Tuberculosis Unit Research Articles

Recurrence Rate of Pulmonary Tuberculosis in Patients Treated with the Standard 6-Month Regimen: Findings and Implications from a Prospective Observational Multicenter Study

Tuberculosis (TB) recurrence following successful treatment is a significant challenge in TB control programs. However, the rate of TB recurrence varies among studies. It depends on several factors, including the country/region where the investigation occurs, the study design, sample characteristics, and the anti-TB regimen used. In Yemen, a few previous studies examined the rate of TB recurrence and reported high recurrence rates, with a 5-year recurrence rate of approximately 9.5%. However, they were conducted before 2010 using the previous anti-TB regimen which was phased out and replaced with the World Health Organization's (WHO) standard 6-month TB regimen. Consequently, this study aimed to examine the rate of TB recurrence after the implementation of the WHO standard 6-month regimen in Yemen. A prospective observational study was conducted with patients diagnosed with drug-susceptible pulmonary TB. The patients were recruited from five health centers with TB units in five governorates from January to December 2011. All the patients were followed up for five years after treatment completion. A total of 439 patients who completed the anti-TB regimen met the inclusion criteria and were included in the study. During the 5-year follow-up period, 8 patients (1.8%) died, and 13 patients (2.96%) were lost to follow-up, resulting in a final cohort of 418 patients. Of the cohort, 50.5% (n = 211) were male, while 49.5% (n = 207) were female patients. Of the patients, 129 patients (30.9%) were illiterate, 56 (13.4%) had cavitary pulmonary disease, and 6.2% (n = 26) had diabetes. The overall 5-year rate of TB recurrence in this study for the patients receiving the standard 6-month regimen was 2.9% (12/418). Moreover, almost half of the recurrent cases (41.7%; n = 5) were seen during the first year of the follow-up period. Some patient groups with risk factors recorded a higher recurrence rate, including patients with diabetes (15.4%), non-compliant patients (14.3%), pre-treatment lung cavitation patients (8.9%), illiterate patients (7.8%), and underweight patients (5.1%). In conclusion, the overall TB recurrence rate with the standard 6-month regimen was lower than that with the previous TB regimens. However, more efforts are needed to decrease TB recurrence rates further and achieve a durable cure for TB. In addition, healthcare professionals and TB control programs should consider potential risk factors of recurrence and address them to provide optimal care.

A mixed method study to assess notification of tuberculosis patients by private practitioners in New Delhi, India.

A staggering one million tuberculosis (TB) cases are missing from notification, most of them being diagnosed and treated in the private sector. To curb this issue, the Government of India declared TB as a notifiable disease and NIKSHAY was launched in 2012. However, even after years of implementation, as per the report published by TB India 2020, the proportion of private case notification of total TB cases is very low. The objectives of the study were to assess the current practices related to TB Notification being followed by private practitioners of Delhi and to explore the enablers and barriers to TB notification among private-sector treatment providers. This cross-sectional study was done from January 2019 to January 2020. Six hundred doctors were line listed under the chosen TB unit, 375 gave consent and in depth interview was conducted among them. Data were collected on the reporting status and facilitators and barrier toward NIKSHAY reporting were assessed. For the qualitative component, focused group discussions were done. Out of 375 private practitioners, over two-third (68%) practitioners reported that they were not treating TB patients. Out of 108 doctors treating patients only 50% were reporting the cases. Major reason cited for not reporting was "don't know how to" and major barrier considered was "lack of training." Strategies such as training and retraining, and one-to-one sensitization of private practitioners to address barriers may enhance TB notification.

Why and where?-Delay in Tuberculosis care cascade: A cross-sectional assessment in two Indian states, Jharkhand, Gujarat.

