Treatment Default Research Articles

Default in Tuberculosis Treatment among Women Registered in DOTS Center of Taplejung District, Nepal: A Descriptive Study

INTRODUCTION: Default is one of the unfavourable outcomes for patients on DOTS and represents an important challenge for the control program. Therefore, this study was designed to assess default in tuberculosis (TB) treatment among women registered in DOTS center at Taplejung District of Nepal. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted at Taplejung district of Nepal in thethe year 2016. Records of TB patients from all DOTS centre for one year were obtained and treatment default cases for women were identified. Face to face interview was conducted by using semi-structured questionnaire to collect data from the patients. The data were entered and analyzed in MS Excel software. RESULTS: Out of total 30 female TB patients, 72.0% of respondents belonged to the age group of 15-49 years where as 73.3% of the respondents were Kirat and from Dalit caste ethnicity. Less than half of the respondents (48.0%) thought, feeling better after medication, was the reason for default TB. A second major cause for default in tuberculosis treatment was distance to reach DOTS center (12.0%) and lack of food at home (10.0%). Likewise, few respondents said lack of family support (6.7%), thinking about side effects (6.7%), medicine not working (3.3%) and stigma (6.7%) were the reasons for the default in tuberculosis treatment. CONCLUSIONS: Majority of the respondents left treatment because they felt better after medication. A second major reason for default in TB treatment was distance to reach DOTS center. The findings may be helpful in planning modifications in DOTS program of Nepal.

Magnitude of Multidrug Resistance and Associated Factors of Pulmonary Tuberculosis Among Adult Smear Positive Patients in Eastern Ethiopia.

BackgroundIn Ethiopia, multidrug resistant tuberculosis is a major public health problem. However, information is scarce regarding MDR-TB and associated factors. ObjectiveThe study was aimed to assess the magnitude of multidrug resistance and associated factors of pulmonary tuberculosis among adult smear-positive patients in Harari regional state health facilities, eastern Ethiopia.MethodsA cross-sectional study was conducted among 395 adult smear-positive pulmonary tuberculosis patients attending health facilities from March to October 2019. Smear-positive sputum samples were collected from health facilities, and transported to Harari Health Research and Regional Laboratory, and tested for drug susceptibility using a line probe assay. Data were analyzed using Statistical Package for Social Sciences version 20. Bivariate and multivariable logistic regression analyses with 95% confidence intervals were carried out to identify factors associated with multidrug-resistant tuberculosis.ResultsThe overall magnitude of multidrug-resistant tuberculosis was 3.8% (15/395) (95% CI: 2.0–5.8%). Being male (AOR = 4.9; 95% CI: 1.16, 20.5), patients with a previous history of tuberculosis (AOR = 4.9; 95% CI: 1.5, 29.6), treatment failure (AOR = 8.5; 95% CI: 1.61, 45.3), treatment default (AOR = 10.38; 95% CI: 1.86, 58.0), human immunodeficiency virus co-infection (AOR = 9.83.95% CI: 3, 21, 30.1) and a previous history of contact with multidrug-resistant tuberculosis patients (AOR = 14.4; 95% CI: 3.1, 67.6) had higher odds of multidrug-resistant tuberculosis.ConclusionThe overall magnitude of multidrug-resistant tuberculosis was high. Strengthening the tuberculosis control program by giving special attention to HIV co-infected patients, treatment failure and default, previously infected patients as well as to those individuals who have a history of contact with multidrug-resistant tuberculosis infected patients .

