Revised National Tuberculosis Control Programme Research Articles

"Healthcare providers' perspectives on Tuberculosis control in a district of Southern India – Insights from 2022 sub-national TB free certification"

BackgroundIn response to the persistent TB challenge, the National Tuberculosis Elimination Programme (NTEP) of India, formerly known as the Revised National Tuberculosis Control Programme (RNTCP), set a strategic goal to eliminate the nation's TB burden by 2025, five years ahead of the Sustainable Development Goals. In recognition of this challenge, the Indian Government launched the Sub-national Certification initiative in 2021, fostering competition among states and districts to attain TB-free status and offering recognition and incentives to the best-performing entities. Leveraging verification methods such as TB scores, treatment data, and community-level incidence estimation, this study seeks to provide a comprehensive view of the landscape. Materials & methodsThe study targeted healthcare providers encompassing doctors and chemists employed in both public and private sectors. A non-probability sampling technique, specifically, the convenient sampling method, was utilized. Two Nominal Group Technique (NGT) sessions were conducted. The first NGT comprised 8 healthcare providers, while the second NGT included 10 healthcare providers, while 14 participants were interviewed for KII. ResultsUtilizing the nominal group technique, the following results were derived: approximately 20 % of patients opt for treatment in the private sector, and pharmacies notifying TB cases comprise around 70 % of the cases. Additionally, most participants concurred that there has been a reduction in TB cases over recent years. ConclusionStudy's findings shed light on healthcare providers' perspectives on various facets of TB control, including incidence trends, patient preferences, drug choices, and compliance.

Diagnosis and Management of Latent Tuberculosis Infection: Updates.

India has the largest problem of tuberculosis (TB) infection globally (estimated at about 35-40 crores cases), and around 18-36 lakh develop active tuberculosis annually. Latent TB is defined as a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens with no evidence of clinically manifested active TB. The progression of a latent infection to active tuberculosis increases several-fold in children < 5 years of age and in people with some or the other form of an immunocompromising condition. Therefore, to cater to this gigantic problem of tuberculosis, it is necessary to have awareness about latent tuberculosis infection (LTBI) amongst clinicians and to prioritise its diagnosis and treatment in high-risk groups. India plans to end TB well before the deadline set by the World Health organisation (WHO). However, this can only be achieved with effective strategies targeting LTBI. Multiple treatment regimens have been approved for LTBI treatment, and all have comparable efficacy. The selection of one regimen over the other depends on various factors, such as availability, risk of adverse events, age, and drug interactions. Recently, the WHO, as well as the Revised National TB Control Programme (RNTCP), have updated their guidelines on TB preventive treatment in 2020 and 2021, respectively. This review has been especially prepared to acknowledge the differences in approach to LTBI in developed and developing countries.

A Prospective Study of 18F-FDG PET-CT Application in Therapeutic Monitoring of Osteoarticular Tuberculosis

Objective: Confident diagnosis, identification of occult sites, assessing treatment response, and precisely ascertaining the duration and endpoint of treatment in skeletal tuberculosis is often challenging. magnetic resonance imaging (MRI) and computed tomography (CT) are less dependable owing to low sensitivity and the inability to discern current illness and old changes. 18F-FDG PET/CT utilizes variations in glycolysis rates between healthy and diseased tissue to quantitatively estimate the maximal standard uptake value (SUVmax) of 18F-FDG to assess disease activity.Material and Methods: 32 patients who presented to the department with a clinicoradiological suspicion and pathologically proven diagnosis of skeletal tuberculosis were prospectively analyzed. All patients underwent a whole body 18F-FDG PET-CT scan before initiation of anti-tubercular therapy (ATT), and then treatment was started as per the Revised National Tuberculosis Control Program (RNTCP) guidelines. All patients were followed up with repeat PET-CT scans and relevant clinical investigations at 2, 6, and 12 months.Results: A gradual decrease in SUVmax values, as the treatment courses progressed indicated a decrease in disease activity with treatment. There was an overall mean decrease of 6.5 units in the SUVmax values when compared to the pre-treatment levels, which was statistically significant (p-value&lt;0.001). At 2 months of anti-tubercular treatment, the mean SUVmax values decreased by 39%, and at 6 and 12 months of ATT, they were reduced by 60% and 81%, respectively.Conclusion: 18F-FDG PET-CT helps to determine the prevalence of occult multifocal activity elsewhere in the body. The gradual decrease in SUVmax values during the course of ATT is a useful tool to assess disease response and to precisely decide the endpoint of ATT.

