Abstract
BackgroundThe Revised National Tuberculosis Control Program (RNTCP) of India recommends follow-up sputum smear examination at two months into the continuation phase of treatment. The main intent of this (mid-CP) follow-up is to detect patients not responding to treatment around two-three months earlier than at the end of the treatment. However, the utility of mid-CP follow-up under programmatic conditions has been questioned. We undertook a multi-district study to determine if mid-CP follow-up is able to detect cases of treatment failures early among all types of patients with sputum smear-positive TB.MethodologyWe reviewed existing records of patients with sputum smear-positive TB registered under the RNTCP in 43 districts across three states of India during a three month period in 2009. We estimated proportions of patients that could be detected as a case of treatment failure early, and assessed the impact of various policy options on laboratory workload and number needed to test to detect one case of treatment failure early.ResultsOf 10055 cases, mid-CP follow-up was done in 6944 (69%) cases. Mid-CP follow-up could benefit 117/8015 (1.5%) new and 206/2040 (10%) previously-treated sputum smear-positive cases by detecting their treatment failure early. Under the current policy, 31 patients had to be tested to detect one case of treatment failure early. All cases of treatment failure would still be detected early if mid-CP follow-up were discontinued for new sputum smear-positive cases who become sputum smear-negative after the intensive-phase of treatment. This would reduce the related laboratory workload by 69% and only 10 patients would need to be tested to detect one case of treatment failure early.ConclusionDiscontinuation of mid-CP follow-up among new sputum smear-positive cases who become sputum smear-negative after completing the intensive-phase of treatment will reduce the laboratory workload without impacting overall early detection of cases of treatment failure.
Highlights
The World Health Organization (WHO) and India’s Revised National Tuberculosis Control Programme (RNTCP) recommend periodic sputum smear microscopy during the course of tuberculosis (TB) treatment to monitor individual patient progress and assess overall programme performance [1,2]
All cases of treatment failure would still be detected early if mid-continuation phase’ (CP) follow-up were discontinued for new sputum smear-positive cases who become sputum smear-negative after the intensive-phase of treatment
As a result of death, default or transfer to some other reporting unit, 2503 (20%) cases did not reach the 2nd month of CP
Summary
The World Health Organization (WHO) and India’s Revised National Tuberculosis Control Programme (RNTCP) recommend periodic sputum smear microscopy during the course of tuberculosis (TB) treatment to monitor individual patient progress and assess overall programme performance [1,2]. One of these followup microscopy examinations is scheduled between the 4th and 6th month of anti-TB treatment, i.e. in the middle of the ‘continuation phase’ (CP) of typical anti-TB treatment.
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