Tuberculosis Elimination Research Articles

Level of adherence to anti-tubercular treatment among drug-sensitive tuberculosis patients on a newly introduced daily dose regimen in South India: A cross-sectional study.

Tuberculosis (TB) patients on the National Tuberculosis Elimination Program (NTEP) treatment protocol receive daily doses without health professional-supervised drug intake as during the previous directly observed treatment short-course (DOTS) regimen. We aimed to measure the level of adherence to anti-tubercular treatment (ATT) and the reasons for non-adherence among drug-sensitive TB patients on a daily-dose regimen in South India. A cross-sectional study was conducted among TB patients who received ATT as part of the standard treatment protocol in NTEP. Patients were interviewed to capture their understanding of TB, adherence, and the reason for non-adherence to ATT using validated instruments. Urine drug metabolite testing was performed using the high-performance liquid chromatography (HPLC) technique to confirm adherence. A total of 488 patients were recruited for the study. 64.8% of patients had 'good knowledge' about TB and ATT. According to the subjective report, 63.7% of patients were adherent, but urine drug metabolite testing revealed 53.4% adherence. A statistically significant difference (p< 0.05) exists between subjective and objective adherence measures. Patient-reported reasons for non-adherence were side effects of ATT (18.6%), loss of daily wages (15.0%), and forgetfulness (10.0%), among others. Nearly half of the patients were non-adherent to the daily dosing regimen. Adherence as reported by the patients is unreliable, and urine testing could be used in routine care to assess adherence. CTRI/2020/04/024941.

Cost Effectiveness of a Shorter Moxifloxacin Based Regimen for Treating Drug Sensitive Tuberculosis in India.

Globally efforts are underway to shorten the existing 6-month tuberculosis (TB) treatment regimen for drug-sensitive patients, which would be equally effective and safe. At present, there is a lack of evidence on the cost implications of a shorter 4-month TB regimen in India. This economic modeling study was conducted in the Indian context with a high TB burden. We used a hybrid economic model comprising of a decision tree and Markov analysis. The study estimated the incremental costs, life years (LYs), and quality-adjusted life years (QALYs) gained by the introduction of a Moxifloxacin-based shorter 4-month treatment regimen for pulmonary TB patients. The outcomes are expressed in incremental cost-effectiveness ratios (ICERs) per QALYs gained. The cost per case to be treated under the 4-month regimen was USD 145.94 whereas for the 6-month regimen it was USD 150.39. A shorter 4-month TB regimen was cost-saving with USD 4.62 per LY and USD 5.29 per QALY. One-way sensitivity analysis revealed that the cost of the drugs for the 4-month regimen, hospitalization cost for adverse drug reactions, and human resources incurred for the 6-month regimen had a higher influence on the ICER. The probability sensitivity analysis highlighted that the joint incremental cost and effectiveness using QALY were less costly and more effective for 67% of the iteration values. The cost-effectiveness acceptability curve highlights that the 4-month regimen was dominant to both patients and the National TB Elimination Programme in India as compared to the 6-month regimen at different cost-effectiveness threshold values.

Outcomes of latent tuberculosis infection treatment in Istanbul.

