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

Abstract

Despite the introduction of molecular diagnostic techniques, operational issues in MDR-TB screening remain a concern and require urgent attention.

MDR-TB in Puducherry, India: reduction in attrition and turnaround time in the diagnosis and treatment pathway

“…14 The mechanisms for routine transportation of specimens, communicating the results to the district TB centre, reporting the results to patients and enrolling patients with MDR-TB on DR-TB treatment were all similar to those previously described. 14 The programme staff felt that as Puducherry was a small geographical area, sputum transportation was not required.…”

“…14 The mechanisms for routine transportation of specimens, communicating the results to the district TB centre, reporting the results to patients and enrolling patients with MDR-TB on DR-TB treatment were all similar to those previously described. 14 The programme staff felt that as Puducherry was a small geographical area, sputum transportation was not required. Because it was identified in the previous study that patients from hard-to-reach primary health centres (PHCs) could have had problems reaching the laboratory, in the present study, local voluntary non-governmental organisations were recruited for the transport of specimens per programme guidelines.…”

“…14 The specific objectives of the present study were: 1) to determine pre-diagnosis and pre-treatment attrition, 2) to determine factors associated with pre-diagnosis attrition, 3) to determine the turnaround time (TAT) from eligibility to testing and from diagnosis to treatment initiation, and 4) to compare these findings with those of the previous study.…”

“…13 Given the limited cohort-related information available within the programme, a mixed-methods operational research (OR) study was conducted by the RNTCP in Puducherry, India, to evaluate the DTP among patients with presumptive MDR-TB from October 2012 to September 2013. 14 Pre-diagnosis and pre-treatment attrition were respectively 45% and 29%. To address these issues, based on the recommendations made in the study, several actions were taken, including: 14 1) improving the mechanisms for tracking referrals: setting up and strengthening the use of referrals for the culture and drug susceptibility testing (DST) register at the district TB centre; consistent recording of TB registration numbers on the referral form for culture and DST and in the diagnostic facility laboratory register to enable tracking; and making cohort analysis part of routine monitoring for PMDT services; 2) health systems strengthening: training and re-sensitising the staff of general health-care delivery systems, especially the laboratory technicians in the designated microscopy centres; and 3) developing a mechanism of sputum transport from the designated microscopy centre to the DST diagnostic facility.…”

MDR-TB in Puducherry, India: Reduction in attrition and turnaround time in the diagnosis and treatment pathway

“…In the case of contaminated samples, a repeat sample was requested. 14 Data were collected during January-May 2016. We tracked each presumptive MDR-TB patient in the records for 3 months from the date of eligibility until diagnosis-extended by an additional 3 months for smear-negative samples and invalid LPA results on smear-positive samples-and 3 months post-diagnosis, if positive for MDR-TB, until treatment initiation.…”