MDR-TB Patients Research Articles

The Effect of KatG S315t M. Tuberculosis Gene Mutation on Conversion Rate of MDR-TB Patients with Shorter-Course Treatment

Background. Resistance to the INH drug is most often caused by a mutation of the KatG S315T M.Tb gene. MDR TB treatment with short-term WHO mixes using high-dose INH drugs is considered less effective in this mutation condition because it causes high resistance to INH. The effectiveness of MDR TB treatment can be seen from the sputum smear conversion rate. This study was aimed to determine the effect of the S315T katG gene mutation on the treatment response of patients with MDR TB who received WHO short-term alloys at Dr Moh Hoesin general hospital, Palembang, Indonesia.
 Method. This study uses observational analytic with a prospective cohort approach. The study subjects were MDR TB patients at Dr Moh Hoesin general hospital, Palembang, Indonesia, and a PCR-RFLP examination was performed to see the katG gene, followed by sputum smear evaluation at the end of the first and second months of treatment to assess the speed of conversion. Data analysis using SPSS 25 with the chi-square statistical test.
 Results. The frequency of katG S315T M.Tb gene mutations was 51.85%. The majority of MDR TB sufferers experience rapid conversion (92.59%). 64.29% of the katG S315T gene mutation group experienced sputum smear conversion after one month, 28.57% after two months, and 7.14% after three months of treatment. There was no significant difference in conversion speed in the two groups (p = 0.741).
 Conclusion. There was no effect of the S315T M.Tb katG gene mutation on the speed of sputum smear conversion of MDR TB patients who received short-term alloy treatment.

Barriers and Strategies: A Review of Access to Affordable Multi-Drug Resistant Tuberculosis Medication in China.

This study analyzed the barriers of patient access to affordable MDR-TB medication in China and the reasons behind, and proposed strategies towards removing the barriers based on literature review and key informant interviews. Reasons behind the high financial burden of MDR-TB patients in China are the lack of a coordinated and multi-sourced financing model to secure patients’ access to the expensive novel medicines, and the absence of the safety-net for the patients with low ability to pay the costs. Appropriate health insurance benefit packages and provider payment mechanisms, supportive legal framework, coordinated policies as well as incentives for off-label use of evidence-based repurposed medicines are missing. The observations identified key intervention areas including continued efforts to make the novel effective medicines affordable and to strengthen the legislative protection for off-label use of evidence-based medicines; increase incentives for pharmaceutical companies to expand indications of established medicines based on the evidence; implement public initiatives to support the use of repurposed medicines for diseases with major public health significance, and scale up good practices from local pilots to create a coordinated multi-sourced financing model. A comprehensive approach to address the barriers in the full treatment course of MDR-TB and a safety-net for low-ability-to-pay patients are also critical to secure universal access to affordable MDR-TB medication.

Analysis of Smear Microscopy and Culture Conversion Results in Multidrug-Resistant Tuberculosis Patients with and without Type 2 Diabetes Mellitus

The World Health Organization (WHO) recommended microscopic AFB smear examination and culture as follow-ups to the response of MDR TB therapy. Analyzed the results of microscopic AFB smear and culture conversion as well as treatment outcome in Multidrug-Resistant Tuberculosis (MDR-TB) patients with and without Diabetes Mellitus (DM). This is a retrospective study involved 70 MDR-TB patients with (27 patients) with DM and without DM (43 patients) who had microscopic AFB smear and culture results at the start of the follow-up therapy. This research was conducted at Labuang Baji Regional Public Hospital, Makassar, from June to July 2019, used medical records of MDR-TB patients the period of June 2016 to December 2017. The results showed that 52 out of 70 MDR-TB patients had microscopic AFB smear and culture conversion in MDR-TB with DM (21 patients) and without DM (31 patients). The duration of microscopic AFB smear conversion in MDR TB patients with DM (3.33±0.54 months) was longer than patients without DM (2.07±0.05 months), p=0.001. While in culture conversion, there was no significant difference between MDR-TB with DM (1.28±0.64 months) and without DM (1.25±0.59), p=0.648. The recovery outcome between MDR-TB with (48.1%) and without DM (48.8%) was not significantly different. However, the output of treatment failure was greater in DM (11.2%) than without DM (2.3%), although statistically, there was no significant difference (p=0.568). Multidrug-resistant tuberculosis patients with DM experienced slower microscopic AFB smear conversion than MDR-TB patients without DM. However, in culture, there was no significant difference in the conversion period between the two groups. MDR-TB patients, both of with and without DM, had the same chance of recovery.

