Drug-resistant Tuberculosis Cases Research Articles

Clinical and socio-demographic profile, drug sensitivity pattern and treatment outcome of drug resistant DR TB patients registered for treatment at a tertiary care centre in South India

Drug resistant tuberculosis is a major threat to TB elimination activities. In our study, we address the clinical, socio-demographic profile, drug sensitivity pattern and treatment outcome of drug resistant TB patients.A record based cross sectional study was conducted in 77 Drug Resistant TB cases registered for standardized treatment at a tertiary care centre in South India from January 2012 to December 2019. The clinical, socio-demographic, radiological characteristics, drug sensitivity pattern and treatment outcome of these patients were recorded. 51 were males and 26 were females. 31 (40.3%) were diabetic, 30 (39%) were tobacco users, 12 (15.6%) were health care workers, 40 (52%) had low BMI and 4 (5.2%) were HIV-TB. 66 (85.7%) showed resistance to isoniazid, 62 (80.5%) to rifampicin, 8 (10.4%) to ethambutol, 9 (11.7%) to Fluoroquinolones, 2 (2.6%) to Second Line Injectables and 6 (7.8%) to Streptomycin. Treatment outcomes were as follows: cured 41 (61%), treatment completed 2 (2.6%), failure 2 (2.6%), lost to follow up 9 (11.7%), regimen changed 3 (3.9%), died 11 (14.3%), not evaluated 2 (2.6%) and treatment stopped due to adverse drug reactions 1 (1.3%). Unfavourable treatment outcomes were associated with low BMI, previous ATT and fluoroquinolone resistance.More than half of the patients had favourable treatment outcomes. Low BMI, previous ATT and fluoroquinolone resistance were factors associated with poor outcomes.

Characteristics of Drug-sensitive and Drug-resistant Tuberculosis Cases among Adults at Tuberculosis Referral Hospitals in Indonesia.

As Indonesia's rifampin resistance testing rates are lower than global testing rates per the 2020 WHO global tuberculosis (TB) report, prevalence of multidrug-resistant TB may be underestimated. Our study aimed to evaluate prevalence and patterns of TB drug resistance (DR) within Indonesia. We conducted a cross-sectional analysis of baseline data collected from 2017-2018 as part of a cohort study of adults with presumed pulmonary TB at 7 DR-TB referral hospitals in Indonesia. Bacteriological examinations (acid-fast bacilli, GeneXpert, sputum culture) and drug-susceptibility testing were performed following the guidelines of the National TB Program. Of 447 participants with complete bacteriological examinations, 312 (69.8%) had positive sputum cultures for Mycobacterium tuberculosis. The proportion of MDR and pre-extensively drug-resistant was higher in previously treated compared with newly diagnosed participants (52.5% [73/139] versus 15% [26/173]). Compared with drug-sensitive case, drug-resistant TB was associated with cavities. Given the difference between rates of DR in TB referral hospitals from our study compared with the WHO survey in 2019 that showed 17.7% and 3.3% DR among previously treated and newly diagnosed participants globally, further characterization of Indonesia's TB epidemiology in the general population is needed. Strategies, including public policies to optimize case finding, strengthen capacity for resistance testing, and prevent loss to follow-up will be critical to reduce the burden of TB in Indonesia.

Spatial Distribution of Drug-Resistant Tuberculosisin Makassar City, South Sulawesi Province, Indonesia

This study aims to determine the domicile distribution, find out the high-risk areas, and determine the risk of drug-resistant tuberculosis patients based on patient location in 15 districts of Makassar City from Tuberculosis register data of South Sulawesi Provincial Health Office in December 2017 – April 2019 period. Gen Xpert rapid or drug sensitivity examinations were used to define drug-resistant tuberculosis. The domicile location of patients was geocoded by maps in Google Earth and aggregated per area by using Kernel Density analysis using ArcView GIS 10.3 software. We found that drug-resistant tuberculosis cases tended to be clustered in the western part of Makassar City, an area with a fairly high population density. There were areas with the highest concentration of predicted cases as a high risk of transmission of drug-resistant TB, around the Bontoala District, Makassar District, and Mamajang District. Healthcare facilities located in hot spots area need to be equipped with molecular rapid test facilities and conduct drug sensitivity tests for all suspected tuberculosis patients. Further research needs to be carried out to determine the distribution of tuberculosis patients who are sensitive and resistant to drugs.

