While detection of tuberculosis (TB) in children remains a challenge, it has now emerged that Multi-Drug Resistant (MDR) TB is higher among children than expected. This has been described as a “worrying trend” by the Union Health Ministry.
As many as 5,500 of over 76,000 children tested in nine cities have been diagnosed with TB. Nine per cent of these paediatric TB cases have been diagnosed to have MDR TB, according to the Foundation for Innovative New Diagnostics (FIND) that conducted the tests in collaboration with the Central TB Division under the Revised National TB Control Programme (RNTCP).
Unique initiative
FIND initially started a unique initiative for diagnosing paediatric TB in four cities of Delhi, Chennai, Hyderabad and Kolkata from April 2014 with funding from the United States Agency for International Development (USAID). It has now scaled up the project to include additional five cities —Nagpur, Surat, Visakhapatnam, Bengaluru and Guwahati. The project will start in Indore next week. The aim of the project is to provide rapid access to quality TB diagnosis for all presumptive paediatric TB patients in the project intervention areas.
Sunil D Khaparde, Deputy Director General (TB) and Head of the Central TB Division, told The Hindu on Tuesday that the RNTCP is committed to providing increasing access to quality TB diagnostics for the paediatric population. In 2016, the proportion of children among new TB patients reported was 6%. Absence of appropriate samples coupled with decentralised capacity to get good samples from children to test for TB remains a challenge in paediatric TB case detection, he said.
Admitting that paediatric MDR-TB cases had not been documented so far, he said children were more prone to primary MDR infection as they were in close contact with their parents and grandparents, who would have been infected.
“A considerable number of the 9% diagnosed to have MDR-TB are primary infections. This is a worrying factor,” said Dr. Khaparde, who is also the Project Director of RNTCP.
Clinical outcomes
“FIND’s collaboration with RNTCP is to enable rapid linkage to treatment with an overall aim of improving clinical outcomes in this vulnerable (paediatric) population. As of now the project is in nine cities and based on the success we will extend it to other cities,” he said.
According to Sanjay Sarin, who heads FIND, India, TB diagnosis in children is complicated due to challenges associated with sample collection and poor sensitivity of tests like the Acid fast bacilli (AFB) smear. FIND, through this project, has collaborated with the Central TB Division to improve access to more sensitive diagnostic tools like the GeneXpert in the paediatric population, he said.
Free test
The project was initially started to assess the feasibility of roll out of GeneXpert MTB/RIF, a cartridge-based test used with an automated molecular diagnostic platform that enables the diagnosis of TB and some drug-resistant TB (DR-TB) in less than two hours.
The focus was on testing various types of paediatric specimens in routine programmatic settings.
According to Debadutta Parija, Medical Officer, FIND, GeneXpert labs have been established within the reference labs of RNTCP in each of the project cities, catering to patients in both the public and private sectors.
GeneXpert MTB/RIF testing was performed free of cost for all presumptive paediatric TB and drug-resistant TB patients (aged under 15 years).
FIND’s Project Coordinator (Paediatric) Aakshi Kalra said both sputum and non-sputum specimens are being tested using GeneXpert except stool, urine and blood. This is as per the World Health Organisation (WHO) recommendations, Dr. Kalra said.