The accuracy of a mobile phone application (Wulira app) compared to standard audiometry in assessing hearing loss among patients on treatment for multidrug-resistant tuberculosis in Uganda

Objectives: Our aim was to validate the “Wulira App” a mHealth application against gold standard audiometry as a pragmatic audiometry solution for under-served and vulnerable groups of patients at risk of hearing loss. The specific objectives were as follows: To compare hearing thresholds determined using the Wulira app to standard pure tone audiometry among patients on MDR-TB treatment. To determine the correlation between the measured hearing loss with the Wulira app and standard audiometry with patient reported hearing loss. To determine the proportion of patients on MDR-TB treatment that experience hearing loss? Materials and Methods: We consecutively recruited patients ≥18 years old and receiving kanamycin in their treatment regimen between February and June 2019 for this study. Clinical and demographic data were obtained from each participant and documented in a secure database. Participants had hearing assessment performed once at enrolment with paired standard audiometry and the Wulira mobile phone app in a soundproof room. Results: A total of 120 MDR-TB patients with a mean age of 34.0 (±9.6) years were recruited for this study and 69 (57.5%) were male. When compared to pure tone audiometry, the Wulira app was able to correctly detect 91.4% hearing loss in right ear and 88.4% in the left ear. The specificity of the Wulira app was equally high, reaching 93.2% in the right ear and 91.5% in the left ear. Conclusion: The Wulira app may be a useful alternative home-based tool for hearing assessment in MDR-TB patients, essentially for early detection of hearing loss following commencement of second-line injectable drugs.

Cochlear Dysfunction after Kanamycin Injection in Multidrug Resistant Tuberculosis Patients

Long-term exposure to aminoglycoside such as kanamycin to cochlear cells is known to be associated with damage to outer hair cells in the organ Corti and type 1 sensory hair cells in the vestibular organs which ultimately causes permanent damage to hair cells. Hair cell damage occurs from the basal cochlea (high frequency area) to the apex cochlea (low frequency area) and followed by damage from the auditory nerve. Evaluation of cochlear dysfunction on multidrug resistant tuberculosis (MDR TB) patients have been rarely reported in the literature based on distortion product otoacoustic emission (DPOAE). Objectives: To prove cochlear dysfunction after kanamycin injection in MDR TB patient based on DPOAE examination of the overall frequencies and specific frequency. This was an observational longitudinal analytic with pre and post design without control group conducted in the infection division of MDR TB Outpatients Pulmonology Department and Otorhinolaryngology Community division of ORL-HNS Department, Dr. Soetomo General Hospital, Surabaya, within 3 months in 2018, 15 ear with the best baseline examination were taken by consecutive sampling and statistical analysis for cochlear dysfunction based on overall frequency and specific frequency DPOAE examination using Mc Nemar test. Based on DPOAE examination of overall frequencies there was no cochlear dysfunction (p>0.05) but a significant difference was found at frequency of 10,000 Hertz (Hz) (p=0.002). On ototoxicity monitoring there was no cochlear dysfunction after 4 weeks Kanamycin injection but cochlear dysfunction occurs at a specific frequency of 10,000 Hz.

Linezolid-Associated Neurologic Adverse Events in Patients with Multidrug-Resistant Tuberculosis, France.