Factors associated with treatment defaulting among adult leprosy patients in Sri Lanka: a case-control study

Background Treatment default in leprosy leads to progression of the disease and to disabilities. A defaulter is an individual who fails to complete treatment within a prescribed time frame. Defaulters can act as a source of infection in the community. Therefore, identifying factors contributing to defaulting will be essential to revise existing control strategies. Methods We conducted a hospital-based unmatched case-control study from March to October 2018 to assess the factors associated with treatment defaulting among adult leprosy patients in the Western province, Sri Lanka. Defaulting cases were true defaulters, and defaulters who have restarted treatment and control cases were patients on regular treatment. Defaulting cases were selected using the Clinic Leprosy Register, and three controls per case were selected by a consecutive sampling method. Data collection was carried out at households and clinics using an interviewer-administered questionnaire. Multivariate analysis using logistic regression was carried out to identify the risk of each significant factor in the bivariate analysis for defaulting, adjusted for all confounders. Results The study was conducted among 98 defaulting cases and 294 control cases. The following risk factors were identified in the logistic regression analysis; age less than 60 years (adjusted OR = 3.2, 95% CI: 1.55–6.64, P < 0.05), poor knowledge about the disease (adjusted OR = 9.6, 95% CI: 4.96–18.55, p < 0.001), normal treatment duration (Paucibacillary 6 months; Multibacillary 12 months therapy) (adjusted OR = 4.0, 95% CI: 1.82–9.02, p < 0.001), and poor caregiver support (adjusted OR = 7.8, 95% CI: 3.97–15.46, p < 0.001). Conclusions Age less than 60 years, inadequate knowledge about the disease, normal treatment duration, and poor caregiver support were found to be factors associated with defaulting. Patients and caregivers should be educated to continue treatment and provided a travelling allowance for the needy to encourage clinic attendance.

Trend dan Faktor yang Berhubungan dengan Keberhasilan Pengobatan Pasien TB MDR Paduan Jangka Pendek di Indonesia 2017-2019

TB problems in Indonesia are TB sensitive, Drug-Resistant TB and TB-HIV. TB-RO is the most challengging problem, the number of case finding is increase every year, but treatment rate is decrease. The use of short-term regiment since September 2017 is one of strategy to reduce default of TB treatment. This research was conducted to see trends and factors related to the TB treatment success rate among patients with Drug Resistance TB (TB RO) using Shorter Treatment Regiment (STR) in Indonesia 2017-2019. The study desain is restropective cohort. Data sources are all patients of TB RO using STR regiment, which is enrolled in the e-TB manager, Sud Directorate of Tuberculosis, MoH RI. The sampling method is total sampling that meets the inclusion and exclusion criteria. The analysis used was the chi-square test and the cox regression test. As many as 3,100 patients were included in the analysis, the trend of successful treatment of short-term mixed RO TB patients since 2017-2019 has continued to decline, with figures of 53.28%, 47.85% and 36.98%. The results of the analysis showed that factors related to treatment success were age, adherence, results of initial sputum examination of treatment, patterns of monoresistant and polyresistant resistance, and area of residence. Adherence is a dominant factor related to treatment success. Efforts should be made to strengthen compliance by conducting counseling as early as possible, PMO assistants from non-helath officers and initiating patient support groups in each MDR facility.

Occurrence, distribution, and ecological risk assessment of emerging and legacy contaminants in the Kadicha river in Lebanon.

The Kadicha river basin in Northern Lebanon is an illustrative example of multiple pressures encountered in the Mediterranean region: it is a small coastal river affected by rapid urbanization, population growth (drastically impacted by the influx of Syrian refugees), and a chronic default of wastewater treatment. In this context, multiple classes of contaminants may attain the river accumulating in sediment. However, very little information is available in the literature on the contamination status in such stressed Mediterranean contexts. This study proposed a first contamination evaluation of a small Mediterranean river submitted to multiple pressures. Two sediment sampling campaigns along sites impacted by increasing urban gradient within the Kadicha river basin were performed to determine the occurrence and the environmental risks of both emerging and legacy contaminants. The results revealed the detection of the 41 studied compounds. The highest concentrations were attained by PAHs and polycyclic musks (up to 311.79, 94.22, and 81.13 ng/g of dry weight for PAH, cashmeran, and galaxolide, respectively). The discontinuous urbanized upstream area and the estuary were the most contaminated areas of the river. An environmental risk assessment showed a hazard quotient (HQ) higher than 1 for both legacy and emerging compounds (EHMC and 4-MBC), indicating a potential risk to benthic species. Monitoring campaigns and implementation of wastewater treatment plants should be encouraged as the anthropogenic pressure on small Mediterranean rivers will increase over the years.

