Has introduction of rapid drug susceptibility testing at diagnosis impacted treatment outcomes among previously treated tuberculosis patients in Gujarat, India?

Dave, Paresh; Vadera, Bhavin; Kumar, Ajay; Chinnakali, Palanivel; Modi, Bhavesh; Solanki, Rajesh; Patel, P.G.; Patel, Prakash A.; Pujara, Kirit; Nimavat, Pankaj; Shah, Ajay; Bharaswadkar, Sandeep; Rade, Kiran; Parmar, Malik; Nair, Sreenivas Achuthan

doi:10.1371/journal.pone.0121996

Cited by 6 publications

(11 citation statements)

References 13 publications

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“…We noticed that patients who were recorded as “lost to follow-up” are no longer at higher risk of defaulting during their retreatment [ 6 , 7 ]. The treatment success is also higher than that observed elsewhere [ 13 ]. Furthermore, of the different types of retreatment TB patients, the highest success rate was reported in those who relapsed.…”

Section: Discussioncontrasting

confidence: 64%

“…MDR-TB patients can promptly start appropriate treatment without having to start and fail a retreatment regimen, which has individual benefits as well as preventing further transmission of drug-resistant TB in the community. Studies from India have also shown that this approach improves treatment outcomes among previously treated patients [ 13 ]. According to our study findings, one-quarter of the patients did not achieve this goal of DST.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics and Treatment Outcomes of Retreatment Tuberculosis Patients in Benin

Adè

Adjibode

Wachinou

et al. 2016

Tuberculosis Research and Treatment

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Objective. To determine among retreatment tuberculosis patients in Benin baseline characteristics, culture, and drug sensitivity testing (DST) results and treatment outcomes. Materials and Methods. A retrospective national cohort study of all retreatment tuberculosis patients in Benin in 2013 using registers and treatment cards. Results. Of 3957 patients with tuberculosis, 241 (6%) were retreatment cases. Compared to new pulmonary bacteriologically confirmed tuberculosis (NPBCT) patients, there were significantly higher numbers of males (P = 0.04), patients from “Atlantique-Littoral” (P = 0.006), patients aged 45–64 years (P = 0.007), and HIV-positive patients (P = 0.04) among those retreated. Overall, 171 (71%) patients submitted sputum for DST, of whom (163) 95% were positive for Mycobacterium tuberculosis on Xpert MTB/RIF and/or culture and 17 (10%) were rifampicin resistant (9 with MDR-TB and 8 monoresistant to rifampicin). For those without MDR-TB (n = 224), treatment success was 93%. Worse outcomes occurred in those with unknown HIV status (RR: 0.27; 0.05–1.45; P < 0.01) while better outcomes occurred in those who relapsed (RR: 1.06, 95 CI: 1.02–1.10, P = 0.04). Conclusion. In 2013, a high proportion of retreatment patients received DST. Treatment success was good although more needs to be done to systematically increase the final follow-up smear examination. Reasons of high losses to follow-up from “Oueme-Plateau” should be investigated.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Characteristics and Treatment Outcomes of Retreatment Tuberculosis Patients in Benin

Adè

Adjibode

Wachinou

et al. 2016

Tuberculosis Research and Treatment

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“…Furthermore MSF is planning to do a clinical trial in collaboration with national health authorities to generate further robust evidence for best treatment options for HIV-VL co-infected patients in India.’ Kyaw N. et al (2015), Myanmar [30]The study used routinely collected programme data on all patients aged ≥ 15 years starting first-line tenofovir-based ART between 2012 and 2013. Creatinine clearance was assessed at base line and 6 monthly and incidence of renal dysfunction was calculated.The low incidence of renal toxicity in the patient cohort suggests that routine assessment of creatinine clearance may not be needed and could be targeted to high risk groups if resources permit. ‘ The national program adopted the alternative low cost screening method (urine protein testing) for screening of renal dysfunction in patients taking tenofovir and now uses the creatinine test only in high risk patients.’ Contributed to existing evidence leading to scale up of interventions Dave P. et al (2015), India [31]This was a retrospective cohort study involving a review of electronic patient records maintained routinely under the National Tuberculosis Programme, Gujarat, India in 2013.Offering rapid drug susceptibility testing (DST) at diagnosis improved the treatment outcomes among patients with pulmonary tuberculosis. ‘ The study findings strengthened the evidence of the effect of rapid DST at diagnosis on treatment outcomes of TB patients, which reinforced the national policy and has contributed to scale up of rapid DST facilities in the country.’ Change in policy and/or practice at subnational level Shewade H. et al (2014), India [32]Mixed-methods study, quantitative component consisted of retrospective cohort study reviewing records of all presumptive MDR-TB patients between October 2012 and September 2013. The qualitative component included in-depth interviews with key informants involved in programmatic management of drug-resistant tuberculosis services.High pre-diagnostic and pre-treatment attrition with 46% and 29%, respectively.…”

Section: Resultsmentioning

confidence: 99%

Does the Structured Operational Research and Training Initiative (SORT IT) continue to influence health policy and/or practice?

