TODAY -

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: www.bit.ly/findalltb

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: www.bit.ly/findalltb .


* Shobha Shukla / Bobby Ramakant wrote this article for e-pao.net
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 e-pao.net. 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.




LATEST IN E-PAO.NET
  • Colonial Knowledge Production in NE #8
  • Violence in Manipur 2023-2025 : Timeline
  • The fight for survival in Manipur
  • A call for unity from displaced voices
  • COVID-19: Update 08 July 2025 : Manipur
  • Dogs Are Staying on the Ground :: Poem
  • Football Tournament at Heinoukhongnembi
  • Condemns Kuki Inpi's Directive
  • Installation Ceremony of Lions Club, Imphal
  • All that can go wrong has gone wrong
  • Manipur peaceful from Delhi's perspective
  • Bashanta Ras @Govindaji #2 : Gallery
  • Hypocrisy & the betrayal of sovereignty
  • Healing with Art for children concluded
  • Manipur : Champions 24th Junior Natl Wushu
  • Path to Becoming a Leader Who Inspires
  • Van Mahotsav 2025, festival of life
  • The Flavours of Life :: Poem
  • Assault on sensibilities of the media
  • Revival of MPP after years of bitter disputes
  • Ougri Lirol :: Part 2 : Ooba Video
  • Jianreilung, Chingamba, Masounii : eMing
  • How Jessami conservation of Nongin
  • Shija Hospitals turns 40
  • COVID-19: Update 06 July 2025 : Manipur
  • The Indomitable Young Souls :: Poem
  • Growing network of drug dealers in country
  • Politics of SoO pact since 2008
  • No takers for disturbance-free education
  • 31st Governor Cup Polo Tournament : Gallery
  • PM welcome to Manipur: Feel the reality
  • Kainkhol wins best Social Message Film Award
  • Distortion of facts: Manipur sports movement
  • Govt services reach Manipur's tribal villages
  • 134th Durand Cup Trophies Flag Off
  • COVID-19: Update 05 July 2025 : Manipur
  • How to take care of oily skin in monsoon
  • First-Ever Tripura Esports Championship
  • Konung Kang Chingba #1 : Gallery
  • Manipur Iskcon's 25th Ratha Yatra 2025
  • Native Threshing machine made for farmers
  • COVID-19: Update 04 July 2025 : Manipur
  • Riso Ejang: Youth-led Transformation
  • Include males too in addressing HPV
  • Whispers from the past :: Poem
  • LPU opens permanent outreach centre
  • Raj Bhavan moving on the right track
  • Speculations over PM Modi's visit to state
  • Colonial Knowledge Production in NE #7
  • Make Yourself Visible to Opportunity
  • Orange bowl: tradition with ecological wisdom
  • 10 ways to keep a kitchen garden disease free
  • Between PR, military mandates & AFSPA
  • Allocation fund for MLALAD Fund during PR
  • Denounces Killing of KNA Deputy C-in-C
  • COVID-19: Update 03 July 2025 : Manipur
  • Cases of fake Aadhaar cards
  • Sincere dealing must for stricter Aadhaar
  • Archaeology: Culture of Manipur : Booklet
  • Wanna be a singer? Get Botox
  • A Central institute in Manipur
  • Nagging in the name of love
  • COVID-19: Update 02 July 2025 : Manipur
  • 'Benefits' of Indira's Emergency
  • Social Stigma :: Poem
  • Inking a peace pact: Why, how: SoO quagmire
  • Van Mahotsav under shadow of declining forest
  • 11th Th Kishan Memorial Lecture : Gallery
  • Manipur crisis & the Left media's blind spot
  • COVID-19: Update 01 July 2025 : Manipur
  • Bombom RK : Musclemania Universe NYC
  • The Grief :: Poem
  • Music Concert & Quiz (MCQ) 2.0
  • SoO agreement unlikely to be scrapped
  • Regulating use of plastic carry bags
  • Mera Houchongba @Kangla #4 : Gallery
  • International Day of Yoga @JNMDA : Gallery
  • BD Behring: The inimitable Gentleman I knew
  • Violence in the name of patriotism : Misguided
  • Daily oral vs long-acting injectable for HIV
  • COVID-19: Update 30 June 2025 : Manipur
  • Smile :: Poem
  • Why was President's Rule imposed ?