A Prospective Study of 18F-FDG PET-CT Application in Therapeutic Monitoring of Osteoarticular Tuberculosis

Objective: Confident diagnosis, identification of occult sites, assessing treatment response, and precisely ascertaining the duration and endpoint of treatment in skeletal tuberculosis is often challenging. magnetic resonance imaging (MRI) and computed tomography (CT) are less dependable owing to low sensitivity and the inability to discern current illness and old changes. 18F-FDG PET/CT utilizes variations in glycolysis rates between healthy and diseased tissue to quantitatively estimate the maximal standard uptake value (SUVmax) of 18F-FDG to assess disease activity.Material and Methods: 32 patients who presented to the department with a clinicoradiological suspicion and pathologically proven diagnosis of skeletal tuberculosis were prospectively analyzed. All patients underwent a whole body 18F-FDG PET-CT scan before initiation of anti-tubercular therapy (ATT), and then treatment was started as per the Revised National Tuberculosis Control Program (RNTCP) guidelines. All patients were followed up with repeat PET-CT scans and relevant clinical investigations at 2, 6, and 12 months.Results: A gradual decrease in SUVmax values, as the treatment courses progressed indicated a decrease in disease activity with treatment. There was an overall mean decrease of 6.5 units in the SUVmax values when compared to the pre-treatment levels, which was statistically significant (p-value&lt;0.001). At 2 months of anti-tubercular treatment, the mean SUVmax values decreased by 39%, and at 6 and 12 months of ATT, they were reduced by 60% and 81%, respectively.Conclusion: 18F-FDG PET-CT helps to determine the prevalence of occult multifocal activity elsewhere in the body. The gradual decrease in SUVmax values during the course of ATT is a useful tool to assess disease response and to precisely decide the endpoint of ATT.

An Epidemiological Profile of Previously Treated Patients Registered in Tuberculosis Units in Urban Visakhapatnam

Background: Tuberculosis (TB) remains a major global public health problem. Retreatment patients havehigher risk of drug resistance compared with new cases. The objective of the study is to describe the typesof retreatment (previously treated) patients and assess the Socio demographic characteristics, co morbidand behavioural conditions of retreatment patients and to identify the factors associated with relapseunder Revised National Tuberculosis Control Program ( RNTCP) in the tuberculosis units located in UrbanVisakhapatnam. The main aim of the study is to study epidemiological profile of previously treated patientsto identify the factors which make tuberculosis patients prone for retreatment so that necessary action canbe taken.Methods: This is an Observational Analytical Cross-sectional study done in Tuberculosis units in GVMC. All thesubjects(193) who were registered as Previously treated patients in TUs during the second and third quarter ofthe year 2016 i.e April to September 2016. A pretested semi structured schedule was administered. Categoricaldata was analysed by Chi square test. Quantitative variables were represented as means and standard deviation.Unpaired t test was used for testing statistical significance in quantitative data.Results : Among 193 study subjects 168 (87%) were having pulmonary TB and remaining 25 (13%) were havingextra pulmonary TB. Majority of the study participants, 141 (73%) were males whereas only 52 (27%) were females.Relapse patients were 125(64.9%) Defaulters were 12 (6.2%), Treatment failure was 9 (4.6%) and Others previouslytreated were 47 (24.3%). Chi square test was used for testing statistical significance of association betweencategorical variables.Conclusion: Socio demographic factors, behavioural and co morbid factors have an effect on Relapse andmodifying these risk factors may bring about favourable outcomes. There is further need for exploring the reasonsfor high rates of relapse.

