India to scale up on TB test that also detects drug resistance

P. T. Jyothi Datta Mumbai | Updated on February 01, 2013

A test that detects tuberculosis and shows whether a patient is resistant to a key tuberculosis drug is set to find greater use in India’s TB control programme.

The Xpert test, endorsed by the World Health Organisation, detects TB accurately and in two hours, besides simultaneously showing whether the patient is resistant to rifampicin, as an indicator of multidrug resistance.

The Government TB-control programme already uses about 30 machines, and will add another 40 this year, a Union Health Ministry official told Business Line. With a handful of new tests in the pipeline, the Government is staggering its approach and not putting all its eggs in one basket, the official added.

At present, the programme that covers the country is a mix of conventional tests (liquid and solid), line probe assays and the Xpert test. The time for diagnosis also varies across these tests, from a month, to a day to a couple of hours, respectively, and the machines and kits are accordingly placed at primary healthcare centres, regular hospitals or large tertiary hospitals, the official said.

Negotiated price

A recent review on The Xpert test published by The Cochrane Library also gave the test its thumbs-up. The test is more sensitive than sputum smears and is less operator-dependent, said Dr Madhukar Pai, Associate Professor (Department of Epidemiology and Biostatistics) with McGill University, Canada.

“While thousands of TB bacteria must be present in each millilitre of sputum sample for TB to be detected under the microscope, Xpert can detect TB bacteria at much lower concentrations. In addition, the conventional microscopy approach does not detect drug resistance, while Xpert can rapidly detect resistance to rifampicin, the most important first-line TB drug,” explained Dr Pai, one of the authors of the recent study.

The kits would be available for the public sector at $10 per cartridge, he said. It is available in the private sector, but priced very high (as much as Rs 3,000 or higher per test), he said, adding efforts were underway to it more affordable in the private sector.

The Government gets the machine and kit at the mentioned negotiated price, the Ministry official concurred, adding that for patients at Government institutions, the test were free.

The private sector is excluded from this subsidised pricing and this should be changed, said Dr Pai, especially since poor patients in India visit private hospitals, as well, he said.

The recent review, the author said, was since there were few studies on the test when the WHO approved it. The latest review combines results from 18 studies and provides greater confidence in the early results that were used by WHO for the policy, he added.


Published on February 01, 2013

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