Revised National Tuberculosis Control Programme Research Articles

Assessment of Adherence to International Standards for Tuberculosis Care among Private Practitioners of Delhi

Context: Tuberculosis (TB) is among the top ten causes of mortality, and to control this growing burden of disease, it is imperative that all TB patients receive the same quality of care, based on the best evidence available. The best practices for TB as enshrined in the International Standards of TB Care (ISTC) if adhered to can expedite the efforts to control TB. Aims: The aim of the study was to evaluate the current practices for diagnosis and treatment of TB among the private medical practitioners against benchmark practices in ISTC and to assess the factors associated with adherence to ISTC. Subjects and Methods: A cross-sectional study was conducted among fifty private practitioners (PPs) of Delhi over a period of 3 months. Data collection was done using a structured pro forma, and interviews were conducted privately in the PPs' office. The key outcome variable was the proportion of practitioners adhering to the ISTC standards of diagnosis (standards: 1–6) and treatment (standards: 7–13). Results: Among fifty practitioners, 42% were found to be adherent, while 58% were found to be non-adherent. Significant association was found between gender and any form of training/sensitization received in the Revised National Tuberculosis Control Program (RNTCP) (P

Effect of an e-learning tool on knowledge of recent Revised National Tuberculosis Control Programme guidelines among Medical Interns.

BACKGROUND:Medical students should have adequate knowledge on tuberculosis (TB) and national guidelines pertaining to its control, which is a major public health problem in developing countries. The present study aims to evaluate the knowledge on TB and Revised National TB Control Programme (RNTCP) among medical interns and the change in the level of knowledge following the dissemination of self-directed learning (SDL) modules using an e-learning tool (WhatsApp).MATERIALS AND METHODS:A prospective, nonrandomized, pre- and posttest study was done among 124 medical interns in a private medical college during July–August 2019. A semi-structured, self-administered questionnaire was prepared and filled by the interns in the pretest. Following the educational intervention, the same questionnaire was administered and posttest data were collected. The pre- and posttest results were expressed in frequency and percentage. Wilcoxon signed rank test was used to compare the change in the total mean score of knowledge using the e-learning tool following the dissemination of SDL modules.RESULTS:The mean age of the interns was 22.82 ± 0.82 years. Of the total 124 interns, 60 (48.3%) had heard about the recent changes in RNTCP. The Internet (25.8%) and textbooks (23.4%) were the most common source of recent information regarding TB and RNTCP. The mean pretest score was 12.9 ± 3.08, which increased to 15.3 ± 2.62 during the posttest (z = −9.75, P < 0.05) following the intervention.CONCLUSIONS:The knowledge regarding TB and RNTCP among the interns was inadequate. The usage of an e-learning tool “WhatsApp” was found to be effective in improving the knowledge in posttest as compared to pretest.

The organizational challenges in the management of the revised national tuberculosis control program of India: an overview

The developing world is facing a serious problem of tuberculosis (TB) since ages. The condition is really profound in resource-constrained countries. The situation in some of the high TB burden countries is so grave that there are huge numbers of TB patients and deaths due to TB. TB control in most of the countries is done by the national TB control programs. In India, this is popularly known as the Revised National Tuberculosis Control Program (RNTCP). The RNTCP comes under the umbrella of the national health mission. The main components of RNTCP are directly observed treatment, short-course (DOTS) and DOTS-Plus. The effective and adequate implementation of the RNTCP is the most effective solution to control the ever growing cases of TB. The present situation, as detailed in the WHO global annual TB report, with ever-rising cases of various categories of TB is really scary and demands prompt attention. In this paper, the authors highlight the important issues related to the RNTCP in India. The main motto of writing this paper was to address the challenges associated with the organizational structure of the national TB control program of India and to suggest solutions for the same. The authors believe that these challenges could pose a serious threat to the efforts aimed at TB elimination from India. Besides, this paper will serve as a tool to modify and/or to formulate new guidelines for the betterment of the program. Also, the challenges detailed here are usually common in the other high TB burden countries of the world and this will help the program managers worldwide.

Performance of revised national tuberculosis control program in Bihar: A situational analysis.