Tuberculosis Elimination in India: Where the Country Stands

Tuberculosis (TB) remains a significant public health challenge in India, with the country bearing the highest burden of TB cases globally. This article provides an overview of India's ongoing efforts towards TB elimination, highlighting both progress and persistent challenges. India's Revised National Tuberculosis Control Program (RNTCP), launched in 1997, has made remarkable strides in TB control. The introduction of the RNTCP and later its expansion as the National Tuberculosis Elimination Program (NTEP) in 2017, aimed to strengthen diagnostic and treatment services, with a focus on achieving universal access to TB care. DOTS (Directly Observed Treatment, Short-course) therapy has been a cornerstone of treatment, contributing to significant reductions in TB mortality. In recent years, India has made strides in adopting new technologies, including molecular diagnostics and telemedicine, to enhance TB case detection and patient care. The introduction of Bedaquiline and Delamanid, novel drugs for drug-resistant TB, has offered hope for patients with more resistant forms of the disease. However, the road to TB elimination in India is not without challenges. There is a pressing need for improved healthcare infrastructure, reduced stigma, and increased awareness among both the public and healthcare providers. The emergence of drug-resistant TB and the impact of the COVID-19 pandemic on TB services have posed additional hurdles. India's journey toward TB elimination is marked by significant progress and continued challenges. To achieve the ambitious goal of eliminating TB by 2025, concerted efforts are required to strengthen healthcare systems, improve diagnostic capabilities, and address social determinants of the disease.

Adverse Drug Reactions in Multi-Drug Resistant Tuberculosis Patients, in India, who had received DOTS Plus Treatment along with Home Care and Counselling

Background: Adverse drug reactions are common in MDR-TB patients on treatment. An adverse drug reaction (ADR) is defined as an appreciably harmful or unpleasant reaction resulting from an intervention related to the use of a medicinal product. Revised National Tuberculosis Control Programme used 24-months long Category IV/DOTS Plus regimen for treatment of MDR-TB. The Community Health Department of St. Stephen’s Hospital started an innovative project in 2009, in the form of Home Care for MDR Patients and it concluded with Long-term Follow-up of patients, who had received DOTS Plus Treatment along with Home Care and Counselling (2015). Aims: To study the spectrum, severity and the risk factors for ADRs in MDR-TB patients. Methods: In this retrospective study files of 109 MDR-TB patients who had received treatment along with home care and counselling support, were reviewed. The study was conducted between January to May 2024. Results: Out of 109 MDR TB patients there were 68 (62%) developed one or more ADR. Joint pains 44(40.36%), was the most commonly observed ADR, followed by nausea 29(26.6%) and vomiting 25(22.93%), weakness 23(21.1%), anxiety and depression 16(14.67%), difficulty in breathing 14(12.84%), tremors 13(11.9%), giddiness 11(10.1%), skin rashes 10(9.2%). According to Hartwig Scale mild ADRs were 58.8%, moderate 5.9% and severe 35.3%. Patients who had BMI &lt;18.5 experienced less ADRs with an Odds Ratio =0.22; 95% CI=0.06 to 0.72, p=0.0124. Unemployment was associated with higher number of ADRs OR=3.5; 95% CI=0.99 to 12.29, p=0.05. Sixty-two % MDR TB patients had ADRs. Our treatment outcomes showed 41(60.3) as cured, 24(35.3) died, 2(2.9) defaulted and 1(1.5) failed treatment. This was possible because healthcare teams counselled and provided all possible support to patients 24x7 thus improving adherence to therapy. Conclusion: ADRs occurred in more than half of the cases, with joint pain being the most common. Interventions such as counselling of patients and their family on importance of adherence to drugs at the initiation of treatment, provision of nutritional support, psychological counselling and motivation, instant referral for ADRs and care of patients at referred facilities, help patients not becoming defaulters.

Tuberculosis and the Effectiveness of the Revised National Tuberculosis Control Program (RNTCP) to Control Tuberculosis: A Narrative Review.

