India has 97 culture and drug susceptibility testing laboratories but requires an estimated 283, leaving a national shortfall of approximately 62 percent, according to a study published in Microbiology Spectrum.
The study was conducted by researchers associated with the Foundation for Advancement of Essential Diagnostics (FAED) and collaborating institutions. It aimed to establish India's preparedness toward the eradication of tuberculosis (TB). The researchers used government data to assess the distribution of TB treatment units and diagnostic laboratories across India. They also visited public health facilities to determine whether tests recommended by the Indian Council of Medical Research were available at different levels of care.
Researchers found that India has 6,308 TB treatment units, compared with the recommended 7,084 based on population size. Eleven states and four union territories had fewer units than recommended.
The gap was greater for culture and drug susceptibility testing (CDST), which is used to confirm TB and identify resistance to antimicrobial treatments. The researchers identified 84 certified public-sector and 13 private-sector CDST laboratories. An additional 186 would be needed to meet the World Health Organization recommendation of one laboratory per 5 million people.
Limited CDST capacity may delay the detection of drug-resistant Mycobacterium tuberculosis and restrict access to susceptibility results needed to select treatment.
Between November 2023 and April 2025, the researchers visited 327 public facilities across seven states and Delhi. These included 76 subcenters, 150 primary health centers, 78 community health centers, and 23 district hospitals.
The proportion of facilities offering every TB test recommended for their level of care ranged from 10 percent to 67 percent across the surveyed regions. Only 5 percent of primary health centers had the complete set, compared with 15 percent of community health centers and 40 percent of district hospitals.
Acid-fast bacilli smear microscopy was the most widely available diagnostic method, present in 78 percent of facilities where it was recommended. Chest X-ray was available in 51 percent of 251 eligible facilities.
Cartridge-based nucleic acid amplification testing was available in 51 percent of 101 community health centers and district hospitals. This molecular method can detect TB more rapidly than culture and identify certain markers of drug resistance. Fluorescence microscopy was available in 31 percent of 23 district hospitals.
Access to laboratory tests used during treatment was also uneven. Complete blood count testing was available at approximately half of primary health centers, while access to components of the comprehensive metabolic panel varied by region and facility. These investigations can identify anemia, liver dysfunction, and other complications related to TB or its treatment.
The researchers argue that strengthening diagnostic access at peripheral health facilities could help achieve the goals of the National TB Elimination Program, while expanding and maintaining CDST capacity would support more effective identification of drug-resistant TB.
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