Linezolid is one of the most effective drugs for treating multidrug-resistant tuberculosis (MDR TB), but adverse effects remain problematic. We evaluated 57 MDR TB patients who had received >1 dose of linezolid during 2011–2016. Overall, patients received 600 mg/day of linezolid for a median of 13 months. In 33 (58%) patients, neurologic or ophthalmologic signs developed, and 18 (32%) had confirmed peripheral neuropathy, which for 78% was irreversible at 12 months after the end of TB treatment despite linezolid withdrawal. Among the 19 patients who underwent ophthalmologic evaluation, 14 patients had optic neuropathy that fully reversed for 2. A total of 16 (33%) of 49 patients had a linezolid trough concentration >2 mg/L, and among these, 14 (88%) experienced adverse effects. No significant association was found between trough concentration and neurologic toxicity. These findings suggest the need to closely monitor patients for neurologic signs and discuss optimal duration of linezolid treatment.

Profil and Evaluation of Resistant Tuberculosis Drug’s Side Effect in Diabetes and Non Diabetes Mellitus Patient at RSUD Arifin Achmad

Backgrounds: Diabetes mellitus (DM) increases the risk of reactivation of tuberculosis included multi-resistant drug tuberculosis (MDR-TB). This situation is threatening Riau province due to the high prevalence of DM. Since 2014 Arifin Achmad Hospital as a referral hospital of MDR-TB management. It’s treatment especially in DM patients, requires an evaluation of both outcome and side effects. This evaluation needs to be compared with non-DM MDR TB patients. The aim of this study was to evaluate and analyse patient’s characteristic, conversion of smear or culture, drugs side effect and treatment outcome. 
 Methods: This is a cross sectional retrospective study in RSUD Arifin Achmad Pekanbaru on April-October 2018. Sample of this study were all patients from 2014 – 2017. This study was divided into 2 groups, namely the DM and non-DM groups, then analysed the differences between the two groups 
 Results: There were 113 MDR TB patients had its treatment, which 61% of the patients were male. Baseline data show 26.5% of MDR TB patients have comorbid DM. The most common side effects were nausea and vomiting (100%) in all subjects. In the MDR TB DM group, we found included: well controlled plasma glucose level was 33.3%, severe side effects was16.7%, conversion in the second month 40% and cured or complete treatment was 30%.
 Conclusions: As many as 26,5% of MDR TB patients had DM comorbidity. There were no differences in the percentage of drugs side effects, smear conversion in the second month and treatment outcome between MDR TB DM and MDR TB non-DM group. (J Respir Indo. 2020; 40(3): 156-62)

Cost-effectiveness of treating multidrug-resistant tuberculosis in treatment initiative centers and treatment follow-up centers in Ethiopia.

BackgroundIn Ethiopia, MDR-TB has become a significant public health threat; therefore, the Ministry of Health introduced two treatment approaches for MDR-TB cases: treatment initiative center (TIC) and treatment follow-up center (TFC). TIC is where patients usually are diagnosed and start the treatment. At TFC, we follow MDR-TB patients until they completed the treatment. However, there is no evidence about the cost-effectiveness of the approaches. Therefore, this study aimed to analyze the cost-effectiveness of MDR-TB treatment in TIC and TFC.MethodsIn this study, we employed a full economic evaluation from a providers' perspective. We followed a hypothetical cohort of individuals from the age of 15 for a lifetime using a Markov model with five mutually exclusive health states. We used both primary and secondary data sources for the study. Ingredient-based costing approach was used. The costs include healthcare provider costs (recurrent and capital cost) and patient-side costs (direct and indirect). We use a human capital approach to estimate the indirect cost. The cost estimates were reported in the 2017 United States Dollar (US$), and effectiveness was measured using disability-adjusted life-years (DALYs) averted. Both costs and health benefits were discounted using a 3% discount rate. Both average and incremental cost-effectiveness ratios (ICER) were reported calculated. One-way and probabilistic sensitivity analyses were reported to determine the robustness of the estimates.ResultsThe cost per HIV negative patient successfully treated for MDR-TB was $8,416 at TIC and $6,657 at TFC. The average cost-effectiveness ratio per DALY averted at TFC was $671 and $1,417 per DALY averted at TIC. The incremental cost-effectiveness ratio (ICER) of MDR-TB treatment at TIC was $1,641 per DALYs averted.ConclusionThis study indicates that the treatment of MDR-TB at both TIC and TFC are cost-effective interventions compared with the willingness to pay threshold of three-times the GDP per capita in Ethiopia.

