Tuberculosis Control In India Research Articles

Enhancing Tuberculosis Detection: Leveraging RF-HOG Model for Automated Diagnosis from Chest X-ray Images

Tuberculosis (TB) is undeniably an infectious condition that stems from the Mycobacterium tuberculosis bacterium. While it primarily impacts the lungs, it can also harm other body regions if not addressed promptly. TB control in India faces several challenges, including high population density, inadequate healthcare infrastructure in certain regions, limited awareness, stigma associated with the disease, and the emergence of drug-resistant strains. These challenges require ongoing efforts to improve diagnosis, treatment, and prevention strategies. To address the burden of TB, recent advancements in machine learning technologies employed to efficiently detect this disease at an early stage. A completely automated diagnostic system can accurately predict the presence of TB, effectively preventing prolonged lung infections and related diseases caused by TB. In this research, we employed augmentation techniques with HOG (Histogram Oriented Gradients) to extract features from chest X-ray images of TB. These features were then utilized in a Random Forest Classifier to train the proposed model of RF-HOG for classifying Tuberculosis and Normal cases from the image. This proposed method holds promise for diagnosing TB in chest X-ray images and can be beneficial for medical analysts.

Journey of tuberculosis control, conceptual changes and implications of the shift from NTP to RNTCP to NTEP

Tuberculosis (TB) has long afflicted communities and nations. People have suffered for generations as a result of tuberculosis, and even today, when newer methods of diagnosing and treating the disease have made it curable, people continue to suffer and dying from it and malnutrition, overcrowding, air pollution, poor living conditions, and other factors that contribute to the TB burden. Financial decentralisation, as well as increased community participation, are required to achieve TB control in India. Furthermore, RNTCP should be effectively integrated with other related programmes i.e., the NACP to address co-infection (TB-HIV) and the National Rural Health Mission. Emerging problems such as childhood tuberculosis, multidrug-resistant tuberculosis, and multidrug-resistant tuberculosis should be addressed. Financial decentralisation, as well as increased community participation, are required to achieve TB control in India. Furthermore, RNTCP should be effectively integrated with other related programmes i.e., the NACP to address co-infection (TB-HIV) and the National Rural Health Mission. Emerging problems such as childhood tuberculosis, multidrug-resistant tuberculosis, and multidrug-resistant tuberculosis should be addressed.

To evaluate the clinical characteristics and microbiological findings in children with suspected pulmonary tuberculosis

Aim: The aim of the present study to evaluate the clinical Characteristics and Microbiological Findings in Children with Suspected Pulmonary Tuberculosis. Methods: After receiving clearance from the protocol review committee and the institutional ethics committee, the prospective observational study was carried out at the Department of......................... This research covered 100 patients. According to the Revised National Tuberculosis Control Program (RNTCP) guidelines published in the Technical and Operational Guidelines for Tuberculosis Control in India 2016, children aged 6 months to 18 years who present with constitutional symptoms such as persistent fever >2 weeks without a known cause and/or unremitting cough for >2 weeks and/or weight loss of 5% in three months or no weight gain in the previous three months along with any one of the following findings, i.e., his The radiology department performed a chest X-ray and reported findings indicative of tuberculosis, such as hilar and paratracheal lymphadenopathy, parenchymal lesions, and cavitatory lesions. Results: The study covered 100 juvenile patients with an average age of 12.044.96 years. In the research, 58 percent of the individuals were older than 11 years old. The study had a female predominance. Only 44 (44%) male patients participated in the trial, compared to 56 (56%) female patients. The most prevalent complaint was fever (84 percent), followed by cough (76 percent). Other major symptoms at the start of the disease were weight loss (88 percent), lack of appetite (86 percent), and shortness of breath (16 percent). Haemoptysis, chest discomfort, and shortness of breath were less common. Out of 100 participants, 22% tested positive for Mycobacterium tuberculosis, whereas the remaining 78 percent tested negative by both ZN staining and CBNAAT. The proportion of CBNAAT positive patients with cavitation on chest X-ray was 63 percent, which was substantially higher than the national average (p-0.0018). Conclusion: We determined that females were more likely than males to be infected with tuberculosis. The study also discovered that patients with clinical findings indicative of pulmonary Koch's do not necessarily have positive sputum CBNAAT. Sputum positivity was shown to be substantially related to a cavitatory lesion on a chest X-ray.

