National Tuberculosis Elimination Programme Research Articles

Association Between Cycle Threshold Value of Cartridge-Based Nucleic Acid Amplification Test and Clinical Severity of Pulmonary Tuberculosis: A Cross-sectional Study

Introduction: Tuberculosis (TB) is a major global health problem caused by Mycobacterium tuberculosis (MTB). The National Tuberculosis Elimination Programme (NTEP) emphasises early diagnosis and treatment of TB cases. The Cartridge-Based Nucleic Acid Amplification Test (CBNAAT) is a semi-automated molecular assay that rapidly detects MTB Deoxyribonucleic Acid (DNA) and Rifampicin (RIF) resistance-associated mutations using Real-Time Polymerase Chain Reaction (RT-PCR). Aim: This cross-sectional study aims to assess the association between the Cycle Threshold (Ct) value of CBNAAT and the clinical severity of Pulmonary Tuberculosis (PTB). Materials and Methods: The study was conducted at the Department of Respiratory Medicine, Navodaya Medical College Hospital and Research Centre-Raichur, from January 2020 to July 2021. A sample size of 106 participants, aged ≥18 years and meeting the NTEP guidelines for presumptive PTB cases, were enrolled. Participants underwent chest radiography, sputum smear microscopy for Acid-Fast Bacilli (AFB), and CBNAAT testing. Clinical severity of PTB was categorised as mild, moderate, or severe using the Bandim TB score. Data was entered into Microsoft Excel 2017, and statistical analysis was performed using SPSS version 23. Descriptive statistics, frequencies, percentages, means, and standard deviations were calculated, and the chi-square test was utilised to assess associations between qualitative variables. Results: Among the participants, the majority (55.7%, n=59) had moderate clinical severity. Of these, 12.3% (n=13) had high CBNAAT Ct values, 20.8% (n=22) had medium Ct values, 11.3% (n=12) had low Ct values, and 11.3% (n=12) had very low Ct values. A total of 31.1% (n=33) had severe clinical severity, with 13.2% (n=6) having high Ct values, 12.3% (n=13) having medium Ct values, and 6.6% (n=7) each having low and very low Ct values. Additionally, 13.2% (n=14) had mild clinical severity, with 0.9% (n=1) having high Ct values, 3.8% (n=4) having medium Ct values, 5.7% (n=6) having low Ct values, and 2.8% (n=3) having very low Ct values. The chi-square value was 4.697, with a p-value of 0.58. Conclusion: There is no association between the Ct value of CBNAAT and the clinical severity of PTB.

Changing trends in the diagnosis of genitourinary tuberculosis in post Covid-19 pandemic era

efforts to achieve a TB-free world by 2030. The health professionals and the health care support team suffered a major setback in reaching out to the patients due to various restrictions imposed on them during this pandemic period. Patients found it difficult to reach out to the health care team, owing largely to the fear factor and also due to inaccessibility to health care services. The delay in TB notifications, emergence of drug resistant strains and restrictions in the supply- chain added further to the difficulties faced. India is a nation with one of the largest numbers of TB victims. The strategic measures taken by the Government of India (GOI) took a sudden jolt with the onset of the COVID-19 pandemic. The TB elimination measures reverted back to TB containment measures. Various African countries including Ethiopia recorded a massive fall out of more than 75% during the various lockdown measures imposed. However, India took collateral measures to combat this setback. Its National Tuberculosis Elimination Programme (NTEP) involved private players to combat TB epidemic, recruited Patient provider support agencies and actively engaged Private Sectors through innovative patient provider incentives to bring down numbers of the TB victims. The diagnostic methods that took about 4 to 6 weeks to confirm the diagnosis of TB had earlier put the diagnosis and management of TB to the back seat. However, recent innovations in the molecular biology, immunology and genomic sequencing techniques have greatly aided an earlier and accurate diagnosis of tuberculosis. One individual, one health agency or one Government cannot achieve the goal TB elimination by 2030. A global effort is the basic pre-requisite, incorporating advanced molecular diagnosis and appropriate treatment would ensure achieving a TB free world by 2030.

Cost-Effectiveness of Currently Available Diagnostic Tools for Diagnosis of Pediatric Tuberculosis Under National Tuberculosis Elimination Program.