Clinical features associated with linezolid resistance among multidrug resistant tuberculosis patients at a tertiary care hospital in Mumbai, India

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is an increasing problem worldwide, and 24% occurs in India. Linezolid is associated with improved MDR-TB treatment outcomes but causes significant side-effects and drug susceptibility testing (DST) is rarely available. This study assessed whether clinical factors could predict linezolid resistance. MethodsAn observational cohort of adults and adolescents with MDR-TB at a tertiary care hospital in Mumbai, India was analyzed for clinical, laboratory, and radiographic findings associated with linezolid resistance. ResultsIn total, 343 MDR-TB patients had linezolid DST performed, and 23 (6.7%) had linezolid-resistant MDR-TB. Univariable analysis associated linezolid resistance with underweight (odds ratio (OR)–1.07, 95% confidence interval (CI):1.01–1.12); number of previous providers (OR:1.03, 95% CI:1.00–1.05); previous treatment with linezolid (OR:1.12, 95% CI:1.06–1.05), bedaquiline (OR:1.55, 95% CI:1.22–1.98), or clofazimine (OR:1.08 95% CI:1.03–1.16); cavitary disease (OR:1.10, 95% CI:1.04–1.16) and percent lung involvement (OR:1.02, 95% CI:1.01–1.03) on radiograph. DST associated linezolid resistance with resistance to fluoroquinolones (OR:1.08, 95% CI:1.01–1.14), injectables (OR:1.09, 95% CI:1.03–1.15), ethionamide (OR:1.09, 95% CI:1.03–1.15), and PAS (OR:1.13, 95% CI:1.06–1.21). In multivariate analysis, only prior linezolid and percent lung involvement were associated with linezolid resistance. ConclusionTo maximize treatment benefits while minimizing toxicity, DST remains an important tool to identify linezolid resistance.

Patient treatment pathways of multidrug-resistant tuberculosis cases in coastal South India: Road to a drug resistant tuberculosis center

Background: Delays in initiating multidrug-resistant tuberculosis (MDR TB) treatment adds risk to individual patients and the community due to disease progression, and on-going transmission. The Government of India offers free TB diagnosis and treatment, however many presumptive MDR TB patients wander within the Indian healthcare system and delay accessing the programme. To improve access to care, it is imperative to understand the treatment pathways taken by MDR TB patients. We aimed to describe the diagnostic and treatment pathway taken by presumptive MDR TB patients registered under Programmatic Management of Drug-resistant TB Program. Methods: We conducted a cross-sectional study amongst patients registered during August 2016 – April 2017 at one District Drug Resistance Tuberculosis centre of Dakshina Kannada district in Karnataka, India. A semi-structured questionnaire was used to collect the number, type (private and public sector), and dates of healthcare facilities (HCFs) visits prior to the initiation of MDR TB treatment. Delays in pathway were measured in days and summarised as median and interquartile range (IQR), from the date of onset of illness until the initiation of MDR TB treatment. Results: We found that patients preferred private HCFs; however, due to lack of treatment and unaffordability they shifted to public HCFs. Median delay to register under the program was more in private HCFs (180 days) in comparison with public HCFs (120 days). We also found that the detection rates were much higher in public HCFs (80%). Conclusion: The present study found that there was substantial patient delay and total delay in diagnosis and treatment of MDR TB patients. Private HCF was first point of contact for most of the patients; however those visited public HCF diagnosed earlier as compared to others. The government should involve private HCFs to provide standard diagnostics and treatment to the patients seeking a private facility.

