Tuberculosis Elimination Program Research Articles

Opportunistic Screening for Enhanced TB Case Detection among Inpatients in a Tertiary Care Hospital, Bengaluru

Abstract Background: Tuberculosis (TB) remains a global health challenge, causing substantial illness and death. In India, the National Tuberculosis Elimination Programme (NTEP) has been working to combat TB, but eliminating the disease remains difficult. To improve TB case detection, a feasibility study took place at a tertiary care hospital in Bengaluru, India. The study’s objective was to assess the occurrence of four TB symptom complexes among admitted patients in medicine, emergency medicine, and pediatrics wards and estimate the screening needed to identify one TB patient among these admissions. Materials and Methods: From April to June 2023, a cross-sectional study was conducted at a 750-bed tertiary care hospital in Bengaluru, which had an established NTEP cell. The study encompassed all patients admitted to the medicine, emergency medicine, and pediatrics wards, with a calculated sample size of 1473 patients. Data collection was done using a validated questionnaire, and inpatients were screened for four TB symptom complexes: cough lasting over 14 days, fever or evening rise of temperature, night sweats, and significant weight loss. Positive cases were referred to a designated microscopy center (DMC) for sputum examination and further diagnosis and treatment. Results: Among the 1497 patients screened, 272 (18%) showed symptoms related to tuberculosis (TB). Out of these, 31 (11.3%) were confirmed to have TB through sputum examination and chest X-ray. The calculated number needed to screen (NNS) to identify one TB case among inpatients was 48. PTB cases were most prevalent in the 56–65 age group, whereas diagnosed TB patients were mainly in the 36–45 age group. Conclusions: In conclusion, the daily screening of admitted patients in the Departments of Medicine, Emergency Medicine, and Pediatrics has yielded positive results and is deemed feasible for implementation within the medical college setting.

A Qualitative Analysis of the Driving Forces behind the Nikshay Mitra in National Tuberculosis Elimination Program of India

ABSTRACT Introduction: The Nikshay Mitra initiative under our national program in India allows citizens to adopt and support tuberculosis (TB) patients by providing additional nutritional, diagnostic, and vocational assistance. Materials and Methods: This study is a cross-sectional qualitative analysis based on data extracted from the Central TB Division website, which houses feedback from Nikshay Mitras who adopted TB patients. Results: Thematic analysis carried out identified five major themes that serve as the reason for motivations for citizens to become Nikshay Mitras: altruism and compassion, professional responsibility and knowledge, government initiatives and national duty, personal experience with TB, and addressing TB stigma. Conclusions: The motivations to become Nikshay Mitras are diverse, ranging from compassion for the poor to professional responsibility and a desire to support national health goals. These factors should be leveraged for expanding the Nikshay Mitra initiative among the family members of TB patients as well.

A study on Evaluation of Patient Satisfaction with National Tuberculosis Elimination Programme Services in Ahmedabad, India

Abstract Background: India accounts for the highest burden of tuberculosis cases in the world. Patient satisfaction is a key criterion for evaluating the quality of healthcare services as satisfaction has been found to be associated with superior compliance and better outcomes. Study was planned with the objectives to assess the patient’s satisfaction regarding treatment-related services under NTEP. Materials and Methods: Community-based cross-sectional study was carried out at Ahmedabad Municipal Corporation (AMC) Area. A total of 200 participants were included in the study from various zones of AMC. Probability-proportional-to-size sampling was done and patients seeking care at public (126; 63%) and private (74; 37%) healthcare facilities were included. Questionnaire contained questions related to general sociodemographic profile of participants and satisfaction to NTEP service for which, PSQ-18 Questionnaire was utilized. Results: Overall satisfaction to NTEP services was found to be 86%. Amongst public healthcare facilities satisfaction was found to be 86.5% whereas in private healthcare facility it was 85.1%. Compliance to TB treatment was found in 91.5% of participants. Domains such as general satisfaction, communication, time spent with doctors, and accessibility and convenience were found to be statistically significant at private facility compared with public healthcare facility. Conclusion: Statistically significant difference was found between patient satisfaction at public and private health facilities in domains of general satisfaction, communication, time spent with doctor, and accessibility and convenience. The same domains at public and private type of healthcare facilities were found to have statistically significant role in treatment compliance by study participants.

