A comparison of patient treatment pathways among multidrug-resistant and drug-sensitive TB cases in Delhi, India: A cross-sectional study.

BACKGROUND: The delay in the diagnosis and treatment initiation of patients with MDR-TB worsens individual prognosis and increases the risk of disease transmission in the community. These delays have been attributed to delay in treatment-seeking by the patient and shifting to multiple healthcare facilities before being tested and diagnosed through India's National Tuberculosis Elimination Program (NTEP). OBJECTIVE: to identify treatment pathways in patients with MDR-TB from the time of onset of symptoms and treatment seeking until diagnosis at a PMDT site and subsequent treatment initiation. We also compared these characteristics with those of patients with DS-TB. METHODS: We recruited a total of 168 patients with MDR-TB and DS-TB each, in Delhi. Data were analyzed using IBM SPSS Version 25. RESULTS: The mean (SD) patient delay for initial treatment-seeking was 20.9 (15.9) days in patients with MDR-TB, and 16.1 (17.1) days in patients with DS-TB (p < 0.001). The median time from visit to the first healthcare facility (HCF) until confirmation of MDR-TB diagnosis was 78.5 days, and until treatment initiation was 102.5 days. Among patients with DS-TB, the time interval from a visit to the first HCF until the initiation of ATT-DOTS was 61.5 days.. Patients diagnosed with DS-TB, whose first source of treatment was a private facility (n = 49), reported a significant delay in the initiation of ATT-DOTS (p < 0.001). CONCLUSIONS: Despite the introduction of universal drug sensitivity testing in individuals having presumptive MDR-TB, a significant delay in the diagnosis and initiation of effective MDR-TB treatment persists as a major public health challenge in India.

Treatment seeking pathways in pediatric tuberculosis patients attending DOTS centers in urban areas of Delhi.

BACKGROUND: The treatment seeking pathways prior to initiation of Direct Observed Treatment Short-course Therapy (DOTS), provides the extent of patient and health system delays among pediatric tuberculosis (TB) patients. OBJECTIVES: The study attempted to understand the treatment seeking pathways of pediatric TB patients under revised national tuberculosis control program (RNTCP). STUDY DESIGN AND SETTING: It was a prospective observational study carried out from January 2015 to December 2015. A predesigned, pretested and semi-structured questionnaire was used to interview 141 caregivers of pediatric patients (0-14 years) at two chest clinics selected purposively. RESULTS: Thirteen different treatment seeking pathways were identified and fever was the commonest symptom (41.8%) for seeking care from 1st health facility. Median time taken from onset of symptoms to first consultation varied from 1 to 144 weeks. More than half of the study subjects were first taken to a private practitioner (64.5%) followed by a pharmacist (19.1%) and trust in provider was the commonest reason for choosing the first care-provider in 52 (41.1%), followed by easy access or convenience in 49 (34.8%). CONCLUSION: A significant delay was found in treatment initiation of patients with extra pulmonary tuberculosis (EPTB), those belonging to lower socio-economic class families, low literacy level of parents, who went to private facility first and availed more than three health facilities before diagnosis.

Universal access to DOTS in Delhi Prisons: Where do we stand?

BACKGROUND: Universal access implies that all tuberculosis (TB) patients in the community should have access to early, good quality diagnosis and treatment services that are affordable and convenient to the patient in time, place, and person. To achieve universal access, all affected vulnerable and marginalized population like prison inmates should have access to TB diagnostic and treatment services. OBJECTIVES: To assess the TB control activities in prisons of Delhi, the capital of India, and to suggest interventions for strengthening the program based on the observations. MATERIALS AND METHODS: Study was conducted at Tihar Prison, Delhi. TB case notification data from the Revised National TB Control Program (RNTCP) between 2008 and 2012 and log process framework were used to assess various parameters. RESULTS: Mean number of patients initiated on TB treatment was 120.6 annually between 2008 and 2012. The RNTCP has been implemented in Delhi Prisons since 2002; however, gaps were identified in human resource, training needs, case finding, diagnostic and treatment services, and supervision on situational analysis. Coordination between prison authorities and RNTCP authorities in relation to initial screening and discharge process appeared to be weak. CONCLUSION AND RECOMMENDATIONS: Because of the restricted access, vulnerability of the prison population, increase in drug-resistant TB, the TB control activities in the prison require restructuring. Initial screening for early diagnosis and treatment and "Discharge planning" needs to be devised so that there is sufficient time before release or transfer of individuals from prison. This needs strong commitment from the prison health authorities and RNTCP staff.

Standards for TB care in India: A tool for universal access to TB care.

In 2014, Government of India in collaboration with World Health Organization Country Office for India released the policy document on Standards for tuberculosis (TB) care in India after in-depth deliberation with national and international experts. The standards for TB care represent what is expected for quality TB care from the Indian healthcare system including both public and private systems. The details of each standard have been compiled in this review article. It is envisioned that the standards detailed in the manuscript are adapted by all TB care providers across the country.

Evaluation of a new quality assessment strategy for blinded rechecking of random sputum smears for TB in Delhi, India.

This study was conducted at the New Delhi Tuberculosis Center, Delhi, India, from 1 January 2006 to 31 December 2007 to assess the feasibility of implementing random blinded rechecking (RBRC), a quality assurance strategy, and its impact on the performance of tuberculosis smear microscopy in Delhi, RBRC activities are carried out monthly at District Tuberculosis Centers (DTCs). Forty thousand five hundred and six slides were rechecked during the study period. RBRC, as a method of quality assurance was found to be feasible for a large application. The quality of sputum microscopy improved, with a significant reduction in the number of false positive and false negative errors in 2007 compared to 2006. The number of microscopy centers reporting high false errors decreased significantly in 2007.