  • BJP under pressure to forge unity
  • Kang @Leikai in Imphal : Gallery
  • July Calendar for Year 2025 : Tools
  • COVID-19 : A recurring crisis in Manipur
  • DC Kaith and Forestry in Manipur : Book
  • COVID-19: Update 29 June 2025 : Manipur
  • Longing for Peace :: Poem
  • Black badge, slogan protest by peeved scribes
  • Present the true picture before Delhi
  • Pung-Cholom @ Polo Tournament : Gallery
  • Life: A Journey Through Thought & Being
  • Khongjai Hills & Kuki claim to indigeneity
  • Master Time by Managing Information
  • COVID-19: Update 28 June 2025 : Manipur
  • Pride & patriotism in CCpur's army families
  • The Power of Poppy - 87 :: Poem
  • World Decarbonisation Day: green environment
  • Welcome Home - Nganthoi #2 : Gallery
  • Loss of two precious lives from Manipur
  • Balancing civil liberties with public safety
  • COVID-19: Update 27 June 2025 : Manipur
  • Gender equality & human rights are indivisible
  • Stay hydrated this summer season
  • Silent Half of the Sun :: Poem
  • Connecting the dots in the wishlist
  • Assembly record tampering claims by ex-CM
  • The immortal legacy of Pukhramba Kajao
  • International Day against Drug Abuse 2025
  • COVID-19: Update 26 June 2025 : Manipur
  • Black pottery from Ukhrul - tribal heritage
  • Program on "Mission-Drug Free Campus"
  • Play makes a better world
  • Urgent Appeal to the Honourable MLAs
  • Tribal Empowerment Campaign at CCpur
  • Talk doing the round: PM to come
  • 'Emergency' relief for under-fire BJP
  • Golden Jubilee Art Fair @Imphal : Gallery
  • Declaration: Meetei People Convention, Delhi
  • A Flower Among the Rocks :: Review
  • Book Donation Campaign
  • Improved road connectivity boosts livelihoods
  • To Have Great Dreams :: Poem
  • COVID-19: Update 25 June 2025 : Manipur
  • Regret vs Sorry: Technical & moral insight
  • Cocktail of inept Govt, selfish people
  • State trailing others in cleanliness
  • Colonial Knowledge in NE India #6
  • UHI effect & rising temperatures in Manipur
  • Frequent road blockades cripple economy
  • COVID-19: Update 24 June 2025 : Manipur
  • Unite Health with Community health services
  • NSU, Imphal, tops IIRF Ranking 2025
  • Endless conflict :: Poem
  • Pak nobel pish prize for Trump
  • May 3, 2023 - June 24, 2025: Failure of Delhi
  • Hotter days, sudden rainfall no more a rarity
  • "The Great June Uprising" #2 : Gallery
  • How to Build a Career, Lead with Purpose
  • 2nd Foundation Day- Karnataka Meitei Assn
  • COVID-19: Update 23 June 2025 : Manipur
  • NSCN-IM Amnesty threatens to isolate it
  • Sunset :: Poem
  • Intl Yoga Day for a healthier environment
  • Of clogged drains and plastics
  • Poor roads testify Govt indifference
  • Welcome Home - Nganthoi #1 : Gallery
  • The Silent Erosion of Manipuri Language
  • Design health services around people
  • Serene Hills Host Inspiring Int'l Yoga Day
  • COVID-19: Update 22 June 2025 : Manipur
  • Chopper services between Senapati & Imphal
  • High Court Judges interacted with convicts
  • Redyeing the Fabric :: Poem
  • Differences yet to be resolved stand
  • Border fencing rage as solution eludes
  • Radio E-pao: 14 new songs updated
  • Climate Adaptive Agroforestry
  • Manipur overlooked demographic shifts
  • Young designers shine on Fashion Stage
  • COVID-19: Update 21 June 2025 : Manipur
  • International Day of Yoga at Lamphelpat
  • International Day of Yoga at JNMDA
  • The Power of Poppy - 86 :: Poem
  • Keishampat Lairembi Haraoba #1 : Gallery
  • Crisis in Manipur's Contemporary Education
  • Best 8 Performances in Manipuri Cinema
  • Identity: Caught between China & India ?
