Key Questions Answered
Q1. What is Universal Drug Susceptibility Testing (UDST)?
UDST means that every diagnosed TB patient should undergo Drug Susceptibility Testing (DST) to determine whether the TB bacteria are susceptible or resistant to anti-TB drugs.
The objective is simple:
“The right treatment begins with the right diagnosis.”
Q2. Why is UDST important?
UDST helps:
*Detect drug resistance early
*Select the most appropriate treatment regimen
*Prevent treatment failure
*Reduce the development and spread of MDR-TB
*Improve treatment outcomes
Without knowing the drug susceptibility pattern, treatment may be inadequate or ineffective.
Q3. What is the global burden of Drug-Resistant TB?
According to the WHO Global TB Report 2023:
*Approximately 4.1 lakh (410,000) people globally were estimated to have MDR/RR-TB.
*Around 2.73 lakh new DR-TB cases occurred worldwide.
*Approximately 3.6% of newly diagnosed TB patients had drug-resistant TB.
Drug-resistant TB remains one of the biggest threats to global TB control.
Q4. What is the burden of Drug-Resistant TB in India?
India continues to carry a substantial DR-TB burden.
*Approximately 1.35 lakh people were estimated to have MDR/RR-TB.
*Around 86,000 new DR-TB cases were estimated.
*Approximately 2.9% of newly diagnosed TB patients were estimated to have DR-TB.
This highlights the importance of timely resistance testing.
Q5. How much progress has India made towards UDST?
India has made significant progress through:
*Expansion of CBNAAT/NAAT platforms
*Wider access to molecular diagnostics
*Strengthening laboratory networks
*Policy commitment under NTEP
Programmatic data indicate increasing use of rapid molecular testing over the last few years.
Q6. Are all TB patients receiving UDST before treatment starts?
Not yet.
While coverage has improved substantially, gaps remain.
Programmatic estimates suggest that test results before treatment initiation are available in approximately two-thirds of notified TB patients, though coverage varies across states and districts.
This means there is still room for improvement.
Q7. What challenges are preventing universal implementation of UDST?
Some major challenges include:
*Delayed testing in certain areas
*Sample transportation issues
*Laboratory capacity constraints
*Delays in reporting results
*Incomplete follow-up testing
*Need for stronger quality assurance systems
Q8. Why is UDST particularly important before using newer regimens such as BPaLM?
Newer regimens such as BPaLM represent major advances in DR-TB treatment.
However, their success depends on:
*Accurate diagnosis
*Timely DST
*Appropriate patient selection
*Continuous monitoring
Using advanced regimens without adequate DST may compromise outcomes and future drug effectiveness.
Q9. What happens if drug resistance is missed?
Missed drug resistance can result in:
*Treatment failure
*Continued transmission
*Development of additional resistance
*Increased healthcare costs
*Greater risk of future MDR-TB cases
Q10. Can India eliminate TB without strengthening UDST?
It will be extremely difficult.
TB elimination requires:
*Early diagnosis
*Universal DST
*Appropriate treatment
*Treatment adherence
*Strong public-health systems
Without timely detection of drug resistance, elimination targets become much harder to achieve.
*Conclusion* Dr S K Arora states that
early detection of resistance is essential to choose the right Treatment and only then we can prevent Drug-Resistant TB.
Take-Home Message is that Innovation in Treatment Requires Precision in Diagnosis.
End Tobacco. → End TB. → Save Lives.
Dr S K Arora
WHO Awardee | Senior Chest Specialist | TB Expert | Tobacco Control Advocate