Increasing the extensity of latent tuberculosis infection (LTBI) treatment which is one of the important parameters of tuberculosis (TB) control and completing the treatment in success are important. The purpose of this study is to evaluate LTBI treatment indications and treatment outcomes of patients who received LTBI treatment in İstanbul between 2016 and 2018. The treatment outcomes of people who started LTBI treatment registered in TB dispensaries in Istanbul between 2016 and 2018 were analyzed retrospectively according to the variables of the age groups, gender, dispensary subgroups, and prevention treatment indications. Data collected from the health institutions were evaluated. 26.920 patients received LTBI treatment in all Istanbul TB dispensaries between 2016 and 2018. The evaluation of LTBI treatment indications; contact 15.696, Tuberculin skin test (TST) positivity 2224, immunosuppression 8746, TST conversion 58, sequelae lesion 15, and other indications are identified as 181. The groups which diagnosed with TB disease, mortality, transfer, other, and still in treatment are excluded from the analysis of LTBI treatment outcomes. A total of 25.253 patients were analyzed. 65 percent of the patients had completed LTBI treatment. Variables effective for treatment outcomes are analyzed with logistic regression. Treatment discontinuation was statistically significantly lower in 2017 (odds ratio [OR]: 0.906 confidence interval [CI] [95%] [0.849-0.968]) and 2018 (OR: 0.635 CI [95%] [0.594-0.679]) compared to 2016. Treatment lost to follow-up was statistically significantly lower in those receiving LTBI treatment with the indication of tuberculin skin test positivity (OR: 0.541 CI [95%] [0.487-0.600]) and the indication of immunosuppression (OR: 0.284 CI [95%] [0.142-0.569]) compared to those who received LTBI treatment due to contact. When the treatment results are evaluated according to the TB incidence of the region where the dispensaries are located, treatment lost to follow-up was higher in 101-200 per 100,000 incidence group (OR: 1.201 CI [95%] [1.123-1.285]) and incidence of 201-370 per 100,000 (OR: 1.461 CI [95%] [1.358-1.572]). Treatment lost to follow-up was higher in dispensaries on the European side (OR: 1.293 CI [95%] [1.203-1389]) and the 0-35 age group (OR: 1.248 CI [95%] [1.168-1.333]). In conclusion, the treatment completion rate should be improved for an effective LTBI treatment which is one of the important parameters of targeted TB elimination. Particularly people under the age of 35 years and regions with high-TB incidence should receive special care and close follow-up.

Integration of national tuberculosis elimination programme with child and adolescent health: India on track of end tuberculosis strategy

As per the global tuberculosis (TB) report 2020, 56% adult males, 32% adult females and 12% children worldwide, have TB. In India, an estimated 3.33 lakh children in the 0-14 years age group become ill with TB each year (28% of global childhood TB burden), with a slightly higher burden among males. In 2019, the national tuberculosis elimination programme (NTEP) reported 1.5 lakh TB cases of children aged 0-14 years, indicating a gap of 55% in TB notifications in this age group.1 In order to address the gaps in pediatric TB coverage, the NTEP collaborated with child health and adolescent health programmes of the ministry of health and family welfare (MoHFW). The two primary health programmes that serve children and adolescents across the country are Rashtriya Bal Swasthya Karyakram (RBSK) and Rashtriya Kishor Swasthya Karyakram (RKSK), respectively. This integration will bring the country forward towards the efforts of its goal to achieve the target of end TB strategy.

A Scoping Review on Accentuating the Pragmatism in the Implication of Mobile Health (mHealth) Technology for Tuberculosis Management in India.

Background: India continues to share a colossal count of the global tuberculosis load, with a perturbing 19% spring in the reported cases in 2021. With the National Tuberculosis Elimination Program (NTEP) consolidated to bring this epidemic to an end by 2025, the rapidly growing mobile health technologies can be utilized to offer promising results. Even though the implementation of this novel strategy is escalating around the globe, its triumph is still sub optimal in India. Objectives: This scoping review intends to explore the available mobile health (mHealth) technologies and analyse the effectiveness of the same for tuberculosis management in India. Methods: An elaborate search in electronic databases, such as PubMed and Google scholar, using the key terms and focussing from the year 2015, provided very broad results focussing on mHealth interventions and their utilisation in TB management in India. Further selection of the inclusive publications was carried out based upon the eligibility requirements as formulated for this review, pertaining to the objective of this study. Results: The collaborate search yielded a total of 858 scientific research papers. After the filtering of the obtained results, a total of 45 articles were selected to be analysed for this review. Published manuscripts, articles in peer review and abstracts from reliable databases were included to obtain vast range of information. Conclusion: The extensive literature search showed a preponderance of mHealth intervention studies focusing on TB treatment and drug monitoring. There exists a paucity of mHealth applications targeted to educate the public and intercept this infectious disease. The scientific articles reviewed and analysed in this scoping review strongly recommend the demployment of mHealth applications to achieve the target of eradicating TB by 2025 in India.

