Magnitude and Reasons for Gaps in Tuberculosis Diagnostic Testing and Treatment Initiation: An Operational Research Study from Dakshina Kannada, South India

Authors

Imaad Mohammed Ismail^{1, *,} , Akshaya Kibballi Madhukeshwar¹, Poonam Ramesh Naik¹, Badarudeen Mohammad Nayarmoole², Srinath Satyanarayana^{3, 4}

¹Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, India

²Department of Health and Family Welfare, District Tuberculosis Office, Dakshina Kannada, Government of Karnataka, India

³Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France

⁴Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India

^*Corresponding author. Email: imaad82@yahoo.com

DOI

10.2991/jegh.k.200516.001How to use a DOI?

Keywords

Tuberculosis; diagnosis; treatment; attrition; Nikshay; qualitative; SORT IT

Abstract

Background: In India, ensuring all Persons with Presumptive TB (PPTB) undergo TB diagnostic tests and initiating all diagnosed TB patients on treatment are two major implementation challenges.

Objectives: In a coastal district of Karnataka state, South India, to (1) determine the number and proportion of PPTB who did not undergo any TB diagnostic test, and the number and proportion of TB patients who were not initiated on treatment (2) explore the facilitators and barriers in TB diagnostic testing and treatment initiation from health care providers’ perspective.

Methods: For objective-1, we used a cross-sectional design involving review of data of PPTB enrolled for care during January–March 2019 and for objective-2, we used a qualitative design involving key informant interviews of health care providers.

Results: Of 8822 PPTB patients enrolled for evaluation of TB, 767 (9%) had not undergone any TB diagnostic test. In those who had undergone any TB diagnostic test, a total of 822 were diagnosed with TB and of them, 26 (3%) were not initiated on treatment. Cartridge-based nucleic acid amplification tests was used as a diagnostic test only among 1188 (13.5%) PPTB patients. The gaps in diagnostic testing were due to: non-availability of doctors/lab-technicians, inadequate knowledge about TB diagnostic tests among health care providers, reluctance of patients to undergo the TB diagnostic tests due to stigma/confidentiality issues and sub-optimal engagement of private health facilities for TB control.

Conclusion: About 9% of PPTB not undergoing any test for TB and 3% of the TB patients not initiated on treatment are of major concern. Revised National TB Control Programme needs to address the identified barriers to improve the process of TB diagnosis and treatment initiation.

Copyright

© 2020 The Authors. Published by Atlantis Press International B.V.

Open Access

This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

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TY  - JOUR
AU  - Imaad Mohammed Ismail
AU  - Akshaya Kibballi Madhukeshwar
AU  - Poonam Ramesh Naik
AU  - Badarudeen Mohammad Nayarmoole
AU  - Srinath Satyanarayana
PY  - 2020
DA  - 2020/05/23
TI  - Magnitude and Reasons for Gaps in Tuberculosis Diagnostic Testing and Treatment Initiation: An Operational Research Study from Dakshina Kannada, South India
JO  - Journal of Epidemiology and Global Health
SP  - 326
EP  - 336
VL  - 10
IS  - 4
SN  - 2210-6014
UR  - https://doi.org/10.2991/jegh.k.200516.001
DO  - 10.2991/jegh.k.200516.001
ID  - Ismail2020
ER  -