Mobile Tuberculosis Treatment Support Tools to Increase Treatment Success in Patients with Tuberculosis in Argentina: Protocol for a Randomized Controlled Trial.

BackgroundTuberculosis (TB) is an urgent global health threat and the world’s deadliest infectious disease despite being largely curable. A critical challenge is to ensure that patients adhere to the full course of treatment to prevent the continued spread of the disease and development of drug-resistant disease. Mobile health interventions hold promise to provide the required adherence support to improve TB treatment outcomes.ObjectiveThis study aims to evaluate the effectiveness of the TB treatment support tools (TB-TSTs) intervention on treatment outcomes (success and default) and to assess patient and provider perceptions of the facilitators and barriers to TB-TSTs implementation.MethodsThe TB-TSTs study is an open-label, randomized controlled trial with 2 parallel groups in which 400 adult patients newly diagnosed with TB will be randomly assigned to receive usual care or usual care plus TB-TSTs. Participants will be recruited on a rolling basis from 4 clinical sites in Argentina. The intervention consists of a smartphone progressive web app, a treatment supporter (eg, TB nurse, physician, or social worker), and a direct adherence test strip engineered for home use. Intervention group participants will report treatment progress and interact with a treatment supporter using the app and metabolite urine test strip. The primary outcome will be treatment success. Secondary outcomes will include treatment default rates, self-reported adherence, technology use, and usability. We will assess patients’ and providers’ perceptions of barriers to implementation and synthesize lessons learned. We hypothesize that the TB-TSTs intervention will be more effective because it allows patients and TB supporters to monitor and address issues in real time and provide tailored support. We will share the results with stakeholders and policy makers.ResultsEnrollment began in November 2020, with a delayed start due to the COVID-19 pandemic, and complete enrollment is expected by approximately July 2022. Data collection and follow-up are expected to be completed 6 months after the last patient is enrolled. Results from the analyses based on the primary end points are expected to be submitted for publication within a year of data collection completion.ConclusionsTo our knowledge, this randomized controlled trial will be the first study to evaluate a patient-centered remote treatment support strategy using a mobile tool and a home-based direct drug metabolite test. The results will provide robust scientific evidence on the effectiveness, implementation, and adoption of mobile health tools. The findings have broader implications not only for TB adherence but also more generally for chronic disease management and will improve our understanding of how to support patients facing challenging treatment regimens.Trial RegistrationClinicalTrials.gov NCT04221789; https://clinicaltrials.gov/ct2/show/NCT04221789.International Registered Report Identifier (IRRID)DERR1-10.2196/28094

Patterns and determinants of treatment completion and default among newly diagnosed multibacillary leprosy patients: A retrospective cohort study

