India must lead the way in developing new diagnostic tools and integrating new tools and delivery systems into the tuberculosis control programme, Peter Small, senior programme officer, TB Global Health Programme Officer, Bill and Melinda Gates Foundation, has said.
“In themselves, new tools have no value. They only have an impact in context and systems in which they are implemented. In turn, these systems have maximum impact only if they are able to take on new technologies as they become available,” Dr. Small said.
Delivering the Indian Council of Medical Research centenary celebration special lecture on ‘TB Control in India: what is the critical path after DOTS scale-up?,' Dr. Small went on to suggest a five-pronged strategy that the nation could embark on, in order to address the undiagnosed and under-treated epidemic in the country. Key among these recommendations was that the country should develop low-cost versions of quality molecular assays to detect TB and resistance that could be used within the country. This will be critical to meet a growing addiction to diagnostic certainty in Indian health care, he added. The World Health Organisation had last week recommended that a new molecular assay diagnostic technique be adopted to facilitate faster and more accurate diagnosis of TB.
“Even as it does this, India must control the use of inappropriate diagnostics for TB, Dr. Small said. These tests are being widely used in the private sector in India. The success of TB control will depend on the ability to prohibit the use of bad tests as much as the ability to use good drugs,” Dr. Small said.
There was no question that India would have to invest more money in TB control. Currently, about $100 million is being used to fight TB in India. But in the context of the emerging economic power that the nation had become, this level of spending was inadequate, Dr. Small said. Another $100 million would be required to treat multi-drug resistant TB and a further $100 million would be needed to use new diagnostics and engage the private sector effectively in the programme. The involvement of the industry, philanthropic institutions and the civil society would be essential.
Even as India is working intensely for the launch of the third phase of its Revised National Tuberculosis Control Programme next year, Dr. Small suggested that it must be “carefully planned, fully funded and thoughtfully managed to ensure equitable implementation.” He added that increased attention must be paid to measures that will treat patients, but also to interrupt transmission of infection. This will ultimately be the key to breaking the back of the epidemic, he said.
The lecture was organised as the concluding event of an intensive course on “TB Diagnostic Research – Beyond the Basics,” organised at the Tuberculosis Research Centre, and supported by TDR, European Commission, EDCTP, McGill University, Stop TB Partnership and FIND.
