April 22Featured ArticleIssue

Future of TB Diagnostics is WSG

Whole Genome Sequencing (WGS) is the need of the hour

Today, TB is still one of the most infectious killers, causing more deaths than malaria or AIDS. According to WHO estimates, a total of 1.5 million people died from TB in 2020, making it the 13th leading cause of death worldwide and the second leading infectious killer only after COVID-19. Further, India accounts for around 26 per cent of the total TB cases across the world.

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The COVID-19 pandemic aggravated the TB scenario. Covid restrictions prevented TB patients from seeking treatment. In addition, many cases remained undiagnosed. WHO states, 4.1 million people currently suffer from TB but have not been diagnosed with the disease or have not officially reported it to national authorities;  increasing 1.5 times from 2.9 million in 2019.

Highest unreported TB in India In 2020, a total of 18.12 lakh cases of tuberculosis were notified, which was 25 per cent less than the total 24 lakh cases notified in 2019, Union Health Minister Mansukh Mandaviya has said. One of the main reasons for the decreased number of TB cases was  the disruption in access to TB services and a reduction in resources and people struggling to seek care in the context of  lockdowns, a HaystackAnalytics  report said. Not only can this have a detrimental impact on the economy, but the situation can also aggravate  considerably, if not addressed in due time. The high  incidence rate within the productive  age group which contributes the most to their families and GDP financiallypoints to a major loss in income and productivity.

“A staggering 65 per cent of the tuberculosis cases in India are in the 15-45 age group, which is the most economically productive  populationsegment,” Mansukh Mandaviya, Union Health Minister said.

High incidence of MDR TB in India

While the world is effectively treating drug-susceptible forms of TB, the community transmission of drug-resistant forms of TB can snowball into a difficult to treat the epidemic. The WHO estimates that globally only two of every three patients with MDR TB are diagnosed, three in every four of the diagnosed are treated, and only one of  every two of the treated patients are cured, resulting in 75 per cent of the incident cases persisting in the community, leading to active transmissions and death. Though a battery of common MDR TB tests is available, these tests fail to detect higher grade strains such as XDR TB, highlighting concerns about their efficacy and treatment options.

With high mortality rates, negative impact on the economy and loss of  productivity, it is imperative to start working towards solving the problem at the core. Accurate diagnosis at an affordable cost is paramount in the  fight against TB.

Why Whole Genome Sequencing (WGS) is the need of the hour

Given the situation, it is imperative to start working towards solving the problem at the core to ensure accurate  and timely diagnosis and scalable treatment options for patients. Whole Genome Sequencing (WGS) can emerge as the revolutionary one-stop solution for the diagnosis and treatment of tuberculosis in India. This
technique can determine the entirety of an organisms’ DNA cost-effectivelythrough a single comprehensive test
by enabling an ‘all-in-one’ approach that provides epidemiological data and comprehensive information on the diagnostic background and expected sensitivity of the strains. It is less expansive to run a WGS than a culture test currently available.

Scaled platforms of WGS are already significantly less cost-intensive than the culture DST HaystackAnalytics report said. The report also pointed out that by utilising the WGS platform labs can be optimally utilised. These  platforms provide unprecedented asset utilisation, wherein each installation can perform more than 600,000 tests per year.

Tentatively, 10 such installations can cover the testing of the entire caseload in the country, HaystackAnalytics report said.

The report further states that in the battle for accurate diagnostics, Universal DST has been declared a key  process of India’s National TB Elimination Program. However, it is evident that in the current system culture DST, which is not only extremely resource-intensive and a highly hazardous process involving multiple cultures of highly drug-resistant isolates, is not going to scale.

And till we have a scale solution, India will not be able to achieve the target of being TB free by 2025

Expanding the scope for WGS Testing in India
While the use of WGS for the treatment of tuberculosis has been deployed in countries such as the UK, Spain and Italy, India has recently called out at a policy level to use WGS for the diagnosis of tuberculosis cases. HaystackAnalytics has partnered with various diagnostic centres such as Thyrocare, Metropolis, Unipath, Anderson, Sterling Accuris,Apollo Hospitals and over 20+ hospitals including AIIMS, to introduce their
Sequencing based game-changing TB test which is being used for accurate diagnosis of tuberculosis in India.

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