BackgroundPoor treatment adherence among leprosy patients contribute to relapse, development of antimicrobial resistance, and the eventual plateauing of the prevalence and incidence of leprosy not just in the Philippines, but also worldwide. For this reason, we aimed to identify the patterns and determinants affecting treatment completion and default among multibacillary leprosy patients. MethodsWe conducted a retrospective cohort study involving three large hospitals in Metro Manila, Philippines. Patients who started the World Health Organization - Multiple Drug Therapy for multibacillary leprosy between January 1, 2007 and December 31, 2013 were included in the study. Selected socio-demographic and clinical data were abstracted from the patient treatment records. Survival analysis and proportional hazards regression were used to analyze the data. ResultsRecords of 1,034 patients with a total follow-up time of 12,287 person-months were included in the analysis. Most patients were male, younger than 45 years old, had an initial bacterial index between 1 and 4, and were residents of Metro Manila. Less than 20% had their treatment duration extended to more than 12 months. Treatment adherence of the patients was poor with less than 60% completing treatment. Most patients complete their treatment within 12 months, but treatment duration may be extended for up to three years. Patients who default from treatment usually do so a few months after initiating it. After adjusting for other variables, hospital, initial bacterial index, and non-extended treatment duration were associated with treatment completion. These factors, in addition to age, were also found to be associated with treatment default. ConclusionThis study provides quantitative evidence that there might be marked variations in how doctors in particular hospitals manage their patients, and these findings underscore the need to revisit and re-evaluate clinical practice guidelines to improve treatment outcomes and adherence.

A risk score for prediction of poor treatment outcomes among tuberculosis patients with diagnosed diabetes mellitus from eastern China

Persons living with diabetes (PLWD) with newly diagnosed tuberculosis are at greater risk of poor treatment outcomes. Identifying and prioritizing high-risk subgroups of PLWD and tuberculosis for tuberculosis programs to target has been rarely performed. We investigated risk factors for poor tuberculosis treatment outcomes among PLWD and developed a predictive risk score for tuberculosis control prioritization. Among PLWD diagnosed with tuberculosis, demographic, clinical, and tuberculosis treatment outcome data were collected. Poor treatment outcomes included treatment failure, death, default, and transfer. Multivariable logistic regression modeling was used to analyze risk factors of poor treatment outcomes. Risk scores were derived based on regression coefficients to classify participants at low-, intermediate-, and high-risk of poor treatment outcomes. Among 335 PLWD newly diagnosed with tuberculosis, 109 were cured and 172 completed treatment. Multivariable logistic regression found that risk factors of poor treatment outcomes included bacteriologically-positivity, low body mass index, no physical activity, and pulmonary cavitation. Rates of poor treatment outcomes in low- (0–2), intermediate- (3–4), and high-risk (5–8) groups were 4.2%, 10.5%, and 55.4% (Ptrend < 0.0001), respectively. The risk score accurately discriminated poor and successful treatment outcomes (C-statistic, 0.85, 95% CI 0.78–0.91). We derived a simple predictive risk score that accurately distinguished those at high- and low-risk of treatment failure. This score provides a potentially useful tool for tuberculosis control programs in settings with a double burden of both tuberculosis and diabetes.

Why Do Patients with Mental Disorders Default Treatment? A Qualitative Enquiry in Rural Kwazulu-Natal, South Africa.

Although treatment default by psychiatric patients or mental health care users is a global challenge, this behavior is reported to be higher in South Africa. The Manguzi District Hospital in rural Kwa-Zulu Natal Province, South Africa, experiences high rates of treatment default by psychiatric patients. The objective of this study was to determine the reasons for treatment defaulting at Manguzi Hospital, KwaZulu-Natal Province, South Africa. An explorative qualitative design, using in-depth interviews, was conducted with mental health care users who had defaulted out-patient psychiatric treatment. Twenty-one mental health care users were interviewed before data saturation was reached. Nvivo version 11 was used to analyze the qualitative data. Major themes that emerged confirmed that social factors are key contributions to treatment defaulting, and these include denial of the mental disorders; belief that they are cured; lack of, or disintegration of social support; preference for traditional medicine; and flaws in the health care system. Social determinants of treatment outcomes for mental disorders require tailor-made support systems for patients in these rural communities, which include increase in health literacy and attention to the cultural understanding of mental disorders.

Treatment outcome of tuberculosis at Dilla Referral Hospital, Gedeo Zone, southern Ethiopia: A retrospective study.