The association between secondhand smoke exposure and risk of developing active tuberculosis in individuals with latent tuberculosis infection: a systematic literature review.

Tuberculosis is one of the leading causes of death from infectious diseases in the world, with approximately 25% of the global population having latent tuberculosis infection. Secondhand smoke exposure has been recognised as a significant risk factor in the development of active Tuberculosis in individuals with latent tuberculosis infection. This study used the Systematic Literature Review method based on PRISMA guidelines. Relevant articles published between 2014-2024 were identified through PubMed, ProQuest, and Scopus databases using related keywords. A total of 13 articles met the inclusion criteria for analysis. Secondhand smoke exposure significantly increases the risk of latent tuberculosis infection conversion to active Tuberculosis, with a stronger effect in vulnerable groups such as children and individuals who are in close contact with active Tuberculosis patient and live in the same household with heavy smokers. This risk of exposure to secondhand smoke follows a dose-response pattern, where longer duration and higher intensity of exposure directly increase the likelihood of Tuberculosis activation in individuals with latent tuberculosis infection. The biological mechanisms involve immune suppression and lung damage caused by toxic particles in the tobacco smoke, which weaken the body's defenses against Mycobacterium tuberculosis and facilitate the progression of latent tuberculosis infection to active Tuberculosis. Therefore, reducing exposure to secondhand smoke is important to mitigate its impact on active Tuberculosis progression. Secondhand smoke exposure has been consistently shown to increase the risk of developing active Tuberculosis in individuals with latent tuberculosis infection. To support the global Tuberculosis elimination programme, concerted efforts are needed to reduce exposure to secondhand smoke, especially in individuals with latent tuberculosis infection.

Evaluation of the Drug-Resistant Tuberculosis (DR-TB) management component under the National Tuberculosis Elimination Program (NTEP) in Kerala, India, 2021-22.

We evaluated the DR-TB component of the National Tuberculosis Elimination Program (NTEP) in a high-burden district in Kerala to identify the programmatic gaps, if any, in screening, diagnosis, treatment, and follow-up of notified DR-TB patients. A mixed-methods design was used, and the evaluation was performed in two steps. In the first step, we reviewed the program documents and conducted stakeholder interviews to develop a detailed description of the program design and developed a logical framework to evaluate program performance. Consequently, in the next step, we conducted programmatic data reviews, facility surveys, and in-depth interviews with key stakeholders to identify the programmatic gaps in implementation, guided by the logic framework. Of the 494 microbiologically confirmed TB patients during 2021-22, 342 (69%) were tested for drug sensitivity, and 30 DR-TB patients were identified. There was no separate district DR-TB treatment center with airborne infection control facilities, and only 16% (66/422) of the various categories of staff were trained in recent guidelines. Only 30% (9/30) of DR-TB patients were provided with any psychological assessment. The favorable treatment outcome was 80% Interviews revealed poor readiness and motivation from the private sector for screening, contextual barriers in human resource availability, transportation, and financial barriers to the beneficiary despite providing financial benefits. Prioritizing the establishment of a district DR-TB treatment center and sputum transport mechanism, posting a clinical psychologist dedicated to counseling patients on therapy, and training all categories of staff on DR-TB management guidelines will significantly contribute to improving program outcomes.

