High pre-diagnosis attrition among patients with presumptive MDR-TB: an operational research from Bhopal district, India View Full Text


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Article Info

DATE

2017-04-04

AUTHORS

Deepak Shewade, Arun M Kokane, Akash Ranjan Singh, Manoj Verma, Malik Parmar, Ashish Chauhan, Sanjay Singh Chahar, Manoj Tiwari, Sheeba Naz Khan, Vivek Gupta, Jaya Prasad Tripathy, Mukesh Nagar, Sanjai Kumar Singh, Pradeep Kumar Mehra, Ajay MV Kumar

ABSTRACT

BACKGROUND: Pre-diagnosis attrition needs to be addressed urgently if we are to make progress in improving MDR-TB case detection and achieve universal access to MDR-TB care. We report the pre-diagnosis attrition, along with factors associated, and turnaround times related to the diagnostic pathway among patient with presumptive MDR-TB in Bhopal district, central India (2014). METHODS: Study was conducted under the Revised National Tuberculosis Control Programme setting. It was a retrospective cohort study involving record review of all registered TB cases in Bhopal district that met the presumptive MDR-TB criteria (eligible for DST) in 2014. In quarter 1, Line Probe Assay (LPA) was used if sample was smear/culture positive. Quarter 2 onwards, LPA and Cartridge-based Nucleic Acid Amplification Test (CbNAAT) was used for smear positive and smear negative samples respectively. Pre-diagnosis attrition was defined as failure to undergo DST among patients with presumptive MDR-TB (as defined by the programme). RESULTS: Of 770 patients eligible for DST, 311 underwent DST and 20 patients were diagnosed as having MDR-TB. Pre-diagnosis attrition was 60% (459/770). Among those with pre-diagnosis attrition, 91% (417/459) were not identified as 'presumptive MDR-TB' by the programme. TAT [median (IQR)] to undergo DST after eligibility was 4 (0, 10) days. Attrition was more than 40% across all subgroups. Age more than 64 years; those from a medical college; those eligible in quarter 1; patients with presumptive criteria 'previously treated - recurrent TB', 'treatment after loss-to-follow-up' and 'previously treated-others'; and patients with extra-pulmonary TB were independent risk factors for not undergoing DST. CONCLUSION: High pre-diagnosis attrition was contributed by failure to identify and refer patients. Attrition reduced modestly with time and one factor that might have contributed to this was introduction of CbNAAT in quarter 2 of 2014. General health system strengthening which includes improvement in identification/referral and patient tracking with focus on those with higher risk for not undergoing DST is urgently required. More... »

PAGES

249

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12913-017-2191-6

DOI

http://dx.doi.org/10.1186/s12913-017-2191-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1084512796

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28376789


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23 schema:description BACKGROUND: Pre-diagnosis attrition needs to be addressed urgently if we are to make progress in improving MDR-TB case detection and achieve universal access to MDR-TB care. We report the pre-diagnosis attrition, along with factors associated, and turnaround times related to the diagnostic pathway among patient with presumptive MDR-TB in Bhopal district, central India (2014). METHODS: Study was conducted under the Revised National Tuberculosis Control Programme setting. It was a retrospective cohort study involving record review of all registered TB cases in Bhopal district that met the presumptive MDR-TB criteria (eligible for DST) in 2014. In quarter 1, Line Probe Assay (LPA) was used if sample was smear/culture positive. Quarter 2 onwards, LPA and Cartridge-based Nucleic Acid Amplification Test (CbNAAT) was used for smear positive and smear negative samples respectively. Pre-diagnosis attrition was defined as failure to undergo DST among patients with presumptive MDR-TB (as defined by the programme). RESULTS: Of 770 patients eligible for DST, 311 underwent DST and 20 patients were diagnosed as having MDR-TB. Pre-diagnosis attrition was 60% (459/770). Among those with pre-diagnosis attrition, 91% (417/459) were not identified as 'presumptive MDR-TB' by the programme. TAT [median (IQR)] to undergo DST after eligibility was 4 (0, 10) days. Attrition was more than 40% across all subgroups. Age more than 64 years; those from a medical college; those eligible in quarter 1; patients with presumptive criteria 'previously treated - recurrent TB', 'treatment after loss-to-follow-up' and 'previously treated-others'; and patients with extra-pulmonary TB were independent risk factors for not undergoing DST. CONCLUSION: High pre-diagnosis attrition was contributed by failure to identify and refer patients. Attrition reduced modestly with time and one factor that might have contributed to this was introduction of CbNAAT in quarter 2 of 2014. General health system strengthening which includes improvement in identification/referral and patient tracking with focus on those with higher risk for not undergoing DST is urgently required.
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30 schema:keywords Acid Amplification Test
31 Bhopal district
32 CBNAAT
33 College
34 DST
35 General health system strengthening
36 High pre-diagnosis attrition
37 India
38 MDR-TB
39 MDR-TB care
40 MDR-TB case detection
41 MDR-TB criteria
42 Medical College
43 National Tuberculosis Control Programme
44 TB
45 TB cases
46 Tat
47 Tuberculosis Control Programme
48 access
49 age
50 amplification tests
51 assays
52 attrition
53 care
54 cartridge
55 case detection
56 cases
57 central India
58 cohort study
59 control programs
60 criteria
61 culture
62 days
63 detection
64 diagnostic pathway
65 district
66 eligibility
67 extra-pulmonary TB
68 factors
69 failure
70 focus
71 health system strengthening
72 high risk
73 identification/referral
74 improvement
75 independent risk factor
76 introduction
77 introduction of CbNAAT
78 line probe assay
79 loss
80 negative samples
81 nucleic acid amplification tests
82 operational research
83 pathway
84 patient tracking
85 patients
86 pre-diagnosis attrition
87 presumptive MDR-TB
88 presumptive MDR-TB criteria
89 presumptive criteria
90 probe assay
91 program
92 progress
93 quarter 1
94 quarter 2
95 record review
96 referral
97 research
98 retrospective cohort study
99 review
100 risk
101 risk factors
102 samples
103 smear/culture
104 strengthening
105 study
106 subgroups
107 system strengthening
108 test
109 time
110 tracking
111 treated - recurrent TB
112 treatment
113 turnaround time
114 underwent DST
115 universal access
116 years
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