Background:Monitoring of a program is a continuous assessment of certain key indicators of it through periodic reports. The efficiency of a health program is assessed by comparing its achievements with the expectations.Methods:The study was conducted based on the annual TB report of India for the year 2018 in order to monitor (Revised National Tuberculosis Control Program) RNTCP performance in the Bihar State and its various districts.Results:Case notification rate of various districts Bihar was far below the national average of 138 per lakh. Considering treatment initiation, the performance of various districts of Bihar were less than national figures (79.0%). In newly diagnosed TB cases, the treatment success rate of Bihar was 73%. This performance was more compared to Uttar Pradesh (66.0%) but less compared to Jharkhand (92.0%), West Bengal (88.0%), and national data (79.5%). Considering human resources, the total human resources in the states of Bihar (61.9%) and Jharkhand (58.3%) were similar. However, in Bihar, there was a vast shortage of ground-level staff [i.e. (senior treatment supervisor) STS, (senior TB lab supervisor) STLS, (public-private mix) PPM Co-ordinator, and (TB health visitor) TBHV)].Conclusion:It was found that Bihar was one of the less performing states in RNTCP with a vast shortage of ground-level staff and low overall treatment success rate compared to its neighboring states. Stringent monitoring and evaluation in every step of the program implementation should be done in order to improve RNTCP performance in Bihar.

Status of contact screening and isoniazid preventive therapy for children under age six in Puducherry district, under the Revised National Tuberculosis Control Programme: An operational research

Introduction: We assessed the contact screening of smear-positive pulmonary tuberculosis (PTB) and the coverage of isoniazid preventive therapy (IPT) in Puducherry district of Puducherry State. Methods: A retrospective record review of treatment cards, under the Revised National Tuberculosis Control Programme, was conducted between the reference period of October 2018 and December 2018. Results: A total of 145 index cases were linelisted. Among them, the number of household contacts of >6 years was 399, of which 359 (90%) were screened for PTB and one was diagnosed with PTB and initiated on treatment. Among the 35 children Conclusions: Implementation of IPT in Puducherry district was satisfactory, and still, there is a hope to improve further. Nationwide data on contact screening and IPT implementation are required.

Treatment outcomes of tuberculosis patients detected by active case finding under the Revised National Tuberculosis Control Programme during 2018 in Haridwar district of Uttarakhand

Background:In India, the active case-finding (ACF) strategy began in 2017 under the Revised National Tuberculosis Control Programme to find its missing tuberculosis (TB) cases. Few studies have been conducted in India to assess the treatment outcome of TB patients detected by ACF.Aim:The aim of this study was to assess the treatment outcomes of patients detected through ACF campaigns during the year 2018 in Haridwar district, Uttarakhand.Study Design:This was a cross-sectional study which used the existing data and records.Materials and Methods:The ACF campaign records of 2018 were extracted from six TB units of Haridwar district. Details of sociodemographic, clinical profile, and treatment outcome of 100 diagnosed patients were obtained and analyzed.Results:Out of the total 100 TB patients detected, the site of disease was pulmonary in 98% of patients. Almost all (92%) the patients were diagnosed microbiologically and treatment was initiated by 78% of the patients. The proportion of successful treatment outcome was found in 64% of the patients. The median time interval from diagnosis to treatment was found to be 2 days.Conclusion:In spite of these efforts of ACF, a high proportion of initial loss to follow-up (22%) and unsuccessful treatment outcome (18%) among ACF patients is a major concern. Findings of ACF campaign pose a concern for active follow-up after diagnosis and close monitoring during treatment.

Contribution of community pharmacy in treating tuberculosis: A pharmacy centric study from Belagavi district

Introduction: Tuberculosis (TB) is an important global health problem, which is aimed to be eradicated by 2025 from India. Community pharmacists play a significant role in treating and eradication of TB. This study aimed to understand the contribution of community pharmacy and their potential role in RNTCP (Revised National TB Control Programme) functioning. Materials and Methods: The study was conducted at Belagavi, Karnataka, India on 312 community pharmacies. A structured interview form was used to assess several factors such as education, knowledge, anti-TB drug dispensing patterns, willingness to be trained, and become a DOTS (Directly Observed Treatment Short course) provider. Results: On an overall scale, we found that the majority of licensed community pharmacy was managed by D. Pharm holders with a limited knowledge of TB. It was also noted that there was a lack of willingness to be rigorously trained for updating their knowledge, although they were interested in being trained for being recognized as a DOTS center. Conclusion: There is a strong need for strengthening community pharmacy services in tune with RNTCP to achieve better efficiency in treating and eradication of TB.