BackgroundTuberculosis (TB) is one of the major public health problems in Ethiopia. Determining treatment outcome of TB cases could help to understand the effectiveness of TB control efforts. The objective of this study was to assess TB treatment outcome and associated factors and determine the risk factors of death among TB cases who were on Directly Observed Treatment Short course (DOTS).MethodologyWe analyzed a retrospective data for TB cases who were on DOTS at Dilla Referral Hospital from July 2011- June 2016. The study population was TB cases with known HIV status and whose treatment outcome was evaluated at the Hospital. Data were entered, cleaned and analyzed using statistical package SPSS for windows, version 20.ResultOut of 899 registered TB cases, 731 included in this analysis. Of these cases, 424 (58.0%) were male and 334 (45.7%) were in the age group of below 25 years. Treatment success rate of TB was 675 (92.3%) and death rate was 18 (2.5%). Treatment outcome showed statistically significant variation by HIV status (P < 0.001). HIV status of the TB cases and pretreatment weight were associated with TB treatment outcome. HIV status of the TB cases was associated with death of the TB cases (Adjusted Odds Ratio (AOR) 5.0; CI 95%: 1.8–13.5).ConclusionTB treatment success rate found in this study was high. Patient’s weight and HIV status were associated with treatment outcome. Moreover, HIV status predicted death of TB cases. Cautious treatment follow-up and defaulter tracing mechanisms for TB cases with these risk factors were suggested.

The impact of unrestricted access to direct-acting antiviral among incarcerated hepatitis C virus-infected patients.

Background/AimsDespite the disproportionally high prevalence rates of hepatitis C virus (HCV) amongst the incarcerated population, eradication remains challenging due to logistic and financial barriers. Although treatment prioritization based on disease severity is commonly practiced, the efficacy of such approach remained uncertain. We aimed to compare the impact of unrestricted access to direct-acting antiviral (DAA) among incarcerated HCV-infected patients in Singapore.MethodsIn this retrospective study, we reviewed all incarcerated HCV-infected patients treated in our hospital during the restricted DAA era (2013–2018) and unrestricted DAA access era (2019). Study outcomes included the rate of sustained virological response (SVR), treatment completion and treatment default. Subgroup analysis was performed based on the presence of liver cirrhosis, HCV genotype and HCV treatment types.ResultsA total of 1,001 HCV patients was followed-up for 1,489 person-year. They were predominantly male (93%) with genotype-3 HCV infection (71%), and 38% were cirrhotic. The overall SVR during the restricted DAA access era and unrestricted DAA access era were 92.1% and 99.1%, respectively. Unrestricted access to DAA exponentially improved the treatment access among HCV-infected patients by 460%, resulting in a higher SVR rate (99% vs. 92%, P=0.003), higher treatment completion rate (99% vs. 93%, P<0.001) and lower treatment default rate (1% vs. 9%, P<0.001).Conclusion: In this large cohort of incarcerated HCV-infected patients, we demonstrated that unrestricted access to DAA is an impactful strategy to allow rapid treatment up-scale in HCV micro-elimination.

Development of a nomogram for predicting treatment default under facility-based directly observed therapy short-course in a region with a high tuberculosis burden.

Background:Poor adherence to tuberculosis (TB) treatment is a substantial barrier to global TB control. The aim of this study was to construct a nomogram for predicting the probability of TB treatment default.Methods:A total of 1185 TB patients who had received treatment between 2010 and 2011 in Peru were analyzed in this study. Patient demographics, social, and medical information were recorded. Predictors were selected by least absolute shrinkage and selection operator (LASSO) regression analysis, and a nomogram for predicting TB treatment default was constructed by using multivariable logistic regression analysis. Bootstrapping method was applied for internal validation. Calibration and clinical utility of the nomogram was also evaluated.Results:The incidence of TB treatment default among the study patients was 11.6% (138/1185). Six predictors (secondary education status, alcohol use, illegal drug use, body mass index, multidrug-resistant tuberculosis, and human immunodeficiency virus serostatus) were selected through the LASSO regression analysis. A nomogram was developed based on the six predictors and it yielded an area under the curve (AUC) value of 0.797 [95% confidence interval (CI), 0.755–0.839]. In the internal validation, the AUC achieved 0.805 (95% CI, 0.759–0.844). Additionally, the nomogram was well-calibrated, and it showed clinical utility in decision curve analysis.Conclusion:A nomogram was constructed that incorporates six characteristics of the TB patients, which provides a good reference for predicting TB treatment default.

