Newer rapid TB diagnostic tests: why the uptake is low in India’s private sector

Abstract

In India, tuberculosis (TB) remains a major public health problem, accounting for 25% of the global TB burden. The situation is being worsened by the emergence of drug-resistant TB. India’s Revised National Tuberculosis Control Programme (RNTCP) emphasises sputum smear microscopy and culture (liquid or solid)/line probe assay (LPA) as the primary tools for the diagnosis of TB and multidrug-resistant TB (MDR-TB). The global scenario changed on 8 December 2010, when the World Health Organization (WHO) endorsed the new cartridge-based nucleic acid amplification test, Xpert® MTB/RIF (Cepheid Inc, Sunnyvale, CA, USA) for the rapid diagnosis of TB and rifampicin resistance. The TB community across the world was given renewed hope, expecting a drastic change in the way TB cases are diagnosed and its impact on the trends of incidence and prevalence. In 2011, the RNTCP began a multicentric feasibility study to look into operational issues for rolling out the test under the programme. The private sector, however, which manages the majority of India’s presumptive TB cases, had fewer than 10 Xpert machines in a few major cities in 2011 and 2012. Although the numbers increased in 2013, there was a huge gap in terms of demand and availability of this diagnostic facility. We describe the various setbacks encountered by the private sector in the uptake of the Xpert assay. This research was supported by the UK Department for International Development’s Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)