Goa : Tuberculosis continues to be a significant healthcare challenge in low and middle-income countries and to hit the United Nations Sustainable Development Goals (SDGs) of at least 80 per cent reduction in incidences by 2030, countries will need to accelerate efforts on a wide set of detection, preventive and treatment measures.
In 2023, India reported 25.37 lakh new cases, a jump over 2022, but world health agencies have attributed the higher incidence in cases to better use of tests and detection strategies.
Delegates drawn from 34 countries, including India, Ghana, Ethiopia, Zimbabwe, Nigeria and Bangladesh met and agreed on a “Goa Declaration” that called on world leaders to adopt successful strategies that are evidence and science-based approaches to find, treat and prevent TB. Those can be integrated as part of their existing programs to demonstrate high impact interventions.
Among the key measures outlined in the meeting held between May 15 and May 17, delegates drawn from government agencies and health groups, shared insights on a plethora of successes in their countries. One of the biggest impacts was from an intensified active case finding initiative for key vulnerable population in Delhi, known to have a high TB incidence.
An extract from the Goa Declaration release says, “TB screening and diagnostic tools (ultraportable x-ray and molecular tests) in a van are reaching closer to the key vulnerable population (KVP) in Delhi and making same day test and treat a reality. Prorad ultraportable x-ray and Truenat molecular test machines in the backpack of a motorcycle rider are reaching difficult to access areas in Delhi and Haryana.”
The increasing use of molecular tests as an alternative to the old method of centralized smear microscopy tests is seen as a key differentiator for faster and quicker turnaround of TB cases. “Microscopy used to take four days to even a week to confirm TB cases. That is now happening almost in real time through the indigenously built Truenat molecular tests,” a delegate deeply engaged in community activity for TB detection told ET HealthWorld.
Truenat test kits, a proprietary test device from MolBio, an Indian diagnostics manufacturer, is seeing a fast ramp up across continents. Its portability and the ability to turn fast and accurate results is making the “same day test and treat strategy” possible, which is proving to be a strong weapon against TB.
Those molecular tests made a commendable difference in finding and treating TB among the homeless people, migrant workers, night shelter home inmates, sex workers, prison inmates, people living with HIV, people who use drugs, workers exposed to silica at workplaces, among others.
Goa became the first state in India that completely replaced smear microscopy tests with upfront molecular testing since December 2020. Some other examples are Andhra Pradesh and Maharashtra. The World Health Organization has called on countries to replace microscopy tests with 100 per cent upfront molecular testing by 2027.
The experience of early detection via Truenat is similar in other countries. In the Philippines, the Goa Declaration points out how Fujifilm ultraportable x-ray and Molbio’s Truenat are being taken from islet to islet in Bantayan municipality in pump boats, to screen, diagnose and treat people with TB. As a result, TB screening of people with presumptive TB went up from 180 in 2021 (before new tools were deployed) to 3153 in 2024.
In Bangladesh, over a lakh people with presumptive TB were missed by the health services in 2022, according to the WHO Global TB Report of 2023. Despite those challenges, TB mortality in that country almost halved by 2022, as compared to 2015.
An accelerated pace for new tests will be an imperative to meet the SDG goals. Also, among the key points that were part of the political declaration of the 2023 United Nations General Assembly High Level Meeting on TB, a range of targets were committed by countries for 2027. The targets include:
- Reaching 90 per cent of TB patients with diagnostic and treatment services and health and social support
- 100 per cent of those tested for presumptive TB to get an upfront WHO recommended diagnostic molecular test.
- 100 per cent of people with TB get health and social benefit packages so that they do not face any catastrophic costs.
- Treat at least 45 million people between 2023 and 2027 globally, including 4.5 million children and 1.5 million people with drug-resistant tuberculosis.
- 90 per cent of high-risk populations (those eligible for TPT) to get TB Preventive Therapy (TPT).
