MDR-TB screening in a setting with molecular diagnostic techniques: who got tested, who didn't and why?
- 21 June 2015
- journal article
- Published by International Union Against Tuberculosis and Lung Disease in Public Health Action
- Vol. 5 (2), 132-139
- https://doi.org/10.5588/pha.14.0098
Abstract
Setting: The Revised National Tuberculosis Control Programme, Puducherry, India, which has facilities for molecular diagnostic technique. Objective: To determine pre-diagnostic and pre-treatment attrition among presumptive multidrug-resistant tuberculosis (MDR-TB) patients and reasons for attrition. Methods: In this mixed-methods study, the quantitative component consisted of retrospective cohort analysis through record review of all presumptive MDR-TB patients recorded between October 2012 and September 2013. The qualitative component included in-depth interviews with key informants involved in programmatic management of drug-resistant tuberculosis services. Results: Of 341 eligible presumptive MDR-TB patients, pre-diagnostic and pre-treatment attrition was respectively 45.5% (155/341) and 29% (2/7). Patients with extra-pulmonary TB (RR = 2.3), those with human immuno-deficiency and TB co-infection (RR = 1.7), those registered during October–December 2012 (RR = 1.3) and those identified from primary/secondary health centres (RR = 1.8) were less likely to be tested. Themes that emerged during the analysis of the qualitative data were ‘lack of a systematic mechanism to track referrals for culture and drug susceptibility testing’, ‘absence of courier service to transport sputum’, ‘lack of knowledge and ownership among staff of general health system’, ‘shortage of diagnostic kits’ and ‘patient non-adherence’. Conclusion: Despite the introduction of molecular diagnostic techniques, operational issues in MDR-TB screening remain a concern and require urgent attention.Keywords
This publication has 16 references indexed in Scilit:
- Management of previously treated tuberculosis patients in Kalutara district, Sri Lanka: how are we faring?Public Health Action, 2014
- Universal access to care for multidrug-resistant tuberculosis: an analysis of surveillance dataThe Lancet Infectious Diseases, 2013
- Mobile health to improve tuberculosis care and control: a call worth making [Review article]The International Journal of Tuberculosis and Lung Disease, 2013
- Operational Challenges in Diagnosing Multi-Drug Resistant TB and Initiating Treatment in Andhra Pradesh, IndiaPLOS ONE, 2011
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studiesThe Lancet, 2007
- Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groupsInternational Journal for Quality in Health Care, 2007
- Timely diagnosis of MDR-TB under program conditions: is rapid drug susceptibility testing sufficient?2006
- Risk factors for multidrug resistant tuberculosis in Europe: a systematic reviewThorax, 2006
- Using a bus service for transporting sputum specimens to the Central Reference Laboratory: effect on the routine TB culture service in Malawi.2004
- Determinants of drug-resistant tuberculosis: analysis of 11 countries.2001