Low pre-diagnosis attrition but high pre-treatment attrition among patients with MDR-TB: An operational research from Chennai, India. Issue 4 (December 2017)

• Record Type: Journal Article
• Authors: Shewade, Hemant Deepak; Nair, Dina; Klinton, Joel S.; Parmar, Malik; Lavanya, J.; Murali, Lakshmi; Gupta, Vivek; Tripathy, Jaya Prasad; Swaminathan, Soumya; Kumar, Ajay M.V.
• Is Part Of: Journal of epidemiology and global health. Volume 7:Issue 4(2017:Dec.)
• Page Start: 227
• Page End: 233
• Publication Date: 2017-12
• Subjects: DR-TB drug resistant tuberculosis -- MDR-TB multidrug resistant tuberculosis -- DST drug susceptibility testing -- DTP diagnosis and treatment pathway -- RNTCP revised national tuberculosis programme -- PMDT programmatic management of drug resistant tuberculosis -- OR operational research -- TAT turnaround time -- DTC district tuberculosis centre -- TU tuberculosis unit -- DMC designated microscopy centre -- SNRL supranational reference laboratory -- LPA line probe assay -- FUS+ follow up smear positive -- IQR interquartile range -- RR relative risk -- CI confidence interval -- DOTS directly observed treatment short course; MDR tuberculosis -- Turnaround time -- Diagnosis and treatment pathway -- Delayed diagnosis -- Drug susceptibility testing; Epidemiology -- Periodicals; World health -- Periodicals; Public Health -- Periodicals; Communicable Disease Control -- Periodicals; World Health -- Periodicals; Electronic journals; 614.405
• DOI: 10.1016/j.jegh.2017.07.001
• Languages: English
• ISSNs: 2210-6014

Abstract

Abstract: Background: Worldwide, there's concern over high pre-diagnosis and pre-treatment attritions or delays in Multidrug resistant tuberculosis (MDR-TB) diagnosis and treatment pathway (DTP). We conducted this operational research among patients with presumptive MDR-TB in north and central Chennai, India to determine attrition and turnaround times (TAT) at various steps of DTP and factors associated with attrition. Methods: Study was conducted in Revised National Tuberculosis Control Programme setting. It was a retrospective cohort study involving record review of all patients with presumptive MDR-TB (eligible for DST) in 2014. Results: Of 628 eligible for DST, 557 (88%) underwent DST and 74 (13%) patients were diagnosed as having MDR-TB. Pre-diagnosis and pre-treatment attrition was 11% (71/628) and 38% (28/74) respectively. TAT [median (IQR)] to test from eligibility for DST and initiate DR-TB treatment from diagnosis were 14 (9, 27) and 18 (13, 36) days respectively. Patients with smear negative TB and detected in first quarter of 2014 were less likely to undergo DST. Patients in first quarter of 2014 had significantly lower risk of pre-treatment attrition. Conclusion: There was high uptake of DST. However, urgent attention is required to reduce pre-treatment attrition, improve TAT to test from eligibility for DST and improve DST among patients with smear-negative TB.