Are all tuberculosis deaths correctly attributed due to tuberculosis? Analysis of causes of death (COD) using verbal autopsy: A cross-sectional study in Puducherry

ABSTRACT Background: State Task Force National Tuberculosis Elimination Programme (STF-NTEP) wanted to ascertain the cause of death of tuberculosis (TB) patients was due to TB. Hence, this study was done to determine the cause of death among TB patients using verbal autopsy. Material and Method: The community-based cross-sectional study was conducted among the closest caregivers of the reported TB death cases using a verbal autopsy questionnaire. A list of TB deaths was extracted from Puducherry’s State Tuberculosis Office (STO). The VA questionnaires were reviewed by two trained faculties and experts independently who were also asked to code the cause of death according to the International Classification of Diseases – 10th Revision. Data were analysed using the SPSS software receiver operator curve (ROC) curve and Cohen’s kappa statistics with 95% confidence interval (CI) were applied to compare agreement between the raters. Results: Out of 307 TB deaths, 143 were contacted and the remaining were migrated, missing or not available. Among them 34.9% of the declared TB deaths are not due to TB. Cohen’s kappa = 0.4; 95% CI: (0.858–0.985) showed moderate agreement between the raters. Experts’ review was used as a reference standard to compare rater agreements. The Predictive accuracy of Rater 2 (area under the curve [AUC] −0.953; P value <0.001) was slightly higher than Rater 1 (AUC −0.942; P value <0.001). Conclusion: The findings of the study have clearly indicated that 34.9% of the declared TB deaths are not due to TB.

Impact of empirical treatment in patients with extrapulmonary tuberculosis and their outcome

BackgroundTuberculosis (TB), primarily caused by mycobacterium tuberculosis (Mtb), remains a significant public health concern globally, particularly in low-resource settings. Extrapulmonary tuberculosis (EPTB), which affects organs beyond the lungs, presents diagnostic and treatment challenges, necessitating improved clinical management strategies. This work was aimed to assess the impact of empirical anti-TB treatment on the outcomes of patients with extrapulmonary tuberculosis and to analyze the demographic and risk factors associated with EPTB.MethodsA retrospective cohort study was conducted over three years (2020–2023) at PSG Hospitals, Coimbatore. Ninety-two subjects, all with negative microbiological results but symptoms indicative of EPTB, were carefully selected.ResultsA total of 92 patients were included in the study, all of whom had negative microbiological diagnosis with symptoms suggestive of EPTB. The mean age of patients was 58.14 years, with a male predominance (59.78%). Pleural effusion was the most common EPTB site, with many patients having no co-morbidities. Occupational factors, such as cotton millwork, and lifestyle factors, including alcohol use and malnutrition, were prominent risk factors. Clinical manifestations varied, with fever being the most common symptom. Treatment completion was 65.22%, falling below National Tuberculosis Elimination Program (NTEP) guidelines, with notable loss to follow-up and mortality rates.ConclusionEmpirical treatment for EPTB showed notable improvement in the patient's symptoms and overall health. However, challenges persist in treatment completion, especially among socioeconomically disadvantaged populations. Early detection, prompt treatment initiation, and comprehensive management are essential to address the multifaceted challenges posed by EPTB effectively.

Clinical profile, risk factors, disease severity, and outcome for COVID-19 disease in patients with tuberculosis on treatment under the National Tuberculosis Elimination Program: a cohort of 1400 patients.

COVID-19 affected millions of people worldwide, and tuberculosis (TB) continues to affect millions of people each year. The combined pandemic of COVID-19 and TB had a catastrophic effect on healthcare policies and healthcare setups around the globe. The clinical profile and factors affecting the outcome of COVID-19 disease in TB patients on treatment in field conditions have not been studied in detail. The present study attempted to study the occurrence of COVID-19 among patients on TB treatment in terms of severity of COVID-19 disease and outcome of both COVID-19 and TB in patients at National Tuberculosis Elimination Program treatment centers over a period of one year during peak COVID-19 times. Out of 1400 TB patients enrolled, 65 (5%) suffered from COVID-19 disease. Of the 65 TB patients with COVID-19 disease, 37 (57%) were male and under 45 years old, 33 (51%) had a TB diagnosis after first receiving a COVID-19 diagnosis, 29 (45%) had a TB diagnosis first, and received anti-TB treatment before receiving a COVID-19 diagnosis, and only 3 patients (5%) had a COVID-19 and TB diagnosis concurrently. The majority of 59 (91%) patients had mild COVID-19 disease. The outcome of TB treatment was available in 25 patients out of these 65 COVID-19-positive patients, with 21 (84%) patients having a favorable outcome. Out of the 65 COVID-19-positive patients, 4/25 (16%) had unfavorable outcomes, with one patient (4%) failing TB treatment and two patients (8%) dying. This is the first study from India that studied the occurrence and course of COVID-19 among a large number of TB patients taking anti-TB treatment under programmatic conditions. Due to the similarity in symptoms of TB and certain viral respiratory illnesses, a protocol should be established for health care to check patients for both illnesses.