Long-term Follow-up of Multidrug Resistant Tuberculosis Patients of Delhi, Who had Received DOTS Plus Treatment along with Home Care and Counseling

Background: To realize the vision of a world free of TB, it becomes mandatory to disallow Ex-TB and Ex-MDR TB patients to have relapse or become Extremely Drug Resistant (XDR). Long follow-up of treated cases, who also received home care and counseling hasn’t been done thus far in India. Objective: To find out whether 50% of Ex-MDR TB patients who had also received home based support with counseling are healthy after five years. Methods: This retrospective study of 109 Ex-MDR-TB patients was carried out by Community Health Department (CHD) of a Tertiary Care Hospital in Delhi. They had received daily MDR Regimen (starting from August 2009 to August 2010 from their respective DOTS Providers) and home care and strong counseling support. They completed it by 2011 or 2012. The study period was from May to August 2015. Result: After a long follow up of these patients in 2015 it was found that 71(65.14%) were alive & healthy, 26(23.85%) dead, 5(4.59%) defaulters, 1(0.92%) failure cases, 4(3.67%) lost to follow-up, whereas 2(1.83%) were on treatment as they had relapsed. Conclusion: Our study concludes that more than 50% Ex-MDR TB cases who had also received home based support with counseling are alive & healthy after five years. We recommend that a mechanism for home-based care & counseling and Long Follow Up for MDR TB patients be developed. How to cite this article:Vaghela JF, Anand T. Long-term Follow-up of Multidrug Resistant Tuberculosis Patients of Delhi, Who had Received DOTS Plus Treatment along with Home Care and Counseling. J Commun Dis 2020; 52(2): 24-30. DOI: https://doi.org/10.24321/0019.5138.202015

Time to sputum culture conversion and its associated factors among multidrug-resistant tuberculosis patients in Eastern Africa: A systematic review and meta-analysis

ObjectiveThis study aimed to consider the estimated time to multi-resistant tuberculosis culture conversion, and associated factors, in order to enhance evidence utilization in eastern Africa. MethodsWe systematically identified available articles on multidrug-resistant tuberculosis culture conversion using PubMed, Scopus, Cochrane Library, Web of Science core collection, and Science Direct databases. A random-effects model was employed using the R 3.6.1 version and Stata/se 14 software. ResultsNine articles with a sample size of 2458 multidrug-resistant tuberculosis patients were included. The two-month culture conversion rate was 75.4%, with a median time of 61.2 days (interquartile range: 48.6-73.8). In the included studies, favorable treatment outcomes of MDR-TB patients were seen in 75% of the cases, while unfavorable treatment outcomes were seen in 18% (10% deaths, 7% defaulted, and 1% treatment failure) of the cases. The independent factor for delayed sputum culture conversion was body mass index below 18.5kg/m2 (HR=3.1, 95% CI: 2.0, 6.7). ConclusionThe median time to sputum culture conversion was 61.2 days, which is a reasonably short time. Body mass index was the identified associated factor leading to delayed culture conversion. Therefore, there is a need for awareness of how to improve the nutritional status of multidrug-resistant tuberculosis patients through appropriate nutritional supports.

Nomogram to predict multidrug-resistant tuberculosis

BackgroundMultidrug-resistant tuberculosis (MDR-TB) is burgeoning globally, and has been a serious challenge in TB management. Clinically, the ability to identify MDR-TB is still limited, especially in smear-negative TB. The aim of this study was to develop a nomogram for predicting MDR-TB.MethodsDemographics and clinical characteristics of both MDR-TB and drug-susceptible TB patients were utilized to develop a nomogram for predicting MDR-TB. The LASSO regression method was applied to filter variables and select predictors, and multivariate logistic regression was used to construct a nomogram. The discriminatory ability of the model was determined by calculating the area under the curve (AUC). Moreover, calibration analysis and decision curve analysis (DCA) of the model were performed. This study involved a second analysis of a completed prospective cohort study conducted in a country with a high TB burden.ResultsFive variables of TB patients were selected through the LASSO regression method, and a nomogram was built based on these variables. The predictive model yielded an AUC of 0.759 (95% CI, 0.719–0.799), and in the internal validation, the AUC was 0.757 (95% CI, 0.715–0.793). The predictive model was well-calibrated, and DCA showed that if the threshold probability of MDR-TB was between 70 and 90%, using the proposed nomogram to predict MDR-TB would obtain a net benefit.ConclusionsIn this study, a nomogram was constructed that incorporated five demographic and clinical characteristics of TB patients. The nomogram may be of great value for the prediction of MDR-TB in patients with sputum-free or smear-negative TB.

