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Hyderabad andhra Pradesh, India

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.

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. Source

Radhakrishnan R.,National Institute for Research in Tuberculosis | Prabuseenivasan S.,National Institute for Research in Tuberculosis | Balaji S.,National Institute for Research in Tuberculosis | Sankar U.,State Tuberculosis Cell | And 3 more authors.
International Journal of Tuberculosis and Lung Disease

BACKGROUND: Blinded rechecking of auramine-stained acid-fast bacilli (AFB) sputum smears using fluorescence microscopy (FM), especially FM using light-emitting diode (LED), is not well understood. OBJECTIVE: To examine the rechecking of auraminestained sputum smears without restaining within a month using LED FM. METHODS: A total of 4799 centrifuged smears of sputum samples were stained by the auramine phenol method and examined using LED FM; 564 systematically selected smears were subjected to blinded rechecking without restaining by controllers. The initial results of the readers were compared to those of the controllers. Discrepancies were resolved by a referee. The quality of LED FM was assessed by the referee using the culture result as gold standard. RESULTS: Among the rechecked smears, one high falsenegative error was made by a reader, while one high false-positive error and 19 high false-negative errors were made by the controllers. The errors were resolved by culture. Smear results for 18 slides were not available due to AFB fading. CONCLUSION: AFB colour fading using LED FM, which affected the accurate evaluation of blinded rechecking of AFB smears without restaining within a month, is confirmed in this large study. © 2013 The Union. Source

Dave P.,State Tuberculosis Cell | Vadera B.,World Health Organization | Vadera B.,State Tuberculosis Training and Demonstration Center | Kumar A.M.V.,International Union Against Tuberculosis and Lung Diseases The Union | And 11 more authors.

Background: Revised National TB Control Programme (RNTCP) in India recommends that all previously-treated TB (PT) patients are offered drug susceptibility testing (DST) at diagnosis, using rapid diagnostics and screened out for rifampicin resistance before being treated with standardized, eight-month, retreatment regimen. This is intended to improve the early diagnosis of rifampicin resistance and its appropriate management and improve the treatment outcomes among the rest of the patients. In this state-wide study from Gujarat, India, we assess proportion of PT patients underwent rapid DST at diagnosis and the impact of this intervention on their treatment outcomes. Methods: This is a retrospective cohort study involving review of electronic patient-records maintained routinely under RNTCP. All PT patients registered for treatment in Gujarat during January- June 2013 were included. Information on DST and treatment outcomes were extracted from 'presumptive DR-TB patient register' and TB treatment register respectively.We performed a multivariate analysis to assess if getting tested is independently associated with unfavourable outcomes (death, loss-to-follow-up, failure, transfer out). Results: Of 5,829 PT patients, 5306(91%) were tested for drug susceptibility with rapid diagnostics. Overall, 71% (4,113) TB patients were successfully treated - 72% among tested versus 60% among non-tested. Patients who did not get tested at diagnosis had a 34% higher risk of unsuccessful outcomes as compared to those who got tested (aRR - 1.34; 95% CI 1.20-1.50) after adjusting for age, sex, HIV status and type of TB. Unfavourable outcomes (particularly failure and switched to category IV) were higher among INH-resistant patients (39%) as compared to INH-sensitive (29%). Conclusion: Offering DST at diagnosis improved the treatment outcomes among PT patients. However, even among tested, treatment outcomes remained suboptimal and were related to INH resistance and high loss-to-follow-up. These need to be addressed urgently for further progress. © 2015 Dave et al. Source

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