Non-response to first-line anti-tuberculosis treatment in Sikkim, India: a risk-factor analysis study

Abstract

Sikkim, India, has the highest proportion of tuberculosis (TB) patients on first-line anti-tuberculosis regimens with the outcome 'failure' or 'shifted to regimen for multidrug-resistant TB (MDR-TB)'. Objective: To assess the factors associated with non-response to treatment, i.e., 'failure' or 'shifted to MDR-TB regimen'. Methods: We conducted a retrospective cohort study using Revised National Tuberculosis Control Programme data of all TB patients registered in 2015 for first-line TB treatment. In addition, we interviewed 42 patients who had not responded to treatment to ascertain their current status. Results: Of 1508 patients enrolled for treatment, about 9% were classified as non-response to treatment. Patient factors associated with non-response were urban setting (adjusted odds ratio [aOR] 2.39, 95%CI 1.22-4.67), ethnicity (being an Indian tribal, aOR 1.73, 95%CI 1.17-2.57, Indian [other] aOR 1.83, 95%CI 1.29-2.60 compared to patients of Nepali origin) and those on retreatment (aOR 2.40, 95%CI 1.99-2.91). Of the patients interviewed, 28 (67%) had received treatment for drug-resistant TB. Conclusion: In Sikkim, one in 11 patients had not responded to first-line anti-tuberculosis treatment. Host-pathogen genetics and socio-behavioural studies may be required to understand the reasons for the differences in non-response, particularly among ethnic groups. * Data for 26 patients were not available and were therefore not included in the table. RNTCP = Revised National Tuberculosis Control Programme; TB = tuberculosis; MDR-TB = multidrug-resistant TB.

Molecular diversity of Mycobacterium tuberculosis complex in Sikkim, India and prediction of dominant spoligotypes using artificial intelligence

“…Moreover, knowledge of the genetic diversity of MTBC is very useful for assessing the impact of the TB control program 9 . Although numerous studies on the genetic diversity of MTBC have been conducted in India 9 – 41 yet no such types of studies are available from the hill state of Sikkim where the prevalence of MDR strains of MTBC is high 42 .…”

Analysis of the molecular diversity of Mycobacterium tuberculosis isolates from patients attending central referral hospital, East Sikkim based on the IS6110 element

“…From relapse instances, two strains had a single copy of the 100 bp fragment, one strain had a single copy of the 500 bp fragment, and one strain had two copies of IS6110.The default instance yielded only one isolate, a strain with a single copy of the 500 bp fragment IS6110. As a result, the predominant strain recovered from relapse cases and default cases was a single copy of IS6110, which was 29 Analyzing the distribution of strains in different ethnic groups in Pulmonary isolates (Figure 5), the strains with the null copy (N=2) was seen in Nepali (50%) & Bhutia (50%) with equal distribution. The strains with a single copy (N=68) in descending orders were Nepali (72.05%) followed by Bhutia (14.70%), the Indian others (7.35%) and then Lepcha (5.88%).…”