Abstract
India has a higher tuberculosis (TB) burden than any other country, accounting for an estimated one-fourth of the global burden. Drug-resistant tuberculosis (DR-TB) presents a major public health problem in India. Patients with DR-TB often require profound changes in their drug regimens, which are invariably linked to poor treatment adherence and sub-optimal treatment outcomes compared to drug-sensitive TB. The challenge of addressing DR-TB is critical for India, as India contributes over 27% of global DR-TB cases. In recent decades, India has been proactive in its battle against TB, even implementing a revised National Strategic Plan to eliminate TB by 2025. However, to achieve this ambitious goal, the country will need to take a multifaceted approach with respect to its management of DR-TB. Despite concerted efforts made by the National TB Elimination Program, India faces substantial challenges with regard to DR-TB care, especially in peripheral and resource-limited endemic zones. This article describes some of the major challenges associated with mitigating the growing DR-TB epidemic in India and their implications.
Highlights
India continues to have one of the highest rates of tuberculosis (TB) incidence and mortality of any country [1]
Results from multicenter studies comparing the diagnostic accuracy of Xpert MTB/RIF Ultra to Xpert MTB/RIF found that the sensitivity of the Ultra assay was 17% higher in smear-negative specimens and 12% higher in people living with human immunodeficiency virus, with a 3.2% lower specificity rate than Xpert MTB/RIF [15]
In July 2020, the Foundation for Innovative New Diagnostics and Cepheid, Inc., announced the launch of the new Xpert MTB/XDR cartridges, which enable expanded DR profiling against multiple drugs such as isoniazid, ethionamide, fluoroquinolones, amikacin, kanamycin, and capreomycin with a turnaround time of less than 90 minutes [20]. While such tests can greatly overcome the diagnostic limitations of existing cartridge-based nucleic acid amplification tests (CBNAAT) systems, they are still being evaluated by the World Health Organization (WHO), and it may take considerable time to scale them up after being introduced into the Indian market
Summary
In 2017, under the revised NSP, the government of India launched the Joint Effort to Eliminate Tuberculosis, a globally-funded project to improve the quality of TB care patients receive in the private sector [2]. Alternatives to CBNAAT systems include commercial LPAs, such as GenotypeMTBDRplus (Hains Lifesciences, Nehren, Germany), which are endorsed by the WHO and offer added advantages of increased sensitivity in addition to detection of MDR (isoniazid and rifampicin) in clinical samples [16] Their inapplicability for sputum smear-negative cases vastly overshadows their advantages as an effective diagnostic solution for MDRTB compared to CBNAAT. In 2017, the WHO introduced and recommended the use of rapid second line LPAs
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