Tuberculosis (TB) is the second leading cause of death due to infectious diseases globally, and delay in the TB care cascade is reported as one of the major challenges in achieving the goals of the TB control programs. The main aim of this study was to investigate the delay and responsible factors for the delay in the various phases of care cascade among TB patients in two Indian states, Jharkhand and Gujarat. This cross-sectional study was conducted among 990 TB patients from the selected tuberculosis units (TUs) of two states. This study adopted a mixed-method approach for the data collection. The study targeted a diverse profile of TB patients, such as drug-sensitive TB (DSTB), drug resistance TB (DRTB), pediatric TB, and extra-pulmonary TB. It included both public and private sector patients. The study findings suggested that about 41% of pulmonary and 51% of extra-pulmonary patients reported total delay. Delay in initial formal consultation is most common, followed by a delay in diagnosis and treatment initiation in pulmonary patients. While in extra-pulmonary patients, delay in treatment initiation is most common, followed by the diagnosis and first formal consultation. DR-TB patients are more prone to total delay and delay in the treatment initiation among pulmonary patients. Addiction, co-morbidity and awareness regarding monetary benefits available for TB patients contribute significantly to the total delay among pulmonary TB patients. There were system-side factors like inadequacy in active case findings, poor infrastructure, improper adverse drug reaction management and follow-up, resulting in delays in the TB care cascade in different phases. Thus, the multi-disciplinary strategies covering the gambit of both system and demand side attributes are recommended to minimize the delays in the TB care cascade.

Utilization of Nikshay Poshan Yojna in tuberculosis patients in two tuberculosis units of North India

Background: Nikshay Poshan Yojana (NPY) was launched in 2018 aiming to provide nutritional incentive of INR 500 per month to all tuberculosis (TB) patients till they complete their treatment. Aim of present study is to determine the number (proportion) of patients being treated for tuberculosis who received the benefits of NPY and to explore the ways incentives were utilized by the patients. Methods: This cross-sectional study was conducted in two tuberculosis units of North India from June 2022 to Dec 2022. All newly diagnosed TB patients registered and receiving treatment in these two Units were included in the study. Defaulters, relapse, failure and multidrug-resistant TB cases were excluded. Data was collected from Nikshay portal. All the patients were contacted telephonically to know whether the incentive was utilized for nutrition. Results: Total 189 patients were included in the study. All patients received benefit under NPY. But only 26 (13.7%) received incentive in scheduled time. Out of 189 patients 56 refused to give telephonic interview about the utilization of incentives. Out of 133 patients who gave interview 85 (64%) patients utilized incentive entirely for nutrition. Conclusions: Government should assure timely availability of funds so that patients can be benefitted timely particularly during initial months of their treatment. Also, there is a need of counselling of patients receiving treatment for tuberculosis about the importance of nutrition in their treatment so that they can utilize financial incentive for nutrition.

Effects of COVID-19 pandemic on tuberculosis control: Evaluation of studies of tuberculosis units

In this study, it was aimed to evaluate the studies carried out in tuberculosis units and the effects of the COVID-19 pandemic on tuberculosis control in Mersin in 2018-2021 years. In this way, deficiencies in tuberculosis units during the pandemic will be determined and solution proposals will be presented. This descriptive study was conducted in Mersin between December 2021 and May 2022. The records of Mersin Provincial Health Directorate tuberculosis units for the years 2018-2019-2020-2021 were included in the study. In the study, the examination, contact examination, organized community scans, BCG vaccinations, tuberculin skin tests, bacteriological and radiological examinations, treated patients and preventive treatment practices in tuberculosis units in Mersin were evaluated. Descriptive statistics were used in summarizing the data. 14029 examinations were performed in 2018, 12097 in 2019, 7601 in 2020 and 7849 in 2021 in the tuberculosis units in Mersin province. The number of radiological examinations in tuberculosis units in 2018, 2019, 2020 and 2021 are; 8148, 7951, 2885, 3278, respectively. The number of bacteriological examinations performed are 2701, 2107, 921, 709. According to the years, the number of people who received treatment was determined as 214, 189, 165, 174. In the years before and after the pandemic, when 2019 and 2020 were compared, 37.2% decrease in the total number of examinations and a 12.7% decrease in the number of patients treated were determined in Mersin. In the years after the onset of the pandemic, there was a decrease in all services in tuberculosis units compared to the years before the pandemic.

Health Status and Treatment Outcome of Tuberculosis with Diabetes Mellitus Cases, Rajkot City, Gujarat - A Longitudinal Study.

