Rollout strategy is key to battling India’s TB epidemic, researchers find
Wednesday, July 16, 2014
A new study led by Johns Hopkins Bloomberg School of Public Health researchers suggests that getting patients in India quickly evaluated by the right doctors can be just as effective at curbing tuberculosis (TB) as a new, highly accurate screening test.
While ideally all suspected TB cases would be evaluated with the new test, it is primarily being used only on the highest-risk populations and only in public health clinics, partly because of its cost and the complexity of the nation’s health care system. This slows diagnosis of a disease that must be caught early, the researchers say.
A report on the research, conducted in conjunction with researchers at McGill University and others, is published July 15 in the journal PLOS Medicine.
Approximately 8.6 million people worldwide develop active TB each year, and 1.4 million die from it. Twenty-five percent of all diagnosed TB patients are in India alone. Although treatment for TB is freely available and highly effective, TB continues to kill hundreds of thousands of people every year in India, and vast numbers of cases go undetected. Public TB clinics are better equipped to quickly diagnose and begin treatment for the disease, but patients are often reluctant to utilize them. The researchers say that for better TB tests to make a major difference they must be made available to the private health care providers where patients first seek care.
“Most people in India with underlying TB initially seek care for cough from the private health care sector,” notes the study’s lead author Henrik Salje, PhD, a postdoctoral fellow in the School’s Department of Epidemiology. “Private providers often use the wrong tests for TB, and without getting the right diagnosis, patients move between providers with long diagnostic delays.”
Often, patients with symptoms start with convenient and more trusted private sector physicians and informal health care providers, but ultimately public sector physicians diagnose and treat more than half of the TB cases in India. They have long used sputum smear microscopy, which may miss up to half of all active cases.