Sixty per cent of people living with HIV in India die due to TB

Sixty per cent of people living with HIV in India are losing their life because of a preventable and curable cause: tuberculosis (TB). India's largest network of people living with HIV (Indian Network of people living with HIV - INP+) held a meeting recently with Cepheid, and Foundation for Innovative New Diagnostics (FIND), the co-developers of a new rapid 100 minute TB diagnostic test (GeneXpert), to push for quick roll-out and better costing. Representatives from India's national TB programme (officially called "Revised National TB Control Programme - RNTCP") also attended the meet. Officials from the Government of India's RNTCP said that RNTCP is planning a multi-site demonstration study for gathering operational evidence for scale up of the new rapid 100 minute TB diagnostic test under programme conditions.

These sites, where demonstration studies will take place, will be spread nationally, will include areas with high incidence of HIV-TB co-infection and high incidence of MDR (multidrug resistant) TB, in order to gather full evidence about the test.

The results of these demonstration sites will feed into taking a decision to include the test while planning for the next phase of the RNTCP programme: that is Phase 3 of the RNTCP which will run from 2012-2017.

The INP+ will  present a report on this interactive meeting within a week to the Planning Commission of Government of India and the Central TB Division, Government of India.

"60% of people living with HIV in India are dying due to preventable and curable TB. Though we have 12,500 microscopy centers available across India, deaths occur mainly due to late diagnosis, owing to technology limitations. Therefore better diagnostics is a major concern for the people living with HIV" said KK Abraham, General Secretary of INP+.

"We are happy to note that RNTCP is planning to include civil society while gathering evidence for the test and will also focus on sites with high TB-HIV co-infection. The availability of 'GeneXpert' will go a long way in addressing this concern, however the cost would be a primary issue while rolling out this test. While the GeneXpert test cartridge is expected to be available at USD 16.86 in 2011 and at USD 14 in 2012, the availability of better pricing will remain a priority issue" said KK Abraham.

"The availability of this tool, GeneXpert, can really help with the early diagnosis of MDR-TB among people living with HIV (PLHIV)" said Hari Singh, who is a National GIPA (greater involvement of people living with HIV/AIDS) Coordinator with the INP+, and an Executive Board Member, Delhi Network of people living with HIV (DNP+).

A lack of properly integrated TB and HIV services is one of the biggest problems in controlling these two epidemics. In 2007, the World Health Organization (WHO) had assessed that 1.4 million people were newly co-infected with TB and HIV. As per WHO in 2009, there were an estimated 380,000 deaths from TB among people living with HIV. Even as nearly half the people living with HIV in India are also co-infected with TB less than 5 percent are tested for TB.

The WHO endorsed GeneXpert TB diagnostic tool is understood to be a DNA-based test that can diagnose TB and multidrug-resistant TB (MDR-TB) within 100 minutes. People who show up as  smear negative or  ones whose sputum does not show TB bacteria under the microscope (PLHIV and paediatric cases) can be easily detected by GeneXpert. This promises a sure diagnosis of TB in HIV positive people.

In December 2010, the WHO had endorsed this new rapid test for TB, especially relevant in countries most affected by the disease. The test could revolutionize TB care and control. Specifically, it can be used as a rapid initial diagnosis for patients suspected of MDR-TB or HIV-associated TB, and does not require major infrastructure and training. The test can detect Rifampicin resistance (one of the drugs that define MDR-TB) in about 100 minutes, compared to current tests that can take up to three months to have test results.

Bobby Ramakant - CNS

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