Evaluation of an “upfront molecular testing” strategy under the National Tuberculosis Elimination Programme (NTEP) in Thiruvananthapuram, Kerala, India

Background India's National Tuberculosis Elimination Programme (NTEP) aims to eliminate Tuberculosis (TB) by 2025. Shifting from sputum smear microscopy to more sensitive nucleic acid amplification tests (NAATs) for TB diagnosis is an important step in that direction. This study aimed to describe and assess the implementation of an upfront molecular testing strategy for patients with presumptive TB in Thiruvananthapuram, Kerala. Methods We conducted a cross-sectional study in Thiruvananthapuram from July to August 2022, using program data from January to June 2022. A logic framework was developed to guide the evaluation and design of the indicators for input, process, output, and outcome. The study included all ten molecular testing facilities, and a subset of Designated Microscopy Centres (DMCs) selected through simple random sampling for the facility survey. We reviewed registers and records at the District TB Centre, DMCs, and TB Units. We interviewed presumptive TB patients and staff using a semi-structured questionnaire. Results The district had a molecular testing capacity of 38 slots. Eight Truenat machines and two Cartridge-based Nucleic Acid Amplification Test (CBNAAT/GeneXpert) machines operated at the sub-district level, linked to peripheral health institutions for specimen collection and transport. About 59% of staff received hands-on training, and 97% of test details were updated in Nikshay in real time. The median turnaround time for molecular testing results was three days. Among the tested presumptive TB samples, 3% were positive, and 3% of those were found to be drug-resistant. Conclusion The implementation of molecular testing has improved case detection and patient satisfaction. However, challenges such as longer turnaround times, sample transportation, and inadequate training must be addressed to improve TB diagnosis and management in the region.