The revised National Tuberculosis (TB) Control Program is an initiative undertaken by the government of India and was active from 1997 to 2020. Later it was renamed as National TB Elimination Program, which eyes the complete eradication of TB by 2025. The revised National Tuberculosis Control Programme (RNTCP) is preceded by the National TB Control Program which was activated when the cases of TB were on the rise in the early 1960s and police intervention was needed. National Tobacco Control Cell (NTCP) guided the efforts until 1997 when various shortcomings, which were registered over the course of time, were addressed and the revised program was launched. It has been a mixed success as beneficiaries belonging to the reachable, urban areas were benefitted, and tribal, and backward areas were lagging behind. Although the RNTCP proved to be effective in containing TB and curing it to a certain extent, the successor of the program, which is NTEP, has set an ambitious goal of eradicating TB by 2025 which needs concerted efforts on behalf of all stakeholders.

“A Descriptive Study Among Staff Nurses Regarding Revised National Tuberculosis Control Program’’

“A Descriptive Study Among Staff Nurses Regarding Revised National Tuberculosis Control Program’’

Evaluation of awareness and factors determining satisfaction among tuberculosis patients regarding RNTCP services in a western district of Uttar Pradesh: a cross sectional study

Background: With the help of ‘Revised National Tuberculosis Control Program’ (RNTCP), India has envisioned to end Tuberculosis (TB) five years ahead of the targets set by SDG which was by 2030. Regular evaluation is necessary for every programme to keep the programme in track and to identify the existing lacunae. Therefore, this study was planned to assess the awareness of TB patients regarding RNTCP along with identifying the factors which determine satisfaction of TB patients. Methods: A community-based cross sectional study was conducted on patients seeking treatment at district tuberculosis centre and DOTs centres of district. The data were collected using a close-ended, pretested and pre-validated questionnaire. Results: The mean score for awareness regarding TB among 205 study participants was 5.76±1.88 with level of awareness being poor, average and good in 41%, 31% and 28% of the study participants respectively. The mean satisfaction score was 9.47±1.02 and the services were perceived as good, average and poor by 56%, 39% and 5% of the study population respectively. Majority of the participants were unsatisfied due to the untimely distribution of the money provided under Nikshay Poshan Yojna (31.7%). The reasons for satisfaction among majority of the participants was the availability of staff at DOTS Centre (87.3%). A significant correlation was observed between satisfaction score and awareness score (r2=0.033, p=0.01). Conclusions: The overall awareness and satisfaction about RNTCP services was good among TB patients with a greater satisfaction among people with high awareness.

Tuberculosis diagnostic practices among private medical practitioners of modern medicine in South India – A cross-sectional study

Abstract Background: India has the highest tuberculosis (TB) burden in the world and account for nearly one-fourth of the global burden of TB. Although the Indian government provides a basic national health service, an increasingly large number of health-care interactions in India are with the physicians in the private sector. Objective: The objective is to study the TB diagnostic practices among private medical practitioners and to determine the association of diagnostic practices with socio-demographic factors, the Revised National Tuberculosis Control Programme (RNTCP) training status, and professional/academic qualification of private medical practitioners. Materials and Methods: The current study was a cross-sectional study conducted in the urban areas of Nalgonda district between October 2015 and September 2017. The study included all medical general practitioners (GP) and all specialists practicing internal medicine, chest medicine, and pediatrics, registered with the Indian Medical Association (IMA) branches and had a private practice in the study area. The study included 101 private medical practitioners from three IMA branches. The data on diagnostic practices of TB and RNTCP training status were collected by an interview using a pretested semi-structured questionnaire. The data analysis was done using Statistical Package for Social Sciences (SPSS) 19th version. Results: The majority of study participants in this study were GP, while specialists constituted a smaller portion. Most of these private medical practitioners opted sputum smear examination as their second preferred investigation after a chest X-ray. For the diagnosis of pulmonary TB, majority of the private practitioners preferred both sputum smears examination and chest X-ray. The private medical practitioners who had received the RNTCP training were employing sputum smear microscopy as a diagnostic tool and were also aware about notification of TB. Conclusions: Overreliance on chest X-ray as the investigation of choice to diagnose pulmonary TB and for follow-up. Training in RNTCP has a positive impact on practicing standard diagnostic practices, treatment, and referral practices on private medical practitioners.