Takayasu's disease: an underdiagnosed entity in Sub-Saharan Africa. Report of five Gabonese cases

RésuméLa maladie de Takayasu est une vascularite affectant de façon préférentielle l'aorte et ses principales branches. Mycobacterium tuberculosis peut notamment être un facteur déclenchant du développement de la maladie de Takayasu par une réaction d'hypersensibilité. Le Maghreb et l'Afrique du Sud cumulent le plus grand nombre d'observations africaines, alors qu'entre les deux, en Afrique subsaharienne, les données parcellaires de la maladie font penser que la prévalence de la maladie est probablement sous-estimée/sous-diagnostiquée. Nous en rapportons 5 observations gabonaises.

Quality of Life Amongst Multidrug-Resistant TB Patients: An Exploratory Study About Distributive Dimensions and Interactions.

Background: Multidrug-resistant (MDR)-TB has emerged as a major challenge to eliminate TB as envisioned at policy level. Distinctive traits associated with the disease such as physical, psychosocial and environmental dimensions may influence the treatment outcome in both directions. Quality of life (QoL) indicators may capture these traits distinctively.Objective: To quantify the differential effect of MDR-TB on specific QoL domains, their distributions across the strata and to check for possible interactions.Method: This community-based cross-sectional study was conducted on 98 MDR-TB patients registered in the calendar year 2017 under National Tuberculosis Elimination Programme (NTEP) in a central Indian district using the WHO-QoL BREF Scale by patients in their vicinity. The transformed domain scores were descriptively summarized, stratified and exploratory visualised. Likert mapping for each item was done. A two-way ANOVA test was applied to check differences across strata and interaction effects were calculated.Result: Participants perceived a higher QoL in the social domain (median score 69, IQR 56-75) while the psychological health domain (median 31 IQR 20.5-44) was professed as most negotiated by disease. More than 50% of participants were found to be dissatisfied with their assumed physical status in item-wise analysis. A statistically significant interaction (p=0.008) was detected with education strata to income tertile most evident in the physical domain while psychological domain alone (p=0.017) without significant interaction with treatment duration (p=0.316) was associated with the type of TB. Overall QoL scores were tilted in favour of an urban setting, male gender and towards a relatively younger population.Conclusion: The overall deficits in QoL are evident in the study, per se in the psychological and physical domains. Moreover there is an inequitable distribution of these scores as revealed in the study. Inclusion of an additional parameter of periodical QoL assessment may thus predict the outcome at individual level and may address this inequity at policy level.

Tubercular pleural effusion with epithelioid cells– A rare cytological case presentation

Tuberculosis is one of the most prevalent disease of the developing countries resulting in significant morbidity. Extra pulmonary tuberculosis results in pleurisy among predilection to other organ and organ systems like lymph nodes. Pleurisy results in tubercular pleural effusion. Pleural effusions are mostly seen in immunocompetent patients. Here we present a case of tubercular pleural effusion which was diagnosed by cytology examination of pleural fluid in a 22-year-old female, who presented with shortness of breath, generalized weakness with decreased appetite. Radiological investigations revealed a unilateral pleural effusion. Pleural tapping was done and sent for cytological examination. Cytospin aspirate smear showed degenerated mesothelial cells, histiocytes, few epithelioid cells, mature lymphocytes and lymphocytes with splintered chromatin. A diagnosis of tubercular pleural effusion was made with further tests like CBNAAT for confirmation of diagnosis. CBNAAT was positive with a strain of Rifampicin sensitive mycobacterial tuberculosis identified. Patient was started on anti tubercular drugs according to the National Tuberculosis Elimination Program. To conclude, cytology is a fast inexpensive method for diagnosing the etiology of pleural effusions by pointing us in the right direction.

