultaneously as a one step process.Overall, the performance of PathoDetectTM was found to be comparable to other molecular assays.According to officials, deployment of this test in the 100-day programme, along with the already available TruNat test, has enhanced capacity of molecular diagnosis of TB and early detection of drug resistance. Moreover, the Quantiplus MTB FAST Detection Kit developed by Huwel Lifesciences is the first in world indigenous open system RTPCR kits developed in India and validated by ICMR. In comparison to the gold standard liquid culture, sensitivity of the kit is 86 % and specificity is 96 %. These kits are likely to be low-cost and have a potential to expand the outreach of TB molecular testing, including more than 3300 RTPCR machines used during the COVID-19 pandemic.Underlining the role of innovations in TB elimination, Patel further said that innovations were crucial for TB elimination, offering faster and more accurate diagnostics, improved treatment regimens, and better prevention strategies.The number of missing cases has been reduced from 15 lakh in 2015 to 2.5 lakhs in 2023. The programme was able to notify 25.5 lakh TB and 26.07 lakh cases in 2023 and 2024 respectively-- the highest ever. WHO’s Global TB Report 2024, mentioned that the incidence of TB in India has shown a 17.7% decline from 237 per lakh population in 2015 to 195 per lakh population in 2023. TB deaths have reduced by 21.4% from 28 per lakh population in 2015 to 22 per lakh population in 2023. In addition, TB treatment coverage in India has increased by 32% in last eight years from 53% in 2015 to 85% in 2023. 100-days intensified tuberculosis (TB) campaign that is underway since December, last year, in 455 high-priority districts, screened at least 10 million vulnerable population.