“TB - Mindedness”-the only way to beat “the great mimicker”: A case series with atypical presentation of female genital tuberculosis

BackgroundIncidence of Tuberculosis (TB) cases in India reported in 2019 is 193 per 1 lakh population [National Tuberculosis Elimination Plan (NTEP)]. In India, annual extra pulmonary TB burden is 20–25%, of which 4% of cases are of urogenital origin (Revised National TB Control Programme, 2019; World Health Organization, 2019). The Ministry of Health and Family Welfare has made a target of eliminating tuberculosis by 2025 under the NTEP by the process of identification, notification and treatment of cases. Tuberculosis being a leading cause of infertility in developing countries, employing best clinical practices and being “TB-minded” will also save the patient of enormous anxiety and uncertainity and also decrease the time gap between clinical presentation and diagnosis to optimize fertility outcome. MethodologyA prospective cohort study of cases presenting with unusual findings and ultimately being diagnosed as genital tuberculosis was conducted in the gynaecology OPD, AIIMS, New Delhi, from November 2020 to November 2021 (1 year). Patients were investigated judiciously, diagnosis made and followed up for their response to anti tuberculosis therapy (ATT). ResultsThis data comprises of conglomerate of ten cases with unconventional exhibition of genital tuberculosis. 70% of the cases presented with pain lower abdomen not specifically related to menstrual cycle and often confused with IBD. Tubo ovarian mass (70%) mimicking as simple ovarian cyst, ovarian carcinoma or endometriosis was the most common clinical finding we came across.

Observation Study among Cured Cases of Pulmonary Tuberculosis: A Long-Term Study under the Revised National Tuberculosis Control Program

Background: Tuberculosis is one of the leading causes of mortality in India. The Revised National Tuberculosis Control Program (RNTCP) is a robust public health system to deal with Tuberculosis (TB) in India. Unless the treated patient comes back to the system with signs and symptoms of TB due to relapse or reinfection, there is no mechanism of follow-up or any method to know the relapse rate in the population. This study aimed to analysed trends in relapse tuberculosis cases and describe their associations with socio-demographic and clinical factors.Subjects dan Method: In this prospective cohort study, 750 selected sample size who were declared “Cured” in four randomly selected TB units of Gwalior district were followed up for 1–5 years through home visits by trained staff with structured data collection forms. Data Collection was done between January 2022 to June 2022 and afterwards analyzed using Microsoft excel spreadsheet.Results: The mean age of the index cases was Mean= 30.53; SD= 14.24 years, and there were 39 females and 64 males. At early stage (1-to-2-year posttreatment follow-up of 248 index cases) 199 (80.2%) were healthy and working without any symptoms of TB. Symptoms of TB were present in 49 (19.8%) cases. The after 2-year posttreatment TB Symptoms were present in 54 (19.3%) cases.Conclusion: Long-term follow-up of cured, new smear-positive TB cases reinforce the effectiveness of anti-TB treatment under the RNTCP as assessed by improved health outcomes in more than two-thirds of cases and posttreatment survival of 80.72% of index cases. Further investigation needed to continue such follow-up for all TB cases treated under the RNTCP for effective end-TB strategy. Keywords: tuberculosis treatment, follow-up, relapses, RNTCP Correspondence: Ramniwas Mahore. Department Of Community Medicine. G R Medical College Gwalior 474009 Madhya Pradesh, India. Email: Drmahore@gmail.com. Mobile: 9425334365.