The Characteristics and Patterns of Drug-Resistant Pulmonary Tuberculosis in Eastern India.

Background: Drug-resistant tuberculosis is a major public health problem throughout the world and accounts for substantial morbidity and mortality rates in India, too. Early diagnosis is the corner stone of tuberculosis treatment. State-level and cluster-wise variations in drug resistance is a possibility and should be regularly checked in from time to time. Materials and Methods: The present prospective cohort study (January 2019 to May 2022) was conducted in Darbhanga Medical College and Hospital on drug-resistant pulmonary tuberculosis patients. Sputum specimens were collected from designated centers. Rapid molecular drug-resistance testing (genotypic tests) and growth-based drug-susceptibility testing (DST) (phenotypic tests) were performed in the National Tuberculosis Elimination Program certified Laboratory. Results: A total of 268 patients with drug-resistant pulmonary tuberculosis were included in the study group. The treatment outcomes revealed as cured in 100 (37.31%); treatment completed in 43 (16.04%); died in 56 (20.89%); treatment failed in 22 (8.21%); loss of follow up in 34 (12.69%); and transferred out in 13 (4.85%) drug-resistant pulmonary tuberculosis patients. Adverse events were recorded in 199 (74.25%) of the drug-resistant pulmonary tuberculosis patients. Conclusions: Drug-resistant pulmonary tuberculosis patients are a matter of concern and need to be addressed.

Evaluation of TB elimination strategies in Canadian Inuit populations: Nunavut as a case study.

Tuberculosis (TB) continues to disproportionately affect Inuit populations in Canada with some communities having over 300 times higher rate of active TB than Canadian-born, non-Indigenous people. Inuit Tuberculosis Elimination Framework has set the goal of reducing active TB incidence by at least 50% by 2025, aiming to eliminate it by 2030. Whether these goals are achievable with available resources and treatment regimens currently in practice has not been evaluated. We developed an agent-based model of TB transmission to evaluate timelines and milestones attainable in Nunavut, Canada by including case findings, contact-tracing and testing, treatment of latent TB infection (LTBI), and the government investment on housing infrastructure to reduce the average household size. The model was calibrated to ten years of TB incidence data, and simulated for 20 years to project program outcomes. We found that, under a range of plausible scenarios with tracing and testing of 25%–100% of frequent contacts of detected active cases, the goal of 50% reduction in annual incidence by 2025 is not achievable. If active TB cases are identified rapidly within one week of becoming symptomatic, then the annual incidence would reduce below 100 per 100,000 population, with 50% reduction being met between 2025 and 2030. Eliminating TB from Inuit populations would require high rates of contact-tracing and would extend beyond 2030. The findings indicate that time-to-identification of active TB is a critical factor determining program effectiveness, suggesting that investment in resources for rapid case detection is fundamental to controlling TB.

To investigate the knowledge, attitude and practices regarding tuberculosis case notification among public and private doctors practicing of modern medicine in South Delhi.

In India, tuberculosis (TB) notification has been required since 2012. Notwithstanding, notification rates remain low. Non-reporting of tuberculosis cases not only results in an underestimation of cases, but also impedes the country's TB control strategy. Our research aims to assess practitioners' awareness, perception, and practice of tuberculosis case notification, as these factors can help reduce the TB burden. A cross-sectional study of 142 physicians was conducted between August 2018 and December 2019. Doctors were interviewed and given evaluation forms. Seventy-seven percent of the 142 physicians polled worked in medicine-related specialties, while 33% worked in surgery. Public sector physicians (64.7%) knew more about the Nikshay App than private practitioners (40.8%). The vast majority of public-sector doctors were only notified through their hospital's National Tuberculosis Elimination Programme (NTEP) center. However, the majority of private practitioners (47.8%) notified cases directly through the hospital, the local District Tuberculosis Officer (DTO) or NTEP medical officer (24 percent), or the Nikshay portal (28%), whereas the majority of public sector doctors notified only through the hospital NTEP center (85.9%). The primary reasons for non-notification are the high patient load on doctors, a lack of understanding about Nikshay App and its functionality, technological difficulties in using the Nikshay App, and the stigma associated with tuberculosis. The Nikshay App must be popularized as a notification mechanism through the NTEP program. To increase notification rates, practitioners must overcome the challenges they face. In terms of notification, more seminars and training, particularly hands-on training, should be held on a regular basis.