Acquired and Transmitted Multidrug-Resistant Tuberculosis among the Incarcerated Population and Its Determinants in the State of Paraná-Brazil.

(1) Background: Tuberculosis remains a public health problem in the world. The study analyzed the factors associated with drug-resistant tuberculosis in the prison population of the state of Paraná. (2) Methods: Ecological study of drug-resistant tuberculosis cases registered in the Paraná Information System, Brazil (2008 to 2018). We performed descriptive statistics of quantitative parameters calculated with absolute frequencies. Additionally, we used binary regression logistics, where the odds ratio with its respective confidence interval was calculated. (3) Results: Of the 653 cases registered as cases of tuberculosis in the incarcerated population, 98 were drug-resistant tuberculosis. We observed that educational level of up to 8 to 11 years of schooling, negative bacterial culture (test outcome) and no tobacco use were factors associated with the non-development of drug-resistant tuberculosis, while clinically confirmed pulmonary TB and positive sputum smear microscopy in the fourth month of follow-up showed an association for the development of drug resistance. (4) Conclusions: The study showed that clinically confirmed pulmonary TB and a positive sputum smear microscopy in the fourth month of follow-up were associated with drug-resistant tuberculosis.

Characterizing in vivo loss of virulence of an HN878 Mycobacterium tuberculosis isolate from a genetic duplication event

The increase of global cases of drug resistant (DR) Mycobacterium tuberculosis (M.tb) is a serious problem for the tuberculosis research community and the goals to END TB by 2030. Due to the need for advancing and screening next generation therapeutics and vaccines, we aimed to design preclinical DR models of Beijing lineage M.tb HN878 strain in different mouse backgrounds. We found escalating sensitivities of morbidity due to low dose aerosol challenge (50–100 bacilli) in CB6F1, C57BL/6 and SWR mice, respectively. We also observed that pulmonary bacterial burden at morbidity endpoints correlated inversely with survival over time between mouse strains. Interestingly, with in vitro passaging and in the process of selecting individual DR mutant colonies, we observed a significant decrease in in vivo HN878 strain virulence, which correlated with the acquisition of a large genetic duplication. We confirmed that low passage infection stocks with no or low prevalence of the duplication, including stocks directly acquired from the BEI resources biorepository, retained virulence, measured by morbidity over time. These data help confirm previous reports and emphasize the importance of monitoring virulence and stock fidelity.

Preventive Therapy for Contacts of Drug-Resistant Tuberculosis.

Preventing the progression of a drug-resistant tuberculosis (DR-TB) infection to disease is an important pillar of the DR-TB elimination strategy. International guidelines have recently proposed fluoroquinolones for tuberculosis preventive therapy (TPT) in DR-TB contacts, although the available evidence is low quality. The pooled data from small observational studies suggest that a fluoroquinolone-based TPT is safe, effective and cost-effective as a preventive treatment in DR-TB contacts. Three clinical trials are currently ongoing to generate higher quality evidence on the efficacy of levofloxacin and delamanid as a DR-TB preventive therapy. Additional evidence is also needed, regarding TPT treatment in fluoroquinolone-resistant-TB contacts, patient and health care worker perceptions on DR-TB preventive therapy for contacts, and the service delivery models to increase DR-TPT access. This state-of-the-art review presents the current literature on TPT for contacts of DR-TB cases, focusing on the available evidence and international guidelines.

