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Introduction

Multidrug-resistant tuberculosis (MDR-TB) poses a serious threat to India’s TB elimination goals. Driven by diagnostic gaps and treatment delays, it reflects systemic weaknesses, requiring early detection, robust infrastructure, and technology-driven, patient-centred solutions.

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Causes of MDR-TB

• Delayed diagnosis: Late or inaccurate detection leads to inappropriate treatment.
  Eg: Reliance on sputum microscopy with low sensitivity.
• Inadequate testing: Limited upfront molecular testing misses drug resistance.
  Eg: Scale-up of CBNAAT and Truenat under National TB Elimination Programme still uneven.
• Treatment interruption: Poor adherence allows bacteria to develop resistance.
  Eg: Gaps in follow-up and patient support systems.
• Diagnostic delays: Slow turnaround for resistance testing delays correct therapy.
• Transmission in community: Undiagnosed cases spread resistant strains.
  Eg: Asymptomatic TB identified in National TB Prevalence Survey.

Challenges of MDR-TB

• Limited access: Uneven availability of advanced diagnostics.
  Eg: Gaps in access to molecular testing in remote areas .
• Complex diagnosis: Difficulty in detecting extra-pulmonary TB.
  Eg: EP-TB forms ~25% of India’s burden and is harder to diagnose.
• Vulnerable groups: Elderly, disabled, and remote populations face access barriers.
  Eg: Need for better sputum collection and transport systems.
• High costs: Expensive diagnostics and treatment increase burden.
  Eg: Out-of-pocket expenditure for TB families remains significant.
• Child TB gaps: Difficulty diagnosing TB in children due to low bacterial load.
  Eg: Need for non-sputum tests like stool or saliva .

Solutions for MDR-TB

• Expand molecular testing: Ensure universal upfront NAAT-based diagnosis.
  Eg: Use of Truenat and CBNAAT under Indian Council of Medical Research validation.
• AI-based screening: Use portable X-rays with AI for early detection.
  Eg: AI-enabled CXR vans under Pradhan Mantri TB Mukt Bharat Abhiyaan.
• Decentralise diagnostics: Bring testing closer to primary healthcare.
  Eg: WHO-recommended near point-of-care NAAT tools .
• Strengthen sample logistics: Improve sputum collection and transport systems by focusing on elderly and remote populations.
• Invest in innovation: Develop non-sputum tests and biomarkers.
  Eg: Tongue swab and saliva-based testing endorsed by the World Health Organization.

Conclusion

Addressing MDR-TB requires strengthening diagnostics, ensuring timely treatment, and leveraging innovation. A comprehensive, decentralised, and technology-enabled approach can reduce transmission, improve outcomes, and accelerate India’s progress towards TB elimination.

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