  • COVID-19: Update 20 June 2025 : Manipur
  • To The Father Who Listens :: Poem
  • How does net suspension affect youths ?
  • Targeting farmers to cripple state's economy
  • The virus is back and spreading
  • Who is afraid of Manipur ?
  • A threatened lily growing at Shirui Hills
  • World Environment Day in Manipur : Gallery
  • Ambubachi Mela at Maa Kamakhya
  • COVID-19: Update 19 June 2025 : Manipur
  • Dolls made from repurposed vegetable refuse
  • Condemns Attack on Farmer & Killing
  • Abhorrent politics of SoO
  • Police arrogance on harmless drivers
  • "The Great June Uprising" #1 : Gallery
  • UK Meetei diaspora run for Myanmar : Gallery
  • Thang-Ta Day @Khuman Lampak #3 : Gallery
  • 50 years of Pebet #2 : Gallery
  • Indo-Naga Talks (From 2012) :: Timeline
  • Protest @Checkon -AT arrest [Jun 9] : Gallery
  • Protests - AT arrest [Jun 8 night] : Gallery
  • Aftermath of flooding @ Khurai #1 : Gallery
  • /li>
  • Flooding at JNIMS Hospital #2 : Gallery
  • North East NSS Festival @ MU : Gallery
  • Trump's tariff legacy & its global echo
  • Flooding Imphal East [31 May] #3 : Gallery
  • Flooding Imphal East [31 May] #2 : Gallery
  • Flooding Imphal East [31 May] #1 : Gallery
  • S Nirupama @Miss Universe : Gallery
  • Protesters to Raj Bhavan [May 25]: Gallery
  • Human Chain @Airport road [May 26]: Gallery
  • Miss Shirui Pageant Contestant: Gallery
  • 48 hrs Bandh: protest security forces: Gallery
  • Protest Rally: Journalist harassment: Gallery
  • HSLC 2025: Full Result (Check Roll No)
  • HSLC 2025: Important Info & Grading System
  • HSLC 2025 : Compartmental candidates
  • HSLC 2025 : Comparative Statement
  • HSLC 2025 : Statistical Abstract
  • HSLC 2025 : District Pass Percentage
  • HSLC 2025 : Govt School Pass %
  • HSLC 2025 : Aided School Pass %
  • HSLC 2025 : Private School Pass %
  • People's Convention on 3rd May #2 : Gallery
  • Featured Front Page Photo 2025 #2: Gallery
  • Riya Khwairakpam : HSE Science Topper
  • Keisham Hannah : HSE Arts Topper
  • Warepam Lidia : HSE Commerce Topper
  • HSE 2025 Result : Science Full Result
  • HSE 2025 Result : Arts Full Result
  • HSE 2025 Result : Commerce Full Result
  • HSE 2025 Information / Abbreviation
  • HSE 2025 Topper : Science
  • HSE 2025 Topper : Arts
  • HSE 2025 Topper : Commerce
  • HSE 2025 : Pass Percentage
  • HSE 2025 : Result Abstract
  • HSE 2025 : Candidates with Highest Marks
  • President's Rule in Manipur : 1967 - 2025
  • Downloadable Manipuri Calendar :: 2025