An Investigation of Extensively Drug - resistant Tuberculosis: Revealing Potential Improvements for Tuberculosis Control Program

On 31 May 2019, the Division of Epidemiology (DoE) was notified of a confirmed extensively drug-resistant tuberculosis (XDR-TB) case in Bangkok. The DoE and local teams conducted a joint investigation to describe the epidemiological characteristics of the case, identify possible source cases and contacts, and implement control measures. A descriptive study was performed among cases and close contacts by interviewing and reviewing the medical records using a standard case definition. An environmental study was performed at the case's house, workplaces, and tuberculosis (TB) clinic. The TB drugs were tested to analyze the content of active ingredients and dissolution. The case was a 36-year-old Thai male. In 2011, he was diagnosed with pulmonary tuberculosis and had received inappropriate treatment. He developed multidrug-resistant tuberculosis (MDR-TB) eight months later and XDR-TB in May 2019 with delayed hospital admission. Two possible source cases, both co-workers of the index case, were identified. Of 21 contacts, 13 were screened with a chest x-ray and found to have no abnormality. At the TB-clinic, drugs were stored in a room with inappropriate levels of temperature and humidity; however, the content of active ingredients and dissolution of TB drugs were within normal limits. Early hospital admission and monitoring of drug stockpile environments according to standard guidelines are recommended.

Trend and Spatial Distribution of Drug-Resistant Tuberculosis in Liberty-Deprived Populations in the State of Paraná, Brazil.

(1) Background: Tuberculosis remains a public health problem in the world. This study evaluated the temporal trends, distribution, and spatial associations of drug-resistant tuberculosis in liberty-deprived populations in the state of Paraná, Brazil. (2) Methods: An ecological study was developed using all cases of drug-resistant tuberculosis in penal establishments reported by the Brazilian Notifiable Diseases Information System between 2008 and 2018. For the time trend, the Prais–Winsten method was used. To verify the spatial association, the Getis–Ord Gi* technique was used. (3) Results: During the study period, 653 cases of tuberculosis were reported in the studied population, of which 98 (15%) were drug-resistant. Prais–Winsten autoregression identified an increasing trend, with APC = 15.08% (95% CI: 0.02–0.09) from 2008 to 2018; when analyzed from 2012 to 2018, the trend increased even more, with APC = 23.31% (95% CI: 0.01–0.16). Hotspots were also noted in the north, east, and west macro-regions of the state. (4) Conclusions: The presence of drug-resistant tuberculosis, as well as an increasing trend of these cases, was evidenced in all regions of the state among liberty-deprived populations,. The spatial analysis revealed priority areas for drug-resistant tuberculosis in penal establishments.

Temporal trend of drug-resistant tuberculosis among Thai children during 2006–2021

BackgroundThe prevalence of drug-resistant tuberculosis (DR-TB) in adults has stabilized in the past decade. Our study aimed to describe the prevalence of DR-TB in Thai children between 2006 and 2021. Materials and methodsChildren younger than 15 years old who had culture-confirmed Mycobacterium tuberculosis complex (MTB), positive PCR-MTB, or positive Xpert MTB/RIF were included in this cohort. Drug susceptibility testing (DST) was performed using phenotypic and/or genotypic methods. The prevalence of DR-TB was compared using the chi-square test. ResultsAmong 163 confirmed TB cases (44% as pulmonary TB, 27% as extrapulmonary TB, and 29% with both), the median age (IQR) was 12.2 (7.3–14.2) years. DST was performed in 139 cases (85%), revealing prevalences of all DR-TB, isoniazid-resistant TB (Hr-TB), and rifampicin monoresistant/multidrug-resistant TB (Rr/MDR-TB) of 21.6% (95% CI 14.7–28.4), 10.8% (95% CI 5.6–16.0%), and 2.9% (95% CI 0.1–5.7%), respectively. The DR-TB rates did not differ significantly between 2006–2013, 2014–2018, and 2019–2021 (p > 0.05). Two pre-extensively DR-TB (pre-XDR) cases with fluoroquinolone resistance were detected after 2014. ConclusionThe prevalence of DR-TB in Thai children was stable. However, one-tenth of DR-TB cases confirmed with DST were Hr-TB, which required adjustment of the treatment regimen. The pre-XDR cases should be closely monitored.

