4 Topic Commentaries

India’s TB Labs Face a Capacity Gap

India’s TB Labs Face a Capacity Gap

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  David W. Dowdy, MD, PhD

  Tuberculosis epidemiology and diagnostics implementation

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  Johns Hopkins Bloomberg School of Public Health

  Microscopic analysis of sputum for TB is cheap and widely available, but misses half of all TB cases," said David Dowdy, MD PhD, lead author of the study and assistant professor in the Department of Epidemiology at the Bloomberg School of Public Health. "TB culture, the current gold standard, requires training and equipment not available in most resource-limited settings. Serological tests are simpler and faster than culture, and are also commercially available in India, so they are an attractive option in theory. However, we found that they are not accurate enough to be useful—after accounting for missed and false-positive TB diagnoses, serological tests cost more and delivered less than either microscopy or culture. Quite simply, serological tests should not be used to diagnose active TB.

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  David W. Dowdy, MD, PhD

  Tuberculosis epidemiology and diagnostics implementation

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  Johns Hopkins Bloomberg School of Public Health

  The impact of better TB diagnosis depends not only on the accuracy of the test, but also on the behavior of both patients and providers, good access to validated new tools, and quality TB treatment following diagnosis," says the study’s senior author David W. Dowdy, MD, PhD, an assistant professor in the Department of Epidemiology. "To achieve maximum impact of novel diagnostics, India should engage the private sector, improve quality of care across all sectors, and dramatically increase the resources used to fight TB.

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  Melvin (Mel) Spigelman, MD

  Tuberculosis drug development and global TB policy

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  TB Alliance (Global Alliance for TB Drug Development)

  “Totally resistant tuberculosis is out there, make no mistake,” says Mel Spigelman, chief executive of the TB Alliance in New York. “The reports from India shouldn't come as a surprise to anybody, but it should come as a wake-up call for the world. We need better diagnostics, surveillance and treatment right away.”

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  Madhukar Pai, MD, PhD

  Tuberculosis diagnostics and health systems

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  McGill University

  “A similar cascade of care analysis to identify critical gaps in the private sector would be most helpful and is urgently needed.”

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