Abstract
Background: Mumbai is witnessing a rising incidence of all forms of drug resistant tuberculosis (DR-TB). Methods: A population-based, retrospective study was conducted between April and July 2014, in 15 high TB burden wards in Mumbai, to capture the patient pathways to TB care. A total of 23 DR-TB patients were identified and their pathways to access DR-TB care were recorded using semi-structured interviews. Results: The total DR-TB pathway time of new patients (who did not report any past episode of TB) (180 days; IQR 123,346) was found to be more than twice that of retreatment patients (who reported a past episode of TB) (69 days; IQR 42,128). Conclusions: The unacceptable delay for diagnosis and treatment of DR-TB in Mumbai advocates for consistent implementation of early screening of patients using rapid gene-based technologies.
Highlights
The rising threat of multidrug resistant-tuberculosis (MDR-TB), defined as in vitro resistance to at least isoniazid and rifampicin, necessitates early detection of drug resistance and appropriate treatment initiation
Census Enumeration Blocks (CEB) maps were used as the reference point for the primary sampling unit (PSU) in the urban area
Even though the study findings show certain significant differences in pathway durations of new and re-treatment drug resistant tuberculosis (DR-TB) patients, we caution that in light of the small sample size, the observations currently be interpreted as indicative
Summary
The rising threat of multidrug resistant-tuberculosis (MDR-TB), defined as in vitro resistance to at least isoniazid and rifampicin, necessitates early detection of drug resistance and appropriate treatment initiation. It is imperative to understand the amount of time taken to detect patients with DR-TB and initiate them on appropriate treatment. This study looks at the durations from the onset of symptoms until initiation of appropriate treatment and tries to understand the type of patients that show maximum delay in accessing care. Methods: A population-based, retrospective study was conducted between April and July 2014, in 15 high TB burden wards in Mumbai, to capture the patient pathways to TB care. Keywords Drug resistant Tuberculosis, Mumbai, delays, pathway to TB care Conclusions: The unacceptable delay for diagnosis and treatment of DR-TB in Mumbai advocates for consistent implementation of early screening of patients using rapid gene-based technologies.
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