Recent changes in guidelines on programmatic management of drug resistant tuberculosis in India 2019: a paradigm shift in tuberculosis control

The new version of guidelines of programmatic management of drug resistant tuberculosis in India 2019 by Revised National Tuberculosis Control Programme, Central TB Division, Directorate General of Health Services, Ministry of Health & Family Welfare, Nirman Bhawan, New Delhi, integrates use of the shorter MDR TB regimen and all oral longer MDR TB regimen with new drugs under RNTCP with opportunity to modify the regimen based on DST results. There are mammoth and comprehensive changes in the guidelines on programmatic management of drug resistant tuberculosis in India 2019.

Diabetes in tuberculosis patients: An emerging public health concern and the determinants and impact on treatment outcome.

BACKGROUND:Tuberculosis (TB) and diabetes mellitus are still of much public health concern. Screening of TB patients for diabetes will ensure early case detection, better management of diabetes, and better TB treatment outcome. The objective of this study was to determine the prevalence and associated factors of diabetes in TB patients and their impact on treatment outcome of TB.MATERIALS AND METHODS:This was a longitudinal follow-up study of registered TB patients under the Revised National Tuberculosis Control Program in all five TB units of Bhopal district. Participants were contacted and the interview was conducted. The blood sugar of all TB patients was checked, and they were followed up to assess the treatment outcome from October 2014 to September 2017. Data were analyzed using SPSS (version 16.0. Chicago, SPSS Inc.). Logistic regression was done to find the factors for diabetes in TB patients. The Chi-square tests were used to find the difference in treatment outcomes and assess the relative risk for poor outcome in diabetic TB patients.RESULTS:Of total 662 TB patients, 82 (12.39%) were diagnosed as diabetic. Age >50 years, males, higher body mass index, pulmonary TB, patients on Category II treatment, and history of smoking were found to be predictors of diabetes in TB patients. The treatment outcome of TB was more unfavorable (defaulter, failure, and death) in diabetic TB patients (16.17%) than in nondiabetic TB patients (5.8%) (risk ratio = 2.78, 1.469–5.284 confidence interval).CONCLUSION:The high prevalence of diabetes and the unfavorable treatment outcome in diabetic TB patients make screening and management of diabetes at an early-stage crucial for a better outcome in TB patients.

Unmasking the human face of TB- The impact of tuberculosis on the families of patients.

Background:As per the World Health Organization (WHO) Global Report 2017, among the 9.6 million cases of tuberculosis (TB) that occur annually in the world, 2.8 million are found in India. TB is the biggest killer in the 15 to 49 years age group—an age range during which people are the most productive. It is a disease that creates and thrives in poverty. Several studies have shown that TB has a negative impact on the socioeconomic status of patients. Limited data are available on the long-term impact of this disease on the families of patients.Aims:This study aimed to analyze the impact of TB on the socioeconomic condition and educational status of the family members of patients and the nutritional status of children younger than 12 years in the family of the patient.Methods:This was a retrospective cohort study conducted in Vellore, Tamil Nadu, India in the month of March 2017. The exposed group consisted of families with a member who completed treatment for TB in the past 5 years obtained from two tuberculosis units under the Revised National Tuberculosis Control Programme. The unexposed group was composed of families in the same neighborhood as the exposed families, matched for the age of one child.Results:Upon analysis, the multifaceted impact of TB led to an increased risk of “financial crises,” delayed and disrupted education among children, and wasting among children younger than 5 years (as measured by weight-for-height Z scores). Older children and adults were also at a higher risk of being undernourished as assessed by BMI-for-age Z scores and BMI, respectively. Reduced social participation as a marker of stigma was found to be higher but not statistically significant.Conclusions:This study found that despite the obvious multifaceted impact of TB on the family, the screening and protective measures often fail to encompass the scope of the disease. These are of great importance to the primary physician, often the only contact of the medical fraternity with the family members of patients.