Defaulters of Tuberculosis Treatment Among MDR-TB Patients Attended in Forlanini/Lazaretto Hospital, Mogadishu, Somalia

Background: Tuberculosis (TB) is a global public health issue, it’s one of the oldest diseases known to affect humans which remains one of the highest leading of mortality worldwide. The main purpose of this study was to assess the factors which influencing to non-adherence TB- Treatment (Defaulters) among TB patient at Forlanini/Lazaretto Hospital-Mogadishu-Somalia. Methodology: - descriptive cross-sectional hospital-based study was conducted among patients who were not-adhered their medication attending TBMUs (FORLANINI/LAZARETITO Hospital-Mogadishu-Somalia)-from March to May 2019. A total of 103 defaulters were the respondents during the study period by using non-probability convenient sampling method. Data were collected by using structured questionnaire. Descriptive statistics was used using SPSS version 20 statistical software. The data were showed tables, figures and graphs for describing the data. Results: This study shades light on the defaulters of tuberculosis treatment among TB patients and it shows that the male population are the most people among the population who fail to complete the TB course of medication treatment with a percentage of 79.6% and women are recorded having much less percentage of defaulting TB medication with a percentage of 20.4%. In terms of education, those who have never been to school and the secondary level are least likely to default the medication with a percentage 12.6% each, followed post graduate level with 16.5% and university level having a percentage of 19.4%. The most likely patients that can default TB medication are the primary level population with a percentage of 38.8%the unemployed and the employed population have slight difference in the percentage of people who defaults the medication of TB with 32.0% and 30.1% respectively. The mothers who are housewives have a percentage of 16.5% and finally the employers have a percentage of 21.4% TB medical treatment defaults. Conclusion: the study concluded and recommended that there are urgent needs for continuous and effective health education for the patients and their families and social support when starting the medications to ensure adherence and compliance to anti tuberculosis drug as well as regular monitoring, counseling and follow-up with the patients and access to drugs and health care centers.

Factors associated with unfavorable outcome of tuberculosis treatment in people deprived of liberty: a systematic review.

to analyze factors associated with unfavorable outcome of tuberculosis treatment in people deprived of liberty. systematic review, carried out in March 2021 in seven databases, with no delimitation of period of publication. The selection process of publications and data extraction was carried out by two independent reviewers. a total of 1,448 publications was identified and nine were included in the study. Unfavorable outcome was higher among those who were men; had low level of education; were living in a rural area before detention; had longer prison time; received occasional visits; had been transferred between prisons; with no sputum smear microscopy or with a positive result at the diagnosis; with no follow-up sputum smear microscopy, previous history of tuberculosis; having both clinical forms of the disease, HIV/AIDS; alcoholics; smokers; low body weight; and self-administered treatment. Treatment default was associated with young people and death with older people. prison health managers and professionals are expected to establish mechanisms of surveillance and health actions innovation aimed at the population deprived of liberty, making efforts to reduce the unfavorable outcomes of tuberculosis treatment.