Bridging the "know-do" gap to improve active case finding for tuberculosis in India: A qualitative exploration into national tuberculosis elimination program staffs' perspectives.

In 2022, India's national tuberculosis (TB) elimination program (NTEP) commissioned a national level evaluation of active case finding (ACF) for TB to guide evidence-based strategic planning. As part of this evaluation, based on secondary data analysis we observed that the quality of ACF was suboptimal in 2021. Hence, this study aimed to understand the enablers, barriers, and suggested solutions to improve ACF for TB in India from NTEP staff (provider) perspective. This was a descriptive qualitative study involving key informant interviews from six districts and eight states, conducted between February and August 2023. We purposively selected key state- district- and sub-district-level program managers and implementers who were experienced and vocal. The interviews were audio recorded and transcribed verbatim by research interns and investigators. Two investigators independently did manual descriptive thematic analysis, and a third investigator resolved inconsistencies. The themes and categories emerged by collating together the results of the coding process. A total of 34 key informant interviews were conducted and of these, four were repeat interviews. Adequate budgets for ACF including incentives, performance review mechanism, engagement of all stakeholders, adopting a community friendly approach, use of rapid diagnostic tests and digitalization were the perceived enablers. In some states ACF was implemented in general population (not restricted to high-risk population) following directives at state level. There were limited mechanisms to ensure ACF quality indicators were met before disbursing incentives and cross-verification of the aggregate ACF care cascade numbers that were reported in Ni-kshay (electronic TB information management system under NTEP). In addition to the state and district level implementers having limited understanding of concepts around ACF (quality indicators, number needed to screen and yield), we also inferred the presence of a 'know-do' gap for many activities under ACF. The suggested solutions were around capacity building and quality improvement strategies. The existing national ACF guidance should be revised to emphasize capacity building, need to carry out ACF in high-risk (not general) population, quality control-linked incentives, and regular implementation monitoring of the activities. This should contribute towards better coverage and improved quality translating into better ACF outcomes.

Sociodemographic factors affecting knowledge levels of tuberculosis patients in New Delhi.

Sociodemographic factors can significantly influence the knowledge level of tuberculosis (TB) patients, affecting the overall health outcomes. Due to lack of awareness and the stigma associated with TB, Indian TB elimination efforts are facing challenges. Patients with less information are more likely to experience delays in diagnosis and proper care. A cross-sectional study was conducted in New Delhi across 26 operational National TB Elimination Program districts, involving 200 adult pulmonary TB patients receiving treatment from April to August 2020. A structured questionnaire guided the interviews, followed with bivariate analysis and descriptive statistics used for analysis. Predominantly, residents of semiurban regions accounted for the highest proportion (70.5%), followed by urban areas (20.5%), with rural areas/slums comprising a minority (9%). Notably, a significant majority (94.5%) reported residing in individually owned dwellings, with shared accommodations limited to a minority (5.5%). Sanitary facilities varied, with 77% possessing personal toilets, 18.5% utilizing private facilities, and only 4.5% relying on public toilets. Awareness levels about TB reflected moderate awareness among 56% of participants, good knowledge among 41%, and minimal awareness (poor knowledge) among only 3% of respondents. Age, sex, socioeconomic level, kind of lodgings, malnutrition, and personal cleanliness should all be taken into account for TB treatment adherence. A new set of frameworks should be developed to enhance the living circumstances of high-risk populations and patients who are living in crowded locations since sharing a room or a house in a populated region increases the risk of TB transmission.

