149 experts call to find all TB to stop TB

Shobha Shukla / Bobby Ramakant *

 149 experts call to find all TB to stop TB

One hundred and forty nine delegates of 78th National Conference of Tuberculosis and Chest Diseases ( NATCON) have endorsed a global call to find all TB to stop TB, which has 1 key ask: Stop missing TB cases, by taking 2 actions:

1) Replace smear microscopy 100% with WHO recommended molecular tests as soon as possible, along with a paradigm shift from a lab-centric to a fundamentally people-centric model to find TB, leaving no one behind

2) Find the missing millions! Screen everyone (and not just those with TB symptoms) in high burden settings with WHO recommended screening tools and confirm those with presumptive TB using molecular tests.

Break the chain of TB transmission

Injustice and inequality mars global health too. On one hand we have few countries that have broken the chain of TB infection transmission but on the other hand we have many high TB burden countries which have failed to stop the spread of TB infection, said Professor (Dr) Guy Marks, noted respiratory medicine expert and scientist from Australia, and President and interim Executive Director of the International Union Against Tuberculosis and Lung Disease (The Union).

He added: "TB is a communicable disease. There are 7 ways we can interrupt the cycle of being reinfected, out of which most effective way is to find all and treat all TB."

Dr Guy Marks shared an important study done in Ca Mau, Viet Nam where they screened everyone for TB (not just those with symptoms), and followed up with linkage to TB treatment and care for those who were found with the disease. TB rates declined by 72% in a four-years period. In communities where the TB rates declined in the adult population, TB rates halved among children too. "We need to break the chain of transmission," stressed Prof Guy Marks. "Find all (or nearly all) the TB cases. Most people with TB are not in high risk groups," he said. "Ensure all the TB cases found are linked to TB care. Sustain this [Find all TB, treat all TB] for ten years until TB rates drop below 50 per 100,000 population."

Dr Guy Marks added that "main beneficiaries are not the people with TB who are found [by active screening and upfront molecular testing], but those who are protected from getting TB infection and TB disease."

TB diagnosis is a critical entry-point to TB care continuum

"Early and accurate TB diagnosis is an important and critical entry-gate to the TB care pathway. It not only helps in reducing TB-related human suffering but also helps in stopping the spread of infection. To end TB, we need to find all TB cases, diagnose all of them by using WHO approved molecular tests upfront and link them to the full cascade of effective treatment, care, and support services," said Dr Kuldeep Singh Sachdeva, former head of India's TB elimination programme (former deputy director general of TB at Ministry of Health and Family Welfare, government of India). Dr Sachdeva was also the Director for Southeast Asia region of International Union Against Tuberculosis and Lung Disease (The Union) and currently leads Molbio Diagnostics as President - Chief Medical Officer.

Change paradigm of cascade of care

Dr Sachdeva rightly pointed out that cascade of TB care begins not from diagnosis but much earlier when active case finding is happening - it begins from willingness of healthcare workers to go closer to the communities or at the doorstep of people to find all TB. Cascade of care does not end with cure, instead it ends after a couple of years of a person being cured of TB. "If we do passive case finding [for new TB cases], we will never find all the TB cases," said Dr Sachdeva.

Verbal screening for TB is not enough

Dr Padmapriyadarsini Chandrasekaran, Director of National Institute for Research in Tuberculosis (NIRT), Indian Council of Medical Research (ICMR), stressed upon the importance of screening everyone (not just those with symptoms) with WHO recommended and evidence-based tools and offering WHO recommended molecular testing to those with presumptive TB. India's National TB Prevalence Survey 2019-2021 findings show that 42.6% TB patients would have been missed if they were not screened by an x-ray (and followed up with a confirmatory molecular test). "Use of ultraportable x-ray [as a screening tool] should be thought of at the community level," she said.

More importantly she said that "number of cases notified was way less than the number of TB cases shown by the prevalence survey."

Dr Padmapriyadarsini recommended that to make TB case finding more efficient, we need to scale up x-ray screening and offer upfront molecular testing to all those with presumptive TB. She also underlined the importance of screening all those with TB risk factors, such as those with diabetes, malnourishment, tobacco or alcohol use, HIV, among others.

Dr Guy Marks had visited NIRT-ICMR and posted on X: "As prevalence survey shows 55% of prevalent, microbiologically confirmed TB do not report symptoms, this will require annual mass screening, regardless of symptoms, with aim of finding at least 80% of prevalent infectious cases."

Progress happened but is it enough?

Globally, we could find a record number of new TB cases in a single year - historically. Over 7.5 million new TB cases were diagnosed in 2022 worldwide – highest ever in the age-old fight against TB (as per the WHO Global TB Report 2023). But, not able to find all TB cases continues to be worrisome.

