Barriers and Solutions to Implementing Universal Drug Susceptibility Testing for Drug-resistant Tuberculosis: Perspectives of Public Health Medical Officers in Pune District, India
Karan Nagpurkar, Vikas Wadgaye, Prashant Bothe, Dhiraj Agarwal, Sanjay Darade, Vaishnavi KaraleBackground:
Tuberculosis (TB) remains a major public health problem, and drug-resistant TB (DR-TB) is a growing concern. World Health Organization’s (WHO’s) end TB strategy emphasizes universal access to rapid drug susceptibility testing (DST) for at least rifampicin, and further DST for fluoroquinolones among all TB patients with rifampicin resistance (preferably before treatment initiation or within 15 days of diagnosis). India accounts for 26% of global DR-TB cases. This qualitative study explores barriers and solutions for universal DST (UDST) from the perspective of public health medical officers (MOs) in Pune district, Maharashtra.
Materials and Methods:
In-depth interviews were conducted with 22 public MOs from rural and urban primary health centers across four TB Units during March–April 2025, using a semi-structured interview guide. One high-performing and one low-performing TB Unit were selected from both Pune Municipal Corporation and Pune Rural, based on TB case notifications. Manual descriptive thematic analysis was performed.
Results:
Key barriers reported were TB-related stigma, poor-quality sputum samples, patient refusal, inadequate sample collection and transportation (SCT), and limited access to extrapulmonary sample extraction centers. Suggested solutions included strengthening SCT, engaging private extrapulmonary diagnostic centers under public–private partnerships, increasing community and patient awareness about TB, and enhancing awareness of the National TB Elimination Program integrated diagnostic algorithm for DR-TB in the public health sector.
Conclusion:
This study provides evidence for policy and practice changes to address DR-TB. Strengthening logistics, engaging private diagnostic partners, and improving community awareness are essential to enhance UDST implementation.