Identifying Predictors of Unfavorable Treatment Outcomes in Tuberculosis Patients.

In South Korea, there has been a continuous decrease in the incidence of tuberculosis (TB) attributable to a national TB elimination program; however, TB still poses a significant socioeconomic burden. This study aimed to analyze factors associated with successful TB treatment and to identify refractory patient groups with unfavorable outcomes. We analyzed anonymized data on 89,150 patients with TB provided by the Korea Disease Control and Prevention Agency. Specifically, we collected independent variables, which were categorized as individual, regional, and medical facility factors. Individual factors included age, sex, nationality, TB type, drug-resistant status, category of TB, housing type, underlying disease status, number of referrals, and smoking status. Regional factors referred to the region where the TB case was reported. Medical facility factors included the first visit to a medical facility, categorized by hospital type and the distinction between private-public mix (PPM) and non-PPM depending on the presence or absence of dedicated TB nurses. These factors were analyzed in relation to treatment success to identify refractory patient groups with unfavorable outcomes. Multivariable logistic regression analysis revealed the following significant factors associated with successful TB treatment: sex, nationality, status of drug-resistant TB, category of TB, number of referrals, region of TB registry, underlying diseases, and smoking status. Specifically, compared with their relevant counterparts, male patients had a lower rate of successful treatment (adjusted odds ratio [aOR]: 0.66, reference [Ref.]: women); Korean nationals had a higher rate of treatment success (aOR: 7.20, Ref. foreign residents in Korea); resistant TB was associated with a lower rate of treatment success (aOR: 0.35, Ref.: non-resistant TB status); newly treated patients had a higher rate of treatment success (aOR: 1.75, Ref.: retreatment patient); switching hospitals once (aOR: 1.78), never (aOR: 1.41), or twice (aOR: 1.37) was associated with increased treatment success (Ref.: three or more times); having zero (aOR: 1.45), one (aOR: 1.31), or two (aOR: 1.24) underlying diseases was associated with a higher rate of treatment success (Ref. three or more underlying diseases); and past smokers (aOR: 1.40) and non-smokers (aOR: 1.35) had a higher rate of treatment success (Ref.: current smokers). Our study identified several factors contributing to unfavorable treatment outcomes in tuberculosis patients, including male patients, foreign residents in Korea, drug-resistant TB, retreatment patients, frequent hospital switching, multiple underlying diseases, and current smoking status. These research findings could inform the development of efficient management strategies and policies for improving the treatment success rate among patients with TB.

Public-private-partnership needs under the National Tuberculosis Elimination Program in an Eastern Indian state

Public-private-partnership needs under the National Tuberculosis Elimination Program in an Eastern Indian state

Verification of Sub-national Claim for 'TB-free' Status of Rajsamand District, Rajasthan, India-2020.

Tuberculosis (TB) caused by Mycobacterium tuberculosis is an opportunistic infection that affects the lungs in humans. Caseload of TB has been deemed it endemic in various regions of the world and India is on top of that list. The Government of India has set out a goal to eliminate tuberculosis in India by the year 2025 with the help of the National Strategic Plan (NSP) 2017-25. The objective of the index study was to verify the claim of Rajsamand district in Rajasthan, that it witnessed a >20% reduction in TB incidence between 2015 and 2020. This was a mixed-methods study. Quantitative component (cross-sectional study): Secondary data review (review of records from Nikshay notification systems and National tuberculosis elimination program (NTEP) reports, utilization of drugs in the public sector, and drug sales in the private sector). Primary data collection through survey. Qualitative component: nominal group technique and key informant interviews. Percentage decline of a ≥ 20% incidence in 2020 compared to baseline 2015 was not seen. The number needed to test (increased by 18.26% in 2020 as compared to the baseline of 2015. TB Score of Rajsamand district for the year 2020 was 68.34 out of 100. Rajsamand district's claim of ≥20% reduction in TB incidence in the year 2020, was rejected.

