Management of previously treated tuberculosis patients in Kalutara district, Sri Lanka: how are we faring?

Abstract

Of all retreatment patients, only 79% were tested for CDST and there were sizeable delays in sample transportation and treatment initiation. Possible ways forward to strengthen the programme are discussed.

High pre-diagnosis attrition among patients with presumptive MDR-TB: an operational research from Bhopal district, India

“…This indicates a huge gap in diagnosis of MDR-TB: India, Indonesia and Nigeria alone accounting for almost half of the gap. Studies worldwide have raised concerns over high attrition and/or delays in MDR-TB DTP [2–8]. …”

Does research through Structured Operational Research and Training (SORT IT) courses impact policy and practice?

“…15 A study from Sri Lanka had led to the creation of a mid-level programme officer post at subdistrict level. 16 Change in hospital-level policy/practice There were several instances of change in policy at the level of the hospital or institution. A study from China had led to the prolongation of the treatment of TB patients with co-existing diabetes mellitus in their hospital.…”

MDR-TB screening in a setting with molecular diagnostic techniques: Who got tested, who didn’t and why?

“…Only about half of the patients were tested in our study, compared to 10% in Tanzania, 9 39% in China, 5 40% in Malawi, 7 50% in Cambodia, 4 64% in Andhra Pradesh, India, 9 74% in Delhi, India 10 and 79% in Sri Lanka. 8 All the above studies took place in settings that used phenotypic diagnostic techniques. Variations worldwide could be due to differences in the criteria for presumptive MDR-TB or in the settings and phase of PMDT implementation.…”

“…2 Studies from around the world have raised concerns over the high pre-diagnostic and pre-treatment attrition in MDR-TB diagnosis and treatment pathways (DTP). [3][4][5][6][7][8][9] Most of these studies were conducted in settings with the capacity for phenotypic diagnostic techniques, with a long turnaround time (TAT). A study from New Delhi, India, identified a significant decrease in TAT and pre-treatment loss to follow-up in 2014 after the introduction of line probe assay (LPA) technology, mainly attributed to a decrease in laboratory diagnostic time, although other operational issues were still of concern.…”