India marching towards TB elimination: How far we are.

Tuberculosis continues to be the leading cause of death worldwide. India shares twenty five percent of total tuberculosis population. Programmatic approach to fight against tuberculosis started in this country in the form of National Tuberculosis Program (NTP). In due course of time India adopted many strategic changes in its fight against tuberculosis. The current program named National tuberculosis elimination program (NTEP) has been set up to eliminate TB by 2025. There are some challenges which India need to overcome to achieve its target five years ahead of the sustainable development goals. Insufficient budget, inadequate diagnostic facilities, under-reporting, low success rate, high dropout rate, social stigma are some of the major challenges in the path to achieve a TB elimination status. Besides that, all the backlogs demand for swift performance in identification, notification, and treatment of TB cases. India has all the potential to eliminate tuberculosis. Strengthening of health system, mainstreaming of private sectors, enhancing diagnostic facilities, inclusion of latest diagnostic techniques, addressing social hindrances, and advocacy for higher budget are some of the program strengthening measures, if followed properly, can take India towards a TB free status.

Assessment of Medication Adherence and Associated Factors Among Patients With Diabetes Attending a Non-communicable Disease Clinic in a Community Health Centre in Eastern India.

Background Non-adherence to medication represents a modifiable risk factor for patients with type 2 diabetes mellitus (T2DM). Identification of patients with poor adherence can have a significant impact on clinical and socio-economic outcomes in the management of diabetes. This study aimed to assess medication adherence and its associated factors among patients with T2DM attending a non-communicable disease (NCD) clinic in a rural community health centre (CHC) in eastern India. Methods The study was a facility-based study that included 207 study participants with an age greater than 18 years. A structured questionnaire was used to collect data on socio-demographic characteristics, health-seeking behaviour, self-care practices, risk factors, clinical information on diabetes, prescription practices, and medication practices. The Hill-Bone Medication Adherence Scale (HB-MAS) has been used to assess medication adherence among study participants. Results The study found that the medication adherence rate among the study participants was 67.1%. On multivariate analysis, subjects with social insurance (adjusted odds ratio (AOR) = 2.73, 95% confidence interval (CI) = 1.01-7.38, p-value = 0.047), current smoking status (AOR = 5.47, 95% CI = 1.55-19.23, p-value = 0.008), anxiety (AOR= 3.52, 95% CI= 1.62- 7.61, p-value= 0.001), polypharmacy (AOR= 3.79, 95% CI= 1.25- 11.45, p-value= 0.018), and using alternative medicine (AOR= 5.82, 95% CI= 1.58 - 21.39, p-value= 0.008), were found to have a significantly higher chance of non-adherence. On the other hand, patients practising regular physical activity (AOR = 0.31, 95% CI= 0.12-0.79, p-value = 0.015) and with deprescription (AOR = 0.12, 95% CI= 0.03-0.47, p-value = 0.002) were found to have less chance of non-adherence as compared to their counterparts. Conclusion The study highlights the need to identify patients with poor medication adherence and develop interventions according to their requirements through a holistic approach. The study contributes to the existing literature on medication adherence among diabetes patients in rural healthcare settings in eastern India.

Hospital-Based Contact Tracing of Patients With COVID-19 and Health Care Workers During the COVID-19 Pandemic in Eastern India: Cross-sectional Study.

BACKGROUND: The contact tracing and subsequent quarantining of health care workers (HCWs) are essential to minimizing the further transmission of SARS-CoV-2 infection and mitigating the shortage of HCWs during the COVID-19 pandemic situation. OBJECTIVE: This study aimed to assess the yield of contact tracing for COVID-19 cases and the risk stratification of HCWs who are exposed to these cases. METHODS: This was an analysis of routine data that were collected for the contact tracing of COVID-19 cases at the All India Institute of Medical Sciences, Bhubaneswar, in Odisha, India. Data from March 19 to August 31, 2020, were considered for this study. COVID-19 cases were admitted patients, outpatients, or HCWs in the hospital. HCWs who were exposed to COVID-19 cases were categorized, per the risk stratification guidelines, as high-risk contacts or low-risk contacts. RESULTS: During contact tracing, 3411 HCWs were identified as those who were exposed to 360 COVID-19 cases. Of these 360 cases, 269 (74.7%) were either admitted patients or outpatients, and 91 (25.3%) were HCWs. After the risk stratification of the 3411 HCWs, 890 (26.1%) were categorized as high-risk contacts, and 2521 (73.9%) were categorized as low-risk contacts. The COVID-19 test positivity rates of high-risk contacts and low-risk contacts were 3.8% (34/890) and 1.9% (48/2521), respectively. The average number of high-risk contacts was significantly higher when the COVID-19 case was an admitted patient (number of contacts: mean 6.6) rather than when the COVID-19 case was an HCW (number of contacts: mean 4.0) or outpatient (number of contacts: mean 0.2; P=.009). Similarly, the average number of high-risk contacts was higher when the COVID-19 case was admitted in a non-COVID-19 area (number of contacts: mean 15.8) rather than when such cases were admitted in a COVID-19 area (number of contacts: mean 0.27; P<.001). There was a significant decline in the mean number of high-risk contacts over the study period (P=.003). CONCLUSIONS: Contact tracing and risk stratification were effective and helped to reduce the number of HCWs requiring quarantine. There was also a decline in the number of high-risk contacts during the study period. This indicates the role of the implementation of hospital-based, COVID-19-related infection control strategies. The contact tracing and risk stratification approaches that were designed in this study can also be implemented in other health care settings.