Comparison of Ziehl–Neelsen light microscopy and fluorescent (light-emitting diode) microscopy with solid culture for the diagnosis of tuberculosis with special reference to extrapulmonary cases

Introduction Owing to the HIV pandemic, partially fuelled by breakdown of infrastructure and poverty, the increase in tuberculosis (TB) cases has reached unmanageable levels in the developing countries. Smear microscopy is still the main diagnostic modality. Efficient and prompt case detection followed by adequate treatment has drastically reduced TB transmission. Hence, an effort was made to compare Auramine-O (AO) and Ziehl–Neelsen (ZN) staining methods for demonstration of acid-fast bacilli with solid culture on Lowenstein–Jenson medium as a reference standard. Patients and methods A total of 100 sputum and 50 extrapulmonary samples from patients clinically suspected of TB were included. Smears were stained by ZN and AO method separately. All the samples were processed as per Revised National Tuberculosis Control Program (RNTCP) guidelines of India and inoculated on Lowenstein–Jenson medium. Mycobacterium tuberculosis was identified by their growth characteristics, nitrate reduction test, and susceptibility to para-nitrobenzoic acid. Results Of 150 samples, 27 (18%), 37 (24.67%), and 38 (25.33%) were positive by ZN stain, AO stain, and culture, respectively. Of 50 extrapulmonary samples, none were positive by ZN stain, four (8%) were positive by AO stain, and two (4%) by culture. AO method detected additional 8% of extrapulmonary TB cases which were missed by ZN and also detected more number of paucibacillary cases. Sensitivity and specificity of ZN were 71.05 and 100%, respectively. Sensitivity and specificity of AO were 86.84 and 96.43%, respectively. Conclusion The higher sensitivity and diagnostic accuracy of AO method indicate that the light-emitting diode fluorescent microscopy can be efficiently implemented in resource-limited settings with a high burden of TB.

Delay in starting therapy in drug-resistant tuberculosis – An insight

Introduction: The Revised National Tuberculosis Control Programme (RNTCP) ensures a prompt diagnosis and effective treatment of all tuberculosis (TB) patients with drug-resistant TB via decentralized drug sensitivity testing (DST). This study was taken in to find out the cause of delays in initiation of treatment. Material and Methods: This cross-sectional observational study included a questionnaire-based interview and retrospective analysis of records of the concerned patients with an aim to explore the reasons associated with this delay. Results: A delay was arbitrarily defined as a time period of more than 15 days from the date of sputum collection for DST to the date of admission. It considered of two parts, one due to lapse in system regarding implementation of program and other due to the lapses in the part of the patient. Out of 402 patients enrolled in the study, 252 (62.7%) sought treatment after the prescribed period and were categorized as delayed and comprised the Group I of study. The remaining 150 (37.3%) were those who sought treatment within the prescribed period and were and were termed in-time treatment seekers and thus comprised Group II of study. Delay in communication of results to DOTS centre and in-patient tracing was the most common reason for delay while unwillingness to avail treatment against the expectation was the least common reason. Conclusions: Undefined time for communication of DST results and patient tracing in PMDT services are the major cause of delay. Strengthening the communication skills of the care providers through expanding DST services at sub-district levels, regular training of care providers, setting district level information cells, creating mobile apps, and involving volunteers who are representatives of the local community is the need of the hour.

Yield of direct sputum smear examination in pulmonary tuberculosis suspect cases with hemoptysis

Introduction: Hemoptysis is one of the cardinal symptoms of pulmonary tuberculosis (PTB) as per the Revised National Tuberculosis Control Programme 2016 guidelines. Hemoptysis in tuberculosis patients usually occurs in those who have a large bacillary load like that in a cavity. Direct smear done from the sputum of a PTB suspect with hemoptysis should have a higher diagnostic yield due to the greater bacillary load in such patients. Keeping this intention in mind, our study was conducted to systematically inquire into the efficacy of a cheap and easily available test like direct sputum smear examination in PTB suspect cases of hemoptysis. Materials and Methods: This was a prospective, hospital-based, analytical study, conducted on 100 PTB suspects with hemoptysis, who were attending the Outpatient and Emergency Department of National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India. Patients were enrolled over a period of 8 months. All patients underwent routine clinical and radiological evaluation and sputum examination in the form of direct smear by Ziehl–Neelsen (ZN) staining and mycobacterium growth indicator tube (MGIT) culture. Results: Most of the patients (25%) belonged to the age bracket 16–25 years followed by 24% of patients who belonged to the age group of 26–35 years. Fifty-two percent of patients had the cavity in their chest X-ray findings in which mostly were the unilateral cavity (39%). Direct sputum microscopy was found to be positive in 56% of patients. In comparison to MGIT, it had a sensitivity of 79% and a positive predictive value of 92%. Conclusion: Direct smear examination in hemoptysis patients should be a first line essential investigation as it is a good, cheap, easily available, and quick test. The yield of the test increases if the patient is young, male, with a previous history of antitubercular therapy intake and cavitary lesions on the radiological findings.