Prevalence of multi-drug resistant tuberculosis and factors associated with treatment outcome in three districts of Himachal Pradesh, India

Background: Tuberculosis (TB) is a leading cause of morbidity and mortality in the world and especially in India. MDR TB has emerged as a major challenge in TB control in India. The prevalence of MDR TB is on the rise in India. We did this study to see the prevalence of MDR TB in 3 districts of Himachal Pradesh and to study the factors affecting treatment outcomes.Methods: The period of the study was from January 2019 to December 2019. We collected data of MDR TB patients from district TB offices of Solan, Bilaspur and Hamirpur. Information from patients was collected through questionnaires while interviews were conducted with district project officer and other health officials and documents, brochures, etc. were collected from Solan, Hamirpur and Bilaspur.Results: Overall prevalence rate of MDR TB in our study was 3.14%. Among new TB cases, the prevalence rate of MDR TB was 2.42% (81/3345), and among old treated cases was 9% (37/411). 31% MDR TB patients were old treated while 69% patients had no previous treatment history. The default rate was low in our study (0.84%) while 8 (6.4%) patients had treatment interruption but for less than 15 days.Conclusions: The prevalence in our study is comparable to the national drug resistance survey. Early detection, timely treatment and contact tracing is vital in decreasing the MDR TB cases. Better supervision, constant monitoring, proper counselling and timely identification and management of adverse effects of the drugs will improve the treatment outcome among MDR TB patients.

Ethical implications of the National Tuberculosis Elimination Programme in India: A framework-based analysis

Tuberculosis (TB), an infectious disease, is transmitted by inhalation of droplet nuclei discharged in the air. Revised National Tuberculosis Control Programme (RNTCP), now National Tuberculosis Elimination Program (NTEP) of India, has made significant gains in strengthening the support structures, program architecture, and implementation environment for TB control in India. Kass's framework for public health includes an analytic tool that consists of a step-by-step list of six questions for deciding how the burdens and benefits of an intervention can be fairly balanced. We have tried to apply each of the elements addressed in the framework with context to RNTCP/NTEP measures, reviewing relevant literature evidence and attempt to view from the “ receiver's” perspective instead of looking at from “ provider's” perspective. We feel the NTEP provides a sound delivery of ethical principles in the program. Involvement of private sectors into the program for TB control, which is a challenging task, is a requirement for a fair provision of uniform TB care across the nation.

Profile of Multi Drug Resistant Tuberculosis patients: A Study at Drug Resistant Tuberculosis Centre in Kumaun Region, Uttarakhand

Background: Drug Resistant Tuberculosis (DR-TB) has frequently been encountered in India, and its presence has been known virtually from the time anti-TB drugs were introduced for the treatment of Tuberculosis. Multi Drug Resistant Tuberculosis (MDR-TB) is a man-made phenomenon and has become a formidable challenge to effective Tuberculosis control in India. Objectives: To study the Socio-demographic and Clinical profile of Multi Drug Resistant Tuberculosis (MDR-TB) patients presenting to Drug Resistant Tuberculosis (DR-TB) Centre at Govt. Medical College, Haldwani in the Kumaun region, Uttarakhand. Methodology: This study is a Record based study, where in service data available at Drug Resistant Tuberculosis (DR-TB) Centre at Govt. Medical College, Haldwani in the Kumaun region, Uttarakhand, was accessed and analyzed. Inclusion criteria included all patients with diagnosis of Multi Drug Resistant Tuberculosis (MDR-TB) presenting to the centre from 1st April 2015 to 31st December 2015. Results: The present study showed that younger age group particularly males were more affected with MDR-TB. Under-nutrition was quite prevalent among the MDR-TB patients. 56.7% cases were addicted to alcohol and 54.3% cases were addicted to smoking. 85.8% patients took treatment for TB and 44.1% not completed their treatment. Relapse of previous anti-tuberculosis treatment was found to be the major contributor in MDR-TB suspect cases. Prevalence of XDR-TB was also found to be low. Conclusion: The findings of the study emphasize the importance of studying the socio-demographic factors and baseline clinical characteristics in different MDR-TB patient categories to timely modify and strengthen the national programs.

