In my last piece I had discussed why TB was a social issue more than a medical issue.
Today I wanted to put down my thoughts on the need for better diagnostics as means to catch the disease. Often the challenge in India is wrong diagnosis. This not only affects the patients but also leads to further complications for the medical services. TB is no exception to this problem. Today many patients suffer due to ineffective diagnosis which sets the patients on the wrong path.
WHO has approved tests which are very effective. But these tests are expensive. The Indian Government does test for free and provides medicines as well, but the number of patients that the Government could track and diagnose are lesser than the whole TB patient population.
The private sector has not been able to bear the costs themselves and why should they ? As they need to be financially profitable to continue the private healthcare set up transfers these costs to the patients. As a result many in the private sector are not able to afford these tests. Lets not forget that the strata of society affected by TB is relatively the poorer sections.
Currently the most common method of testing is the sputum smear microscopy. This test is more than a 100 years old and can prove to be very ineffective. Also the coincidence of TB and HIV further reduces the efficiency of this test. The most accurate form of testing is the Nucleic Acid Amplification test that is automated by using a cartilage.
Now this test costs around $26 that would be roughly Rs 1300. Under the NSP the plan was to get $16 subsidized by a consortium including the USAID, Bill & Melinda Gates Foundation & PEPFAR. The rest would be borne by the Government of India. So the Government technically pays $ 10 per test.
Also there are plans to set up a decentralized system for screening especially the resistant instances of TB. The Revised National TB Control Program (RNTCP) created a plan with an aim to provide universal access for quality diagnosis and treatment for all TB patients in the community. Outlined in plan the RNTCP is supposed to decentralize screening of drug-resistant patients at the district level and also strengthen laboratory capacity to ensure timely and accurate diagnosis of TB. In this context the programme conducted a nation-wide survey to study the feasibility and cost-effectiveness of the World Health Organization (WHO) approved automated cartridge based nucleic acid amplification (i.e GeneXpert). The Program aims to install at least two such machines in every district of India by 2016-17.
But the key is to reduce the cost of the tests while increasing their accuracy. The currently serological tests are only available at the Government facilities with the private sector being banned from conducting these tests. The other tests available to detect latent TB are expensive as well. Tests like Interferron Gamma Release Assys can cost upto Rs 3000 per tests.
But I think the key is to develop effective tests indigenous. Considering 80 % of the Indians carry the TB Bacilli latently within them, it makes sense for research organizations and pharmaceutical companies alike to focus on looking at a domestically created test that will not only increase the efficiency of the tests and also reduce the burden of the disease both financially and emotionally.
In the end TB is a lot about diagnosis. The earlier and more accurately it is diagnosed, the better are its chances of getting cured completely. In the end the old adage goes “Prevention is better than cure”.
As always, comments, Suggestions and questions are welcome….