Expenditure Incurred by Patients of Pulmonary and Extrapulmonary Tuberculosis Under Revised National Tuberculosis Control Programme in District Tuberculosis Center, Jammu

Background: Tuberculosis (TB) patients suffer enormously due to huge cost on diagnosis and treatment. This study aims to assess the total expenditure and its predictors among patients of TB. Methodology: A longitudinal study was conducted among TB Patients registered in first quarter of 2018 at District Tuberculosis Center, Jammu. Data was collected by interviewing the patients and their attendants. Statistical significance of median expenditure between patients of pulmonary and extrapulmonary TB in relation to various predictors was assessed using nonparametric tests followed by Multiple Linear Regression. Results: Total median cost, median direct and indirect cost incurred by a TB patient were recorded as USD 489.55, USD 246.55 and USD 229.5 respectively. Treatment costs were slightly higher in patients of pulmonary TB in comparison to extrapulmonary TB (p&gt;0.05). On bivariate analysis, upper class, previously treated patients, Category 2 patients, with chronic illnesses, with guardians and who were employed expended significantly higher amounts on their treatment, but on multivariate analysis, only formal employment, current earning and being reimbursed significantly predicted the total cost (p &lt; .001, adjusted R square = 0.56). Conclusion: Huge direct costs incurred by patients is a matter of great concern, more so as the Indian government has made all diagnostics and treatment free since the inception of the RNTCP.

Prevention of relapse in drug sensitive pulmonary tuberculosis patients with and without vitamin D3 supplementation: A double blinded randomized control clinical trial.

The immunomodulatory effects of vitamin D are widely recognized and a few studies have been conducted to determine its utility in the treatment of tuberculosis, with mixed results. This study was conducted to see if vitamin D supplementation in patients with active pulmonary tuberculosis (PTB) in the Indian population contributed to sputum smear and culture conversion as well as the prevention of relapse. This randomized double-blind placebo-controlled trial was conducted in three sites in India. HIV negative participants aged 15-60 years with sputum smear positive PTB were recruited according to the Revised National Tuberculosis Control Program guidelines and were randomly assigned (1:1) to receive standard anti-tubercular treatment (ATT) with either supplemental dose of oral vitamin D3 (60,000 IU/sachet weekly for first two months, fortnightly for next four months followed by monthly for the next 18 months) or placebo with same schedule. The primary outcome was relapse of PTB and secondary outcomes were time to conversion of sputum smear and sputum culture. A total of 846 participants were enrolled between February 1, 2017 to February 27, 2021, and randomly assigned to receive either 60,000 IU vitamin D3 (n = 424) or placebo (n = 422) along with standard ATT. Among the 697 who were cured of PTB, relapse occurred in 14 participants from the vitamin D group and 19 participants from the placebo group (hazard risk ratio 0.68, 95%CI 0.34 to 1.37, log rank p value 0.29). Similarly, no statistically significant difference was seen in time to sputum smear and sputum culture conversion between both groups. Five patients died each in vitamin D and placebo groups, but none of the deaths were attributable to the study intervention. Serum levels of vitamin D were significantly raised in the vitamin D group as compared to the placebo group, with other blood parameters not showing any significant difference between groups. The study reveals that vitamin D supplementation does not seem to have any beneficial effect in the treatment of PTB in terms to the prevention of relapse and time to sputum smear and culture conversion. CTRI/2021/02/030977 (ICMR, Clinical trial registry-India).

Treatment outcome on pulmonary tuberculosis and extra pulmonary tuberculosis in government general hospital, ongole