Incidence and Clinical Profile of Antituberculosis Treatment-Induced Hepatitis in a Tertiary Care Hospital in Southern India

Introduction: Tuberculosis (TB) is a major health problem. After the widespread use of Antituberculosis Treatment (ATT) effective control has been achieved. As with any drug ATT has its own side effects among which hepatitis is of main concern as it can cause significant morbidity and mortality. Aim: To assess the incidence of hepatitis in patients receiving ATT as per Revised National Tuberculosis Control Programme (RNTCP) and to know the possible risk factors for the development of drug-induced hepatotoxicity. Materials and Methods: This study was done on 318 presumed and confirmed cases of TB patients with baseline bilirubin, liver enzymes (transaminases) and albumin values. Out of these 48 lost follow-up and remaining 270 were followed-up and repeat bilirubin, liver enzymes and albumin were done at two weeks or even earlier in patients with symptoms after starting ATT. ATT was reintroduced in a stepwise manner as per American Thoracic Society guidelines. Results were analysed using MS Excel. Results: Out of the 270 cases, 30 (11.1%) developed ATT-induced hepatitis, among which 26 (86.67%) were followed-up and 4 (13.33%) lost to follow-up. Among 26, 3 (11.53%) developed hepatitis after reintroduction of ATT, two patients with Rifampicin and one with Isoniazid (INH) hence they were treated with alternative regimen and cured. According to this study, CNS tuberculosis had higher incidence of ATT-induced hepatitis. Old age and alcoholism were the independent risk factors. ATT-induced hepatitis commonly developed within two weeks of start of treatment. Average time for resolution of symptoms and restart of ATT was one month. There was no mortality in the study. Conclusion: The incidence was comparable to other studies. Alcoholism, old age and CNS tuberculosis needs caution when starting ATT. Patients usually require follow-up of two weeks after starting ATT. Caution is required while reintroducing ATT and it is advisable to introduce in a stepwise manner.

Strategies for smoking cessation (pharmacologic intervention versus enhanced motivation vs. standard motivation) in TB patients under treatment in the RNTCP, India - A cluster - Randomized trial

BackgroundTuberculosis burden is still high and smoking prevalence among males has increased in India. It is found that increased morbidity, mortality and relapse among TB smokers. MethodSetting: Patients from two Revised National Tuberculosis Control Program Centres of Tamilnadu form the study population. ObjectiveTo compare the effectiveness of Bupropion therapy along with standard counselling versus enhanced counseling versus standard counseling for smoking cessation among TB patients. Study designCluster randomized effectiveness trial. ProcedurePatients from each of the thirty-six Designated Microscopic Centres were randomly allocated to receive one of the three interventions using cluster randomization. Smoking cessation was assessed by self-reporting and confirmed by Carbon monoxide(CO) monitors, done at three-time points and TB treatment outcome at the end of ATT. ResultsOut of 517 male patients enrolled to the study, the smoking status is available only to 381 subjects. The proportion of patients who have quit smoking in drug, enhanced and standard arms at the end of treatment was 67%, 83% and 52% (P= < 0.001). There was no statistical significance in response to TB treatment between those who quit and those who did not (Favourable response 99.2% vs 97.6%). ConclusionBoth enhanced counselling arm and drug arm are effective strategies for smoking cessation among TB patients and their implementation in the TB programs are recommended.

Identifying and Addressing Factors Contributing to Pretreatment Loss to Follow-Up of Tuberculosis Patients Referred for Treatment from Medical Colleges in Pondicherry: An Implementation Research.