Status and challenges for tuberculosis control in India – Stakeholders' perspective

BackgroundTuberculosis is one of the ten major causes of mortality worldwide. The trend of increasing TB cases and drug resistance in India is very disturbing. The objectives of the study were to study the perspectives and opinions of different stakeholders on the status, challenges and the ways to tackle the issues of TB in India. MethodsThe online survey was done for the data collection from national and international experts. The data collection took place during October 2017. We received 46 responses. ResultsThe experts had varied answers as to the menace of TB in India, effect of TB on individuals, family and society, failure of government plans in India, TB awareness campaign and ways to create awareness. Everyone believed that urgent action needs to be taken against the disease like improving the healthcare infrastructure of the country (improving the quality and quantity of medical facilities and doctors) and creating awareness about the TB. ConclusionGovernment of India is making lot of efforts to bring down the problems associated with TB through. In spite of this, there is a long way to go to achieve significant reduction in high incidence and prevalence of TB in India. Factors like lack of awareness and resources, poor infrastructure, increasing drug resistant cases, poor notification and overall negligence are the major challenges. If we eradicate poverty and undernourishment, educate the masses and eliminate the stigma attached with TB, we can hope for a disease free future.

Allocating outreach resources for disease control in a dynamic population with information spread

Infected individuals must be aware of disease symptoms to seek care, so outreach and education programs are critical to disease control. However, public health organizations often only have limited resources for outreach and must carefully design campaigns to maximize effectiveness, potentially leveraging word-of-mouth information spread. We show how classic epidemiological models can be reformulated such that identifying an efficient disease control resource allocation policy in the context of information spread becomes a submodular maximization problem. This means that our framework can simultaneously handle multiple, interacting dynamic processes coupled through the likelihood of disease clearance, allowing our framework to provide insight into optimal resource allocation while considering social dynamics in addition to disease dynamics (e.g., knowledge spread and disease spread). We then demonstrate that this problem can be algorithmically solved and can handle stochasticity in input parameters by examining a numerical example of tuberculosis control in India.

Journey of tuberculosis control in India

NTP was pilot tested in Anantapur district of Andhra Pradesh during 1961 and thereafter the programme was launched throughout the country.In 1992, the Government of India together with the World Health Organization (WHO) and Swedish International Development Agency (SIDA) reviewed the National TB Programme and concluded that it suffered from managerial weakness, inadequate funding, over-reliance on x-ray, non-standard treatment regimens, low rates of treatment completion and lack of systematic information on treatment outcomes. Programme review showed that only 30% of patients were diagnosed and only 30% of those treated successfully. Based on the findings and recommendations of the review in 1992, the GOI evolved a revised strategy and launched the Revised National TB Control Programme (RNTCP).

Need-based approach for cost-effective tuberculosis control in India.

Need-based approach for cost-effective tuberculosis control in India.

Mitigating the financial effects of tuberculosis requires more than expansion of services.

Mitigating the financial effects of tuberculosis requires more than expansion of services.

Catastrophic costs potentially averted by tuberculosis control in India and South Africa: a modelling study

SummaryBackgroundThe economic burden on households affected by tuberculosis through costs to patients can be catastrophic. WHO's End TB Strategy recognises and aims to eliminate these potentially devastating economic effects. We assessed whether aggressive expansion of tuberculosis services might reduce catastrophic costs.MethodsWe estimated the reduction in tuberculosis-related catastrophic costs with an aggressive expansion of tuberculosis services in India and South Africa from 2016 to 2035, in line with the End TB Strategy. Using modelled incidence and mortality for tuberculosis and patient-incurred cost estimates, we investigated three intervention scenarios: improved treatment of drug-sensitive tuberculosis; improved treatment of multidrug-resistant tuberculosis; and expansion of access to tuberculosis care through intensified case finding (South Africa only). We defined tuberculosis-related catastrophic costs as the sum of direct medical, direct non-medical, and indirect costs to patients exceeding 20% of total annual household income. Intervention effects were quantified as changes in the number of households incurring catastrophic costs and were assessed by quintiles of household income.FindingsIn India and South Africa, improvements in treatment for drug-sensitive and multidrug-resistant tuberculosis could reduce the number of households incurring tuberculosis-related catastrophic costs by 6–19%. The benefits would be greatest for the poorest households. In South Africa, expanded access to care could decrease household tuberculosis-related catastrophic costs by 5–20%, but gains would be seen largely after 5–10 years.InterpretationAggressive expansion of tuberculosis services in India and South Africa could lessen, although not eliminate, the catastrophic financial burden on affected households.FundingBill & Melinda Gates Foundation.

