TB testing stuck in the previous century, and waiting for change

A classic case, as Madhukar Pai, renowned researcher on Tuberculosis anAssociate Director, McGill International TB Centre, McGill University, Canada, put it in a tweet as a pithy foreword to his article in Nature: Billions of molecular (PCR) tests were done for Covid-19 Why are we still using century-old microscopy for tuberculosis?.

Accompanied with a messy, unhygienic kitchen sink with racks of slides (presumably for sputum testing, requiring the patient to violently cough up phlegm from the lungs), there could not have been a more convincing argument to change the way testing is being done for Tuberculosis, pronto...

So, it is deeply frustrating that many high-burden countries, including India, are still so heavily reliant on microscopy, when nearly every country, including India, scaled up PCR (molecular) testing for COVID-19...

Interestingly, even when investments were made and good products like CB-NAAT [tests] were developed, many high burden countries have limited their use only to certain special risk groups (people with HIV, people at high risk of drug-resistance, children), instead of replacing microscopy with molecular testing, Dr..

In Nature, the authors recommend using molecular tests with non sputum samples in a decentralised testing facility that can test for multiple conditions, and testing that would focus on yield and population covered, cost lower but have high volumes and possibly manufactured in low and middle-income countries..

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