Background:In India, there is no feedback regarding 34% of tuberculosis (TB) patients diagnosed and referred from medical colleges for treatment to peripheral health institutions (PHIs).Objectives:The aim of this study is to measure the effectiveness of the new intervention package, developed based on qualitative study in reducing pretreatment loss to follow-up (PTLFU) of all TB patients diagnosed and referred for treatment from medical colleges to PHIs.Materials and Methods:An intervention was developed based on the findings of in depth-interviews conducted among different stakeholders such as TB patients who did/did not report, service providers working in four medical colleges in Pondicherry. Intervention consisting of phone calls, home visits, etc., was implemented for a period of 6 months. The baseline and endline proportion of TB patients for whom feedback received was determined from the available records (Revised National TB Control Program State Task Force Quarterly reports).Results:Patient's ignorance, lack of faith in healthcare system, side effects and social stigma, unpleasant experience in hospitals, poor accessibility to directly observed treatment, short-course centers, drugs shortage, poor coordination between program and hospital staff were the risk factors for PTLFU. At baseline, the proportions of feedback received about TB patients referred for treatment from medical colleges to PHIs was 46%. After the initiation of interventions, it increased to 61% and 66% in the first and second quarters of 2017, respectively.Conclusion:Risk factors for PTLFU were multi-factorial related to both patient and health system. Simple, feasible interventions such as phone calls and home visits to TB patients were effective in reducing PTLFU.

Threefold Increase in the Number of Drug Resistant TB Cases after Introduction of Universal Drug Susceptibility Testing: Experiences from Two South India Districts

Background: In India, tuberculosis (TB) is a major public health problem, and the advent of drug resistance TB (DR-TB) has worsened the situation. The Revised National TB Control Programme (RNTCP) has introduced universal drug susceptibility testing (UDST) for all diagnosed TB cases in 2018. We conducted this study to know the advantage of implementing UDST when compared to selective testing existent in 2017 on key diagnostic cascade parameters and to identify the challenges in the implementation of UDST. Methods: The study was conducted in two districts of Karnataka, India during January 2017-December 2018. The quantitative part consisted of before-and-after design and the qualitative part consisted of descriptive design. Results: In 2017 (during selective testing/“before” period) out of the 2440 TB patients, 80 (3%) were diagnosed with Isoniazid and Rifampicin resistance patients; in contrast in 2018 (during UDST/“after” period) of the 5129 TB patients 258 (5%) were diagnosed with Isoniazid and Rifampicin resistance. However, the proportion of eligible patients tested for rifampicin resistance during the “after” period was 60% when compared to 100% during the “before” period and median turnaround time for testing was also longer during the “after” period when compared to the “before” period (32.5 days vs 27.5 days). Major reasons for these two gaps were found to be difficulties in collecting sputum specimens and transportation. Conclusion: The rollout of UDST has led to a three-fold increase in a number of DR-TB cases detected in the region. There is a need for the programme to increase the proportion tested for DST by increasing the laboratory capacity and address the challenges in sputum collection and transportation.

‘Have we missed reporting adverse drug reactions under Revised National TB Control Programme?’ - A mixed method study in Bengaluru, India

ObjectivePrompt identification, reporting and management of ADRs during anti tuberculosis treatment can ensure better compliance and treatment outcomes. The study was conducted to identify the gaps and associated factors in reporting of ADRs under RNTCP; assess knowledge, attitude and practice of RNTCP staff regarding pharmacovigilance programme and explore the barriers in reporting of ADRs from provider's perspective. MethodsMixed method research with sequential explanatory design was carried out in Tuberculosis Units of RNTCP administrative district of Bangalore city during July to December 2017. Quantitative study was carried out among 222 patients on intensive phase of Category I and Category II DOTS to study the incidence, severity and causality of ADRs; and records of these patients were analysed for gaps in reporting. Knowledge, attitude and practice (KAP) regarding recording and reporting aspect of pharmacovigilance programme was assessed among RNTCP staff. As part of the qualitative study, focus group discussion was carried out among RNTCP staff to study barriers for reporting ADRs from the provider's perspective. ResultsRecord analysis at the time of recruitment showed documentation of ADRs in only five patients. Subsequent analysis of patient records during the middle and end of the intensive phase (IP) did not show documentation of any ADRs. Simultaneously interviews with patients revealed 116 (52.2%), 72 (32.4%) and 53 (23.8%) patients reported one or more symptoms of ADRs. The commonest ADR symptom reported were fatigability and gastrointestinal symptoms followed by musculoskeletal symptoms. KAP among 25 RNTCP staff showed that 96% of them felt reporting of ADRs was necessary and 92% reported the ADRs to their seniors, however 12% were scared to report. The main reason expressed for non-reporting was ‘managing ADRs is more important than reporting’ (52%). Also, 32% felt the need for retraining of staff on reporting and documentation. Barriers to reporting of ADRs were both health-system related like insufficient training and inadequate guidelines provided to RNTCP staff and patient-related factors like lack of awareness and reluctance to report ADRs. ConclusionSuccessful implementation of RNTCP and achievement of TB elimination requires provision of adequate information regarding ADRs to patients and intense follow-up and probing at each contact by programme staff to effectively manage ADRs.

