Centre plans DNA-based diagnostic facilities to nail drug-resistant TB

Killer disease

The Centre plans to provide DNA-based diagnostic facilities in 200 districts in the next one year for treating multi-drug resistant tuberculosis (MDR-TB) cases, which are not only difficult to treat but also emerging as a much more serious public health problem than what had been anticipated a decade ago.

“Our aim is to provide diagnostic facilities for drug resistant TB cases in every district by the end of 12th Five Year Plan. To begin with, the facilities will be provided in 200 districts in 2013-14,” Anshu Prakash, a joint secretary in the Health Ministry looking after TB programme, told Deccan Herald.

Many studies in the last 6-7 years have demonstrated how MDR-TB spread fast across the country. The latest evidence have come from a group of Lucknow-based microbiologists who showed a steady and continuous increase in MDR-TB cases between 2007 and 2010.

Microbiologists from King George Medical University, Lucknow, found a high prevalence (38.8 per cent) of MDR-TB cases among all tuberculosis patients visiting the tertiary care hospital suggesting the immediate need for strategies for testing, surveillance, monitoring and management of such drug-resistant cases at the grass root level.

The KGMU study – published in the latest issue of Indian Journal of Medical Microbiology – showed MDR-TB increased from 2007 to 2010 in both new and previously treated cases.
The World Health Organisation, in its latest report on TB, gave the number two spot to India (after China) in the list of nations with highest number of drug resistant cases.

The Union Health Ministry’s MDR-TB plan focuses on two detection strategies – providing an expensive diagnostic machine known as GeneXpert as well as a low-cost detection tool known as line probe assay – in the districts. While the GeneXpert can detect a MDR case in two hours, line probe assay takes two days.

“GeneXpert has some disadvantages too. It can only screen rifampicin-resistant TB cases but not those that are resistant to isoniazid. Also, every test in GeneXpert costs $12 (about Rs 600). We will definitely buy more GeneXpert but wont rely on them solely,” said Prakash.

At present, India has 48 of the expensive diagnostic machines, which have been widely recommended by TB researchers all over the world for picking up the signatures of resistant cases.

“It can detect both TB and drug-resistance with little skilled expertise,” said Madhukar Pai, a tuberculosis researcher at McGill University, Canada.

“But with each machine costing upwards of Rs 1 crore in addition to high running cost, I am not sure how much resource the government can spare on these machines,” said R Lakshminarayan, vice president (research) at Public Health Foundation of India.