Patterns of Presentation of Drug-Resistant Tuberculosis in Nigeria: A Retrospective File Review

Background: An understanding of the patterns of drug-resistant tuberculosis (DR-TB) is needed to develop the best diagnostic tools and decide on optimal treatment combination therapies for the management of DR-TB in Nigeria. Objective: We aimed to investigate patterns of DR-TB for the five first-line anti-TB drugs over a period of seven years (2010–2016) and the associated clinical and socio-demographic factors. Methods: A retrospective study recruited 2555 DR-TB patients between 2010 and 2016 across the six geopolitical treatment zones in Nigeria. We determined DR-TB patterns based on standard case definition and their association with demographic and clinical information. Data were analyzed using Statistical Package for Social Sciences (SPSS) software. Independent predictors of DR-TB patterns/types were determined using bivariate and multivariate analyses with a statistical significance of p < 0.05 and a 95% confidence interval. Results: The majority of the participants were males, 66.93% (1710), 31–40 years old, 35.19% (899), previously treated, 77.10% (1909), had received at least two treatments, 411 (49.94%) and were multi-drug resistant, 61.41% (1165). The Southwest zone had the highest number of DR-TB cases, 36.92%. We found an upward trend in the prevalence of DR-TB from 2010 to 2016. Participants who had received one previous treatment showed statistically significant higher rifampicin resistance (59.68%), those with two previous treatments reported a statistically significant higher polydrug resistance (78.57%), and those with three or more previous treatments had a statistically significant higher multidrug resistance (19.83%) (χ2 = 36.39; p = 0.001). Mono-drug resistance and rifampicin resistance were statistically significantly higher in the southwest zone (29.48% and 34.12% respectively), polydrug resistance in the northcentral (20.69%) and south-south zones (20.69%), and multidrug resistance in the southwest (30.03%) and northcentral zones (19.18%) (χ2 = 98.26; p = 0.001). Conclusions: We present patterns of DR-TB across the six geopolitical zones in Nigeria. Clinicians should weigh in on these patterns while deciding on the best first-line drug combinations to optimize treatment outcomes for DR-TB patients. A national scale-up plan for DST services should focus on patients with previous multiple exposures to anti-TB treatments and on those in the Northeastern zone of the country.

Impacts of clofazimine on the treatment outcomes of drug-resistant tuberculosis

BackgroundThe purpose of this research was to evaluate the effect of clofazimine on drug-resistant tuberculosis treatment outcomes. MethodsA systematic search was conducted in the PubMed, Web of Science and EMBASE databases to identify eligible studies published up to July 10, 2021. The search terms were as follows: “clofazimine,” “tuberculosis,” “multidrug resistant tuberculosis” or “extensively drug resistant tuberculosis” and their synonyms or similar words. Two researchers independently screened the titles, abstracts, and full texts for inclusion. Meta-analysis was performed with Stata version 16.0 (Stata Corp., College Station, Texas, USA). Risk ratios (RRs) with 95% CIs were calculated to evaluate the treatment outcome. ResultsEight studies including 3219 participants were included in the meta-analysis. The meta-analysis found that the rates of treatment completion was higher in patients receiving clofazimine-containing regimens than in those not receiving clofazimine-containing regimens (RR: 1.185 (1.060–1.325), P = 0.003). Significant reduction in treatment failure (RR: 0.598 (0.473–0.756), P < 0.001) was found in the clofazimine treatment group. The subgroup analyses of randomized controlled trials (RCTs) found a higher rates of favorable outcomes, treatment completion and cure in the clofazimine group than in the control group (RR: 1.203 (1.029–1.407), P = 0.020; RR: 3.167 (2.043–4.908), P < 0.001; and RR: 1.251 (1.031–1.518), P = 0.023, respectively). Patients receiving clofazimine had a lower risk of treatment failure than those not receiving clofazimine (RR: 0.529 (0.454–0.616), P < 0.001). However, clofazimine treatment did not have a statistically significant effect on all-cause mortality in RCTs. ConclusionsThis study demonstrated that compared with patients who do not receive clofazimine, this drug has the potential to achieve a higher favorable outcome, treatment completion and cure rates, and a lower treatment failure risk among drug-resistant tuberculosis cases.

A cross-sectional study to determine the psychological distress among pulmonary tuberculosis patients during COVID-19 pandemic.

