Low pre-diagnosis attrition but high pre-treatment attrition among patients with MDR-TB: An operational research from Chennai, India

Hemant Deepak Shewade; Dina Nair; Joel S. Klinton; Malik Parmar; J. Lavanya; Lakshmi Murali; Vivek Gupta; Jaya Prasad Tripathy; Soumya Swaminathan; Ajay M.V. Kumar

doi:10.1016/j.jegh.2017.07.001

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Volume 7, Issue 4, December 2017, Pages 227 - 233

Low pre-diagnosis attrition but high pre-treatment attrition among patients with MDR-TB: An operational research from Chennai, India

Authors

Hemant Deepak Shewade^a^{, *}^{, 1}^,hemantjipmer@gmail.com, Dina Nair^b^{, 1}, Joel S. Klinton^b, Malik Parmar^c, J. Lavanya^d, Lakshmi Murali^d, Vivek Gupta^a^{, e}, Jaya Prasad Tripathy^a, Soumya Swaminathan^b^{, f}, Ajay M.V. Kumar^a^{, g}

^aInternational Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India

^bNational Institute for Research in Tuberculosis (NIRT), Chennai, India

^cWorld Health Organization (WHO), Country Office for India, New Delhi, India

^dState TB Cell, Department of Health and Family Welfare, Chennai, Tamil Nadu, India

^eAll India Institute of Medical Sciences (AIIMS), New Delhi, India

^fIndian Council of Medical Research (ICMR), New Delhi, India

^gInternational Union Against Tuberculosis and Lung Disease (The Union), Paris, France

¹

HDS and DN are joint first authors, both contributed equally.

^* Corresponding author at: International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi 110016, India.

Corresponding Author

Hemant Deepak Shewadehemantjipmer@gmail.com

Received 10 March 2017, Revised 25 June 2017, Accepted 1 July 2017, Available Online 6 July 2017.

DOI: 10.1016/j.jegh.2017.07.001 How to use a DOI?
Keywords: MDR tuberculosis; Turnaround time; Diagnosis and treatment pathway; Delayed diagnosis; Drug susceptibility testing
Abstract: Background: Worldwide, there’s concern over high pre-diagnosis and pre-treatment attritions or delays in Multidrug resistant tuberculosis (MDR-TB) diagnosis and treatment pathway (DTP). We conducted this operational research among patients with presumptive MDR-TB in north and central Chennai, India to determine attrition and turnaround times (TAT) at various steps of DTP and factors associated with attrition.

Methods: Study was conducted in Revised National Tuberculosis Control Programme setting. It was a retrospective cohort study involving record review of all patients with presumptive MDR-TB (eligible for DST) in 2014.

Results: Of 628 eligible for DST, 557 (88%) underwent DST and 74 (13%) patients were diagnosed as having MDR-TB. Pre-diagnosis and pre-treatment attrition was 11% (71/628) and 38% (28/74) respectively. TAT [median (IQR)] to test from eligibility for DST and initiate DR-TB treatment from diagnosis were 14 (9,27) and 18 (13,36) days respectively. Patients with smear negative TB and detected in first quarter of 2014 were less likely to undergo DST. Patients in first quarter of 2014 had significantly lower risk of pre-treatment attrition.

Conclusion: There was high uptake of DST. However, urgent attention is required to reduce pre-treatment attrition, improve TAT to test from eligibility for DST and improve DST among patients with smear-negative TB.
Open Access: This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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Journal: Journal of Epidemiology and Global Health
Volume-Issue: 7 - 4
Pages: 227 - 233
Publication Date: 2017/07/06
ISSN (Online): 2210-6014
ISSN (Print): 2210-6006
DOI: 10.1016/j.jegh.2017.07.001 How to use a DOI?
Open Access: This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Cite this article

ris enw bib

TY  - JOUR
AU  - Hemant Deepak Shewade
AU  - Dina Nair
AU  - Joel S. Klinton
AU  - Malik Parmar
AU  - J. Lavanya
AU  - Lakshmi Murali
AU  - Vivek Gupta
AU  - Jaya Prasad Tripathy
AU  - Soumya Swaminathan
AU  - Ajay M.V. Kumar
PY  - 2017
DA  - 2017/07/06
TI  - Low pre-diagnosis attrition but high pre-treatment attrition among patients with MDR-TB: An operational research from Chennai, India
JO  - Journal of Epidemiology and Global Health
SP  - 227
EP  - 233
VL  - 7
IS  - 4
SN  - 2210-6014
UR  - https://doi.org/10.1016/j.jegh.2017.07.001
DO  - 10.1016/j.jegh.2017.07.001
ID  - Shewade2017
ER  -

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