Abstract
SettingNational Tuberculosis Programme, Cambodia.ObjectiveIn a cohort of TB patients, to ascertain the proportion of patients who fulfil the criteria for presumptive MDR-TB, assess whether they underwent investigation for MDR-TB, and the results of the culture and drug susceptibility testing (DST).MethodsA cross sectional record review of TB patients registered for treatment between July-December 2011.ResultsOf 19,236 TB patients registered, 409 (2%) fulfilled the criteria of presumptive MDR-TB; of these, 187 (46%) were examined for culture. This proportion was higher among relapse, failure, return after default (RAD) and non-converters at 3 months of new smear positive TB patients (>60%) as compared to non-converters at 2 months of new TB cases (<20%). Nearly two thirds (n = 113) of the samples were culture positive; of these, three-fourth (n = 85) grew Mycobacterium tuberculosis complex (MTBc) and one-fourth (n = 28) grew non-tuberculous Mycobacteria. DST results were available for 96% of the MTBc isolates. Overall, 21 patients were diagnosed as MDR-TB (all diagnosed among retreatment TB cases and none from non-converters) and all of them were initiated on MDR-TB treatment.ConclusionThere is a need to strengthen mechanisms for linking patients with presumptive MDR-TB to culture centers. The policy of testing non-converters for culture and DST needs to be reviewed.
Highlights
Of the estimated 290,000 cases of multidrug resistant tuberculosis (MDR-TB) among the notified pulmonary TB cases in 2010, just over 50,000 cases (18%) were diagnosed and among those only 45,553 (16%) were enrolled on MDR-TB treatment under the National Tuberculosis Programmes (NTP) [1]
The following group of TB patients fulfil the criteria of presumptive MDR-TB: smear positive previously treated patients who define as relapse, return after default (RAD), and failure; new smear positive pulmonary TB patients who sputum remains smear positive at month 2 or 3 of treatment; symptomatic close contacts of known MDR-TB patient, and new smear positive with Human Immunodeficiency Virus (HIV) infected patients
70% of relapse, failure, RAD, and non converter at 3 months cases had their specimens examined for culture and drug susceptibility testing (DST) as compared to only 16% among the non-converters at 2 months
Summary
Of the estimated 290,000 cases of multidrug resistant tuberculosis (MDR-TB) among the notified pulmonary TB cases in 2010, just over 50,000 cases (18%) were diagnosed and among those only 45,553 (16%) were enrolled on MDR-TB treatment under the National Tuberculosis Programmes (NTP) [1]. Detection of MDR-TB requires Mycobacterium Tuberculosis culture and drug susceptibility testing (DST) facilities. The journey begins with identification of presumptive MDR-TB patients in the peripheral health facilities. Patients are either referred or their sputum samples collected and transported to the designated culture and DST facilities and those diagnosed to be MDR-TB are initiated on treatment. Several patients may be lost along the way in this journey due to operational challenges: eligible patients may not be identified, many are not referred and/or may not have their sputum collected and transported to undergo culture and DST, and of those diagnosed to be MDR-TB, many are not initiated on treatment as has been shown in a recent publication from India [3]
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