COVID-19 pandemic had adversely affected the services of the National Tuberculosis (TB) Elimination Programme, resulting in psychological distress among pulmonary tuberculosis patients (PTB). This cross-sectional, hospital-based study included 361 PTB patients. Three pre-defined questionnaires were used for the analysis, a questionnaire to evaluate anxiety related to COVID-19, a patient health questionnaire (PHQ-9) for depression, and a fear of COVID-19 scale (FCV-19S) questionnaire. Among 361 PTB patients, 13% (n=47) had COVID-19 infection. Out of the total patients, 69% (n=250) were DR-TB (drug resistance-tuberculosis) cases. Proportion of anxiety, fear and depression due to COVID-19 was found in 49% (n=177), 23% (n=83), 67% (n=247) respectively. Delay in the initiation of anti-tubercular treatment was found in 58% (n=210) of the cases, among which the majority, i.e., 69% (n=172, p=0.011), were DR-TB. This pandemic has led to a sudden step-down of PTB. Trend analysis of the psychological distress showed a peak following the COVID-19 pandemic. Most DR-TB patients had delayed initiation of the anti-tubercular treatment during the pandemic. The preponderance of the younger age group was seen in the pulmonary tuberculosis patients, and a majority of them had DR-TB. Depression was the predominant psychological distress among the study subjects during the pandemic.

Semi-Automated Therapeutic Drug Monitoring as a Pillar toward Personalized Medicine for Tuberculosis Management.

Standard tuberculosis (TB) management has failed to control the growing number of drug-resistant TB cases worldwide. Therefore, innovative approaches are required to eradicate TB. Model-informed precision dosing and therapeutic drug monitoring (TDM) have become promising tools for adjusting anti-TB drug doses corresponding with individual pharmacokinetic profiles. These are crucial to improving the treatment outcome of the patients, particularly for those with complex comorbidity and a high risk of treatment failure. Despite the actual benefits of TDM at the bedside, conventional TDM encounters several hurdles related to laborious, time-consuming, and costly processes. Herein, we review the current practice of TDM and discuss the main obstacles that impede it from successful clinical implementation. Moreover, we propose a semi-automated TDM approach to further enhance precision medicine for TB management.

Country-specific lockdown measures in response to the COVID-19 pandemic and its impact on tuberculosis control: a global study.

ABSTRACTThe objective of this study was to describe country-specific lockdown measures and tuberculosis indicators collected during the first year of the COVID-19 pandemic. Data on lockdown/social restrictions (compulsory face masks and hand hygiene; international and local travel restrictions; restrictions to family visits, and school closures) were collected from 24 countries spanning five continents. The majority of the countries implemented multiple lockdowns with partial or full reopening. There was an overall decrease in active tuberculosis, drug-resistant tuberculosis, and latent tuberculosis cases. Although national lockdowns were effective in containing COVID-19 cases, several indicators of tuberculosis were affected during the pandemic.

A triterpene ketone from an anti-mycobacterial tuberculosis chromatography eluate from the n-hexane fraction of the fruits of Harungana madagascariensis Lam. Ex Poiret (Hypericaceae)

Clinical cases of drug resistant tuberculosis (TB) are a global threat because of the cost and extended duration of treatment regimen. This underscores the continuous drive to discover new therapeutic agents that are faster, simpler and affordable often by recourse to natural products. This report highlights the potentials of the Nigerian medicinal plant Harungana madagascariensis Lam. Ex Poiret (Hypericaceae) as a source of lead agents for the discovery and development of anti-tuberculosis drugs. The fruit of H. madagascariensis was extracted with 70% aqueous ethanol by cold maceration. The crude 70 % aqueous ethanol extract was partitioned with n-hexane to give n-hexane (NHF) soluble portions. The NHF was fractionated further on a column packed with normal phase silica gel (200-400 Mesh size) to afford the chromatography fractions used in this study. The structure of isolated compound was elucidated using spectroscopic (NMR, IR, and MS) techniques. Anti-Mycobacteria tuberculosis susceptibility screening of the chromatography fractions was done using Lowenstein Jensen method with rifampicin, ethambutol, isoniazid and dihydrostreptomycin as reference anti-TB drugs for comparison. Four fractions NHF1-4 were obtained from the NHF. The chromatography fractions: NHF2 and NHF3 inhibited the growth of the Mycobacteria tuberculosis. From the NHF2 was isolated the known bioactive triterpene ketone friedelan-3-one. This preliminary screening underscores the potentials of this ethno medicinal plant as a source of lead compounds for the development of anti-TB drugs.

