Interview with Dr. Gurusaravanan Kutti Sridharan 

I had the opportunity to interview Dr. Gurusaravanan Kutti Sridharan, who is an Associate Professor of Medicine and Hospitalist at the University of Arizona. I asked him general TB questions, but it was an amazing opportunity to gain insight into the impact of TB within Arizona specifically. While Arizona does not have as much of a problem with TB as other third-world countries, it’s still a fairly common and recurring disease within our society. I was surprised at some of his responses, such as the prevalence of MDR-TB, which shows how different TB is in a country with ample resources for treatment and in countries within minimal resources. 

Below I formatted the questions I asked him (Q) in topic categories with his direct responses (A) underneath. I hope you learn as much as I did from this interview!

1. Prevalence and Encounter Frequency

  Q: How often do you encounter TB cases in your practice or community, and has this frequency changed over the past 5–10 years?

A: In my personal practice as a hospitalist physician who is working in a University medical center, I typically encounter about one active TB case on an average per year .Because this is such a small baseline, it is difficult to say I’ve seen a meaningful shift in frequency within my own patient load over the last decade.

  Q: In your experience, which demographics (e.g., age groups, socioeconomic backgrounds, or regions) are most affected by TB, and why do you think that is?

A: TB is a disease that often affects the disadvantaged. The groups I see most frequently affected are:

1. The socio-economically disadvantaged: People who live in poorly ventilated spaces, especially unhoused patients living in shelters.

2. Migrants: Those who have moved from countries where TB is endemic, as well as those with latent TB 

3. Immuno-compromised: Specifically those living with HIV/AIDS.

Q: What role does migration, urbanization, or travel play in the spread of TB in your area?

A: Given that we are close to the U.S.-Mexico border, migration plays an important role. Because TB rates in Mexico are significantly higher than in the U.S., the constant movement of people for work, family, and trade provides a steady influx of both latent and active TB cases.

2. Impact on Patients

Q: Can you describe a memorable case where TB significantly altered a patient's life, such as their work, family, or mental health?

A: The case I remember most is a middle-aged immigrant man who was the sole provider for his family. From the moment TB was suspected, he was isolated in the hospital while waiting for test results. Once diagnosed, he remained in isolation for weeks. He couldn’t work or be with his young children, which had a profound impact on his mental health. The disease not only took a toll on his body but also severely affected his family's financial well-being.

Q: How does TB stigma affect your patients' willingness to seek treatment, and what strategies have you used to address it?

A: Many patients feel embarrassed due to social isolation.  I’ve had patients who wouldn't tell their extended family or relatives because they feared they wouldn't be invited to family occasions or allowed to hold their grandkids. To help, I explain that TB is just a disease caused by bacteria.

 Q: What long-term effects have you seen in patients who recover from TB, such as respiratory issues or economic hardship?

A: TB damages the lungs and leads to scarring. This means a patient's lung function (their ability to breathe well) can be permanently affected. Even though the infection is cured with medications, many suffer from chronic shortness of breath for the rest of their lives.

3. Diagnostic Challenges 

Q: What makes TB so difficult to diagnose early, and how has this impacted outcomes in your patients?

A: The symptoms: cough, fever, and weight loss are very non-specific. In a big academic center like Banner, we see dozens of people with these symptoms every week. In Arizona, we often confuse these symptoms with Valley Fever. Because Valley Fever is so common here (causing about one-third of all pneumonia in AZ), we often test for it first, which can delay a TB diagnosis by weeks.

  Q: In your view, how effective are current diagnostic tools like sputum tests or chest X-rays, and what improvements would you prioritize?

A: Chest X-rays are excellent for screening but cannot provide a definitive diagnosis. Along with newer tests like GeneXpert that allow for a quick diagnosis, sputum tests remain a widely used and important diagnostic tool in hospitals.

Q: How do co-infections (e.g., HIV) complicate TB diagnosis, and what challenges does that pose in resource-limited settings?

A: In a patient with advanced HIV, an X-ray might not show the typical "cavities" even if they have TB. This is because their body cannot mount the immune response that creates those classic X-ray signs. Additionally, "extrapulmonary TB" (TB outside the lungs) is common in these patients, meaning their sputum tests may come back negative. In these cases, I have see physicians often treat patients based on clinical suspicion rather than waiting for lab results.

4.  Treatment and Management Obstacles

Q: Why do you think drug-resistant TB (e.g., MDR-TB or XDR-TB) remains such a persistent problem, and how often do you see it?

A: Drug-resistant TB is very rare; I have not seen a case in the past five years. Treating TB requires a long-term commitment, is expensive, and requires the patient to manage various side effects. Patients often stop treatment once they start feeling better, which allows strong bacteria to survive, mutate, and become the dominant, resistant strain.

Q: What are the biggest barriers to treatment adherence for your patients, and how do you overcome them?

A: Often, patients stop treatment a few weeks in because they feel much better and no longer see the need for medicine. We use DOT (Directly Observed Therapy) or vDOT (Video DOT) to ensure patients are compliant and actually taking their medications.

Q: How has the COVID-19 pandemic influenced TB treatment protocols or access to care in your practice?

A: During the pandemic, it was harder for people to get to clinics. However, it forced us to use technology like video calls much more, which actually helped some patients stay on track with their treatment from home.

5.  ⁠Broader Perspectives and Prevention

Q: What preventive measures (e.g., BCG vaccination, contact tracing) have proven most effective in your experience, and where do gaps exist?

A: The BCG vaccine helps prevent severe TB in children but is not reliable for adults. Contact tracing is the real backbone of prevention in the U.S. When we identify one active case, we notify the health department and the health department finds every person they’ve spent time with to prevent further spread. Gaps still exist in primary care, where testing needs to be more robust and widely available.

Q: If you could advocate for one policy change to combat TB globally or locally, what would it be and why?

A: I would advocate for the Mandatory Integration of TB Screening into Routine Primary Care for high-risk populations  and make the treatment completely free of cast.

Q: Looking ahead, what emerging trends or technologies do you see as game-changers in fighting TB?

A: Preventing serious disease is very important. It is possible for a human to miss a subtle case of TB on an X-ray. Newer AI softwares can now screen X-rays in seconds with higher accuracy than many human readers, flagging cases for immediate isolation. Finally, new vaccines are being tested that might finally replace BCG and prove effective for adults as well.