India, with the highest number of tuberculosis (TB) cases in the world, is also facing epidemic growth in diabetes mellitus (DM). TB is curable while DM is a metabolic and incurable disease that if not controlled will affect the health status of a person. This study was conducted to assess the health status and treatment outcome of TB with DM cases. We selected a total of 64 newly registered pulmonary TB (PTB) with DM cases from five tuberculosis units (TUs) in Rajkot city from October 2019 to December 2020. At the end of treatment, 64 cases were analyzed for treatment outcome and 56 cases (5 deaths; 3 lost to follow-up) were followed up to observe progression in health status. The information was collected in pretested proforma by interview. There was a significant improvement in TB symptoms (cough, weight loss, weakness, anorexia, evening rise of temperature, dyspnea, chest pain, hemoptysis), DM symptoms (frequent urination, excessive thirst and hunger, tingling and numbness), symptoms of mental health (fatigue, sleep disturbance, negative emotions, socially inactive), and adverse drug reactions (ADRs) on consecutive visits (McNemar's test, P < 0.001) and at the end of treatment (Cochran's Q test, P < 0.001). Improvement of nutritional status was also found statistically significant on consecutive visits (Wilcoxon test, P < 0.001) and at the end of treatment (Friedman's test, P < 0.001). The cure rate was 82.8% and 4.7% of cases had completed treatment. At the end of treatment, there was a significant improvement in health status and treatment outcome; also good cure rate was reported among cases.

Knowledge, Attitude, and Practice on Pediatric Tuberculosis Management among Healthcare Workers in the Centre Region of Cameroon: A Cross-Sectional Study.

This study was designed to assess the level of knowledge, attitude, and practice (KAP) of healthcare workers (HCWs) on pediatric TB management and its associated factors in the Centre Region of Cameroon. A cross-sectional study was conducted between January and March 2022. HCWs, selected through a multistage sampling technique in 21 health facilities, were interviewed using a KAP questionnaire on pediatric TB management. Logistic regression analyses were used to test associations between HCWs' characteristics and knowledge, attitudes, and practice levels at a 0.05 level of significance. The median age of the participants was 35 years (IQR = 30-42), and the majority (73.2%) were females. About half (50.9%) of the participants (173/340) had good knowledge, 55.6% (189/340) had a good attitude, and 57.1% (194/340) had good practice scores on pediatric TB management. Having a bachelor's degree and above, working in the TB unit, and having received training on pediatric TB in the last five years were significantly associated with good knowledge of pediatric TB management. Similarly, having a bachelor's degree or higher and more than five years of experience providing TB services were significantly associated with a good attitude towards pediatric TB management. Being a general practitioner, nurse, and lab technician was significantly associated with good practice in pediatric TB management. The level of knowledge, attitude, and practice on pediatric TB management among HCWs was suboptimal, as substantial gaps were identified. The Ministry of Health and other international organizations need to prioritize training, coaching, and mentoring support to help HCWs improve their knowledge, attitude, and practice to detect, diagnose, and treat pediatric TB.

Survival Analysis of Tuberculosis Patients Registered in a Rural Tuberculosis Unit of Purba Bardhaman District, West Bengal, India

Survival Analysis of Tuberculosis Patients Registered in a Rural Tuberculosis Unit of Purba Bardhaman District, West Bengal, India

Prevalence and Retrospective Insight on Tuberculosis in Human Patients in Cross River State, Nigeria; One Health Approach to its Control.