A Snapshot of Grassroots Primary Care and Tuberculosis Control in India—a US Fulbright–Nehru Scholar Program Experience

The Department of Community Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Medical College, Ahmedabad, India, under the aegis of the US Fulbright–Nehru Scholar Program, reviewed the rural and urban primary and district health delivery system, with focus on primary care, child and maternal health and tuberculosis control. The National Health Mission program in India utilizes public and private resources and partnerships to optimally increase access, referrals and improve quality of care. As a collateral, the Revised National Tuberculosis Program, within its broader umbrella, incorporates digital-based locally applicable innovative approaches to tuberculosis (TB) control, to implement the World Health Organization strategy of the Directly Observed Treatment Short-course (DOTS) program. With this approach the program has consistently maintained a high treatment success rate. However, the deficiencies in the program include the loss to follow-up of missing persons with TB, incomplete data in some cases, and erratic coordination between private, academic, public health primary and tertiary care centers.

The Tuberculosis Cascade of Care in India’s Public Sector: A Systematic Review and Meta-analysis

BackgroundIndia has 23% of the global burden of active tuberculosis (TB) patients and 27% of the world’s “missing” patients, which includes those who may not have received effective TB care and could potentially spread TB to others. The “cascade of care” is a useful model for visualizing deficiencies in case detection and retention in care, in order to prioritize interventions.Methods and FindingsThe care cascade constructed in this paper focuses on the Revised National TB Control Programme (RNTCP), which treats about half of India’s TB patients. We define the TB cascade as including the following patient populations: total prevalent active TB patients in India, TB patients who reach and undergo evaluation at RNTCP diagnostic facilities, patients successfully diagnosed with TB, patients who start treatment, patients retained to treatment completion, and patients who achieve 1-y recurrence-free survival. We estimate each step of the cascade for 2013 using data from two World Health Organization (WHO) reports (2014–2015), one WHO dataset (2015), and three RNTCP reports (2014–2016). In addition, we conduct three targeted systematic reviews of the scientific literature to identify 39 unique articles published from 2000–2015 that provide additional data on five indicators that help estimate different steps of the TB cascade. We construct separate care cascades for the overall population of patients with active TB and for patients with specific forms of TB—including new smear-positive, new smear-negative, retreatment smear-positive, and multidrug-resistant (MDR) TB.The WHO estimated that there were 2,700,000 (95%CI: 1,800,000–3,800,000) prevalent TB patients in India in 2013. Of these patients, we estimate that 1,938,027 (72%) TB patients were evaluated at RNTCP facilities; 1,629,906 (60%) were successfully diagnosed; 1,417,838 (53%) got registered for treatment; 1,221,764 (45%) completed treatment; and 1,049,237 (95%CI: 1,008,775–1,083,243), or 39%, of 2,700,000 TB patients achieved the optimal outcome of 1-y recurrence-free survival.The separate cascades for different forms of TB highlight different patterns of patient attrition. Pretreatment loss to follow-up of diagnosed patients and post-treatment TB recurrence were major points of attrition in the new smear-positive TB cascade. In the new smear-negative and MDR TB cascades, a substantial proportion of patients who were evaluated at RNTCP diagnostic facilities were not successfully diagnosed. Retreatment smear-positive and MDR TB patients had poorer treatment outcomes than the general TB population. Limitations of our analysis include the lack of available data on the cascade of care in the private sector and substantial uncertainty regarding the 1-y period prevalence of TB in India.ConclusionsIncreasing case detection is critical to improving outcomes in India’s TB cascade of care, especially for smear-negative and MDR TB patients. For new smear-positive patients, pretreatment loss to follow-up and post-treatment TB recurrence are considerable points of attrition that may contribute to ongoing TB transmission. Future multisite studies providing more accurate information on key steps in the public sector TB cascade and extension of this analysis to private sector patients may help to better target interventions and resources for TB control in India.

