1. What are the goals of India's National Strategic Plan (NSP) for Tuberculosis (TB) elimination?
India's NSP aims to eliminate TB by 2025. It focuses on early detection of TB cases using highly sensitive diagnostic tools and enhancing precision diagnostic services.
2. What were the targets set by NSP 2017-2025 for TB diagnostics?
The NSP 2017-2025 aimed to reduce the number of presumptive TB cases tested through smear microscopy from over 9.1 million in 2015 to 5.8 million in 2022, while increasing molecular tests from 40,000 in 2015 to over 13.4 million in 2022.
3. Were the diagnostic targets of NSP 2017-2025 met?
No, the India TB report indicated that the diagnostic targets set by NSP 2017-2025 were not met. Smear microscopy was used for 77% (13.9 million) of presumptive TB cases in 2022, while molecular tests were used for only 23% (4.1 million) of cases.
4. What is the focus of the revised NSP 2020-2025 for TB diagnostics?
The revised NSP aims for early detection of presumptive TB cases using advanced diagnostic tools. It emphasizes scaling up precision diagnostic services and replacing smear microscopy with molecular tests in all TB diagnostic centers.
5. Has the replacement of smear microscopy with molecular tests been successful?
As of now, the replacement of smear microscopy with molecular tests is yet to become a reality. The transition to using molecular tests for initial diagnosis has not been achieved despite the revised NSP's goals.
6. What are the challenges in achieving the transition to molecular tests?
Challenges include limited availability of machines for molecular tests, shortage of trained personnel to conduct these tests, and the need to prioritize testing for vulnerable groups, such as pediatric patients, people with extrapulmonary TB, and those who are HIV positive.
7. What recommendations were made by WHO and the Joint Monitoring Mission (JMM)?
In 2019, WHO and JMM recommended urgently replacing smear microscopy with molecular tests across the country. They also suggested utilizing the private sector's molecular testing capacity to achieve a target of 20 million molecular tests annually.
8. How does the revised NSP address the challenges of access to molecular tests?
The revised NSP emphasizes the need to replace smear microscopy with rapid molecular diagnostic tests for active case finding. It acknowledges the lack of access to molecular tests in peripheral health institutions and suggests outsourcing tests to the private sector until universal access is achieved.
9. What is the importance of drug resistance testing?
Universal drug susceptibility testing is crucial for early identification of drug-resistant TB cases. However, the goal of providing universal access to drug resistance testing as per the revised NSP has not been fully realized.
10. What is the overall progress towards TB elimination in India?
Despite the ambitious goals set by various NSPs, the progress towards TB elimination remains challenging, especially in terms of transitioning to advanced diagnostic tools and achieving universal access to molecular tests.
In summary, India's efforts to eliminate TB by 2025 through advanced diagnostics and precision tools face challenges in terms of implementation, resource availability, and access to molecular tests. The revised NSP highlights the need for prompt and accurate diagnosis of TB cases, especially among vulnerable populations, to achieve the goal of TB elimination.
