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Kondapaka K.K.,Osmania Medical College | Prasad S.V.,Osmania Medical College | Satyanarayana S.,International Union Against Tuberculosis and Lung Disease The Union | Kandi S.,Osmania Medical College | And 11 more authors.
PLoS ONE | Year: 2012

Setting: A tertiary health care facility (Government General and Chest hospital) in Hyderabad, India. Objectives: To assess a) the extent of compliance of specialists to standardized national (RNTCP) tuberculosis management guidelines and b) if patients on discharge from hospital were being appropriately linked up with peripheral health facilities for continuation of anti-Tuberculosis (TB) treatment. Methods: A descriptive study using routine programme data and involving all TB patients admitted to inpatient care from 1 st January to 30 th June, 2010. Results and Conclusions: There were a total of 3120 patients admitted of whom, 1218 (39%) required anti-TB treatment. Of these 1104 (98%) were treated with one of the RNTCP recommended regimens, while 28 (2%) were treated with non-RNTCP regimens. The latter included individually tailored MDR-TB treatment regimens for 19 patients and adhoc regimens for nine patients. A total of 957 (86%) patients were eventually discharged from the hospital of whom 921 (96%) had a referral form filled for continuing treatment at a peripheral health facility. Formal feedback from peripheral health facilities on continuation of TB treatment was received for 682 (74%) patients. In a tertiary health facility with specialists the great majority of TB patients are managed in line with national guidelines. However a number of short-comings were revealed and measures to rectify these are discussed. © 2012 Kondapaka et al.


Nagaraja S.B.,Office of the WHO Representative in India | Satyanarayana S.,International Union Against Tuberculosis and Lung Diseases The Union | Chadha S.S.,International Union Against Tuberculosis and Lung Diseases The Union | Kalemane S.,Impact Health Solutions | And 13 more authors.
PLoS ONE | Year: 2011

Setting: Seven districts in Andhra Pradesh, South India Objectives: To a) determine treatment outcomes of patients who fail first line anti-TB treatment and are not placed on an multi-drug resistant TB (MDR-TB) regimen, and b) relate the treatment outcomes to culture and drug susceptibility patterns (C&DST). Design: Retrospective cohort study using routine programme data and Mycobacterium TB Culture C&DST between July 2008 and December 2009. Results: There were 202 individuals given a re-treatment regimen and included in the study. Overall treatment outcomes were: 68(34%) with treatment success, 84(42%) failed, 36(18%) died, 13(6.5%) defaulted and 1 transferred out. Treatment success for category I and II failures was low at 37%. In those with positive cultures, 81 had pan-sensitive strains with 31(38%) showing treatment success, while 61 had drug-resistance strains with 9(15%) showing treatment success. In 58 patients with negative cultures, 28(48%) showed treatment success. Conclusion: Treatment outcomes of patients who fail a first-line anti-TB treatment and who are not placed on an MDR-TB regimen are unacceptably poor. The worst outcomes are seen among category II failures and those with negative cultures or drug-resistance. There are important programmatic implications which need to be addressed. © 2011 Burugina Nagaraja et al.

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