About IPAQT Initiative
The Initiative for Promoting Affordable and Quality TB tests (IPAQT) is a platform to bring Revised National TB Control Programme (RNTCP) or WHO-approved tests at affordable prices to patients in the private sector. Under the Initiative, 54 private sector labs and clinics have come together with a commitment to provide quality tests for Tuberculosis (TB) at a subsidised price in India. These tests are:
- GeneXpert test
- Hain Genotype test
- MGIT test
- BacT/Alert test
This disease affects 2 million people annually in India, and each undiagnosed and falsely diagnosed case spreads the disease in their family and their community. The early diagnosis, followed by early treatment is the solution to this disease that even today, kills about 1000 Indians every 24 hours.
Objectives of the Initiative
- To facilitate the delivery of validated tests to the TB patient at affordable prices.
- To promote the use of validated TB tests through a coordinated communications and behaviour change effort to replace suboptimal tests and build awareness about the validated tests among health providers.
In eight months since the novel initiative IPAQT was launched, the number people accessing these labs for the subsidised tests has risen to 30,000. Of them, over 15,000 people have availed the geneXpert test.
But starting January 15, 2014, the cost of the subsidised geneXpert test will go up from Rs.1700 to Rs.2000. Probably the compulsion to increase the price was due to the depreciation of rupee against the U.S. dollar. Labs which are not part of the IPAQT initiative charge anywhere between Rs.3500 and Rs. 5000 for the geneXpert test.
While the sensitivity of smear microscopy (a popular but suboptimal testing method) is about 50 per cent, Xpert has 90 per cent sensitivity. It can therefore diagnose more people who have TB and with a greater degree of confidence. It can turn in results in about two hours.
And unlike smear microscopy, geneXpert can also indicate resistance to rifampicin-a first-line TB drug. Almost 98 per cent of people who are resistant to rifampicin are also resistant to isoniazid, another first-line TB drug. A person is said to have Multi-Drug Resistant TB (MDR-TB) when he is resistant to at least two first-line TB drugs. In short, Xpert can help doctors know if a patient suffers from MDR-TB even before starting treatment.
Replacement of unreliable Serological test
A ban on the serological test by the government of India, will go a long way in correctly diagnosing TB disease on time. The serological TB test diagnoses TB disease based on the presence of antibody response. But the presence or absence of antibody response does not reflect the true TB disease status. Hence, serological test is a highly unreliable for diagnosing TB disease. This ban had created a void in the diagnostic tests that the private labs could offer. The IPAQT initiative is now successfully filling this vacuum.
While the Revised National TB Control Programme (RNTCP) uses geneXpert and other WHO-approved diagnostic tests only for retreatment cases (where the patient had earlier been successfully treated for TB), private practitioners prefer geneXpert even in the case of fresh cases.
[Courtesy – The Hindu, ipaqt.org]