Tripathy

Kumar

Guillerm

et al. 2018

Global Health Action

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Background: The Structured Operational Research and Training Initiative (SORT IT) is a successful model of integrated operational research and capacity building with about 90% of participants completing the training and publishing in scientific journals. Objective: The study aims at assessing the influence of research papers from six SORT IT courses conducted between April 2014 and January 2015 on policy and/or practice. Methods: This was a cross-sectional mixed-method study involving e-mail based, self-administered questionnaires sent to course participants coupled with telephone/Skype/in-person responses from participants, senior facilitators and local co-authors of course papers. A descriptive content analysis was performed to generate themes. Results: Of 71 participants, 67 (94%) completed the course. A total of 67 papers (original research) were submitted for publication, of which 61 (91%) were published or were in press at the censor date (31 December 2016). Among the 67 eligible participants, 65 (97%) responded to the questionnaire. Of the latter, 43 (66%) research papers were self-reported to have contributed to a change in policy and/or practice by the course participants: 38 to a change in government policy or practice (26 at the national level, six at the subnational level and six at the local/hospital level); four to a change in organisational policy or practice; and one study fostered global policy development. Conclusion: Nearly two-thirds of SORT IT course papers contributed to a change in policy and/or practice as reported by the participants. Identifying the actual linkage of research to policy/practice change requires more robust methodology, in-depth assessment and independent validation of the reported change with all concerned stakeholders.

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“…Reasons for PTLFU in adults with drug-susceptible TB Patient-, family, or society-related reasons for PTLFU among drug-susceptible TB patients included financial and job constraints preventing patients from returning to health facilities to start therapy [68,76] ( Fig 11). Patient mobility was a barrier across multiple studies [67,68,77],…”

Section: Factors Associated With Non-completion Of Sputum Microscopy ...mentioning

confidence: 99%

“…with nearly one-third of patients in 1 study experiencing PTLFU due to temporary job-related migration [68]. Psychological reasons were common, with 5% to 25% of patients across multiple studies citing concerns about TB stigma, disbelief in their diagnosis, or treatment refusal as contributing to PTLFU [44,67,72,76,77]. Death before treatment initiation affected 4% to 40% of patients across multiple studies [64,67,72,74,77].…”

Section: Factors Associated With Non-completion Of Sputum Microscopy ...mentioning

confidence: 99%

Barriers to engagement by people with active tuberculosis in the care cascade in India: a systematic review of two decades of quantitative research

Jhaveri,

Galivanche

et al. 2023

Preprint

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Background. India has the highest burden of tuberculosis (TB), accounting for more than one-quarter of people with active TB and nearly one-third of TB deaths globally. Most people contracting active TB in India do not successfully navigate all stages of the care cascade to receive treatment and achieve TB recurrence-free survival. Understanding reasons for losses across the care cascade is critical to improve outcomes. In this paper, guided by a PECO (population/exposure/comparison/outcome) framework, we describe quantitative findings of a systematic review aimed at identifying factors contributing to unfavorable outcomes experienced by people with TB at each care cascade gap in India. Methods and findings. We defined care cascade gaps as comprising people with confirmed or presumptive TB who did not: start the TB diagnostic workup (Gap 1), complete the diagnostic workup (Gap 2), start treatment (Gap 3), achieve treatment success (Gap 4), or achieve TB recurrence-free survival (Gap 5). Three systematic searches were conducted to identify 147 unique articles published from 2000 to 2021 that evaluated factors associated with unfavorable outcomes for each gap (reported as odds, relative risk, or hazard ratios) and, among people experiencing unfavorable outcomes, reasons reported for these outcomes (reported as proportions). Findings were organized into patient-, family-, society-, or health system-related factors, using a social-ecological framework. Some factors were common and associated with unfavorable outcomes across multiple care cascade stages. These included male sex, older age (variably defined across studies), a broad array of poverty-related factors, lower symptom severity or duration, undernutrition, alcohol use, smoking, and distrust of (or dissatisfaction with) local government health services. People who had been previously treated for TB were more likely to seek care and engage in the TB diagnostic workup (Gaps 1 and 2) but were also more likely to suffer pretreatment loss to follow-up (Gap 3) and unfavorable outcomes during TB treatment (Gap 4), especially those who had been lost to follow-up during their prior treatment episode. For individual care cascade gaps, multiple studies highlighted the importance of lack of TB knowledge and structural barriers to care (e.g., transport or financial challenges in reaching clinics) in contributing to lack of care-seeking for TB symptoms (Gap 1, 15 studies or analyses); lack of access to diagnostics (e.g., chest X-ray), non-identification of eligible patients for testing, and failure of providers to communicate concern for TB to patients in contributing to non-completion of the diagnostic workup (Gap 2, 20 studies or analyses); TB stigma, poor recording of patient contact information by providers, and early death due to diagnostic delays in contributing to pretreatment loss to follow-up (Gap 3, 25 studies); and medication adverse effects, TB stigma, and lack of TB knowledge in contributing to unfavorable treatment outcomes (Gap 4, 104 studies). Medication nonadherence contributed to unfavorable treatment outcomes (Gap 4) and post-treatment TB recurrence (Gap 5, 15 studies). Conclusions. This extensive systematic review illuminates common patterns of risk that shape outcomes for people with TB in India, while also highlighting gaps in knowledge, particularly with regard to TB care for children or in the private sector, that can help to guide future research. These findings may help inform targeting of additional support services to people with TB who are at higher risk of poor outcomes and inform development of multi-component interventions to close gaps in India′s TB care cascade.

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Has introduction of rapid drug susceptibility testing at diagnosis impacted treatment outcomes among previously treated tuberculosis patients in Gujarat, India?

Cited by 6 publications

References 13 publications

Characteristics and Treatment Outcomes of Retreatment Tuberculosis Patients in Benin

Characteristics and Treatment Outcomes of Retreatment Tuberculosis Patients in Benin

Does the Structured Operational Research and Training Initiative (SORT IT) continue to influence health policy and/or practice?

Barriers to engagement by people with active tuberculosis in the care cascade in India: a systematic review of two decades of quantitative research

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