Profile and treatment outcomes among young patients with tuberculosis aged 15–24 years in Faridabad district of Haryana, India

ObjectiveThis study examined profile and treatment outcomes of young patients with tuberculosis (TB) registered at a district TB centre under the National TB Elimination Programme in Faridabad district of Haryana...

Evaluating the effect of short-course rifapentine-based regimens with or without enhanced behaviour-targeted treatment support on adherence and completion of treatment for latent tuberculosis infection among adults in the UK (RID-TB: Treat): protocol for an open-label, multicentre, randomised controlled trial

IntroductionThe successful scale-up of a latent tuberculosis (TB) infection testing and treatment programme is essential to achieve TB elimination. However, poor adherence compromises its therapeutic effectiveness. Novel rifapentine-based regimens and...

Impact of COVID-19 restrictive measures on income and health service utilization of tuberculosis patients in India

BackgroundThe nationwide lockdown (March 25 to June 8, 2020) to curb the spread of coronavirus infection had significant health and economic impacts on the Indian economy. There is limited empirical evidence on how COVID-19 restrictive measures may impact the economic welfare of specific groups of patients, e.g., tuberculosis patients. We provide the first such evidence for India.MethodsA total of 291 tuberculosis patients from the general population and from a high-risk group, patients from tea garden areas, were interviewed at different time points to understand household income loss during the complete lockdown, three and eight months after the complete lockdown was lifted. Income loss was estimated by comparing net monthly household income during and after lockdown with prelockdown income. Tuberculosis service utilization patterns before and during the lockdown period also were examined. Household income loss, travel and other expenses related to tuberculosis drug pickup were presented in 2020 US dollars (1 US$ = INR 74.132).Results26% of households with tuberculosis patients in tea garden areas and 51% of households in the general population had zero monthly income during the complete lockdown months (April–May 2020). Overall income loss slowly recovered during July–August compared to April–May 2020. Approximately 7% of patients in the general population and 4% in tea garden areas discontinued their tuberculosis medicines because of the complete lockdown.ConclusionDiscontinuation of medicine will have an additional burden on the tuberculosis elimination program in terms of additional cases, including multidrug resistant tuberculosis cases. Income loss for households and poor restoration of income after the lockdown will likely have an impact on the nutrition of tuberculosis patients and families. Tuberculosis patients working in the informal sector were the worst affected group during the nationwide lockdown. This emphasizes that a policy priority must continue to protect those working in informal sectors from the economic consequences of such restrictive measures, including paid sick leave, additional food support, and direct benefit transfers. Alongside ensuring widespread access to COVID-19 vaccines, these policy actions remain pivotal in ensuring the well-being of those who are unfortunate enough to be living with tuberculosis.

Strengthening resistance testing for tuberculosis in India - Investment cost, throughput, and efficiency of new laboratories

A lack of laboratory capacity for drug-resistant tuberculosis (DR-TB) testing is a major barrier to DR-TB control. To overcome this barrier, the Central Tuberculosis Division (CTD), Ministry of Health and Family Welfare (MoHFW), Government of India (GoI), and FIND India established a partnership under the National Tuberculosis Elimination Program (NTEP) to strengthen and expand tuberculosis (TB) laboratory diagnostic capabilities. This partnership has led to the establishment of 61 culture & DST laboratories, increasing the testing capacity to a capability of performing over 200,000 liquid cultures and over 170,000 molecular drug sensitivity tests annually. In this study, we assess the data on throughput, efficiency, investment cost, and the capacity of the laboratory services supported by this partnership to understand impact and inform future resource allocation. We estimated the technical efficiency using Stochastic Frontier Analysis (SFA). Our results show that the established laboratory network is operating at 69% efficiency, with the capacity to perform an additional 450,000 cultures and 180,000 first-line molecular drug-susceptibility tests by 2025. This additional capacity, together with current efforts to enhance the laboratory network, has the potential to make a significant contribution to NTEP's TB elimination target by 2025.