Tuberculosis (TB) is a major zoonotic disease of public health importance worldwide. Its burden is more in developing countries due to inadequate surveillance, co-infection with HIV/AIDS and poor social amenities; hence consumption of unpasteurized milk, contaminated meat and inhalation of infected droplets from animals or patients with active TB are the major risk practices. A survey was conducted on TB prevalence from 2013 to 2014 while patients records from TB and Leprosy units of hospitals in the three Agricultural zones (Ogoja, Ikom and Calabar) of Cross River State, Nigeria were assessed from 2000 to 2010. Out of 1,170 sampled patients, 8 (0.7%) were positive, of which 6 and 2 isolates were identified as M. tuberculosis and M. bovis, respectively. Out of 52,558 studied patients files, 235 (0.4%) were positive with varied annual prevalence; the highest (1.0%) and lowest (0.2%) in 2009 and 2011, respectively. The prevalence was higher in dry (0.9% and 0.5%) than the rainy season (0.5% and 0.4%), in females (0.9% and 0.5%) than the males (0.4% and 0.4%) in the survey and retrospective studies, respectively. The age distribution of TB among the patients were; (0% and 0.3%), (0.4% and 0.4%), (0.7% and 0.4%) and (1.5% and 0.7%) for those (≤ 18), (19-40), (41-60) and (> 60) yrs old in the survey and retrospective study, respectively. TB is prevalent in human patients in Cross River State hence, the need for sustainable campaign, continuous surveillance and private/ public health partnership in accurate and early diagnosis, treatment and one health approach to its control.

Thin Film Composite Membranes Based on the Polymer of Intrinsic Microporosity PIM-EA(Me2)-TB Blended with Matrimid®5218.

In this work, thin film composite (TFC) membranes were fabricated with the selective layer based on a blend of polyimide Matrimid®5218 and polymer of intrinsic microporosity (PIM) composed of Tröger’s base, TB, and dimethylethanoanthracene units, PIM-EA(Me2)-TB. The TFCs were prepared with different ratios of the two polymers and the effect of the PIM content in the blend of the gas transport properties was studied for pure He, H2, O2, N2, CH4, and CO2 using the well-known time lag method. The prepared TFC membranes were further characterized by IR spectroscopy and scanning electron microscopy (SEM). The role of the support properties for the TFC membrane preparation was analysed for four different commercial porous supports (Nanostone Water PV 350, Vladipor Fluoroplast 50, Synder PAN 30 kDa, and Sulzer PAN UF). The Sulzer PAN UF support with a relatively small pore size favoured the formation of a defect-free dense layer. All the TFC membranes supported on Sulzer PAN UF presented a synergistic enhancement in CO2 permeance, and CO2/CH4 and CO2/N2 ideal selectivity. The permeance increased about two orders of magnitude with respect to neat Matrimid, up to ca. 100 GPU, the ideal CO2/CH4 selectivity increased from approximately 10 to 14, and the CO2/N2 selectivity from approximately 20 to 26 compared to the thick dense reference membrane of PIM-EA(Me2)-TB. The TFC membranes exhibited lower CO2 permeances than expected on the basis of their thickness—most likely due to enhanced aging of thin films and to the low surface porosity of the support membrane, but a higher selectivity for the gas pairs CO2/N2, CO2/CH4, O2/N2, and H2/N2.

Chronic obstructive pulmonary disease as a comorbidity in pulmonary tuberculosis patients in Manjeri, Kerala

Chronic obstructive pulmonary disease as a comorbidity among pulmonary tuberculosis patients is less studied in south India. To determine the proportion of Pulmonary tuberculosis patients in Manjeri Tuberculosis Unit who have COPD as a co-morbidity. Study design -Cross sectional study. Study setting -Manjeri Tuberculosis unit of Malapuram district. Study population -All diagnosed Pulmonary Tuberculosis patients registered in the Manjeri Tuberculosis unit of Malapuram district. Sample size-178 patients satisfying inclusion criteria. Study tools- Questionnaire – A structured questionnaire used for collecting the basic demographic data and patient characteristics. COPD screener tool to be applied at the start of treatment. Pulmonary function test at end of intensive phase in patients or when patients are sputum smear negative, whichever is later. Of the total 181 persons who participated in the study 114[62.98%] were males. 35[19.34%] were smokers. 70 persons reported to have some form of chronic respiratory illness in the past. By using the COPD screener tool, 70 persons [38.89%] had score from 5 to 10 implying that they had high chance of having COPD. Spirometry was done for 174 persons. 31(17.81%) persons showed evidence of obstructive airway disease. The prevalence of COPD among pulmonary tuberculosis patients was 17.81%. In a high tuberculosis burden country like India, more studies are needed to find out how COPD in tuberculosis patients adversely affects the disease progression, morbidity, and mortality.