Adherence to the MDR-TB intensive phase treatment protocol amongst individuals followed up at central and peripheral health care facilities in Uganda - a descriptive study.

Following initiation of MDR-TB treatment, patients have a choice to receive follow up DOT supervision at either the central initiating facility or at a peripheral facility. We describe the adherence patterns of MDR-TB patients undergoing DOT supervision at the two health facility categories during intensive phase of treatment. We used a retrospective cohort of patients initiated on MDR TB treatment at Mulago National Referral Hospital between 2014 and 2016. We extracted data from the National Tuberculosis and Leprosy Program records and analysed these using STATA V14. Majority (84.01%) of the patients received their DOT supervision from the peripheral facilities. Males made up 62.1% of patients, and 91.2% had had their household contacts screened for MDR-TB. 26.5% of the patients on peripheral DOT supervision had good adherence to treatment protocol compared to 0% among patients on central initiating health facility DOT supervision. Among the patients with good adherence, 24.1% had contacts screened for MDR-TB as compared to 3.6% with poor adherence. More patients preferred MDR-TB DOT supervision at peripheral facilities, which had better adherence to the treatment protocol compared to the central initiating facility. Younger people and those with household contacts screened had better adherence to the treatment protocol, highlighting areas for targeted interventional programs for MDR-TB in resource limited settingsMore patients preferred MDR-TB DOT supervision at peripheral facilities, which had better adherence to the treatment protocol compared to the central initiating facility. Younger people and those with household contacts screened had better adherence to the treatment protocol, highlighting areas for targeted interventional programs for MDR-TB in resource limited settings.

TREATMENT OUTCOMES OF MULTIDRUG RESISTANT TUBERCULOSIS PATIENTS IN EAST JAVA FROM 2014 TO 2017

Background: Multidrug resistant tuberculosis (MDR TB) is a major public health problem marked by the Mycobacterium tuberculosis strain that is resistant to first line anti TB drugs, including rifampicin and isoniazid simultaneously. A patient confirmed as having MDR TB can transmit this form of TB to other individuals. Therefore, treatment success is the main target when addressing MDR TB. Purpose: This study aimed to assess the treatment outcomes of MDR TB patients in East Java Province from 2014 to 2017. Method: This is a quantitative-descriptive study using the secondary data of drug resistant TB patients sourced from the e-TB Manager website in the East Java Province Health Office. Results: The results show that the average MDR TB patients was 47 years old, 57.44% were male, 37.52% had a negative HIV status, 44.87% were relapse patients, 71.95% had undergone two or less previous treatments, and 69.24% had sputum culture conversion. The treatment outcomes included 161 patients (31.14%) confirmed as cured, 27 patients (5.22%) completing treatment, 174 patients (33.65%) defaulting, two patients (0.38%) confirmed as having failed treatment, and 59 patients (11.41%) dying during the treatment period. Conclusion: The treatment success rate was low and the number of defaults was high. Therefore, it is hoped that there will be support from those closest to the patient and health workers who will maintain and increase the patient's motivation to complete the treatment.