In India, states like Uttar Pradesh have reported highest ever notification of new cases (around 625,000 as reported in news) in 2023 as more WHO recommended ultraportable x-ray screening and point-of-care and decentralised molecular test Truenat is being appropriately deployed at the block level across the state.

Of the 7.5 million new people who were diagnosed with TB in 2022 worldwide, only 47% were diagnosed using a WHO recommended molecular test. In India, as per the India TB Report 2023, only 23% of all TB testing was done on a molecular test. This is so unacceptable as we cannot afford to miss TB.

The WHO's highest level initiative – Find.Treat.All (first launched in 2018) - had called upon all governments to replace the old and poorly performing microscopy TB test with WHO recommended rapid molecular tests by 2027. World leaders at the 2023 UN High Level Meeting on TB had also re-echoed this call to completely phase out microscopy with upfront molecular test diagnosis for TB by 2027.

Upfront molecular testing for TB in India doubled in 2022

Despite glaring gaps, there is historic progress made in India too in fight against TB. India saw the largest-ever rollout of WHO recommended molecular tests across the nation. Molecular testing grew by 82% in India in 2022 as compared to the levels in 2021 – this is the largest jump in molecular testing figures so far (as per the data in India TB Reports of 2022 and 2023).

Point-of-care, decentralised, battery operated and laboratory independent Truenat is the most used molecular test in India. As compared to 2021, in 2022 India increased the rollout of Truenat by 90% (made by Molbio Diagnostics), and Gene Xpert by 67% (made by Cepheid). Microscopy increased during the same period by 68.1%. But when we look at absolute numbers, the rise in microscopy dwarfs the historic scale up of molecular testing in India in 2022.

Two Indian states (Goa and Lakshadweep) have completely phased out microscopy and transitioned to 100% use of molecular tests while one Indian state (Andhra Pradesh) is majorly using molecular tests (~70%) and has reduced microscopy. Most of the other Indian states have also increased the use of molecular tests manifold and are at different levels of scaling it up.

Before coming to 78th NATCON, Scientia Professor (Dr) Guy Marks, met the Indian Council of Medical Research (ICMR). “Excellent meeting today with the ICMR regarding evidence/ data-based interventions to end TB in India by breaking the chain of transmission. Need to find all, or nearly all, people with infectious TB (most of whom do not have symptoms)” he said on X.

Endorse the global call to find all TB:

The global call to find all TB to stop TB demands a paradigm shift from a lab-centric to a fundamentally people-centric model to find TB, leaving no one behind. It also reinforces the science-based call to “reach the unreached” by using WHO recommended point of care tools to screen and diagnose TB. If we act upon this key ask, imagine the difference it will make when no TB case is missed, and all people with TB are brought in the care fold in a rights-based manner. A people-centric approach to find all TB, treat all TB, and prevent TB is critical to end TB. Endorse the global call here: .

* Shobha Shukla / Bobby Ramakant wrote this article for
Shobha Shukla and Bobby Ramakant co-lead the editorial of CNS (Citizen News Service)
and on the governing board of Global Antimicrobial Resistance Media Alliance (GAMA)
and Asia Pacific Media Alliance for Health and Development (APCAT Media).
Follow them on Twitter @shobha1shukla and @bobbyramakant
This article was webcasted on February 20 2024.

* Comments posted by users in this discussion thread and other parts of this site are opinions of the individuals posting them (whose user ID is displayed alongside) and not the views of We strongly recommend that users exercise responsibility, sensitivity and caution over language while writing your opinions which will be seen and read by other users. Please read a complete Guideline on using comments on this website.