A study to critically analyze Revised National Tuberculosis Control Program norms implementation at a medical college-level facility

Background: Tuberculosis (TB) control activities are implemented in the country for more than 50 years. The countrywide lockdown in 2020 adversely impacted routine health-care services including those for the management of TB. Operational research is needed to know whether Revised National Tuberculosis Control Program (RNTCP) (National Tuberculosis Elimination Program) is heading in the right direction as far as the pace and quality of implementation of the program are concerned. Aims and Objectives: The aim of the present study was to investigate the strength, weaknesses, and opportunities of RNTCP. An analysis of RNTCP was done to identify competencies and gaps. Materials and Methods: The present retroprospective and observational study was carried out at the RNTCP facility of a Government Medical College in the Central India in Madhya Pradesh during the year 2019–20. Samples of 238 patients registered under RNTCP for anti-tubercular treatment were taken in the study. Data were collected using a structured schedule from the RNTCP center and tabulated in a Microsoft Excel sheet, to assess the compliance of RNTCP norms in the management of TB. Results: The most commonly affected age was 16–49 years and the male: female ratio was 3:2. The most common basis of diagnosis was microbiological (60.92%). Follow-up sputum testing was done on time in 64.71% of patients. Adherence to anti-tubercular treatment (ATT) was regular in 78.57% of patients. All patients were telephoned while 43.14% of patients were home visited as a default action. After default action, 35.29% of patients return to regular ATT. Out of all registered patients initiated on ATT, 81.09% were treatment success, while 7.14% lost to follow-up, 2.1% became defaulters, and 4.62% patients died. Conclusion: We conclude that treatment success of TB unit was near the RNTCP norm of 85% which is below the national 88%. The probable reasons for the higher default rate and loss to follow-up rate during the study period could be the ongoing COVID-19 pandemic.

COVID-19 pandemic effects on the distribution of healthcare services in India: A systematic review.

BACKGROUNDThe coronavirus disease 2019 (COVID-19) pandemic has brought fundamental changes to our problems and priorities, especially those related to the healthcare sector. India was one of the countries severely affected by the harsh consequences of the COVID-19 pandemic.AIMTo understand the challenges faced by the healthcare system during a pandemic.METHODSThe literature search for this review was conducted using PubMed, EMBASE, Scopus, Web of Science, and Google Scholar. We also used Reference Citation Analysis (RCA) to search and improve the results. We focused on the published scientific articles concerned with two major vital areas: (1) The Indian healthcare system; and (2) COVID-19 pandemic effects on the Indian healthcare system.RESULTSThe Indian healthcare system was suffering even before the pandemic. The pandemic has further stretched the healthcare services in India. The main obstacle in the healthcare system was to combat the rising number of communicable as well as noncommunicable diseases. Besides the pandemic measures, there was a diversion of focus of the already established healthcare services away from the chronic conditions and vaccinations. The disruption of the vaccination services may have more severe short and long-term consequences than the pandemic’s adverse effects.CONCLUSIONSeverely restricted resources limited the interaction of the Indian healthcare system with the COVID-19 pandemic. Re-establishment of primary healthcare services, maternal and child health services, noncommunicable diseases programs, National Tuberculosis Elimination Program, etc. are important to prevent serious long-term consequences of this pandemic.