Cost-effective analysis of active case finding (ACF) strategy to detect pulmonary tuberculosis (PTB) in selected public health care facilities of the northern state, India

BackgroundIn addition to passive case finding (PCF), active case finding (ACF) strategy under National Tuberculosis Elimination Program is a vital secondary prevention intervention under National Strategic Plan (NSP). The present study was conducted to assess ACF's cost-effectiveness compared to PCF in selected public health facilities for the detection of presumptive TB cases under NTEP. Material and methodsA cross-sectional study was carried out in randomly selected seven public health facilities of a health block of one district of Himachal Pradesh. Bottom-up costing method was used with bootstrapping of results to assess incremental cost-effectiveness ratio (CEAC) and cost-effectiveness acceptability curve (CEAC). ResultsMean cost for ACF and PCF with US$ 3325.8 and 3006.0 respectively to detect all presumptive PTB cases; and US$ 4121.2 and to US$ 3709.0 to confirm all PTB cases. Below WTP threshold (per capita income US$ 2735), WTP 80.3% of simulated ICER values were cost-effective. CEAC showed that saturation was achieved around US$ 300 indicating a likely WTP threshold at which 79.5% of simulated values were cost-effective. For both strategies, One way sensitivity analysis showed the cost is influenced mostly by human resources. ConclusionCurrent study used bottom-up costing method in public health care facilities observed ACF as a cost-effective strategy in reaching out for presumptive PTB. The major cost driver in both strategies is human resource for training, travelling, and administration.

A retrospective record-based study to evaluate the profile of TB patients diagnosed and registered at DOTS center at the tertiary care center and to study the gaps in the implementation of the latest guidelines toward TB elimination

Context: Tuberculosis (TB) has infected mankind since time immemorial. India has been a breeding ground for this disease due to high population density and lack of awareness and education in the population. It is thus very important to understand the profile of TB patients and to find out the various limitations in the functioning of the National Tuberculosis Elimination Programme in order to focus on strengthening the goal of TB elimination in India. Aim: To describe the demographic profile and clinical characteristics of TB patients enrolled at DOTS Centre between October 2018 and December 2022 at a tertiary care center in North India. Settings and Design: A retrospective record-based study. Materials and Methods: A retrospective record-based study was carried out involving a review of existing data in Nikshay-2, which was accessed from the DOTS center at a tertiary care center in North India. Statistical Analysis Used: The data entry was done in a Microsoft EXCEL spreadsheet and analyzed using the SPSS version 17. Results: Of the total 2689 patients, 1222 (45.4%) were diagnosed with pulmonary TB (PTB) and 1467 (54.6%) with extrapulmonary TB, with most common type of EPTB was lymph node TB in 750 (51.1%) patients. The most common comorbidity was diabetes mellitus in 154 (30.1%) patients. Diagnosis of PTB was made by sputum microscopy in 410 (33.5%), CBNAAT 712 (58.2%), chest X-ray 21 (1.7%), and CT chest in 79 (6.4%) patients. Diagnosis of extra-PTB was made by CBNAAT 145 (9.8%), CT and MRI 190 (12.9%), and by cytopathology in 1132 (77.1%) patients. Outcome of TB patients was cured in 1082 (40.2%), treatment completed 1300 (48.3%), 32 (1.2%) patients died during treatment, 190 (7.1%) lost to follow-up, 2 patient migrated, treatment failed in 5 patients, regimen changed in 6 patients and data were not updated for 41 (1.5%) patients. Conclusion: This study thrusts on intensification of strategies like to improve lab infrastructure, to provide CBNAAT and LPA facilities at all medical colleges and district level, and IEC training to doctors (Interns, Medical officers, specialists), TB health workers and laboratory staff with the latest guidelines, importance of updating Nikshay portal and sensitization of treating physicians and lab personnel to send relevant samples for CBNAAT and LPA testing so as to detect drug-resistant cases on time in order to achieve elimination of disease.