  • Nupi Landa Thaunaphabishing #14 :: Book
  • Violence in Manipur 2023-2024 : Timeline
  • 174th Anniv Maharaj Narasingh #1 : Gallery
  • Ensuring Fair Voting in Hills of Manipur
  • Dr Irengbam Mohendra's latest book :: Rvw
  • NDA has the advantage in both
  • Lok Sabha polls in Manipur #1 : Gallery
  • L Rup's Robot 'Kangleinganbi' in Manipuri
  • Art- means of connecting hearts in Manipur
  • Is it Living Alive or Living Death ? :: Poem
  • Rabies - A preventable zoonotic disease
  • April 19, 2024: The blackest day of all
  • Ugly turns on voting day
  • Children Camp @JNMDA Imphal #2 : Gallery
  • The chasm between TB & HIV continues
  • Parliament and its Members
  • Kimchi for health and glowing skin
  • LS election with a difference
  • To vote, or not to vote ?
  • Sajibu Cheiraoba Chak Katpa #2 : Gallery
  • "ST status for Meetei" at Lamjao, Kakching
  • The Power of Poppy - 27 :: Poem
  • Mother Language based education essential
  • Modi's warriors wear regional hats
  • Nest Asia promoting Northeastern Cuisine
  • Now look beyond LS poll
  • The rot in the system
  • Scientists of Manipur : Laitonjam Warjeet
  • Community seed bank @Umathel : Gallery
  • 10 candidates cracked Civil Services Exam
  • Milk of Paradise: History of Opium : Rvw
  • How plastics find their way into our bodies
  • Condemning attack on Trucks along NH-37
  • Cong looking to buck the trend
  • Saving Manipur
  • Sajibu Cheiraoba: 1 occasion, 2 narratives #2
  • Election Duty :: Travellog
  • 1st Nagas' Meet in Punjab
  • How to select right MP to represent Manipur
  • "ST status for Meetei" at Tejpur
  • Bats are Keystone species for the Planet
  • The '15 days' conundrum
  • Free but not so fair
  • Descent of Radha-Krishna #30: Download
  • Before You Vote : My Rumbling Thoughts
  • "ST status for Meetei" at Kakching
  • Meiraba wins All India Sr tournament
  • Finding light in dark through my daughter
  • Navigating life's unreasonable expectations
  • Test of people's character
  • BJP's election manifesto
  • Athoubasingi Numit #1 : Gallery
  • Black rice & Glycemic Index
  • What Nadda should speak at Dimapur rally
  • Open Letter to CM Office Manipur
  • Meghalaya unveils Strawberry festival
  • Benefits of maths newspapers for students
  • Id-ul-Fitr @Hatta #1 : Gallery
  • Are you a good person ?
  • Physics Academy of NE : Executive Body
  • "ST status for Meetei" at Moirang
  • Cherrapunji Eastern Craft Gin launched
  • Cong on cautious path
  • Botox for Hair
  • Posers voters should raise now
  • The lull before the storm
  • 80th Anniv- Battle of Kanglatongbi @UK
  • Vir Chakra Ngangom Joydutta's bust unveiled
  • Hun - Thadou Cultural Festival : Gallery
  • "ST status for Meetei" at Singjamei
  • Election Eclipses: Ballad of Battle & Loss
  • Our voices are equal at the ballot box
  • Scientists of Manipur : Ngangkham Nimai
  • Urgent Call for Solidarity in Manipur
  • Meitei Nongsha #2 :: An Artwork
  • "ST status for Meetei" at Waikhong
  • About NPF-BJP-NPP alliance & why ?
  • World Veterinary Day, 2024
  • The heavy stake behind the LS polls
  • The politics of lying & deception
  • Sajibu Cheiraoba Chak Katpa #1 : Gallery
  • Hun-Thadou Cultural Fest @ Delhi: Report
  • Appeal to Parties & Candidates
  • "ST status for Meetei" at Wangoo
  • Establishment of community seed bank
  • Awareness Programme on new Criminal Laws
  • Make a right choice at the Lok Sabha election
  • Sajibu Cheiraoba: 1 occasion, 2 narratives #1
  • RIST talk-58 : Support systems of elderly
  • "ST status for Meetei" at Hiyanglam
  • Vote, do not boycott !
  • Lok Sabha election: A new dawn in politics ?
  • IIT-Guwahati Half Marathon report
  • Taking ST demand to the election ring
  • Lesson to be learnt from across border
  • Mirabai: Poised for Paris Olympics
  • Legal position for protection of environment
  • "ST status for Meetei" at Keisamthong
  • Heterocyclic compound & biochemical science
  • Inner, torn between two lovers
  • Certification Music Therapy Workshop
  • NOTA as a choice
  • Caesar's wife must be above suspicion
  • Descent of Radha-Krishna #29: Download
  • World Health Day 2024
  • "ST status for Meetei" at Pangantabi
  • The Power of Poppy - 26 :: Poem
  • Fulbright Fellowship Outreach at Arunachal
  • Id-ul Fitr da namaz nattana..
  • Nupi Landa Thaunaphabishing #13 :: Book
  • Lok Sabha election is coming, be prepared
  • 6th Hun-Thadou Cultural Festival
  • Let There Be Free & Fair Election
  • "ST status for Meetei" at Lamlong
  • Science magazines are important for student
  • Interesting choice of candidates
  • The power of We, the voters
  • Inspirations from Scientists of Manipur #1
  • The Case for Amendment of Article 371-C