Profile of the tuberculosis patients enrolled in nikshay portal (a web-based online portal) from Chittoor district: A monitoring tool for tuberculosis in India

Background: The Revised National TB Control Programme developed a case based web-based online reporting mechanism called NIKSHAY. A community-based survey conducted in 2011 reported that 46% of the tuberculosis (TB) patients in India were treated outside the public health system (private sector) and hence they are not the part of the national TB notification system. Methodology: The objective of the study was to assess the profile of the TB individuals in the Chittoor district in Andhra Pradesh, south India. A secondary data were retrieved from the district TB center NIKSHAY web-based online portal in Chittoor and analyzed using SPSS 21.0 version. Data were taken from the last 1 year (April 2017 to March 2018). Results: A total of 3952 individuals were registered in the web based online NIKSHAY portal during the study. Among them in 2918 (73.7%) were males and 1033 (26.2%) were females with the mean age of the patients was 44.6 years with a standard deviation of ± 16.3 ranges. The clinically confirmed cases were 587 patients and microbiologically positive were 2495 (79.8%) and negative were 633 (20.2%). Majority 3263 (82.5%) were had pulmonary and 452 (11.4%) had extra-pulmonary TB. Depending on the HIV-positive cases were 274 (6.9%) and 3560 (90.2%) were negative and the remaining 118 (2.9%) do not know the status of the HIV/AIDS. The CBNAAT results were 411 (10.5%) of the patients had rifampicin sensitivity and 26 (0.6%) of them were resistant. Conclusion: India had taken the nice initiative for the web-based online portal for the notification of the TB patients. Several ongoing efforts have been implemented to improve the quality of surveillance reporting. A series of trainings on quality assurance of TB data should be taken to all the field staff.

HIV positivity in presumptive tuberculosis cases in a tertiary respiratory care institute in New Delhi, India

Background: Routine screening of presumptive tuberculosis (TB) patients for HIV was advised by the Treatment and Operational Guidelines of TB in India in 2016. This was in contrast to the earlier policy in which only diagnosed TB cases underwent HIV screening. Keeping this in mind, our study was carried to look at the prevalence of HIV in presumptive TB cases in a tertiary respiratory disease hospital in New Delhi, India. Materials and Methods: This prospective observational study was carried out from 2015 to 2017 in which patients (>18 years of age) attending the outpatient department diagnosed as presumptive TB were enrolled. They underwent sputum examination in Revised National TB Control Programme Designated Microscopy Centre by fluorescence microscopy/Ziehl–Neelsen staining technique for the diagnosis of PTB, and they were taken to Integrated Counselling and Testing Centre in our hospital. Fine-needle aspiration cytology from lymph nodes and pleural or ascitic fluid studies were also done as per requirement for the diagnosis of extrapulmonary tuberculosis. Pretest counseling and HIV test were performed after informed consent. Results: Forty out of 1020 enrolled patients were HIV positive (3.9%). Fifteen out of 617 patients who were not suffering from TB came out to be HIV positive (2.4%). Our strategy led to an enhanced case finding of 15/25 (60%) new HIV-positive patients. Conclusion: Routine HIV screening in presumptive TB patients is a viable model to increase the case finding of HIV patients.