The National Strategic Plan (NSP) for Tuberculosis (TB) elimination in India aims to eradicate TB by the year 2025. The primary focus of this initiative is on the early detection of TB cases, employing highly sensitive diagnostic tools to enhance the accuracy and efficiency of diagnostic services.
Under the NSP 2017-2025 framework, ambitious targets were established for TB diagnostics. The goal was to decrease the number of presumptive TB cases tested via smear microscopy from over 9.1 million in 2015 to 5.8 million by 2022. Simultaneously, the NSP aimed to significantly increase the number of molecular tests conducted, escalating from just 40,000 in 2015 to over 13.4 million by 2022.
However, the India TB report indicated that these diagnostic targets were not achieved. In 2022, smear microscopy was utilized for 77% of presumptive TB cases, accounting for approximately 13.9 million cases, whereas molecular tests were implemented for only 23% (4.1 million) of cases.
The revised NSP for 2020-2025 shifts its emphasis towards early detection of presumptive TB cases through advanced diagnostic tools. It prioritizes scaling up precision diagnostic services and seeks to replace smear microscopy with molecular tests across all TB diagnostic centers.
Despite these objectives, the transition from smear microscopy to molecular tests has yet to be fully realized. Significant challenges persist, including a limited availability of machines capable of performing molecular tests, a shortage of trained personnel to carry out these tests, and the necessity to prioritize testing for vulnerable groups, such as pediatric patients, individuals with extrapulmonary TB, and those who are HIV positive.
In 2019, the World Health Organization (WHO) and the Joint Monitoring Mission (JMM) recommended the urgent replacement of smear microscopy with molecular tests nationwide. They advocated for leveraging the molecular testing capacity of the private sector to meet an ambitious target of 20 million molecular tests conducted annually.
The revised NSP tackles the challenges regarding access to molecular tests by emphasizing the need to transition from smear microscopy to rapid molecular diagnostic tests for active case finding. It recognizes the limited access to molecular testing in peripheral health institutions and suggests outsourcing tests to the private sector until universal access is achieved.
Universal drug susceptibility testing is essential for the early identification of drug-resistant TB cases. Nonetheless, the revised NSP's objective to provide universal access to drug resistance testing remains unfulfilled.
Despite the ambitious targets set by various NSPs, the journey towards TB elimination in India continues to face numerous challenges. These include the need for a transition to advanced diagnostic tools and ensuring universal access to molecular tests.
In conclusion, India's pursuit of TB elimination by 2025 through advanced diagnostics and precision tools encounters various implementation challenges, resource availability issues, and accessibility hurdles. The revised NSP underscores the importance of timely and accurate TB case diagnosis, especially among vulnerable populations, to achieve the ultimate goal of TB elimination.
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