Tuberculosis (TB) Aftermath: study protocol for a hybrid type I effectiveness-implementation non-inferiority randomized trial in India comparing two active case finding (ACF) strategies among individuals treated for TB and their household contacts

BackgroundApproximately 7% of all reported tuberculosis (TB) cases each year are recurrent, occurring among people who have had TB in the recent or distant past. TB recurrence is particularly common in India, which has the largest TB burden worldwide. Although patients recently treated for TB are at high risk of developing TB again, evidence around effective active case finding (ACF) strategies in this population is scarce. We will conduct a hybrid type I effectiveness-implementation non-inferiority randomized trial to compare the effectiveness, cost-effectiveness, and feasibility of two ACF strategies among individuals who have completed TB treatment and their household contacts (HHCs).MethodsWe will enroll 1076 adults (≥ 18 years) who have completed TB treatment at a public TB unit (TU) in Pune, India, along with their HHCs (averaging two per patient, n = 2152). Participants will undergo symptom-based ACF by existing healthcare workers (HCWs) at 6-month intervals and will be randomized to either home-based ACF (HACF) or telephonic ACF (TACF). Symptomatic participants will undergo microbiologic testing through the program. Asymptomatic HHCs will be referred for TB preventive treatment (TPT) per national guidelines. The primary outcome is rate per 100 person-years of people diagnosed with new or recurrent TB by study arm, within 12 months following treatment completion. The secondary outcome is proportion of HHCs < 6 years, by study arm, initiated on TPT after ruling out TB disease. Study staff will collect socio-demographic and clinical data to identify risk factors for TB recurrence and will measure post-TB lung impairment. In both arms, an 18-month “mop-up” visit will be conducted to ascertain outcomes. We will use the RE-AIM framework to characterize implementation processes and explore acceptability through in-depth interviews with index patients, HHCs and HCWs (n = 100). Cost-effectiveness will be assessed by calculating the incremental cost per TB case detected within 12 months and projected for disability-adjusted life years averted based on modeled estimates of morbidity, mortality, and time with infectious TB.DiscussionThis novel trial will guide India’s scale-up of post-treatment ACF and provide an evidence base for designing strategies to detect recurrent and new TB in other high burden settings.Trial registrationNCT04333485, registered April 3, 2020.CTRI/2020/05/025059 [Clinical Trials Registry of India], registered May 6 2020.

A study to critically analyze Revised National Tuberculosis Control Program norms implementation at a medical college-level facility

Background: Tuberculosis (TB) control activities are implemented in the country for more than 50 years. The countrywide lockdown in 2020 adversely impacted routine health-care services including those for the management of TB. Operational research is needed to know whether Revised National Tuberculosis Control Program (RNTCP) (National Tuberculosis Elimination Program) is heading in the right direction as far as the pace and quality of implementation of the program are concerned. Aims and Objectives: The aim of the present study was to investigate the strength, weaknesses, and opportunities of RNTCP. An analysis of RNTCP was done to identify competencies and gaps. Materials and Methods: The present retroprospective and observational study was carried out at the RNTCP facility of a Government Medical College in the Central India in Madhya Pradesh during the year 2019–20. Samples of 238 patients registered under RNTCP for anti-tubercular treatment were taken in the study. Data were collected using a structured schedule from the RNTCP center and tabulated in a Microsoft Excel sheet, to assess the compliance of RNTCP norms in the management of TB. Results: The most commonly affected age was 16–49 years and the male: female ratio was 3:2. The most common basis of diagnosis was microbiological (60.92%). Follow-up sputum testing was done on time in 64.71% of patients. Adherence to anti-tubercular treatment (ATT) was regular in 78.57% of patients. All patients were telephoned while 43.14% of patients were home visited as a default action. After default action, 35.29% of patients return to regular ATT. Out of all registered patients initiated on ATT, 81.09% were treatment success, while 7.14% lost to follow-up, 2.1% became defaulters, and 4.62% patients died. Conclusion: We conclude that treatment success of TB unit was near the RNTCP norm of 85% which is below the national 88%. The probable reasons for the higher default rate and loss to follow-up rate during the study period could be the ongoing COVID-19 pandemic.