  • Meitei Nongsha #1 :: Artwork
  • Link between forest & conflict in Manipur
  • Final Call for Application MFA - Phase-2
  • ST for Meiteis call before elections
  • Passing the buck
  • Beating of the Retreat #1 : Gallery
  • Life of our Lives in Ethnic Strife Era! :: Poem
  • IIT-Guwahati annual Half Marathon
  • Follow up: European Parliament on Manipur
  • Yoga & Kegel exercise: Pelvic floor workout
  • Opting for the NOTA button
  • Yearning of the displaced people
  • Kenedy Khuman (Singer) : Gallery
  • 5th NE Women's Peace Congregation
  • World Autism Awareness Day 2024
  • Election fever grips Manipur despite unrest
  • Looking for a decent election hustings
  • Clock ticking towards voting day
  • An exemplary directive
  • Children Camp @JNMDA Imphal #1 : Gallery
  • Memo to Election Commission of India
  • Easter & Holi echo in Nilgiris
  • Holiday Camp for children at JNMDA, Imphal
  • Zero waste is our moral responsibility
  • Elections & loyalty vis-a-vis Manipur crisis
  • Show of strength without unity
  • Yaoshang Pichakari #2 : Gallery
  • Panthoi Chanu : 1st to play in Australia
  • Intensive labs in film preservation
  • Building bridges with books
  • Need of the hour: Political maturity
  • Accepting defeat before the election
  • Descent of Radha-Krishna #28: Download
  • April Calendar for Year 2024 : Tools
  • Natural packaging from bamboo : Gallery
  • The Power of Poppy - 25 :: Poem
  • Everyone has their own Bharat Ratna
  • Nupi Landa Thaunaphabishing #12 :: Book
  • Demand- Manipuri as classical language
  • The Drummer from Odisha
  • Beauty benefits of lemon
  • Yaoshang Mei Thaba #2 : Gallery
  • Manipur's original Ponies : Gallery
  • Yaoshang & Dance of Democracy loom
  • Symposium on Jagadguru Shankaracharya
  • Choosing ITI as a campus after X
  • Yaoshang Pichakari #1 : Gallery
  • Yaoshang @Nabadwip Dham : Gallery
  • How oral health affects your pregnancy
  • Two faces of Holi
  • Prawaas 4.0, Multimodal Transport Show
  • A decade of development of higher education
  • Yaoshang Mei Thaba #1 : Gallery
  • Our Eternal Kangleipak :: Poem
  • Micro-livestock for livelihoods: For NE States
  • The fun of Holi used to be monotonous
  • 2nd Annual Art Exhibition #1 : Gallery
  • About the "Meitei" community from Manipur
  • Unveiling the medicinal benefits of honey
  • The incalculable value of wildlife
  • Promises of true love
  • Trends, Alliances, & Challenges in Elections
  • Meitei Goddess Ngaleima : An Artwork
  • Water is the most precious gift of God
  • Bharat needs a strong 'India'
  • Transformation of railway stations
  • Not quite the final countdown
  • Missing of 'The Saffron' from electoral colour
  • Descent of Radha-Krishna #27: Download
  • 3rd North East Games: Manipur champion
  • The Power of Poppy - 24 :: Poem
  • EBTC & JCRE signed MoU
  • Early Detection Program at Toubul
  • How Holi affects our mood & mental health
  • Lamta Thangja @ Imphal : Gallery
  • Manipur cinema legacy shines at ARCUREA
  • The pulse of politics amidst conflict
  • Forest is most important vital organ of Earth
  • Tips to play safe Holi
  • Politics of naming candidates
  • Disappearing of spring from season cycle
  • Meira Paibis of Manipur
  • Demand for ST status by Meiteis
  • Project Personal Opening @Assam University
  • World Poetry Day at Manipur University
  • Green skills for sustainable world
  • Supportive interventions during exam time
  • Interesting run up to LS polls
  • Onus definitely on PM to restore peace
  • Nupi Landa Thaunaphabishing #11 :: Book
  • Water, water everywhere ...
  • 21st March - A special day for Forest
  • RI imprisonment to Rapists at Silchar
  • Arrests threaten fragile ceasefire
  • The Valor Within :: Poem
  • Monitoring the rehab centres
  • True colour of politicians
  • North East Film Festival #2 : Gallery
  • Linthoingambi- 'Jury Honourable Mention'
  • Meitei Goddess Phouoibi : An Artwork #3
  • Formation of Wesean Student Federation
  • 20th March- International Day of Happiness
  • A call to first time voter youths
  • Playing the card close to its chest
  • Targeting FOCS and ITLF
  • Students @ Class X Exam : Gallery
  • Saroi Khangba @ Kangla : Gallery
  • Special scholarship scheme for girls
  • Imphal Book Fair 2023 #3 : Gallery
  • Protest for scrapping SoO #2 :Gallery
  • Maharaj Narasingh Statue @Kangla :Gallery
  • Shopping List for Shivaratri : Gallery
  • N Tombi Equestrian C'ships #1 : Gallery
  • Featured Front Page Photo 2024 #1: Gallery
  • Radio E-pao: Manipuri Film OST (130+ song)
  • Save Manipur : Protest [Feb 15] #3 : Gallery
  • Naorem Roshibina- Wushu Medallist : Gallery
  • GHOST of PEACE :: Download Booklet
  • List of Kings of Manipur: 33 - 1984 AD