News & Events
Press Releases - 2010

30th November, 2010 | New Delhi

India’s largest network of People Living with HIV, INP +, calls for availability of Xpert MTB/RIF Diagnostic tool for the PLHA community on eve of World AIDS Day, 2010. This tool accurately and reliably tests for TB within 90 minutes among PLHA; TB is the leading cause of death among People Living with HIV(PLHA) in India.

International NGO Global Health Advocates India - ACTION Project, medical experts, join the call for availability of tests like Xpert MTB/RIF, that use molecular testing ,close to the PLHA community, for speedy diagnostics and treatment.

The largest group of People Living with HIV(PLHA) in India, with a network of 2.5 lakh members, INP + has made a concerted call for availability for better diagnostics than can reliably test for TB and MDR TB among PLHA. Tools like the Xpert MTB/RIF, based on molecular testing, can produce highly reliable results in less than two hours. The current gold standard for such tests uses the liquid culture method that can take as long as three months to show whether a person living with HIV has TB or not.

Jahnabi Goswami, President, INP+ says, “Tests that use molecular technology like Xpert MTB/RIF can potentially save millions of lives by timely detection and treatment for people affected by TB especially people living with HIV (PLHAs) and those living with MDR TB who are resistant to rifampicin, one of the drugs in the first line treatment for tuberculosis. TB is the leading cause of death for PLHAs who are also more likely to develop TB. MDR TB has a high mortality rate and also involves more expensive treatment using the second line of drugs treatment regime."

Comprehensive advocacy has driven efforts towards better diagnostics; such an effort has not been seen in previous years. This has led to an incredible array of weapons being developed in the fight against tuberculosis including vaccine research, new drugs and cutting edge diagnostics. At the forefront is nucleic acid-amplification testing, based on molecular technology, used in Xpert MTB/RIF.

Vivek Dharmaraj, Project Leader, ACTION Project – Global Health Advocates, India, “Nothing with the promise to be a game changer in the world of tuberculosis has been seen for decades. Advocacy efforts from the north and south, from professionals and civil society have driven research and innovation which have led to the Xpert MTB/RIF. At the very least, it can be deployed in its present form to the huge benefit of the PLHA community. But if it truly can be used as a point-of-care tool – and price is going to be a huge challenge - we are not only talking control of tuberculosis but possibilities of elimination.

The test, Xpert MTB/RIF, has been developed by Cepheid (US based) in collaboration with the Foundation for Innovative New Diagnostics (FIND), the University of Medicine and Dentistry of New Jersey (UMDNJ), and the US-run National Institute of Allergy and Infectious Diseases (NIAID). A review of this new diagnostic tool has appeared in the New England Journal of Medicine (NEJM) in September 2010. Publication of the performance of Xpert MTB/RIF in a large multicentre trial was heralded as representing a new era in tuberculosis diagnostics.

“Early diagnosis, early treatment and cure of the disease is the main objective of TB control. With largest TB burden and the highest HIV/TB co-infection accurate, early, rapid and qualitative diagnosis is key; it forms the cornerstone on which care and control rest. Molecular technology would achieve this effectively. A careful and strategic uptake of tools that use this platform has the potential to change the tuberculosis landscape, not only for treatment but transmission.” Dr. J.N. Banavaliker, Senior Consultant and Medical Superintendent, Head of Department TB and Pulmonary Medicine, Rajan Babu Institute for Pulmonary Medicine and Tuberculosis.

Though preventable and treatable TB is the leading cause of mortality in people living with HIV; in India nearly half of the estimated 2.4 million people affected by HIV/AIDS are likely to be also infected with Tuberculosis.

With such large numbers of people living with HIV in India, the need for a robust and fully integrated TB/HIV control programme in India is essential. Without early diagnosis and rapid initiation on proper treatment, an estimated 90% percent of PLHAs could die within months of developing active TB.

Referrals from AIDS control programs (like from the Integrated Counseling and Testing Centre or ICTC) to TB Control Programmes( under the Revised National TB Control Programme or RNTCP) is part of HIV/TB co-infection control management but many PLHAs don’t make it from point to the other.

KK Abraham, General Secretary INP+ points out that, “While guidelines recommend that PLHAs should test for tuberculosis the inconvenience of two separate testing centers, different timings and bearing the cost of transport in addition to lost income prohibit many for getting their TB test done early. If TB testing could be done at the same place that the HIV counseling and testing is done, then there would be 100% testing of PLHA. The patient-friendly Xpert MTB/RIF make this possible."

Xpert MTB/RIF is the first automated molecular tuberculosis test developed that has the potential to be a point-of-care tool. Placed strategically at ICTCs, the tool could allow PLHAs to get tested instantly. This one-window testing system could foster blanket screening of PLHAs and prevent drop-outs that occur in the current scenario where testing sites differ for HIV and TB. Widespread availability of this tool will help to detect and treat tuberculosis among PLHA much faster, vastly improving quality of life. However, the technology and the test- kits at current price indications would be prohibitive for most developing countries. The Indian biotech industry can play a significant in developing domestic models and manufacturing capacity.

Dr B.R. Das, Executive Director Research and Innovation, Super Religare Laboratories (SRL) elaborates, “The development of this tool is truly a technological advancement enabling Mycobacterium tuberculosis detection as well as drug resistance in same step. From a clinical aspect this tool has the prospectus to improve the TB detection rate with effective patient management as well as efficient control of the infection. At the moment the cost of this technology is prohibitive for its pan implementation particularly in developing countries where majority of the healthcare needs are managed by patient or to a certain extent through public health funds. However this should not be seen as a problem but rather as an opportunity and challenge for the public-private sector to work together on partnership basis to implement this technology by co-funding or sharing the existing expertise or capabilities. Also in long run government can plan for funding the development as well as implementation of innovative but cost-effective tools of similar caliber. Private players on other hand can share their experience, expertise and capability in developing such innovative tools which will be more suitable in resource poor settings. No doubt this tool is a breakthrough technological leap which is expected to change the diagnostic landscape of Tuberculosis, mankind’s biggest medical problem since last 100 years."

ABOUT INP+ and Global Health Advocates India

INP + is an ISO 9001:2000 certified Community Based Organization – The Indian Network for People Living with HIV/AIDS (INP+) is a national network for people living with HIV/AIDS. INP+ is a social movement by and for People Living with HIV/AIDS (PLHIV) in enforcing the recognition for Human Rights of PLHIV in India . INP+ has waged a long and intensive struggle against fear, ignorance, prejudice and despair born out of the epidemic and stood to represent courage, insight, acceptance and hope to hundreds and thousands of People Living with HIV/AIDS.

Global Health Advocates (GHA) India is a non-governmental organization that focuses on engaging all sections of society to fight diseases that disproportionately affect people living in poverty, and are also causes of people living in poverty. In particular, Global Health Advocates India works towards the formulation and implementation of effective public policies to fight disease and ill health in India. GHA India runs The Advocacy to Control Tuberculosis Internationally (ACTION) project, an international partnership of advocates working in 7 countries to mobilize political will and resources to treat and prevent the spread of tuberculosis (TB), a global disease that kills one person every 20 seconds.

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