Rocking-chair syndrome gripping the TB response?

SHOBHA SHUKLA, BOBBY RAMAKANT - CNS

We are off-track to end TB, says former WHO Director of Global TB Programme
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Akin to a rocking chair that moves forwards and backwards without any real progress, we cannot assume busy TB programmes that may appear to have a lot of movement, to be making any real progress - unless they are doing what is warranted as per science and evidence to end TB.

Despite having the best of evidence-backed tools to prevent, diagnose and treat TB, the latest World Health Organization (WHO) Global TB Report shows that 3 million people (out of an estimated 10.6 million people with TB) were missed in 2022.

More worrying is that of the 7.5 million people who got diagnosed of TB in 2022, only 47% were diagnosed on an upfront molecular test. In other words, more than half of those with TB were diagnosed on sputum microscopy, which significantly underperforms in diagnosing TB (it may miss 40-50% of cases). Should not we set accountability for missing TB cases even among those who take a TB test?

Despite WHO recommendation and promises by world leaders to replace microscopy 100% with upfront molecular test for TB diagnosis, the abysmally slow pace at which this transition is happening is unacceptable.

A lot of TB prevalence surveys in high TB burden countries have shown that a very large number of people are asymptomatic for TB - and TB disease in them could only be found when they were screened with an x-ray - and those with presumptive TB, were offered a molecular test diagnosis.

Thanks to science, recently we have x-rays that can be taken out of the labs. In March 2021, WHO, for the first-time, recommended the use of portable x-ray in combination with compatible AI (Artificial Intelligence)-powered Computer-Aided Detection (CAD) software solutions. In September 2021, The Lancet wrote: "All five AI algorithms significantly outperformed the radiologists."

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