The State has proposed to move towards WHO’s goal of offering Universal Culture and Drug Susceptibility (sensitivity) Testing (DST) for all new cases of tuberculosis (TB) diagnosed in Wayanad and Idukki, the two districts chosen for implementing the TB Elimination Strategy this year, in the first phase.
TB elimination is defined as a stage when there is only one positive tuberculosis case for a million population.
Already, creation of grassroots-level awareness and active case detection, treatment, and surveillance have been launched in Idukki and Wayanad.
Universal Culture and DST would mean that as soon as a patient is diagnosed with TB, sputum samples are sent for culture for species identification and drug sensitivity tests to both first and second line drugs, so that appropriate drug regimen can be administered right from the initial phase.
Kerala is in a unique position to do this in the country because the TB load in its population is low and the State has accredited lab facilities for performing the latest liquid medium culture and DST for both first line and second-line drugs.
A significant proportion of MDR-TB patients were not being put on treatment during the initial implementation years of Revised National Tuberculosis Control Programme (RNTCP), because of the long processing period required for the solid culture and drug sensitivity tests. This not only affected treatment outcome, many patients used to die in the interim.
Between 2012-14, Kerala acquired faster WHO-approved rapid molecular diagnostics such as Line Probe Assay (LPA), which takes two days, and Cartridge Based Nucleic Acid Amplification Test (CBNAAT), which takes only two hours, for the results.
Today, CBNAAT facility is available in every district. Apart from the accredited Intermediate Reference Lab in the capital which can perform LPA tests for both first and second-line drugs, a second such lab is being readied at the Kozhikode Medical College also.
“We have now put up a proposal to the Centre that we offer Universal Culture and DST for two first-line drugs — INH and Rifampicin — to all new cases diagnosed in Idukki and Wayanad. Rifampicin resistance can be tested by CBNAAT in the districts itself, while INH resistance can be done at the IRL, as soon as the bio specimen is despatched.
‘‘Once the lab in Kozhikode is ready, we plan to extend the process to the entire State,” a senior RNTCP official said.