Formulation of rifampicin softpellets for high dose delivery to the lungs with a novel high dose dry powder inhaler

Lung tuberculosis (TB) is the most deadly infectious disease worldwide although it is treatable. High doses of antibiotics are used for therapy over a period of at least 6 months. Since in many treated patients only subtherapeutic concentrations are reached in the infected tissue of the lung, about half a million cases of multi drug resistant tuberculosis (MDR TB) occur every year. In order to increase the concentration of the active pharmaceutical ingredient (API) at the site of the primary infection, inhalation of antibiotics seems to be promising. In this study, we show the capability of softpellets, engineered dry powder agglomerates, to deliver high doses to the lungs. For this, the antibiotic rifampicin was milled and processed into softpellets which were then dispersed utilising a novel high dose dry powder inhaler, the 8Shot from Hovione Technology. Aerodynamic assessment resulted in a fine particle dose of 21.35 mg with a device retention of < 15% after loading all eight chambers of the inhaler with 10 mg softpellet formulation. At the same time, we present a new process design to produce softpellets, namely vibro-pelletisation.

Assessment of Pattern of Drug-resistant TB and Associated Factors in Rewa, Madhya Pradesh, India

Background and aims: The emergence and spread of drug-resistant strains of Mycobacterium tuberculosis are greatly complicating tuberculosis (TB) control efforts in many countries. In India, in 2018, out of 2.4 million notified cases of TB, there were an estimated 66359 and 3,882 laboratory-confirmed cases of multi-drug resistant tuberculosis (MDR-TB) and extensively drug-resistant TB (XDR-TB) respectively. The main objective of this study was to assess pattern of drug-resistant tuberculosis (DR-TB) and factors associated with it in Rewa district of Madhya Pradesh, India. Methods: This descriptive-analytical cross-sectional study was carried out at a tertiary care center in Rewa district from March 1, 2019, to February 29, 2020 (12 months). Taking the census method into account, all of 186 DR-TB cases registered at District Tuberculosis Centre (DTC), Rewa district, with the age of 18 years and above were included in the study. All the patients were interviewed thoroughly using a pre-tested, pre-validated, and reliable pro forma which included information regarding socio-demographic profile and history of TB. For statistical analysis, chi-square test (with/without Yate’s correction) was applied and a P value less than 0.05 was considered statistically significant. Results: In the present study, 71.6% and 28.4% of the cases were reported to be male and female, respectively. Additionally, 78.4% of the study subjects belonged to the age group of less than 45 years. Besides, rifampicin-resistant TB (RR-TB) was found to be the most prevalent type (56.4%), followed by isoniazid-resistant TB (HR-TB) (13.4%), and mixed pattern (12.4%) of DR-TB. Conclusion: DR-TB was more commonly observed in males of the economically productive age group (45 years and below), which can affect the social and economic development of individual, society, and nation.

Differentiating between drug-sensitive and drug-resistant tuberculosis with machine learning for clinical and radiological features

