An Outcome-Based Follow-up Study of Cured Category I Pulmonary Tuberculosis Adult Cases from Various Tuberculosis Units under Revised National Tuberculosis Control Program from a Western Indian City.

ABSTRACT

CONTEXT Despite the nationwide implementation of the Revised National Tuberculosis Control Program in India, adverse outcome after treatment is on rise. Program guidelines propose follow-up of cured patients for 2 years which is rarely done. OBJECTIVES: The main objectives of this study is (1) To find the response of treatment in terms of failure and drug resistance (recurrence of symptoms and mortality experience) and (2) Collect client perspective about the program and suggest the same to program managers. SUBJECTS AND METHODS: Community-based tracking of 365 cured adult Category I pulmonary tuberculosis (TB) cases drawn from three nearby TB units was done with a structured designed questionnaire. It was done to record the adverse events after 1-3 years of completion of treatment and also to record the client perspective about the program. In case of nonsurvivors, verbal autopsy was conducted by interviewing the next available relative. RESULTS: A total of 365, only 226 (60%) could be covered mainly due to wrong/incomplete address and 35 cases did not survive. Of 191 survivors who were tracked, 94.7% had sputum microscopy at the completion of treatment. Total 54 (23.9%) cases had adverse outcomes, including 31 with symptoms suggestive of TB and 23 died directly/indirectly due to TB. This cohort of cured cases, posttreatment, observed 15 times (annualized) high mortality than their counterparts. Clients or relatives largely rated the program as good/very good. CONCLUSIONS: Post-treatment tracking is must to detect an adverse outcome which is high. Most survivors and relatives of expired cases rated the program as good to very good.