In India, children do not get diagnosed with tuberculosis (TB) for reasons such as lack of screening modality at the health-care settings, inadequate sputum sample, and low detection rate. This study aims to assess various modalities for diagnosis of pediatric TB and their cost-effectiveness. Cost-effectiveness was found for various diagnostic modalities for TB diagnosis in children of India below 15 years of age. TrueNat MTB was the intervention being compared to GeneXpert MTB and sputum microscopy. Evidence pertinent to effectiveness and cost per test, and health benefits in terms of disability adjusted life years were researched and documented. Modeling a cohort of children through a decision tree and assimilating costs and disability-adjusted life years (DALYs) at each step gave results in the form of cost-effectiveness. Interventions were compared by calculating the cost-effectiveness ratio. The results revealed that TrueNat is more cost effective (Rs. 9450/DALY averted) compared to GeneXpert MTB/RIF (Rs. 9750/DALY averted). The incremental cost effectiveness ratio of TrueNat with respect to GeneXpert was found to be Rs. 5925 per DALY averted. Diagnosis through TrueNat point of care (POC) will avert 962 more DALYs compared to GeneXpert. As is evident from the results, TrueNat does alleviate disability caused by TB in children as more DALYs are averted. At an additional cost of Rs. 5925 to avert one DALY, which is below the gross domestic product (GDP) per capita for India (for 2021, it was $2277), TrueNat can have significant health benefits.

Epidemiological and Time Series Analysis of Tuberculosis with Prediction during COVID-19 Pandemic using ARIMA Model: A Study from Churu District of Rajasthan.

As Tuberculosis (TB) is a major public health problem in India and to achieve the goal of TB elimination, it is important to assess the trend of TB cases and the impact of lockdowns and other restrictions imposed for control of COVID-19 in India on the National TB Elimination Programme. Hence, the present study aims to study the temporal trend of TB cases and assess the impact of lockdown on TB detection. A retrospective record-based study was conducted in a tertiary care institute of India. A time series analysis of TB cases from April 2018 to May 2020 was carried out. An Auto-Regressive Integrated Moving Averages (ARIMA) model was used to forecast TB cases during the lockdown period and the result was compared with actual cases detected. The statistical analysis was accomplished with R software. The time series analysis showed that the projected TB cases in April and May 2020 were 67 and 86, respectively, while the observed cases in these months were 35 and 76. The trend of TB cases during the study period showed no steady increase or decrease and the detection of TB has declined during the COVID-19 lockdown period. The TB cases peaked from April to June and males constitute the majority of TB cases.

Cost-effectiveness of TrueNat as compared to GeneXpert as a diagnostic tool for diagnosis of pediatric tuberculosis/MDR Tuberculosis under the National Tuberculosis Elimination Program of India

Cost-effectiveness of TrueNat as compared to GeneXpert as a diagnostic tool for diagnosis of pediatric tuberculosis/MDR Tuberculosis under the National Tuberculosis Elimination Program of India

Utility of laboratory diagnostic tests in women suspected of genital tuberculosis attending a tertiary care teaching hospital.

Genital Tuberculosis is a form of extrapulmonary tuberculosis, which if not diagnosed early can lead to complications. The objective of this study was to determine the sensitivity and specificity of Xpert Mycobacterium tuberculosis/rifampin (MTB/RIF) assay in genital tuberculosis (TB) in comparison with culture as a gold standard. The results of the Xpert MTB/RIF assay performed from January 2020 to August 2021 were compared with the results of culture by Mycobacterium Growth Indicator Tube (MGIT) 960. Out of 75 specimens, fluorescent microscopy and liquid culture using MGIT and Xpert assay were positive in 3 (4%), 21 (28%), and 14 (18%), respectively. The sensitivity and specificity of the Xpert MTB/RIF assay were 66.67% and 100%. All smear-positive specimens were positive by culture and Xpert assay. Three specimens were positive by all the tests, i.e., microscopy, culture, and Xpert assay. Fifty-four specimens were negative by microscopy, culture, and Xpert assay. Discordance between the results of culture and Xpert assay was observed in seven specimens which were culture positive and Xpert assay negative. Three (21.42%) out of 21 culture-positive specimens showed monoresistance to rifampicin by Xpert MTB/RIF assay and culture drug susceptibility testing. Xpert MTB/RIF assay showed good sensitivity and specificity compared to liquid culture in genital TB. This test is easy to perform, provides results in 2 h, and can also detect rifampicin resistance, which is a surrogate marker for multidrug-resistant TB. Hence, the Xpert assay can be used under the National TB Elimination Program for early and rapid diagnosis of TB in endometrial specimens to prevent complications like infertility.

