Uptake of universal drug susceptibility testing among people with TB in a south Indian district: How are we faring?

Background: India implements universal drug susceptibility testing (UDST) using rapid genotypic tests (cartridge-based nucleic acid amplification test CBNAAT - and line probe assay - LPA). to bridge the gap of diagnosis of multidrug/rifampicin-resistant TB. There is limited evidence assessing the implementation of UDST in India. We assessed the implementation among people with pulmonary TB notified from public facilities in October 2019 from Raichur (Karnataka), India. Methods: A cohort study involving secondary data in routine programme settings was conducted. All people with TB underwent a rapid genotypic DST for rifampicin resistance followed by first line-LPA (FL-LPA) if sensitive and second line-LPA (SL-LPA) if resistant. Results: Of 217 people, 15.7% (n=34) did not undergo rapid genotypic DST. Of 135 whowere rifampicin-sensitive detected on CBNAAT, 68.1% (n=92) underwent FL-LPA, and out of the six rifampicin-resistant cases, 66.7% (n=4) underwent SL-LPA. Overall, 65.4% (142/217) completed the UDST algorithm. Children (aged <15 y) and people with bacteriological non-confirmation on microscopy were less likely to undergo rapid genotypic DST. Of 183 patients who underwent both rapid genotypic DST and sputum smear microscopy, 150 were bacteriologically confirmed and, of them, 9 (6%) were 'rapid DST-negative'. Conclusion: We found gaps at various steps. There were a significant number of 'rapid DST-negative, smearpositive' patients.

Automated summary

The implementation of universal drug susceptibility testing (UDST) using rapid genotypic tests in India showed gaps in completion rates and detection of 'rapid DST-negative, smear-positive' cases, indicating the need for further improvement and attention to these issues.