Pre-diagnosis attrition in patients with presumptive MDR-TB in Bhopal, India, 2015: a follow-up study

Natrajan, Srivalli; Singh, Akash Ranjan; Shewade, Hemant Deepak; Verma, Manoj Kumar; Bali, Surya

doi:10.5588/pha.18.0015

Cited by 5 publications

(7 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Another cause of concern has been treatment success, which remains poor at 46% for MDR-TB patients and 28% among XDR-TB patients in India [11]. The possible reasons for this might be related to delays in diagnosis of additional drug resistance [10,[12][13][14] and non-…”

Section: Introductionmentioning

confidence: 99%

Implementation of the new integrated algorithm for diagnosis of drug-resistant tuberculosis in Karnataka State, India: How well are we doing?

et al. 2021

View full text Add to dashboard Cite

Background As per national policy, all diagnosed tuberculosis patients in India are to be tested using Xpert® MTB/RIF assay at the district level to diagnose rifampicin resistance. Regardless of the result, samples are transported to the reference laboratories for further testing: first-line Line Probe Assay (FL-LPA) for rifampicin-sensitive samples and second-line LPA(SL-LPA) for rifampicin-resistant samples. Based on the results, samples undergo culture and phenotypic drug susceptibility testing. We assessed among patients diagnosed with tuberculosis at 13 selected Xpert laboratories of Karnataka state, India, i) the proportion whose samples reached the reference laboratories and among them, proportion who completed the diagnostic algorithm ii) factors associated with non-reaching and non-completion and iii) the delays involved. Methods This was a cohort study involving review of programme records. For each TB patient diagnosed between 1st July and 31st August 2018 at the Xpert laboratory, we tracked the laboratory register at the linked reference laboratory until 30th September (censor date) using Nikshay ID (a unique patient identifier), phone number, name, age and sex. Results Of 1660 TB patients, 1208(73%) samples reached the reference laboratories and among those reached, 1124(93%) completed the algorithm. Of 1590 rifampicin-sensitive samples, 1170(74%) reached and 1104(94%) completed the algorithm. Of 64 rifampicin-resistant samples, only 35(55%) reached and 17(49%) completed the algorithm. Samples from rifampicin-resistant TB, extra-pulmonary TB and two districts were less likely to reach the reference laboratory. Non-completion was more likely among rifampicin-resistant TB and sputum-negative samples. The median time for conducting and reporting results of Xpert® MTB/RIF was one day, of FL-LPA 5 days and of SL-LPA16 days. Conclusion These findings are encouraging given the complexity of the algorithm. High non-reaching and non-completion rates in rifampicin-resistant patients is a major concern. Future research should focus on understanding the reasons for the gaps identified using qualitative research methods.

show abstract

Section: Introductionmentioning

confidence: 99%

Implementation of the new integrated algorithm for diagnosis of drug-resistant tuberculosis in Karnataka State, India: How well are we doing?

et al. 2021

View full text Add to dashboard Cite

show abstract

“…d Of these 10 studies, 2 reported on non-completion of sputum microscopy evaluation from patient interviews [44,54], 2 reported on chest X-ray non-completion from patient interviews [55,56], and 6 reported on NAAT non-completion from evaluation of health records [49][50][51][52]57,58].…”

Section: Characteristics and Quality Of The Included Studiesmentioning

confidence: 99%

“…Reasons for PTLFU in adults with drug-resistant TB Two studies also evaluated reasons for PTLFU among patients diagnosed with drug-resistant TB through audits of health system records [57,58] and interviews with patients (Fig 12). As with studies of drug-susceptible TB, inability to track patients due to poor recording of contact information, death before treatment initiation, and refusal of treatment were common reasons for PTLFU.…”

Section: Factors Associated With Ptlfu In Adults With Drug-resistant Tbmentioning

confidence: 99%

“…For Gap 3, a meaningful proportion of patients who experienced PTLFU (4% to 40%) [57,58,64,67,72,74,77] died after diagnosis but before starting treatment, likely due to advanced TB resulting from diagnostic delays. This finding suggests that, by identifying patients at earlier disease stages, active case-finding may improve later care cascade outcomes.…”

Section: Findings Specific To Each Care Cascade Gapmentioning

confidence: 99%

“…This finding suggests that, by identifying patients at earlier disease stages, active case-finding may improve later care cascade outcomes. TB stigma prevented some patients experiencing PTLFU (10% to 23%) [44,72,76] from starting treatment and may have contributed to high treatment refusal (up to 83% of those experiencing PTLFU) in some studies [44,57,58,67,77]. The contribution of TB stigma to losses in Gap 3 highlights the need for robust counseling and education from the start of the TB diagnostic workup.…”

Section: Findings Specific To Each Care Cascade Gapmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Uptake of universal drug susceptibility testing among people with TB in a south Indian district: How are we faring?

Ranganath

Shewade

Bahadur

et al. 2021

Transactions of the Royal Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Background India implements universal drug susceptibility testing (UDST) using rapid genotypic tests (cartridge-based nucleic acid amplification test CBNAAT - and line probe assay - LPA). to bridge the gap of diagnosis of multidrug/rifampicin-resistant TB. There is limited evidence assessing the implementation of UDST in India. We assessed the implementation among people with pulmonary TB notified from public facilities in October 2019 from Raichur (Karnataka), India. Methods A cohort study involving secondary data in routine programme settings was conducted. All people with TB underwent a rapid genotypic DST for rifampicin resistance followed by first line-LPA (FL-LPA) if sensitive and second line-LPA (SL-LPA) if resistant. Results Of 217 people, 15.7% (n=34) did not undergo rapid genotypic DST. Of 135 who were rifampicin-sensitive detected on CBNAAT, 68.1% (n=92) underwent FL-LPA, and out of the six rifampicin-resistant cases, 66.7% (n=4) underwent SL-LPA. Overall, 65.4% (142/217) completed the UDST algorithm. Children (aged <15 y) and people with bacteriological non-confirmation on microscopy were less likely to undergo rapid genotypic DST. Of 183 patients who underwent both rapid genotypic DST and sputum smear microscopy, 150 were bacteriologically confirmed and, of them, 9 (6%) were ‘rapid DST-negative’. Conclusion We found gaps at various steps. There were a significant number of ‘rapid DST-negative, smear-positive’ patients.

show abstract

Pre-diagnosis attrition in patients with presumptive MDR-TB in Bhopal, India, 2015: a follow-up study

Abstract: Published by The Union (www.theunion.org), PHA provides a platform to fulfil its mission, 'Health solutions for the poor'. PHA publishes high-quality scientific research that provides new knowledge to improve the accessibility, equity, quality and efficiency of health systems and services.

Cited by 5 publications

References 3 publications

Implementation of the new integrated algorithm for diagnosis of drug-resistant tuberculosis in Karnataka State, India: How well are we doing?

Implementation of the new integrated algorithm for diagnosis of drug-resistant tuberculosis in Karnataka State, India: How well are we doing?

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

Uptake of universal drug susceptibility testing among people with TB in a south Indian district: How are we faring?

Contact Info

Product

Resources

About