Appraisal on patient compliance and factors influencing the daily regimen of anti-tubercular drugs in Mangalore city: A cross-sectional study.

Background: Globally, India is the country with the highest tuberculosis (TB) burden with respect to the number of new cases occurring each year. Annual incident cases of TB in India accounts for more than 25% of total TB morbidity and mortality worldwide. Several factors have been associated with the adherence of TB medication, which can be broadly classified as patient/personal, social, structural and health service. The aims of the present study were to determine the compliance to daily regimen of directly observed treatment, short-course (DOTS) therapy among TB patients registered at the Tuberculosis Unit (TU) of Mangalore and to identify the factors influencing non-compliance for treatment. Methods: A cross sectional study was performed. The study sample was drawn from the TUs, General Hospital, Mangalore, after taking permission from District TB Officer. The names and addresses of TB patients were collected from treatment cards. The TB patients were approached at their homes/DOTS centers/Primary Health Centre's (PHCs) with the help of senior treatment supervisors. Results: It was found that patients positive for human immunodeficiency virus (HIV) were more likely to be non-adherent, which was statistically significant. Amongst the participants, 66 (33%) were diabetic and 28.8% of them were found to be non-adherent. The proportion of non-adherence was 27 times higher in those with poor patient provider relationships. Patients who reported to have side effects of TB medication were 5.23 times more likely to be non-adherent. Conclusions: Advice on routine consultation with the health care facility, adherence to treatment regimen and education about its benefits should be the prime focus of providing health education to all TB patients, both at the individual and community levels.

Impact of the Covid-19 pandemic in a specialized Tuberculosis unit

Dear editor, The COVID-19 pandemic has negatively affected other disease prevention and control programs that could cause more deaths than the coronavirus itself (1), and also having substantial consequences for other domains, such as social impact: slowing economic growth and increasing rates of unemployment, poverty, and food insecurity.

Isoniazid preventive therapy among child contacts of TB patients, India.

BACKGROUND: Isoniazid preventive therapy (IPT) for child contacts of TB patients, a globally accepted intervention, needs to be evaluated in diverse geographical regions.OBJECTIVES: To assess the extent of IPT coverage and adherence, to ascertain its sociodemographic and programmatic correlates and to explore existing constraints from service providers and beneficiaries´ perspectives.METHODS: A mixed-method study was conducted in January-June 2021 in Paschim Bardhaman District, West Bengal, India. Quantitative assessment was done among 280 child contacts of TB cases registered between January and December 2020 in all TB units in the district. Primary caregivers were interviewed using a pre-designed questionnaire. Two focus group discussions with all senior treatment supervisors of the district and in-depth interviews with 12 purposively selected caregivers of the children were undertaken. Qualitative data were analysed thematically.RESULTS: Only 48.9% (137/280) of child contacts were screened; 58.9% (165/280) were initiated on IPT and 40% (66/165) adhered to a full course. Coverage of the full 6-month IPT among total study participants was 23.6% (66/280). Household visits by health personnel and initial screening significantly predicted increased coverage. Programmatic inadequacies, poor understanding, social stigma and COVID situation were major constraints.CONCLUSION: Coverage of IPT remains unacceptably low and requires health system strengthening for effectively implementing current recommendations of TB preventive treatment.

A study to assess the prevalence of Tuberculosis to review “TB free status” in Nashik district, Maharashtra, India

Tuberculosis (TB) is an infectious disease that is a significant cause of ill health and one of the leading causes of death worldwide. The prevalence of tuberculosis varies significantly across the country. Recent sub-national surveys have revealed wide geographical variation and discordance with corresponding annual notification rates. Present study aimed to estimate the prevalence of TB in 2022 to review the TB-free status of Nashik Districts. Methods: We conducted community-based crosssectional household survey between Jan 2021- March 2021. The district was divided into 15 survey units based on the number of TB units. We selected one village/ward from each survey unit using probability proportional to sampling. The estimated sample size was 30 bacteriologically positive TB patients using inverse sampling method. The prevalence of TB in 2020 was estimated by two methods- direct and indirect. Besides, proportionate decline, numbers needed to test and TB score were also estimated. Along with this, the prevalence was also estimated by drug consumption. Results:The TB prevalence was estimated as 60, 43 and 40 per 100,000 using direct estimate, indirect estimate, and drug consumption methods, respectively. There was a significant reduction in TB prevalence from the baseline year 2015 to more than 40 percent (62 %, 46%, and 64 % according to indirect estimate, direct estimate, and drug consumption, respectively). Conclusion: The study reported reduction of the prevalence of TB in Nashik district in 2020 as compared to 2015. Thus there is need of strategic execution of planned strategies to achieve the goal or TB elimination

