TB case detection in India: Urgent need to scale up Rapid TB Test Machines and cartridges

On September 15, 2015 organizations, associations, and individuals working with people and communities affected by tuberculosis (TB) sent an open letter to the Indian Minister of Health & Family Welfare calling for the immediate scale up of rapid, cartridge-based nucleic acid amplification tests to detect TB disease and rifampicin resistance. These tests, such as GeneXpert MTB/RIF, can improve detection for TB disease, DR-TB, and TB/HIV coinfection. Xpert MTB/RIF simultaneously detects TB and resistance to rifampicin in just two hours, and is to date the only WHO-endorsed cartridge based nucleic acid amplification based test.

India has the largest burden of TB in the world, with an estimated 2.6 million people living with TB in the country, as well as a high burden drug-resistant TB (DR-TB) and TB/HIV co-infection. Yet according to a recently leaked draft report from the Joint Monitoring Mission (JMM) to India, only about 60% of TB cases are currently being detected in India. The leaked report highlights that TB case detection is one of the biggest challenges for India, with an estimated 1 million cases undiagnosed or not notified.

“Without concrete action for the procurement and systematic roll out of GeneXpert and cartridges, all the planning and revising of policies are meaningless, and TB—particularly among the most vulnerable, including children and people with HIV—will remain undetected and untreated.”

Therefore, TB advocates call on Indian Health Minister to bring the strong political commitment and resources necessary to hasten the roll out of GeneXpert testing in India.

In particular, the letter reiterates the recommendations of the JMM and requests the Central TB Division (CTD) and the Health Ministry to:

1. Immediately finalize procurement of 300 GeneXpert devices and 780,000 GeneXpert MTB/RIF cartridges through the Global Fund and proceed with implementation;
2. Ensure a sustained supply of cartridges in all facilities using GeneXpert, especially in ART centres and in districts with high HIV and MDR-TB prevalence;
3. Rapidly implement new algorithms and scale-up the use of GeneXpert to detect TB and rifampicin resistance upfront, especially in children, people with HIV, people at risk of DR-TB, and people to be evaluated for extra-pulmonary TB;
4. Scale-up second-line drug susceptibility testing capacity and DR-TB treatment capacity in parallel, to guarantee that patients with GeneXpert-identified rifampicin resistance are linked to appropriate diagnosis, treatment, and care;
5. Provide full exemption from customs duty on GeneXpert devices and cartridges to reduce the cost of procurement for CTD and the private sector.

To download the open letter, click here.