Tuberculosis Preventive Treatment (TPT) in India: A Qualitative Review

Abstract This review examines TB preventive treatment (TPT) implementation in India, highlighting barriers and potential solutions to improve outcomes under the National Tuberculosis Elimination Programme. Qualitative insights from beneficiaries, healthcare workers and policymakers reveal barriers and facilitators in TPT implementation. Key findings include requirements for strong policy commitment and customised interventions to address system-level barriers such as limited human resources, inadequate infrastructure, treatment adherence issues and community engagement barriers. The findings also revealed to create a responsive system that addresses the specific supportive system to ensure treatment adherence and successful outcomes. The integration of TB infection algorithm in existing TB diagnostic and treatment algorithms and comprehensive active case findings could result in positive outcome in reduction of TB, advancing India’s goal of TB elimination.

Quantitative Study of Physical, Social, Psychological, and Environmental Challenges Faced by Patients With Drug-Resistant Tuberculosis.

Background This study chronicles the socioeconomic and emotional challenges experienced by patients suffering from drug-resistant tuberculosis (DR-TB) in India, the country with the highest tuberculosis (TB) burden globally. Current government measures under the National TB Elimination Programme (NTEP) that include widely available molecular diagnostic methods, well-defined DR-TB regimens, free drug distribution, treatment adherence strategies, etc. need to expand to cover socioeconomic and emotional aspects of the disease. Objective The objective of this study was to assess the effects of DR-TB and its treatment on the quality of life of patients in the psychological, social, environmental, and physical domains using validated scales. Method Conducted at a tertiary care center in Pune, this quantitative study utilized the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire to objectively assess the quality of life of 64 DR-TB patients. The questionnaire was self-administered but assisted by the investigator to understand the meaning of the questions, and it covered four domains: psychological, social, environmental, and physical. Results The results indicated significant psychological distress, with the psychological domain scoring the lowest mean (33.41), followed by social (35.52), environmental (41.27), and physical domains (41.88). These findings underscore the profound impact of DR-TB on the mental health, social interactions, and overall well-being of these patients. Furthermore, substantial employment challenges, financial constraints, and fears of disease transmission were prevalent among patients, highlighting socioeconomic disparities. Conclusion The study emphasizes the necessity of holistic interventions that include psychological support, socioeconomic empowerment, and public health campaigns to improve the quality of life and treatment adherence for DR-TB patients. Future research should explore integrated care models that address both the clinical and psychosocial needs of patients. The insights from this study suggest a need for policy enhancements and resource allocation to better support this vulnerable population, ultimately aiming for more comprehensive and sustainable DR-TB management, thus focusing not only on the outcome but also on morbidity.

Audit of risk factors of drug-sensitive, drug-resistant tuberculosis disease, a case-control study of patients registered under NTEP, Gujarat.

Characterizing risk factors for drug-resistant tuberculosis (TB) is critical to guide targeted interventions in high-burden settings like India. We aimed to identify socioeconomic, lifestyle, and clinical factors associated with drug-sensitive and drug-resistant TB acquisition. A comparative cross-sectional study recruited 350 bacteriologically confirmed TB patients registered under the National Tuberculosis Elimination Program (NTEP) in Gujarat, India, and 300 matched participants without active/past TB. Multinomial logistic regression analyzed risk factors for 200 drug-sensitive and 150 drug-resistant TB cases compared to participants without active or past TB. Key factors independently associated with higher adjusted odds ratios (aOR) of both TB types included low socioeconomic status (SES) (drug-sensitive TB: aOR 1.7, 95% CI 1.2-2.5; drug-resistant TB: aOR 2.2, 95% CI 1.3-3.7), crowding (>5 persons/room) (drug-sensitive TB: aOR 1.6, 95% CI 1.1-2.3; drug-resistant TB: aOR 1.9, 95% CI 1.2-2.9), undernutrition (drug-sensitive TB: aOR 1.6, 95% CI 1.1-2.3; drug-resistant TB: aOR 2.0, 95% CI 1.2-3.2), smoking (drug-sensitive TB: aOR 1.5, 95% CI 1.0-2.3; drug-resistant TB: aOR 1.7, 95% CI 1.1-2.7), and indoor air pollution (drug-sensitive TB: aOR 1.5, 95% CI 1.0-2.2; drug-resistant TB: aOR 1.8, 95% CI 1.2-2.8). Marked social determinants and clinical risks drive heightened susceptibility for both TB types in India, while prior inadequate treatment and nosocomial exposures selectively enable additional drug resistance. Holistic prevention policies jointly targeting transmission, vulnerability, and curative factors are imperative.

