Abstract
Setting: Urban slums and poor rural areas in India, 2012–2014.Objective: To describe the characteristics of tuberculosis (TB) patients enrolled in treatment through Operation ASHA, a non-governmental organisation serving disadvantaged populations in India, and to identify risk factors for unfavourable treatment outcomes.Design: This was a retrospective cohort study. Patient characteristics were assessed for their relationship with treatment outcomes using mixed effects logistic regression, adjusting for clustering by treatment centre and Indian state. Outcomes were considered favourable (cured/treatment completed) or unfavourable (treatment failure, loss to follow-up, death, switch to multidrug-resistant TB treatment, transfer out).Results: Of 8415 patients, 7148 (84.9%) had a favourable outcome. On multivariable analysis, unfavourable outcomes were more common among men (OR 1.31, 95%CI 1.15–1.51), older patients (OR 1.12, 95%CI 1.04–1.21) and previously treated patients (OR 2.05, 95%CI 1.79–2.36). Compared to pulmonary smear-negative patients, those with extra-pulmonary disease were less likely to have unfavourable outcomes (OR 0.72, 95%CI 0.60–0.87), while smear-positive pulmonary patients were more likely to have unfavourable outcomes (OR 1.38, 95%CI 1.15–1.66 for low [scanty/1+] and OR 1.71, 95%CI 1.44–2.04 for high [2+/3+] positive smears).Conclusion: The treatment success rate within Operation ASHA is comparable to that reported nationally for India. Men, older patients, retreatment cases and smear-positive pulmonary TB patients may need additional interventions to ensure a favourable outcome.
Highlights
Despite recent declines in reported tuberculosis (TB) rates in India, the disease remains a major public health challenge.[1,2] With an estimated 2.8 million incident cases in 2015 (217 per 100 000 population),[1] India is considered a high-burden country for TB by the World Health Organization (WHO)
We identify risk factors for unfavourable treatment outcomes in a vulnerable population receiving treatment through the non-governmental organisation (NGO) Operation ASHA (New Delhi, India), which aims to enhance case identification and treatment delivery for patients who might not seek care through the Revised National Tuberculosis Control Programme (RNTCP)
A priori, we considered all of these factors as likely to be associated with treatment outcomes, so all were included in a multivariable model
Summary
Despite recent declines in reported tuberculosis (TB) rates in India, the disease remains a major public health challenge.[1,2] With an estimated 2.8 million incident cases in 2015 (217 per 100 000 population),[1] India is considered a high-burden country for TB by the World Health Organization (WHO). We identify risk factors for unfavourable treatment outcomes in a vulnerable population receiving treatment through the non-governmental organisation (NGO) Operation ASHA (New Delhi, India), which aims to enhance case identification and treatment delivery for patients who might not seek care through the Revised National Tuberculosis Control Programme (RNTCP). Operation ASHA (New Delhi, India, www/opasha.org/) works with national programmes to provide free health services, including TB diagnostics and treatment, in India’s urban slums and poor rural areas, where health care access is typically limited.[12,13] Their approach includes community engagement, patient empowerment and biometric technology. Patients were included if they had pulmonary TB with an initial sputum smear result or extra-pulmonary TB, and were not multidrug-resistant (MDR, defined as TB that is resistant to both isoniazid [H] and rifampicin [R]) at presentation
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