Heteroresistance to rifampicin & isoniazid in clinical samples of patients with presumptive drug-resistant tuberculosis in Central India.

A combination of resistant and susceptible Mycobacterium tuberculosis (MTB) isolated from clinical specimens is referred to as heteroresistance. Heteroresistance leads to difficulties in drug resistance testing and may adversely affect treatment outcomes. The present study estimated the proportion of heteroresistance among MTB in clinical samples of presumptive drug-resistant tuberculosis (TB) patients in Central India. A retrospective analysis of data generated from line probe assay (LPA) at a tertiary care hospital in Central India between January 2013 and December 2018 was carried out. A heteroresistant MTB in a sample was indicated by the presence of both wild-type and mutant-type patterns on an LPA strip. Data analysis was carried out on interpretable 11,788 LPA results. Heteroresistance in MTB was detected in 637 (5.4%) samples. Of these, heteroresistance in MTB was detected in 413 (64.8%), 163 (25.5%) and 61 (9.5%) samples with respect to rpoB, katG and inhA genes, respectively. Heteroresistance is considered a preliminary step in the development of drug resistance. Delayed or suboptimal anti-tubercular therapy in patients with heteroresistance of MTB may elicit full clinical resistance and negatively impact the National TB Elimination Programme. Further studies are, however, needed to determine the impact of heteroresistance on treatment outcomes in individual patients.

Predictors for Mortality in Multidrug Resistant Pulmonary Tuberculosis Patients in a South Indian Region

Background: Although various factors depicting the mortality in multi drug resistant tuberculosis available there exist no concise data on the factors contributing to mortality globally. The predictors for mortality in multi drug resistant tuberculosis patients vary from localities. Objectives: The study aimed to find the factors contributing to mortality in multi drug resistant tuberculosis in Warangal district of Telangana. Materials and Methods: The prospective study determining the predictors of mortality in multidrug resistant pulmonary tuberculosis patients had a sample size of 296. The follow-up of the patients was conducted for twenty four months to determine the treatment outcome. Patients’ mortality was noted from the hospital case sheets, relatives and healthcare facilitators’ viz., National tuberculosis elimination program supervisors, Auxiliary Nursing Midwifery in case of death at home. Patients’ demography was denoted in number and percentage. Predictors for mortality determined using binary logistic regression analysis. The predictor variables significant with p<0.2 in univariate analysis were considered for binary logistic regression analysis. The dependent variable was the occurrence of event - mortality and the independent variables chosen from the available literature. Results: The predictors for mortality identified as low body weight of 16-30kg (p=0.002; aOR=10.43); comorbids (p=0.002; aOR=3.21); severe radiological manifestations at admission to hospital (p=0.001; aOR=6.98) and incompliance to treatment (p=0.0001; aOR=5.06) in the present study. Conclusion: The factors identified for mortality in multidrug resistant tuberculosis patients are malleable and modifiable with timely follow-up of the patients. The results imply strengthening the anti-TB program with a multidisciplinary approach for a systematic follow-up of the patients and favorable treatment responses.