Background: Tuberculosis is a global disease leading to cause death worldwide. The Revised National Tuberculosis Control Programme (RNTCP), Directly Observed Treatment Short Course (DOTS), was launched to reduce tuberculosis mortality, improve patient adherence to treatment, and prevent the development of drug resistance. The aim of this study was treatment outcome of tuberculosis. Treatment outcome is an important indication of tuberculosis control programme. Methodology: An ambispective observational study was conducted in a government general hospital from August 2019 to January 2020 on the treatment outcomes of PTB and EPTB in the 15 years and older age group, both males and females, on category I regimens. Patients with comorbidities like HIV, diabetes, and social habits like smoking were included. Record based TB diagnosed data (August 2019 to January 2020) are taken and asses their treatment outcome after 6months of complete therapy. The recorded and collected data were analysed to evaluate the success rate of treatment outcomes for PTB and EPTB. Results: A total of 350 subjects were enrolled in the study, of which 311 are included and 39 are excluded due to incomplete data. The study with age group of 15 and above years where males 218(70.10%) and females 93(29.90%). Total pulmonary tuberculosis cases are 277 (89.07%), and extrapulmonary tuberculosis cases are 34 (10.93%). Subjects with HIV 48(15.43%), Diabetes 54(17.37%) and Tobacco smoking 85(27.33%). The treatment outcome was observed as follows: cured 144 (46.30%), treatment completed 98 (31.51%), transfer out 10 (3.21%), died 27 (8.69%), treatment failure 7 (2.26%), treatment lost to follow-up 14 (4.50%), and treatment regimen changed 11 (3.53%). At the end of the treatment, the success rate was found to be 78%. Conclusion: This study shows that the TB patients' treatment success rate was 78%, which is slightly less than the RNTCP norms. The died rate was 8% which is higher than national average. Perhaps the services need to improve tuberculosis case detection in HIV patients, while cure rates have to be improved in RNTCP. EPTB case enrolment is very low, whereas the referral system has to improve its services. So that EPTB cases enrolment may increase its number. The early detection may enhance the cure rates in patients.

A cross-sectional study of extent and causes of interruption of treatment of tuberculosis in a tuberculosis unit of Purba Bardhaman district of West Bengal, India

Background: Tuberculosis (TB) is a communicable disease which requires prolonged treatment and having both medical and social dimensions. Adherence to treatment is very important issue in successful treatment of TB. Directly observed therapy was a key strategy in The Revised National TB Control Program. However, treatment interruption is very common. Aims and Objectives: The objective of this study is to assess the nature, extent, and reasons for interruption of treatment in Bhatar TB Unit (TU) of Purba Bardhaman district of West Bengal. Materials and Methods: The study was a descriptive and cross-sectional study with two components. The study was conducted in the area covered under Bhatar TU of Burdwan district of West Bengal. Complete enumeration technique was followed in the study. In the first component of the study, 231 study subjects were found by complete enumeration, out of which 26 were discarded due to incomplete records. In the other component, 90 study subjects were interviewed at the beginning of treatment and after treatment interruption, if any. Data were analyzed using RStudio. Results: Out of the group with only record review, 205 subjects were included in the study, out of which 160 (78.05%) were male and 45 (21.95%) were female. In the other group with both record review and interview, out of 90 subjects, 64 (71.1%) were male and 26 (28.9%) were female. Out of 295 cases, 270 (91.5%) were new and 25 (8.5%) were previously treated. Out of 295 subjects, 36 (12.2%) had interrupted treatment. Seven persons out of 36 had interrupted more than once. Thirty-four persons had interrupted in intensive phase of treatment. Thirty-two persons had taken 10–20 days before interruption of treatment. The most common reason for interruption of treatment was “Not willing to take tablets.” Among the other reasons were “Side effects,” “Hospitalization,” “Away from home,” etc. Conclusion: Non-compliance to anti-tubercular drugs remains an important issue in the elimination of TB.

A Case Report on Pulmonary Tuberculosis Associated with Deep Vein Thrombosis

Public health problems such as tuberculosis remain a major concern, especially in developing countries. According to WHO (World Health Organization), for every second someone gets infected with tuberculosis. India is the second most populated nation in the world contributes to 23% of TB incident cases annually out of 9.6 million worldwide. The overall morbidity and mortality associated with TB are reduced with early initiation of anti-TB treatment. In India, most antituberculosis regimens are Rifampicin-based under the Revised National Tuberculosis Control Program (RNTCP). Despite its rarity, deep venous thrombosis (DVT) should be considered especially in those with severe disseminated or pulmonary tuberculosis. This case report describes a 31-year-old female with pulmonary tuberculosis initiated on rifampicin-based antituberculosis treatment presented with deep vein thrombosis.&#x0D; Keywords: Tuberculosis, Deep vein thrombosis, pulmonary tuberculosis

Knowledge of Private Practitioners Regarding Revised National Tuberculosis Control Program- A Cross-Sectional Study from the Haryana state of India.