Over-the-counter drug distribution and tuberculosis control in India

Over-the-counter drug distribution and tuberculosis control in India

Cost-effectiveness of improvements in diagnosis and treatment accessibility for tuberculosis control in India

Inaccurate diagnosis and inaccessibility of care undercut the effectiveness of high-quality anti-tuberculosis treatment and select for resistance. Rapid diagnostic systems, such as Xpert(®) MTB/RIF for tuberculosis (TB) diagnosis and drug susceptibility testing (DST), and programs that provide high-quality DOTS anti-tuberculosis treatment to patients in the unregulated private sector (public-private mix [PPM]), may help address these challenges, albeit at increased cost. We extended a microsimulation model of TB in India calibrated to demographic, epidemiologic, and care trends to evaluate 1) replacing DST with Xpert; 2) replacing microscopy and culture with Xpert to diagnose multidrug-resistant TB (MDR-TB) and non-MDR-TB; 3) implementing nationwide PPM; and combinations of (3) with (1) or (2). PPM (assuming costs of $38/person) and Xpert improved health and increase costs relative to the status quo. PPM alone or with Xpert cost <1 gross domestic product/capita per quality-adjusted life-year gained relative to the next best intervention, and dominated Xpert interventions excluding PPM. While both PPM and Xpert are promising tools for combatting TB in India, PPM should be prioritized over Xpert, as private sector engagement is more cost-effective than Xpert alone and, if sufficient resources are available, would substantially increase the value of Xpert if both interventions are implemented together.

Newer initiatives in revised national tuberculosis control programme and its current implementation status

The Revised National Tuberculosis Control programme has continuously innovative and progressive in addressing issues related to Tuberculosis control in India. With the implementation of RNTCP, India has taken huge stride in reduction of mortality and morbidity due to TB. The programme has actively incorporated various new ideas, innovations and information communication technology to curb this menace. These newer initiatives provide unprecedented opportunities to control Tuberculosis more efficiently if it implemented effectively. India has made enormous progress towards TB control through their honest effort. Innovations will effectively leverage India’s endeavour. Programme must continue and sustain these efforts to make India TB free.DOI: http://dx.doi.org/10.3126/ajms.v6i5.11945 Asian Journal of Medical Sciences Vol.6(5) 2015 1-8

Assessment of treatment interruption among pulmonary tuberculosis patients: A cross-sectional study.

Background:Multi-drug resistant tuberculosis (TB) is a rising peril of the TB control in India caused mostly by incomplete treatment.Aim:The aim was to assess the treatment interruption among pulmonary TB (PTB) patients.Materials and Methods:A cross-sectional study was carried out for a period of 9 months among PTB patients. Patients admitted with active pulmonary Koch's and history of anti-TB treatment (ATT) for 1-month or more from any source and who returns to treatment after not taking ATT consecutively for 2 months or more were included in the study. The data were collected from the patients or their caretakers to obtain the source of treatment given previously before default, number of treatment interruptions, phase and reasons for treatment interruption treatment.Results:A total of 107 defaulters were identified during the study period. In the present study, 62.6% of the patients interrupted treatment only once, 55.34% of the patient's early continuation (3–4 months) treatment, and 47.66% of the patient's only one reason for the treatment interruptions during the course of the treatment. The most common reason for the treatment interruptions were felt well with TB treatment (29.53%) followed by side effects (16.06%), lack of money (8.29%), and other reasons.Conclusion:The study revealed that most of the defaulters were in the age group between 35 and 60 years, male gender, illiterates, daily wage labor, and married. The treatment interruptions were minimized by putting the efforts to improve direct supervision; pretreatment counseling and retrieve treatment interrupters were recommended.

Alarming levels of drug-resistant tuberculosis in HIV-infected patients in metropolitan Mumbai, India.