Pulmonary tuberculosis presenting as cystic disease/abscess

There was a 19% increase in year 2021 when compared to 2020 in TB patients’ notification in India, even though TB notifications noted around the period corresponding to India’s two major COVID-19 waves showed a brief decline, the National Tuberculosis Elimination Programme (NTEP) managed to reclaim the lost numbers. Cystic changes of the soft tissue and chest wall associated with pulmonary tuberculosis is rarely diagnosed and reported, and only few patients were diagnosed based only on the radiological and histopathological findings. Herewith, we report the microbiological, histopathological, computed tomographic, ultrasound and clinical findings of cystic change in pulmonary tuberculosis in an immunocompetent 18-year-old male who presented with pain in the Chest and swelling in the left infra mammary region for a short duration of one month. The lesion regressed and patient showed clinical improvement following Anti-tuberculous therapy treatment initiation after linking the patient with NIKSHAY system and is currently under ATT.

A Study of the Level of Awareness about Tuberculosis among Employees of a Tertiary Care Hospital

Background: Tuberculosis (TB) in India is a major public health problem. Government of India has committed to end TB by 2025 through its National Tuberculosis Elimination Programme. Awareness about tuberculosis especially among healthcare workers (HCWs) is considered crucial for the success of the program. Objective: The study aimed to assess TB awareness level among HCWs (other than the medical officers) and other employees. Methods: The study was carried out in a large city in Uttar Pradesh, India, from Jul 2021 to Dec 2021. Study population included all employees of the hospital except medical officers. The employees other than the HCWs provided the inbuilt comparison group. Data were collected using structured interviewer-administered questionnaires which included questions related to cause, mode of transmission, organ involvement, preventive, and treatment aspects of TB. Data were analyzed using STATA 17.0 statistical software. Results: Out of 244 study subjects, 128 (52.5%) were HCWs and 116 (47.5%) were other than HCWs. More than 80% of HCWs correctly knew that TB was a communicable disease that spread through air; most commonly affected lungs; was preventable as well as treatable; and the Govt. of India provided free of cost medicine to all TB patients. The overall awareness level among HCWs and Others was 74.5% and 66.0%, respectively. Compared to Others, HCWs were found more aware about 9 out of 10 aspects included in the questionnaire. The difference was found statistically significant in 4 out of 10 aspects. Conclusion: TB awareness among HCWs was found better than other hospital employees.

Glycemic status among newly diagnosed tuberculosis patients and their treatment outcomes- A prospective cohort study

Introduction and Aim: Tuberculosis is a serious systemic infection, which is a serious threat for developing countries including India. To address the disease burden, India has rolled out National Tuberculosis Elimination Program (NTEP) incorporating daily drug regimen with appropriate weight bands for treatment. Monitoring treatment outcomes for daily drug regimen with one-year post-treatment follow-up was the objective of the study. Materials and Methods: A prospective community-based cohort study was conducted between January 2020 and September 2021, in Udupi district. Patients were recruited from 62 different Primary health centres. Their baseline data was collected, glycaemic status was assessed using glycated hemoglobin. The patients were followed up till their treatment completion and one-year post-treatment follow-up was also done. Results: One hundred and two patients were diagnosed with tuberculosis during the 1st quarter of 2020 (Jan-Mar 2020) and started on daily drug regimen treatment. Favourable outcomes were noted among 107(95.1%), while unfavourable outcomes were noted among 5(4.9%). Females in younger age group and free from comorbidities had favourable outcomes. Older age groups, prediabetics, patients with lower BMI, and pulmonary tuberculosis had unfavourable outcomes. Conclusion: The daily drug regimen for tuberculosis was found to be effective in terms of reducing the treatment failure rates. Evaluation of glycaemic status using Glycosylated hemoglobin at the time of diagnosis of tuberculosis is desirable. So that, life style modification could be suggested to avoid progression of prediabetes to diabetes. Screening for diabetes using Glycosylated hemoglobin at treatment initiation is advocated to avoid unfavourable outcomes during TB treatment.