India's aim to achieve tuberculosis (TB) eradication by 2025 necessitates the engagement of all stakeholders, encompassing both private and public sectors, across all phases of the TB program - spanning from diagnosis to the curative outcome. However, certain private practitioners pursue an individualized approach instead of adopting a collective strategy, thereby contributing to the emergence of multidrug-resistant tuberculosis. Consequently, in order to formulate an enhanced strategy that fosters improved collaboration and professional behavioral change among all partners, it is imperative to comprehensively assess their level of knowledge. This study aims to assess the knowledge level of private practitioners with regard to the diagnosis and management of pulmonary tuberculosis cases within the framework of the Revised National Tuberculosis Control Program (RNTCP). A descriptive cross-sectional study was conducted among 78 selected private practitioners located in seven towns within the Sonepat district of Haryana State, India. The study was approved by the ethics committee of Bhagat Phool Singh Government Medical College for Women, Sonepat, Haryana. Data collection involved the utilization of a self-administered, pre-tested, semi-structured questionnaire. Descriptive analysis was applied, utilizing proportions and percentages. The collective understanding of private practitioners concerning Tuberculosis and RNTCP was found to be deficient. Around one-third of the practitioners reported that they had not received any visits from health workers in relation to RNTCP. A mere 33% of the practitioners had attended any Continuing Medical Education (CME) sessions, and only a quarter of the participants expressed an intention to collaborate with the RNTCP program. In conclusion, this study underscores the necessity for RNTCP to focus on fostering the willingness of private practitioners to engage with the program, while simultaneously enhancing their knowledge about Tuberculosis and RNTCP.

Treatment Outcome of Tuberculosis in Patients with Diabetes under RNTCP in a Tertiary Care Centre, Chengalpattu, India: A Prospective Cohort StudyTreatment Outcome of Tuberculosis in Patients with Diabetes under RNTCP in a Tertiary Care Centre, Chengalpattu, India: A Prospective Cohort Study

Introduction: Diabetes increases the risk of Tuberculosis (TB) by three times, and this bidirectional association is currently one of the major concerns. A stronger evidence base is required to clarify the impact of Diabetes Mellitus (DM) on the treatment outcome of TB. Aim: To compare the treatment outcome among diabetic and non diabetic patients on Category-I TB treatment based on the Revised National Tuberculosis Control Program (RNTCP). Also, to assess the various factors influencing the treatment outcome of TB among diabetic patients. Material and Methods: A prospective cohort study was conducted on 75 newly diagnosed TB patients enrolled for Category-I treatment Department of Pulmonary Medicine, Chengalpattu Medical College, Chengalpattu, Tamil Nadu, India, between October 2018 to November 2019. All patients with TB underwent blood glucose screening at treatment initiation and were categorised into two groups: with diabetes and without diabetes. Demographic details, family history of DM, smoking, alcohol consumption, and clinical profile were collected using a semi-structured questionnaire and followed-up for six months to assess their treatment outcome. The treatment outcome was compared statistically based on diabetes status using the Chi-square test. Results: The mean age of the study population was 49.9±0.5 years, with the majority being male 56 (74.7%). More than half of the study population belonged to a low socio-economic status. Among the study population, 42 (56%) were diabetic, with a mean blood glucose level of 242.7±80.5 mg/dL. Eighty-two percent had Pulmonary TB, with a 68% smear positivity rate among diabetic patients. In terms of treatment outcome, 44 (58.7%) were cured, 15 (20%) completed treatment, 10 (13.3%) were lost to followup, and 6 (8%) expired during the treatment course. Conclusion: Smear positivity and pulmonary TB were predominant among patients with diabetes. Treatment completion was lower, and mortality was higher among diabetic patients with TB.