Antiretroviral treatment default and associated factors among people living with HIV/AIDS in Ayder Referral Hospital, Tigray, Ethiopia

Antiretroviral treatment default and associated factors among people living with HIV/AIDS in Ayder Referral Hospital, Tigray, Ethiopia

“I Feel Healthy Like Any Other Person” Reasons for Defaulting from ART Treatments Use Among Adults Living with HIV in Tunduru District: A Qualitative Inquiry

<i>Background</i>: Continuing use of ART treatments is reported to improve health and health outcomes of people living with HIV. However, adherence to ART prescriptions is generally a challenge and many people default from HIV care and treatment. This study assessed reasons for ART treatment default among adults living with HIV in Tunduru district Tanzania. <i>Methods</i>: We conducted a qualitative cross-sectional study between January and February 2018. Ten key informants who had defaulted from HIV care and treatment for five or more months were engaged in in-depth interviews on reasons behind defaulting. Thematic analysis using NVivo was conducted to identify emerging themes. <i>Results</i>: Reasons for defaulting from ART treatments which emerged include being tired of using the ART medications for a long time, not experiencing HIV related symptoms, fear of stigma and shame of being known to use ART, inadequate food, fear of side effects and use of local herbs as alternative. Other reasons include long distance to the health facilities and long waiting time for the services at the facility. <i>Conclusion</i>: Reasons for defaulting from HIV treatment and care among adults are multifaceted in nature requiring multifaceted efforts to address them if the gains intended from the use of ART are to be achieved and sustained.

Impact of COVID-19 nationwide lockdown on retinoblastoma treatment and outcome: A study of 476 eyes of 326 children.

Purpose:The novel coronavirus SARS-CoV-2 (COVID-19) and the resultant nationwide lockdown and travel restrictions led to difficulty in providing timely and regular treatment to patients with childhood cancers such as retinoblastoma. This study is aimed at assessing the demography, clinical presentation, treatment strategies, and outcome of treatment defaulters due to the lockdown.Methods:Cross-sectional, observational study of retinoblastoma patients at a tertiary care ocular oncology center during the first wave of COVID-19 and the resulting nationwide lockdown.Results:Of the 476 eyes of 326 patients undergoing active management with a median age of 57 months (range: 4–214 months), 205 (63%) patients returned for follow-up after a mean delay of 45.8 ± 24.3 weeks (range: 8–80 weeks) and 121 (37%) were defaulters according to the data analyzed till June 30, 2021. Distance of residence was ≥1000 km for 148 patients (46%). In terms of need for active treatment, the number of emergent cases was 2 (<1%), 11 (3%) were urgent, and 313 (96%) were semi-urgent. International classification groups D (n = 107 eyes, 23%) and E (n = 173 eyes, 36%) were in majority, and 13 eyes (4%) and 4 eyes (1%) were at stages 3 and 4, respectively. Prior to lockdown, 86 eyes (18%) had active tumor, which remained unchanged (n = 26, 30%) or worsened (n = 49, 60%) after failure to follow-up. Vision (47%), eye (92%), and life salvage (98%) were achieved by individualized protocol-based management after the patients returned for further management. Five children succumbed to intracranial extension.Conclusion:The COVID-19-related nationwide lockdown has deprived retinoblastoma patients of optimal and timely management, leading to prolonged treatment interruptions, delays, permanent default, and death. It is of paramount importance for all the stakeholders to increase awareness, make necessary travel and logistic arrangements, and ensure continuity of care for children with retinoblastoma.

Evaluation of revised national tuberculosis control program at rural health unit and training center with special reference to category II cases

Background: Tuberculosis (TB) is major public health threat in India and still is a reason for large number of mortality and morbidity. R.N.T.C.P. was implemented to minimize the defaulter, failure rate, but, in spite of implementation of directly observed therapy short (DOTS), there are a huge number of treatment default and failure. Aim and Objective: Our objectives are to evaluate current status of RNTCP under the field service area of R.H.U. & T.C., Singur, and to find out the proportion of failure, relapse, and treatment after default cases, the factors associated with it and propose corrective measures. Materials and Methods: This was an institution-based cross-sectional observational study held from April 2015 to March 2016 over the 186 TB patients under three public health institutions, namely, Nasibpur, Anandanagar, and Paltagarh under R.H.U. & T.C., Singur. This study was based on interview method and record analysis. Data collected from DOTS clinic and study tools were TB treatment card, TU and BPHC records, pre-tested, pre-designed, semi-structured schedule. Results: This study revealed that most of the TB patients were unskilled labors and belonging to upper-lower socioeconomic status. TB was significantly more among the patients with initiation of smoking at the age of 16–20 years. There were 32 CAT II cases out of 186 patients and out of 32 CAT II TB patients, 25%, 6.25%, 12.5%, 6.25%, and 50% have undergone death, migrated out, default, failure, and cured, respectively. Conclusion: The government as well as various NGOs should be involved to increase the knowledge and the approaches toward the preventive aspects of the disease beside only medications.

