Mumbai Explores Tongue Swab Pilot for TB Testing After WHO Recommendation
Mumbai: A month after the World Health Organisation (WHO) recommended that countries with a high burden of tuberculosis (TB) consider new, faster, and easier testing methods, there are clear indications that the Brihanmumbai Municipal Corporation (BMC) may launch a pilot project to evaluate one of these innovative approaches: tongue swabs. This potential initiative aims to check the efficacy of using tongue swabs as a simpler alternative to traditional sputum-based tests, which could revolutionize TB diagnosis in high-density areas like Mumbai.
What Are Tongue Swabs and How Do They Compare to Traditional Tests?
Tongue swabs involve using a swab to collect saliva or fluid directly from the tongue, offering a less invasive and more straightforward procedure. In contrast, the conventional TB test requires patients to cough up mucus (sputum) from deep within the lungs, a process that can be challenging, particularly for vulnerable groups such as children and the elderly. Dr. Daksha Shah, BMC executive health officer, emphasized that "collecting tongue swabs would be easier for some patients, especially children," highlighting the potential for improved patient compliance and accessibility.
BMC's History of Innovation in TB Detection
While the pilot project is still in its early stages, Dr. Shah noted that the BMC has consistently shown interest in adopting newer methods to enhance TB detection. A few years ago, the BMC became the first civic corporation in India to conduct a pilot project utilizing artificial intelligence (AI) to detect TB in X-ray scans, demonstrating a proactive approach to leveraging technology in public health. This history of innovation positions Mumbai as a potential leader in implementing advanced TB testing strategies.
Mumbai's TB Burden and the Need for Improved Testing
Mumbai is recognized as one of the world's high-density TB hubs, with the emergence of extremely difficult-to-treat drug-resistant cases first noted in the city between 2011 and 2012. In response, the National TB Programme rolled out a special plan for Mumbai, fast-tracking new tests and medicines to combat the disease. In 2022, Mumbai registered 65,435 TB cases, a number that decreased to 54,390 patients in subsequent years, with approximately 8% of these cases involving drug-resistant TB. This persistent burden underscores the urgent need for more efficient and accessible testing methods.
WHO Recommendations and Global Impact
On February 26, the WHO recommended new near-point-of-care (NPOC) molecular tests for TB diagnosis, specifically endorsing easy-to-collect tongue swab samples to simplify and expand access to testing. Dr. Madhukar Pai, a Canada-based epidemiologist and public health expert, told The Times of India that "this new WHO policy is a big deal in the world of TB. For the first time, it has approved a near point-of-care molecular test that can be used at the primary care level, and also with a tongue swab since many people are unable to produce a sputum." He added that this test is available through the Global Drug Facility at $3.5 per test, making it "far more affordable than any molecular test so far," with Indian companies like Huwel and Molbio offering products in this category.
Industry Perspectives and Future Outlook
When contacted, Shiva Sriram, president of Goa-based Molbio Diagnostics, stated that his company's Truenat platform, already deployed in primary health centers across India, is designed to accommodate multiple sample types, including tongue swabs. However, he cautioned that tongue swab-based testing remains an emerging approach with limited field data. "As programmatic adoption increases, it is expected to generate stronger evidence and inform scaled implementation," he said, indicating that while promising, further validation is needed before widespread use.
The potential pilot project in Mumbai represents a significant step forward in the global fight against TB, aligning with WHO guidelines to make testing more patient-friendly and accessible. If successful, it could set a precedent for other high-burden regions, ultimately contributing to reduced TB transmission and improved public health outcomes worldwide.