Clinical profile of extra pulmonary tuberculosis: A retrospective south Indian study

: Tuberculosis (TB) is one of the most important global health problems. The prevalence of TB is high among the developing world. India has the highest TB burden, accounting for 1.9 million cases of the 9.1 million cases of globally. Although tuberculosis is primarily the disease affecting the lungs, Called Pulmonary TB (PTB), it may also affect other sites such as lymph nodes, central nervous system, bones, and gastrointestinal tract which is known as Extra pulmonary tuberculosis (EPTB). Extra-pulmonary TB patient reporting has been increased from 17% to 21% over period of 10 years which demands the evaluation of clinical profiles of EPTB in order to diagnose and implement the precise treatment plan. : To Determine the clinical profile of extra pulmonary tuberculosis (EPTB) patients in South Indian population. : Three years’ retrospective data of TB patients from 2015 – 2017 registered in 4 TB units of central Chennai was collected. The Study included the confirmed cases of EPTB without co-infections. Parameters such as Socio-demographic variables, clinical features and treatment outcome was collected. Age and gender wise comparisons was done for all the parameters using descriptive statistics. Lymphnode TB was the most common type of EPTB and significant association between age, gender and site of EPTB was found in the study necessitating well planned strategies, program-specified protocols for the diagnosis and treatment of extra pulmonary tuberculosis cases.

Appraisal on patient compliance and factors influencing the daily regimen of anti-tubercular drugs in Mangalore city: A cross-sectional study

Background: Globally, India is the country with the highest tuberculosis (TB) burden with respect to the number of new cases occurring each year. Annual incident cases of TB in India accounts for more than 25% of total TB morbidity and mortality worldwide. Several factors have been associated with the adherence of TB medication, which can be broadly classified as patient/personal, social, structural and health service. The aims of the present study were to determine the compliance to daily regimen of directly observed treatment, short-course (DOTS) therapy among TB patients registered at the Tuberculosis Unit (TU) of Mangalore and to identify the factors influencing non-compliance for treatment. Methods: A cross sectional study was performed. The study sample was drawn from the TUs, General Hospital, Mangalore, after taking permission from District TB Officer. The names and addresses of TB patients were collected from treatment cards. The TB patients were approached at their homes/DOTS centers/Primary Health Centre’s (PHCs) with the help of senior treatment supervisors. Results: It was found that patients positive for human immunodeficiency virus (HIV) were more likely to be non-adherent, which was statistically significant. Amongst the participants, 66 (33%) were diabetic and 28.8% of them were found to be non-adherent. The proportion of non-adherence was 27 times higher in those with poor patient provider relationships. Patients who reported to have side effects of TB medication were 5.23 times more likely to be non-adherent. Conclusions: Advice on routine consultation with the health care facility, adherence to treatment regimen and education about its benefits should be the prime focus of providing health education to all TB patients, both at the individual and community levels.

Models of сlinical situations – a new methodological approach to analysis of patient populations in TB facilities

The objective: to develop methodological approaches for assessing patient population in a TB unit based on models of patients who died in a TB hospital.Subjects and Methods. A retrospective study included 413 patients who died in a TB hospital during periods of varying HIV infection prevalence. As a methodological approach to assessing the structure of this group of patients, 4 models of clinical situations have been proposed. The models considered severity and presence of tuberculosis infection, HIV infection, lesions of the central nervous system and concomitant non-communicable diseases. As an example of proposed clinical models, a comparison was made of deceased patients in a TB hospital in two periods – 2007 and 2017, which differed mainly in the prevalence of HIV infection among TB patients.