BackgroundDrug-resistant tuberculosis (DR-TB) is a looming threat to tuberculosis control in India. However, no countrywide prevalence data are available. The burden of DR-TB in HIV-co-infected patients is likewise unknown. Undiagnosed and untreated DR-TB among HIV-infected patients is a major cause of mortality and morbidity. We aimed to assess the prevalence of DR-TB (defined as resistance to any anti-TB drug) in patients attending public antiretroviral treatment (ART) centers in greater metropolitan Mumbai, India.MethodsA cross-sectional survey was conducted among adults and children ART-center attendees. Smear microscopy, culture and drug-susceptibility-testing (DST) against all first and second-line TB-drugs using phenotypic liquid culture (MGIT) were conducted on all presumptive tuberculosis patients. Analyses were performed to determine DR-TB prevalence and resistance patterns separately for new and previously treated, culture-positive TB-cases.ResultsBetween March 2013 and January 2014, ART-center attendees were screened during 14135 visits, of whom 1724 had presumptive TB. Of 1724 attendees, 72 (4%) were smear-positive and 202 (12%) had a positive culture for Mycobacterium tuberculosis. Overall DR-TB was diagnosed in 68 (34%, 95% CI: 27%–40%) TB-patients. The proportions of DR-TB were 25% (29/114) and 44% (39/88) among new and previously treated cases respectively. The patterns of DR-TB were: 21% mono-resistant, 12% poly-resistant, 38% multidrug-resistant (MDR-TB), 21% pre-extensively-drug-resistant (MDR-TB plus resistance to either a fluoroquinolone or second-line injectable), 6% extensively drug-resistant (XDR-TB) and 2% extremely drug-resistant TB (XDR-TB plus resistance to any group-IV/V drug). Only previous history of TB was significantly associated with the diagnosis of DR-TB in multivariate models.ConclusionThe burden of DR-TB among HIV-infected patients attending public ART-centers in Mumbai was alarmingly high, likely representing ongoing transmission in the community and health facilities. These data highlight the need to promptly diagnose drug-resistance among all HIV-infected patients by systematically offering access to first and second-line DST to all patients with ‘presumptive TB’ rather than ‘presumptive DR-TB’ and tailor the treatment regimen based on the resistance patterns.

Tuberculosis control in India: growing complexities for management.

In India, tuberculosis (TB) remains a major public health problem despite the creation of the Revised National Tuberculosis Control Programme (RNTCP) in 1997. India has 30 States and 6 Union Territories (UT), with 637 districts.1 The Ministry of Health and Family Welfare (MoHFW) provides technical guidance and extends financial support to the RNTCP in the states and districts. For implementation, there are 697 programme management units (PMU) managed by District TB control officers. The onus of implementation remains with the general health system along with a few additional RNTCP contractual staff, and is supported by technical assistance provided by the World Health Organization (WHO). As health is a subject of national importance, the focus on RNTCP implementation issues risks being sidelined, and its challenges remain unaddressed as the issues become diluted along with various national health programmes. We discuss some of challenges that we believe, if addressed appropriately, could strengthen the RNTCP. First, as it is a centrally driven programme, the RNTCP is accorded varying levels of priority by the individual States/UTs, resulting in a lack of appropriate ownership. Sub-optimal administrative commitment to providing exclusive, full-time programme managers continues to plague the system. To meet the higher standards of programme implementation, such as ‘composite indicators’,2 there is a need for dedicated full-time RNTCP managers at all levels. Second, there is a fragile professional relationship between the contractual RNTCP staff and permanent general health system staff working in the field. The former are responsible for supervision and monitoring activities and are considered as dedicated staff of a vertical programme by the permanent general health staff. These misplaced notions trigger hierarchical issues that lead to disharmony and disfunctionality. Discontent also prevails among contractual RNTCP staff as regards job security, salaries, lack of opportunities for promotion and lack of health insurance or other facilities. Technical assistance and support strategies also remain unclear. Third, despite the robust guidelines in place for drugs and logistics management, the absence of real- time monitoring mechanisms has hindered the delivery of quality services. Fourth, failure to devise strategies and leadership that can appositely and effectively engage the private and non-governmental sector has become a complex managerial problem. Fifth, the health system is slower to adapt newer diagnostic technologies and treatment regimens than other high-burden TB countries. Lastly, the complex imbroglio of fund flow and fiscal management within the programme precludes the effective and timely utilisation of money, thereby creating a vicious cycle of less expenditure and less disbursement, leading to compromised activities. Feasible solutions to these complex managerial issues urgently need to be found for TB control to be effective in India.