A step up to end tuberculosis: Lessons from a community-based death review of patients with tuberculosis from western India

Understanding factors leading to death following the onset of symptoms of tuberculosis (TB) is important to predict prognosis among patients with TB. With aiming the End TB strategy, mortality is declining not as expected globally and in India. Although India is one of the highest incidence countries globally, India lacks evidence of understanding of the factors for TB death. Thus, this study aims to document the characteristics of deaths due to TB in the Western state of India, Gujarat.About 74 deaths were randomly documented from 7 different geographic regions of Gujarat through a community-based death review from Oct 2021 to February 2022. The trained researchers administered a semi-structured questionnaire to capture the demographic, socioeconomic, history of comorbidity and addiction, medical history, case records, and chronology of events preceding death.Most deaths happened within 24 weeks from the onset of symptoms, which reduced to half (12 weeks) in the other cascades, i.e., diagnosis and treatment initiation to the death. Out of 74 reviewed deaths, 47 (64%) deaths had the cause of death as TB, with an average duration of 87 days from onset of symptoms to death. The study observed the time, place, and person distribution on different epidemiological parameters. While analyzing narratives from the relative, the gaps between the system (service provider) and demand (patient perspective) sides were synthesized.It is recommended to conduct such kind of community-based death reviews in the routine practices of the National TB Elimination Program to ensure the appropriate review of the underlying causes of deaths due to TB. The matrix developed in this study is easy to replicate in any other death reviews to understand the intercept of the supply-demand side determinants for the deaths.

Tuberculosis in India: Overview, Challenges, and Way Forward in the Post-COVID-19 Era

Tuberculosis (TB) remains one of India’s most pressing and challenging problems. Globally, India remains the highest TB burden country, infecting people of all age groups, mainly affecting the younger population. The bacterium Mycobacterium tuberculosis is highly infectious and spreads through droplet infection. Millions of people die due to TB annually, and India alone accounts for a significant portion of these fatalities. TB is a major barrier to social and economic development, and each day hundreds of workdays are lost because of the illness. TB mortality over the years has reduced, and India currently has revised its mission under the new program, that is, National Tuberculosis Elimination Program (NTEP). The NTEP has a goal to end TB by 2025 under an ambitious “Detect-Treat-Prevent-Build” model. Tackling TB during the COVID-19 pandemic became more challenging, and the global community was compelled to rethink its operation and implementation. The present article recommends the feasibility and scope of telemedicine and the integration of social development approaches in policy planning to ensure social and health equity.

Dietary Intake and Nutritional Status of Patients with Pulmonary Tuberculosis in Puducherry, South India

A bidirectional relationship exists between tuberculosis (TB) and nutrition. To examine the dietary intakes of tuberculosis (TB) patients and to identify the factors associated with dietary deficiencies. In this cross-sectional study, 173 newly diagnosed sputum smear-positive TB patients, and taking treatment in the National Tuberculosis Elimination Programme (NTEP) were included. Nutrient intakes were evaluated through one day 24-h dietary recall and compared with the Recommended Dietary Allowance (RDA). Data on dietary intake was analyzed using DietSoft software. The mean (SD) age of the study participants was 45.5 (18.7) years with majority male (73.4%). More than one-third (35.3%) didn’t receive any formal education and 28% were unemployed. Nearly half (47%) had diabetes mellitus, 45.1% were alcoholics, 39.3% were smokers, and 36% underweight. The mean (SD) daily intake of energy was 1414.33 (458.45) kcal and the median (Interquartile Range) of protein was 43.15 (30.00-60.26) gms. The daily energy and protein intake were lower than the national guidelines for RDA. The intake of micronutrients was found to be much lower than recommended. The intake of macronutrients and selected micronutrients in TB patients were grossly inadequate. Along with vitamin supplementation, dietary counseling also is needed in this population. Keywords: Dietary intake, Nutritional status, Risk behaviors, Tuberculosis

Impact of COVID-19 Coinfection on Management of Tuberculosis Patients Registered at DOTS Center in a Tertiary Care Hospital