“Diabetes among tuberculosis patients in Bengaluru is alarming: Time to tackle it efficiently!”

ContextTuberculosis (TB) remains a major health challenge in India, with the country bearing the highest global burden. Co-existing with this epidemic is the surge in diabetes mellitus (DM) cases, earning India the title of "Diabetes Capital." AimThis study investigates the association between TB and DM, focusing on the feasibility and outcomes of screening TB patients for diabetes. It also explores the challenges and opportunities for integrated care of TB-DM comorbidities. Settingsand Design: This cross-sectional study was conducted in 32 tuberculosis units in the BBMP district of Bengaluru, Karnataka, India. Materials and methodsData were collected from TB laboratory registers and through interviews with National Tuberculosis Elimination Program (NTEP) healthcare providers. The study assessed the implementation of diabetes screening, challenges in the process, and suggestions for improvement. ResultsAs part of the Quantitative data, of the 17,052 presumptive TB cases examined, 41% were aware of their diabetes status. Diabetics constituted 14.61% of the presumptive cases. Of the diagnosed TB patients, 25.2% were found to be positive for DM as well. Qualitatively, healthcare providers highlighted operational challenges, mainly concerning the timing of blood sugar testing and the need for referral to higher-level facilities. They also emphasized the importance of generating awareness among communities and training healthcare workers for on-the-spot diabetes screening. ConclusionThe findings highlight the urgent need for improved screening of TB patients for diabetes, timely initiation of anti-diabetic treatment, and comprehensive healthcare services under one roof. Advocacy, communication, and social mobilization strategies should be intensified to create awareness of TB-DM comorbidities in the general population.

Clinical spectrum of tuberculosis in adolescents (10–19 years) in a tertiary care center of North India

Background\\objectivesThere is limited literature available to characterize tuberculosis (TB) in adolescents despite them sharing a high burden of the disease. Ours is the first prospective study in India and worldwide to study the clinical profile of tuberculosis in adolescents aged 10–19 years.Methods: We enrolled 82 children and adolescents between March 2021 to March 2022. The diagnosis of TB was made on the basis of National Tuberculosis Elimination Program (NTEP) guidelines 2020. Adolescents were divided into 3 age groups: early (10–13 years), middle (14–17 years), and late adolescents (18–19 years)and the results were compared among the three groups. A two-sided p value of <0.05 was considered statistically significant.Results: The middle age adolescents comprised majority of our study population and females were more than males. The common presenting features were fever, chest pain, breathing difficulty with majority belonging to lower socioeconomic status. The pulmonary TB accounted for 56% and extrapulmonary constituted 44% of the cases. The notable extrapulmonary cases were disseminated TB with secondary lymphangiectasia, compressive myelopathy, sacroiliac joint arthropathy among others. Infiltrates/consolidation were the most frequent radiological findings in patients with pulmonary TB. The microbiological confirmation was available in 44% of the cases. The microbiological positivity was higher in histopathological specimens and in late adolescents. Two patients were rifampicin resistant. Conclusion: There was a varied clinical presentation of TB in this population. The extrapulmonary cases as well as the microbiological yield increased with increasing age of the cases.