Why TB Tests Aren’t Reaching Patients

Primary-care facilities face gaps in molecular testing, chest imaging, culture, and drug-susceptibility testing

By
Jessica Allerton
October 26, 2026
9 min

The Pathologist

At a Glance

Category	Detail
Condition	Tuberculosis (TB) diagnosis and access to essential diagnostics in India
Key Mechanisms	Diagnostic capacity is unevenly distributed across healthcare tiers; gaps in point-of-care testing, specimen transport, and culture and drug-susceptibility testing (CDST) limit access.
Target Population	People with presumptive TB, particularly those in rural, remote, and underserved communities.
Care Setting	India’s public healthcare system, from primary health centers (PHCs) and community health centers (CHCs) to district hospitals and specialized laboratory networks.

Key Highlights

The study assessed 327 public healthcare facilities across seven states and Delhi; the largest diagnostic gaps were at the primary-care level.
Complete availability of both AFB smear microscopy and chest X-ray at PHCs generally ranged from 0% to 10% across surveyed regions.
Across tiers where tests are recommended, AFB microscopy was available in approximately 78% of facilities; chest X-ray and CBNAAT in around 51%; and fluorescence microscopy in approximately 31% of district hospitals assessed.
India had 97 identified CDST laboratories against an estimated requirement of 283, a reported shortfall of 62%.
WHO recommends rapid molecular diagnostics as initial tests for people with presumptive TB; the article reports that access in India remains concentrated at secondary and higher levels of care.

Guideline-Based Recommendations

Diagnosis

WHO recommends rapid molecular diagnostics as initial tests for people with presumptive TB.
The article reports that India’s National Essential Diagnostics List recommends AFB smear microscopy and chest X-ray at PHCs.

Management

The interviewee recommends expanding rapid molecular testing systematically at CHCs and, where feasible, closer to PHCs.
The interviewee recommends reliable specimen-referral and transport systems where onsite testing is impractical.
The interviewee recommends improving primary-care access to chest radiography and identifies portable digital systems as a possible way to extend access in remote regions.
The interviewee recommends strengthening CDST capacity through laboratory and specimen-transport networks.

Monitoring & Follow-up

The interviewee states that smear microscopy continues to have a role in some monitoring settings.

Risks

The source states that smear microscopy is less sensitive than contemporary molecular testing and may miss TB in people with low bacterial loads, including some people living with HIV.
The source states that a negative smear does not exclude TB and that ending the diagnostic pathway at smear microscopy may delay diagnosis and appropriate treatment.
The source states that smear microscopy cannot determine whether TB is drug-susceptible or drug-resistant.

Patient & Prescribing Data

People with presumptive TB in India, with particular access concerns for rural, remote, and underserved populations.

The article does not provide prescribing regimens. It states that delayed or missed diagnosis can delay appropriate treatment and that clinicians need timely results to act on diagnostic findings.

Clinical Best Practices

The interviewee recommends treating diagnostic access as a connected network involving testing, specimen transport, timely result return, and clinical action.
The source states that a negative smear does not exclude TB.
The interviewee describes chest X-ray and computer-aided detection as screening tools, not replacements for bacteriological confirmation.
The interviewee states that culture requires containment facilities, specialist expertise, quality systems, and biosafety measures.