Introduction: This study was conducted to determine the impact of coronavirus disease 2019 (COVID-19) and the ensuing lockdown on tuberculosis (TB) management undergoing treatment under the National Tuberculosis Elimination Program (NTEP) and vice-versa. Aims: To study (1) the occurrence of COVID-19 and its severity among patients suffering from TB and (2) the impact of a pandemic on TB management under NTEP. Materials and methods: A retrospective observational study was conducted in patients registered at Directly observed therapy short-course (DOTS) center from 1st April 2020 to 31st July 2021 at ESIC Medical College and Hospital, Faridabad, Haryana, India, using a semi-structured predesigned questionnaire administered telephonically. Results: Out of 387 TB patients registered at the DOTS center, 191 participated in the study. The occurrence of COVID-19 in patients with TB was 10 (5.2%), of which five (50%) were symptomatic; four (40%) had pulmonary TB, and six (60%) had extrapulmonary TB. Nine (90%) patients had mild and one (10%) moderately severe disease requiring hospitalization. Amongst 191 patients, 29 (15.2%) missed anti-TB treatment (ATT); 15 (51.7%) could not access the DOTS center due to restrictions, and seven (24.1%) due to personal reasons, eight (27.5%) forgot to take medication, and one (0.34%) migrated elsewhere. Conclusions: The occurrence of COVID-19 in patients with TB was found to be 5.2% in this study. The severity of COVID-19 was mostly mild and the mortality rate in patients with a coinfection of TB and COVID-19 was 10%. The COVID-19 pandemic had a negative impact on TB management under NTEP due to the imposed lockdown. The limitation of this study was the small sample size.

Study on Tuberculosis Treatment and Drug Resistance Testing in a Tertiary Care Center in Central India

National TB Elimination Program (NTEP) in India has planned for free of cost diagnosis and treatment for tuberculosis (TB) patients. This study is carried out to find out the deficiencies in treatment prescribed by practitioners, whether they were as per NTEP guidelines or not, and to assess the use of cartridge-based nucleic acid amplification test (CBNAAT) by practitioners for the detection of rifampicin resistance as per the current guidelines. Aims and objectives: This study was conducted to see the deficiencies in treatment prescribed by practitioners, whether they were as per NTEP guidelines or not, and to assess the use of CBNAAT by practitioners for the detection of rifampicin resistance as per the current guidelines. Materials and methods: The doctor’s prescription of a total of 199 patients who visited the outpatient department (OPD) were assessed, and data was collected as per inclusion and exclusion criteria. Results: Out of the total 199 prescriptions, 83.4% of patients were prescribed antitubercular treatment (ATT) under directly observed treatment short course (DOTS), while in the remaining 16.6% of patients non-DOTS ATT [57% prescribed fixed dosage combination (FDC) and 43% prescribed individual drug] were prescribed by practitioners. CBNAAT was prescribed by only 52.8% of practitioners for TB diagnosis and drug resistance. Conclusion: The method of prescribing non-DOTS ATT prescription drugs was not as per NTEP guidelines, and CBNAAT prescription was also less.

Characteristics and contributing factors of adverse drug reactions: an analytical study of patients with tuberculosis receiving treatment under the National TB Program of India

Background Tuberculosis (TB) continues to pose a serious threat to the public health system in India. Although the National Tuberculosis Elimination Program (NTEP) is providing a wide range of interventions from early diagnosis to complete treatment to reduce morbidity and mortality from TB, adverse drug reactions (ADR) remain a challenge in treatment adherence and completion. Methods An observational cross-sectional study was conducted in selected districts of Gujarat state. A total of 593 reported TB patients were recruited with an adjusted unified distribution based on the type of cases, site of diseases, and service facility through a simple random sampling method. A semi-structured questionnaire tool was used to collect socio-demographic, clinical, and ADR-related data from the TB patients. Data was analyzed for the frequency, percentage, chi-squared, and adjusted odds ratio to find the association between the variables. Results The majority of the study participants were male (87.2%), aged 15 to 60 (57.8%), daily laborers (22.4%), and married (64.2%). Over 75% of individuals had pulmonary TB, with 87% having experienced their first episode, 83% being new cases, and 44.7% having a history of addiction. ADR with mild symptoms was reported by more than a quarter (29%) of TB patients during the intensive phase (77%). The association between ADR experience and drug susceptibility was significant (p<0.005) and drug-resistant TB patients experience two times more ADRs than drug-sensitive TB patients (OR 2.04). Binomial logistic regression was carried out to describe the association between various variables and occurrence of ADRs. Conclusion The study highlighted a need to enhance health care providers’ capacity and program structure for managing ADRs among TB patients. In order to completely eliminate TB across the country, it also emphasized the attention for a holistic and all-encompassing strategy for managing TB patients at the field level.

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.

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.

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.