Tuberculosis (TB) drug resistance is a worldwide public health problem that threatens progress made in TB care and control. Early detection of drug resistance is important for disease control, with discrimination between drug-resistant TB (DR-TB) and drug-sensitive TB (DS-TB) still being an open problem. The objective of this work is to investigate the relevance of readily available clinical data and data derived from chest X-rays (CXRs) in DR-TB prediction and to investigate the possibility of applying machine learning techniques to selected clinical and radiological features for discrimination between DR-TB and DS-TB. We hypothesize that the number of sextants affected by abnormalities such as nodule, cavity, collapse and infiltrate may serve as a radiological feature for DR-TB identification, and that both clinical and radiological features are important factors for machine classification of DR-TB and DS-TB. We use data from the NIAID TB Portals program (https://tbportals.niaid.nih.gov), 1,455 DR-TB cases and 782 DS-TB cases from 11 countries. We first select three clinical features and 26 radiological features from the dataset. Then, we perform Pearson's chi-squared test to analyze the significance of the selected clinical and radiological features. Finally, we train machine classifiers based on different features and evaluate their ability to differentiate between DR-TB and DS-TB. Pearson's chi-squared test shows that two clinical features and 23 radiological features are statistically significant regarding DR-TB vs. DS-TB. A ten-fold cross-validation using a support vector machine shows that automatic discrimination between DR-TB and DS-TB achieves an average accuracy of 72.34% and an average AUC value of 78.42%, when combing all 25 statistically significant features. Our study suggests that the number of affected lung sextants can be used for predicting DR-TB, and that automatic discrimination between DR-TB and DS-TB is possible, with a combination of clinical features and radiological features providing the best performance.

A Study of Tuberculosis among Patients Visiting Regional Tuberculosis Centre in Central India- A Cross-sectional Study

Introduction: Number of Drug-Resistant Tuberculosis (DRTB) patients has increased. Determination of the causes of delay in timely diagnosis and treatment is one of the most important steps for complete cure. Delay in diagnosis and treatment of disease are important factors and these may arise from patients and by the healthcare system. Aim: To study factors contributing to Tuberculosis (TB) patients , visiting a regional DRTB centre in central India. Materials and Methods: A cross-sectional study was conducted at DRTB centre, Lashkar, Gwalior, Madhya Pradesh, India, from January 2019 to June 2019. Purposive sampling technique was used for data collection. Patients who visited the centre were requested to fill the performa regarding their TB status. Total 371 patients, who visited and filled the form, participated in the study. Patients were divided into drug resistant and drug sensitive patients. For the significant independent variables adjusted odds ratio and p-values were calculated. The p-values &lt;0.05 was considered to be significant. Results: Total 227 (61.2%) drug-resistant and 144 (38.8%) drugsensitive patients were included in the study. Education played a significant role with only 5.7% and 6.9% of drug resistant and sensitive patients, respectively, developed disease. Overall, 186 (81.9%) participants took more than 6 months of treatment prior to final initiation of Proper Anti-Tubercular Treatment (ATT) were DRTB cases. Conclusion: Delay in proper diagnosis and multiple visits to health facility and further delay in initiation of definitive treatment poses threat for emergence of drug resistance.

Prevalence and Determinants of Depression among Multi Drug Resistant (MDR) TB cases registered under National Tuberculosis Elimination Program in Ahmedabad City.

Background:Multidrug-resistant tuberculosis (MDR-TB) increases the risk of depression, lowers treatment compliance leading to poor outcomes.Objectives:To (1) document the prevalence of depression among MDR-TB cases registered at tuberculosis units (TUs) of Ahmedabad city and (2) assess determinants of depression.Methodology:Adult MDR-TB patients registered at all (23) TUs of Ahmedabad city, were studied using semi-structured questionnaire along with Gujarati translated version of the Hamilton Depression Rating Scale (HAM-D) to assess the severity of depression based on 17 items. The sample size at 95% level of significance, was 251. Probability proportional to size sampling was adopted for selecting participants from each of the 23 TUs. Proportions and odds ratio with confidence interval with probability value were calculated.Results:Of 251, only 185 (73.7%) cases could be contacted. Mortality proportion among selected cases was 18.7%. More than one-fifth (22%) had ≥1 comorbidity and 9.7% had another active TB case in the family. 161 (87.1) experienced ≥1 adverse event. Financial, social, or psychological stressors were reported by 22% of cases. Based on the HAM-D scale, 16.2% suffered from depression, determinants of depression by univariate analysis showed significant association with recent family issues, discrimination, financial/other troubling issues, and the presence of adverse drug event.Conclusion:MDR-TB cases are more vulnerable for developing depression as the prevalence was 16.2% among them. Hence, cases need to be monitored closely for depression at TU as well at community level.