New Delhi: Against the backdrop of India’s TB Elimination Mission by 2025, a Parliamentary Standing Committee on Health and Family Welfare has pointed out that the lack of control of disease transmission, particularly in the slums, is leading to the rise in infection rate. The committee chaired by Rajya Sabha MP Bhubaneswar Kalita further stated that the detection of TB cases was being delayed due to a lack of an X-ray machine and cartridge-based nucleic acid amplification test (CBNAAT) tool.
The committee in its latest report tabled in Parliament recently stated that the efforts to screen and detect TB at early stages should be made on a war footing basis. Given the large population of the country as well as the target of achieving TB elimination by 2025, the committee suggested that there was a need to significantly increase the rate of TB detection cases by making efforts such as aggressive use of X-rays for faster TB diagnosis and confirmation of the disease.
The National TB Prevalence Survey 2021 showed that out of 100 TB cases, clinical assessment picked up only 62 cases while X-ray examination detected 95 cases. Also, among those diagnosed during the survey, more than 50 per cent did not have typical signs or symptoms suggestive of TB but had an abnormality in the chest X-ray, which led to their TB diagnosis.
“Hence, dependence on clinical assessment based on symptoms alone and the non-availability of X-ray diagnostic facilities led to about 33 per cent missed cases,” the committee said in its report. The committee suggested to the government to ensure X-ray facilities at all public healthcare facilities. Furthermore, to speed up the early detection of TB cases, deploying Artificial Intelligence-enabled portable and hand-held X-ray units for screening at district as well as block levels should be considered. Also, the provision of hand-held X-ray machines at registered private centres at discounted rates may be considered.
The committee also informed that in 2022, the percentage of PTBER-NAAT examinations where molecular diagnostic tests were conducted as the first test of diagnosis was 23 per cent of the total PTBER tests, including microscopy.
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National TB Prevalence Survey also showed that among one lakh people, microscopy picked up 152 TB patients while molecular tests picked up 285. Hence, considering the efficiency of molecular diagnostics is much higher than microscopy, further decentralisation of rapid molecular diagnostics, ensuring optimal utilisation of NAAT capacity to peripheral levels, at least the block levels, will lead to a significant decrease in missed TB cases per lakh population and curb transmission of the disease, the committee stated.
The committee also emphasised the holistic implementation of intensified case finding in OPDs of all healthcare facilities. “This involves systematic screening of all people seeking care in a health facility or a clinic for identification of people at risk for TB. Bi-directional screening of patients visiting the hospitals for diseases like diabetes must be brought into wide practice, which includes simultaneous diagnosis for TB, along with other ailments,” the committee said.
Stating that contract tracing is also very important to detect TB cases, the committee is of the view that there is a requirement for systematic planning and implementation of active case-finding campaigns among vulnerable population in the community. It should be done more aggressively to minimise the delays in the detection and treatment of TB cases.
“The government may also consider incentivising anybody in the community for a case referred to and diagnosed as TB,” it said. The committee also found that the causes for the spread of TB can vary across different regions due to a combination of social, economic, healthcare and geographical factors. “The detection and case finding pattern, along with control measures, should be well strategised with an understanding of the differences,” the committee said.