Determinants of drug resistant & drug sensitive tuberculosis patients from North India-a case control study

Background and objectiveThe burden of drug resistant tuberculosis (DRTB) has posed a huge challenge to for the governments, throughout the world. India has 27% of the global DRTB burden with incidence of 130,000 cases. India has kept an ambitious target of elimination of tuberculosis by 2025 which requires understanding and mitigating various determinants of DRTB. MethodsThe retrospective case control study was undertaken from May to September 2019 among drugresistant (cases) and drug sensitive (controls) tuberculosis patients from two districts of Himachal Pradesh, India. A total of 211 participants were recruited in the study, which includes all 102 cases and randomly selected, age and sex matched 109 controls. A semi structured questionnaire, adapted from a study by Lobo et al, was used for assessing the determinants of DRTB and DSTB. The data collection was undertaken from district and block level health care facilities followed by home visits to patients. Multivariate logistic regression was used to determine risk factors associated with DRTB. ResultsDiagnostic delay (aOR-7.72, p value 0.000), history of treatment default (aOR-2.97, self history of tuberculosis (aOR 1.42, p value 0.01), migration (aOR-4.84, p value 0.000), smoking (aOR-2.70, p value 0.014), and belonging to rural area (aOR-2.62, p value- 0.013) were found as independent risk factors for the occurrence of DRTB. ConclusionThe risk factors identified in the study should be prioritized by the policy makers, implementators and educators for framing appropriate policies in TB control programme in India. The diagnostic delay as a risk factor merits active case finding of TB patients and educating health care staff and community.

Treatment default and its related factors among tuberculosis patients, a case-control study in Iran.

Introduction: Treatment default is one of the main challenges in tuberculosis (TB) control and is considered a major barrier to achieving the sustainable development goals (SDG). Identifying the factors associated with this outcome can help us provide appropriate strategies for decision making. This study investigates the determining factors of treatment default among TB patients. Methodology: In this case-control study, all 88 TB patients experiencing treatment default during an11-year-period in Mazandaran province, Iran, were compared with 176 randomly selected TB patients without a history of default. Cases and controls were matched based on the year of incidence as well as the treatment center. Related factors of treatment default were determined using multivariate logistic regression models. Results: For men, the odds ratio of experiencing treatment default was 1.67 (p=0.165). In addition, considering ages >64 years as the reference group, the odds ratios for 15- to 24- and 55- to 64-year-olds were 0.95 (p=0.940) and 0.37 (p=0.123), respectively. The corresponding odds ratios for patients 25–34, 35–44 and 45–54 years of age were 1.29 (p=0.547), 1.40 (p=0.472), and 1.39 (p=0.512) respectively. Moreover, the odds ratios for urban residents, patients with a history of imprisonment, a history of previous treatment, adverse treatment effects, previous exposure, non-Iranians and patients with smear-positive TB were 1.72 (p=0.070), 1.24 (p=0.657), 1.47 (p=0.756), 0.99 (p=0.998), 0.98 (p=0.960), 9.29 (p=0.010), and 2.27 (p=0.049) respectively.Conclusion: Non-Iranian nationality and smear-positive TB were detected as predictors of treatment default among patients with tuberculosis.