BY INVITATION. Time to scale-up innovations in TB diagnosis & treatment

Tuberculosis was first identified as a bacterial infection by Robert Koch, a German physician, in 1882. Sadly, even after a century since Koch’s breakthrough discovery, TB continues to kill over 1.5 million people every year.

On March 24, we observe World TB Day. This year’s theme for TB Day is ‘Reach, Treat, Cure Everyone.’ Every year, among the 9 million new cases of TB that occur worldwide, 3 million cases are missed. These patients are either not diagnosed or not notified to national TB programmes.

In 2015, India continues to be the world’s highest TB burden country, with over 2 million cases each year. According to the World Health Organisation, India alone accounts for 1 of the 3 million missing cases of TB. Furthermore, cities such as Mumbai are dealing with highly drug-resistant forms of TB, some of which are practically incurable.

How can we win the battle against TB in India? To curb the epidemic, we will need to reach the missing TB patients, diagnose TB without long delays, and make sure they take the full course of anti-tuberculosis therapy. Only then will they stop transmitting the infection to others.

Reaching all the missing patients and ensuring appropriate TB treatment will require doctors and TB control programmes to adopt innovative tools, and modernise TB care.

Thankfully, new technologies are finally here. We now have a novel, molecular test called Xpert MTB/RIF that can rapidly detect TB, including drug-resistance, within 2 hours. Over 10 million Xpert tests have been performed worldwide. With more laboratories offering such rapid tests, there has been a three-fold increase in the number of multidrug-resistant (MDR) cases detected.

Every patient with TB deserves a drug-susceptibility test to decide on the best treatment approach. Only then can we curb the emergence of MDR-TB.

To ensure this, doctors will need to use molecular tests that can detect mutations associated with drug-resistance, and also ask for culture tests to be performed. While such tests are expensive, a unique initiative called IPAQT ( www.ipaqt.org ) has made these tests more affordable and accessible to patients in India, through a network of over 80 private labs and hospitals. Many more labs and hospitals should join this worthy initiative, coordinated by Clinton Foundation.

There is also good news on the treatment front. Two new TB drugs, called bedaquiline and delamanid are already in the market in some countries.

In addition, trials are underway to evaluate the efficacy of a new TB treatment called PaMZ (which contains pretomanid, moxifloxacin and pyrazinamide). If these trials succeed, then TB patients might get new, shorter treatments within the next 5 years.

To make sure that Indian patients benefit from new drugs, the Government will need to streamline its regulatory and policy adoption processes, and proactively coordinate the introduction of new drug regimens, along with companion diagnostics that can detect drug-resistance to new regimens.

While we wait for better and shorter therapies, doctors and programmes can improve the effectiveness of existing treatments by improving treatment adherence. Drug-sensitive TB requires a full 6-month course of treatment. If adherence is poor, then drug-resistance can emerge.

There are many methods to ensure adherence, including directly observed therapy (DOT). While it is challenging for TB patients to visit health centres for DOT, we can and must harness the enormous potential offered by mobile phones to electronically monitor adherence to medications.

We simply cannot control TB with tools that Robert Koch used. It is time for doctors, hospitals, and healthcare programmes to embrace new TB technologies, and make sure TB patients get the best care that they deserve.

The writer is the Director of Global Health and Associate Director of McGill International TB Centre, McGill University, Montreal, Canada

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