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Afutu F.K.,National Tuberculosis Programme | Zachariah R.,Medecins Sans Frontieres | Hinderaker S.G.,University of Bergen | Ntoah-Boadi H.,Ridge Regional Hospital | And 3 more authors.
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2012

Sputum smear-positive TB patients, diagnosed in the laboratory, who never start anti-TB treatment are classified as 'initial defaulters'. In Ridge Hospital, Accra, Ghana, there were 84 laboratory confirmed TB cases in 2009, of whom 32 (38%) were initial defaulters. Cure and default rates based on this cohort were 54% and 43% respectively, compared with rates of 87% and 8% when using the cohort based on 52 patients registered for treatment. This study highlights the problem of initial defaulters, and shows that programme performance may be poor when patients in laboratory registers are used as the cohort to evaluate treatment outcomes. © 2012 Royal Society of Tropical Medicine and Hygiene.


Achanta S.,World Health Organization | Kumar A.M.V.,World Health Organization | Nagaraja S.B.,World Health Organization | Jaju J.,World Health Organization | And 7 more authors.
PLoS ONE | Year: 2012

Background: Though internationally recommended, provider initiated HIV testing and counseling (PITC) of persons suspected of tuberculosis (TB) is not a policy in India; HIV seroprevalence among TB suspects has never been reported. The current policy of PITC for diagnosed TB cases may limit opportunities of early HIV diagnosis and treatment. We determined HIV seroprevalence among persons suspected of TB and assessed feasibility and effectiveness of PITC implementation at this earlier stage in the TB diagnostic pathway. Methods: All adults examined for diagnostic sputum microscopy (TB suspects) in Vizianagaram district (population 2.5 million), in November-December 2010, were offered voluntary HIV counseling and testing (VCT) and assessed for TB diagnosis. Results: Of 2918 eligible TB suspects, 2465(85%) consented to VCT. Among these, 246(10%) were HIV-positive. Of the 246, 84(34%) were newly diagnosed as HIV (HIV status not known previously). To detect a new case of HIV infection, the number needed to screen (NNS) was 26 among 'TB suspects', comparable to that among 'TB patients'. Among suspects aged 25-54 years, not diagnosed as TB, the NNS was 17. Conclusion: The seroprevalence of HIV among 'TB suspects' was as high as that among 'TB patients'. Implementation of PITC among TB suspects was feasible and effective, detecting a large number of new HIV cases with minimal additional workload on staff of HIV testing centre. HIV testing of TB suspects aged 25-54 years demonstrated higher yield for a given effort, and should be considered by policy makers at least in settings with high HIV prevalence. © 2012 Achanta et al.


Chadha S.S.,International Union against Tuberculosis and Lung Disease The Union | BN S.,World Health Organization | Reddy K.,State Training and Demonstration Center | Jaju J.,World Health Organization | And 7 more authors.
PLoS ONE | Year: 2011

Background: Revised National TB Control Programme (RNTCP), Andhra Pradesh, India. There is limited information on whether MDR-TB suspects are identified, undergo diagnostic assessment and are initiated on treatment according to the programme guidelines. Objectives: To assess i) using the programme definition, the number and proportion of MDR-TB suspects in a large cohort of TB patients on first-line treatment under RNTCP ii) the proportion of these MDR-TB suspects who underwent diagnosis for MDR-TB and iii) the number and proportion of those diagnosed as MDR-TB who were successfully initiated on treatment. Methods: A retrospective cohort analysis, by reviewing RNTCP records and reports, was conducted in four districts of Andhra Pradesh, India, among patients registered for first line treatment during October 2008 to December 2009. Results: Among 23,999 TB patients registered for treatment there were 559 (2%) MDR-TB suspects (according to programme definition) of which 307 (55%) underwent diagnosis and amongst these 169 (55%) were found to be MDR-TB. Of the MDR-TB patients, 112 (66%) were successfully initiated on treatment. Amongst those eligible for MDR-TB services, significant proportions are lost during the diagnostic and treatment initiation pathway due to a variety of operational challenges. The programme needs to urgently address these challenges for effective delivery and utilisation of the MDR-TB services. © 2011 Chadha et al.


Achanta S.,World Health Organization | Jaju J.,World Health Organization | Kumar A.M.V.,Directorate General of Health Services | Nagaraja S.B.,World Health Organization | And 7 more authors.
PLoS ONE | Year: 2013

Setting:Private medical practitioners in Visakhapatnam district, Andhra Pradesh, India.Objectives:To evaluate self-reported TB diagnostic and treatment practices amongst private medical practitioners against benchmark practices articulated in the International Standards of Tuberculosis Care (ISTC), and factors associated with compliance with ISTC.Design:Cross- sectional survey using semi-structured interviews.Results:Of 296 randomly selected private practitioners, 201 (68%) were assessed for compliance to ISTC diagnostic and treatment standards in TB management. Only 11 (6%) followed a combination of 6 diagnostic standards together and only 1 followed a combination of all seven treatment standards together. There were 28 (14%) private practitioners who complied with a combination of three core ISTC (cough for tuberculosis suspects, sputum smear examination and use of standardized treatment). Higher ISTC compliance was associated with caring for more than 20 TB patients annually, prior sensitization to TB control guidelines, and practice of alternate systems of medicine.Conclusion:Few private practitioners in Visakhapatnam, India reported TB diagnostic and treatment practices that met ISTC. Better engagement of the private sector is urgently required to improve TB management practices and to prevent diagnostic delay and drug resistance. © 2013 Achanta et al.


Patra S.,University of Delhi | Lukhmana S.,University of Delhi | Tayler Smith K.,Medecins Sans Frontieres | Kannan A.T.,University of Delhi | And 5 more authors.
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2013

Background: Given India's high rate of TB, rising burden of non-communicable diseases (NCDs) and growing elderly population, elderly TB patients may be at higher risk of adverse outcomes including death, loss-to-follow-up (LTFU) and treatment failure. This may call for modifications in their management. This study thus aimed to compare the profile and treatment outcomes between elderly (≥60 years) and non-elderly (15-59 years) TB patients. Methods: This was a retrospective cohort study using routinely-collected programme data from a chest clinic in Delhi, India. It included all elderly and selected non-elderly TB patients registered for treatment between 2005 and 2010. Data on patients' clinical and demographic characteristics and treatment outcomes were analysed. Results: There were 812 elderly and 1624 non-elderly TB patients. Elderly patients were more likely to be male (63.2% vs 51.1%) and have smear-positive TB (56.0% vs 47.4%). Adverse outcomes were more frequent among elderly patients (adjusted OR 1.9, 95% CI: 1.5-2.4), specifically deaths (adjusted OR 5.0, 95% CI: 3.1-8.1) and lost-to-follow-up (adjusted OR 1.4, 95% CI: 1.0-1.9). Conclusions: The profile and worse outcomes of elderly Indian TB patients may be indicative of co-existing NCDs. This needs further investigation and likely calls for a more comprehensive and intensive approach to their management. © The Author 2013. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved.

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