Patient treatment pathways of multidrug-resistant tuberculosis cases in coastal South India: Road to a drug resistant tuberculosis center

Background: Delays in initiating multidrug-resistant tuberculosis (MDR TB) treatment adds risk to individual patients and the community due to disease progression, and on-going transmission. The Government of India offers free TB diagnosis and treatment, however many presumptive MDR TB patients wander within the Indian healthcare system and delay accessing the programme. To improve access to care, it is imperative to understand the treatment pathways taken by MDR TB patients. We aimed to describe the diagnostic and treatment pathway taken by presumptive MDR TB patients registered under Programmatic Management of Drug-resistant TB Program. Methods: We conducted a cross-sectional study amongst patients registered during August 2016 - April 2017 at one District Drug Resistance Tuberculosis centre of Dakshina Kannada district in Karnataka, India. A semi-structured questionnaire was used to collect the number, type (private and public sector), and dates of healthcare facilities (HCFs) visits prior to the initiation of MDR TB treatment. Delays in pathway were measured in days and summarised as median and interquartile range (IQR), from the date of onset of illness until the initiation of MDR TB treatment. Results: We found that patients preferred private HCFs; however, due to lack of treatment and unaffordability they shifted to public HCFs. Median delay to register under the program was more in private HCFs (180 days) in comparison with public HCFs (120 days). We also found that the detection rates were much higher in public HCFs (80%). Conclusion: The present study found that there was substantial patient delay and total delay in diagnosis and treatment of MDR TB patients. Private HCF was first point of contact for most of the patients; however the diagnostic rate was high in public HCF. The government should involve private HCFs to provide standard diagnostics and treatment to the patients seeking a private facility.

KARAKTERISTIK PASIEN TB-MDR DI RSUD CILACAP PERIODE JANUARI - DESEMBER 2017

Background: Cilacap General Hospital or RSUD Cilacap is a referral center for patients with multidrug resistance tuberculosis (MDR-TB) in western Central Java (Cilacap, Banyumas, Purbalingga, Brebes, Kebumen, Bumiayu, Banjarnegara). Until now there are still few reports on the characteristics of patients with MDR-TB in hospitalsObjective: To identify the characteristics of MDR TB patients in 2017, such as age, gender, education, working status, criteria suspected, treatment and comorbidities.Methods: This was quantitative research with descriptive design uses a survey approach with document analysis. The sampling technique was total sampling. Research subjects was 68 peoples. Data were analyzed using descriptive statisticResults: The age characteristics of patients 20-40 years 50%, women 58.8%, elementary education 42.6%, non-working 32.4%, suspected relapse criteria 42.6%, still under treatment 72.1% and no comorbidities 70.6%, with comorbid DM 22.1%, HIV 5.9%, CHF 1.5%Conclusion: The characteristics of MDR-TB patients in Cilacap General Hospital are half of patients aged 20-40 years, more than half of women, almost half have elementary school education, almost half do not work, almost half have suspected relapse criteria, most are still in the treatment process and most are not comorbid

Patient treatment pathways of multidrug-resistant tuberculosis cases in coastal South India: Road to a drug resistant tuberculosis center.

Background: Delays in initiating multidrug-resistant tuberculosis (MDR TB) treatment adds risk to individual patients and the community due to disease progression, and on-going transmission. The Government of India offers free TB diagnosis and treatment, however many presumptive MDR TB patients wander within the Indian healthcare system and delay accessing the programme. To improve access to care, it is imperative to understand the treatment pathways taken by MDR TB patients. We aimed to describe the diagnostic and treatment pathway taken by presumptive MDR TB patients registered under Programmatic Management of Drug-resistant TB Program. Methods: We conducted a cross-sectional study amongst patients registered during August 2016 - April 2017 at one District Drug Resistance Tuberculosis centre of Dakshina Kannada district in Karnataka, India. A semi-structured questionnaire was used to collect the number, type (private and public sector), and dates of healthcare facilities (HCFs) visits prior to the initiation of MDR TB treatment. Delays in pathway were measured in days and summarised as median and interquartile range (IQR), from the date of onset of illness until the initiation of MDR TB treatment. Results: We found that patients preferred private HCFs; however, due to lack of treatment and unaffordability they shifted to public HCFs. Median delay to register under the program was more in private HCFs (180 days) in comparison with public HCFs (120 days). We also found that the detection rates were much higher in public HCFs (80%). Conclusion: The present study found that there was substantial patient delay and total delay in diagnosis and treatment of MDR TB patients. Private HCF was first point of contact for most of the patients; however the diagnostic yield was high in public HCF. The government should involve private HCFs to provide standard diagnostics and treatment to the patients seeking a private facility.

