Tuberculosis Laboratories help in bacteriological diagnosis (evidence) of TB allowing clinicians (medical doctors and paramedical staff) to start TB treatment for people suffering from TB disease. It's a good medical practice to start treatment with confirmed laboratory results ensuing evidenced based medicine, rather than empirical practice of medicine. Laboratories help avoid unnecessary wastage of drugs as well as drug misuse leading to 'drug-resistance'. Everyone should get a laboratory diagnostic test before starting treatment. However, this does not happen all the time- especially in the public health resource limited settings for various reasons. Key issues are sensitivity limitation of the sputum microscopy as a tool for laboratory diagnosis, and extensive use of 'readily-available' chest-x-rays as alternate aid to help clinical diagnosis. However, this is changing fast in last few years- advanced molecular rapid and accurate diagnosis of TB is now possible through GeneXpert platform based Xpert MTB/Rif test. WHO global TB reports, year after year, indicate that there is a considerable gap (from approximately 40%-60%) in developing world where in people suffering from TB are treated without any laboratory based evidence. In 2015, about 42% of people treated for pulmonary TB, all over the world, had no laboratory test!! In absolute numbers this is about 2,034,953 people (WHO Global TB report, 2015). That is- about 2 million people were treated basically on a 'hunch' or 'gut-feeling' from clinician (sometimes aided with Chest-X-ray) that the disease the patients were suffering from is TB. May be to some extent, in the medical practise (in the absence of appropriate resources), the gut- feeling is better than no 'feeling' and thus no treatment. At least, some percent of those clinically treated people may be getting appropriate treatment if one considers that TB is not a rare disease, chest x-rays aid in diagnosis and medical staff are well trained to identifying signs and symptoms of TB for several generations now. Let's leave this aspect here- there are pros and cons to clinical treatment. However, there are no dispute on the bacteriologically treated TB positive people. All agree that every one should get a TB laboratory test before starting TB treatment, and at an early stage of disease. In other words, this is called defined as "Universal TB testing". The word Universal means all those who are eligible as judged by signs and symptoms of TB. The table given below provides data in Africa on extent of universal TB testing, together with universal TB drug susceptibility testing (DST) for first and second line Drugs.
As we see in Africa- in 2015 global TB report (data of the year 2014): (1) about 32% of people (about 400,000) treated for lung TB did not get any laboratory TB test before being placed on TB treatment (2) about 46% of people (286,210) of those who had positive laboratory result had no test done to confirm if it is normal TB (drug-sensitive TB) or Multi-Drug resistant TB (MDR-TB) (3) about 76% (12,536) of those who had MDR-TB were not tested if they had Extensively drug resistant TB (XDR-TB).
Global TB report of 2016 (with annual data from 2015) shows considerable increase in access to second line DST in Africa from about 15% to 32.9% (as given below), although there is no further change in numbers for first-line DST:
The WHO-Afro region-wise information for the universal diagnostic testing is given below:
This situation needs to change. WHO is working hard to implement the END TB strategy to eliminate TB as a 'public health threat' by year 2030. This is part of UN strategy of sustainable development goals for all countries. The Strategy advocates for the universal TB testing in two stages. First achieve Universal Drug resistant testing goal i.e., all those who had bacteriologically confirmed TB should be tested for MDR-TB/or its surrogate definition. This is followed by greater goal of eliminating the clinical TB, i.e., all those to be treated should have a lab results to indicate that they are positive. Global need is ambitious to remove clinical TB completely. However, implementation dictates prudence, that we dream in limited scale to start with and not set lofty goals and fail. This requires that people, communities and societies who suffer from TB should take responsibility. Lets contribute to the awareness. How about new laboratories group? Say- TB Laboratories- with following logo.
Responsible care provider and more importantly responsible health seekers- if you don't seek why should you be provided? In the increasingly capitalistic world- why should I increase your awareness of your role in society unless you are not able to help yourself. People suffering from TB should help themselves. Let's work for it (Contributor: Ajay Thirumala).
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