Relationship of Mutation of Kodon S 315 T katG Mycobaterium Tuberculosis Gene with Multidrug Resistance Tuberculosis in South Sumatera

MDR TB is a condition of M. tuberculosis that is resistant to isoniazid and rifampicin. This occurs because of certain genomic mutations in certain Mtb specific genes. Some of the genes that play a role in the INH mutation are the katG gene, the inhA gene, the ahpC gene, the ndh gene and the kasA gene. The most frequent mutation gene is the katG gene, around 50-80%, and the most mutations (64%) are found in the S 315T codon. The aim was to determine the relationship of S315T genotype in the M. tuberculosis katG gene with the incidence of Mtb resistance in MDR TB patients in South Sumatra. This type of research is an observational cross sectional study approach, conducted in Palembang RSMH in collaboration with the Clinical Microbiology Laboratory of FK UNSRI Palembang from January - July 2019. The sample of the case group (MDR TB) was 50 people while the control group (TB SO) was 21 people. Each group was tested for S315T genotype katG M. tuberculosis gene using the PCR-RFLP method with the Mspl enzyme. Visualization of the katG gene in codon 315 in this study was only found in 40 samples, 26 samples in the case group (MDR TB) and 14 samples in the control group (TB SO). Results Genetic frequency distribution in the case group (MDR TB) was 65.38% wildtype and 34.62% mutant, whereas in the control group (TBSO) it was 92.86% wildtype and 7.14% mutant. The 315 coded KatG gene mutation in this study was not related to the incidence of MDR TB, with p = 0.07, an odds ratio of 6.8 (0.77 - 61.40, 95% CI). The conclusions of this study found 315G katG M. tuberculosis codon mutation mutations of 34.62% but not significantly related to the incidence of MDR TB in South Sumatra.

Patient treatment pathways of multidrug-resistant tuberculosis cases in coastal South India: Road to a drug resistant tuberculosis center

Background: Delays in initiating multidrug-resistant tuberculosis (MDR TB) treatment adds risk to individual patients and the community due to disease progression, and on-going transmission. The Government of India offers free TB diagnosis and treatment, however many presumptive MDR TB patients wander within the Indian healthcare system and delay accessing the programme. To improve access to care, it is imperative to understand the treatment pathways taken by MDR TB patients. We aimed to describe the diagnostic and treatment pathway taken by presumptive MDR TB patients registered under Programmatic Management of Drug-resistant TB Program. Methods: We conducted a cross-sectional study amongst patients registered during August 2016 – April 2017 at one District Drug Resistance Tuberculosis centre of Dakshina Kannada district in Karnataka, India. A semi-structured questionnaire was used to collect the number, type (private and public sector), and dates of healthcare facilities (HCFs) visits prior to the initiation of MDR TB treatment. Delays in pathway were measured in days and summarised as median and interquartile range (IQR), from the date of onset of illness until the initiation of MDR TB treatment. Results: We found that patients preferred private HCFs; however, due to lack of treatment and unaffordability they shifted to public HCFs. Median delay to register under the program was more in private HCFs (180 days) in comparison with public HCFs (120 days). We also found that the detection rates were much higher in public HCFs (80%). Conclusion: The present study found that there was substantial patient delay and total delay in diagnosis and treatment of MDR TB patients. Private HCF was first point of contact for most of the patients; however those visited public HCF diagnosed earlier as compared to others. The government should involve private HCFs to provide standard diagnostics and treatment to the patients seeking a private facility.