To study the occurrence of risk factors for pulmonary tuberculosis in the homeless population in areas of Delhi, India.

BACKGROUND: In India, there are only a few studies done in the area of assessing the risk factors of Tuberculosis (TB) among the homeless population. The homeless population has quite a higher chance of developing Pulmonary Tuberculosis (PTB) as compared with the general population due to the presence of an inappropriate environment and high prevalence of risk factors. METHODS: This study was done among the homeless population in both males and females aged 18 years and above in areas of Delhi (Yamuna Pusta and Mansarovar Park). The participants were screened for TB symptoms and risk factors to diagnose active PTB in them. RESULTS: Out of 200 participants, 17 were diagnosed with active PTB. The overall occurrence of Tuberculosis among the studied homeless population was found to be 85 cases per 1000 population. The occurrence of behavioral habits such as smoking was found to be 41.2% (7/17), tobacco chewing at 47.1% (8/17), and alcohol at 47.1% (8/17) among the cases. The occurrence of HIV coinfection was 5.9% (1/17) and diabetes was 5.9% (1/17). The prevalence of TB among homeless females was 1.5 times higher than homeless males but out of 17 diagnosed patients, males had a higher prevalence of TB as compared to females. CONCLUSION: The occurrence of PTB in the homeless population is quite high as it is also reported in a study in the United States that the national incidence of tuberculosis in the homeless population was 36 cases/100,000 and it needs to be addressed to eliminate tuberculosis.7 Moreover, the risk factors such as tobacco, smoking, alcohol, coinfections, etc. might have played a major role in the development of PTB. Also, there is a need for larger studies with large sample sizes to provide evidence against the same.

Infection control and preventing the transmission of tuberculosis in high-risk centres - recovery shelter for homeless people.

The term "infection control" refers to the policies and practices used in hospitals and other healthcare facilities to limit the spread of illnesses with the primary goal of lowering infection rates. The objective is to reduce the chance of infection in patients and Healthcare workers (HCWs). This may be achieved by making all the HCWs to follow and practice the infection prevention and control (IPC) guidelines and by providing safe and quality healthcare. Because of more exposure to TB patients and insufficient TB infection prevention and control (TBIPC) procedures in a healthcare facility, healthcare workers (HCWs) working in TB centers are at an elevated risk of contracting TB. Although there are a number of TBIPC guidelines, there is limited knowledge of their contents, if they are applicable in the given situation, and whether they are being properly applied in TB centers. The purpose of this study was to observe the TBIPC guidelines' implementation in CES (Centre of equity studies) recovery shelters well as the elements that affect it. The percentage of public health care personnel who used proper TBIPC practices was low. The execution of TBIPC guidelines in tuberculosis (TB) centers was poor. It was impacted because TB treatment institutions and centers have unique health systems and TB disease burdens.

Adherence to Isoniazid Preventive Therapy among children living with tuberculosis patients in Delhi, India: An exploratory prospective study.

INH Preventive Therapy (IPT) substantially reduces the risk of incidence of TB disease in pediatric household contacts of TB patients. The National TB Elimination Program (NTEP) of India prescribes a daily regimen of Isoniazid to all under-6 pediatric contacts for 6 months duration. We conducted, this exploratory prospective study (June to Nov' 2020) to assess adherence to IPT and reasons for nonadherence among child contacts of microbiologically confirmed, drug sensitive, non-PLHIV Tuberculosis patients in Delhi, India. The study outcomes included the initiation, adherence and completion of IPT. The caregivers of the child TB contacts were interviewed face to face by the field investigator. The data were entered on EpiData 3.1 and analysed with IBM SPSS 25. The INH adherence was assessed in a total of 86 household child TB contacts. IPT had been initiated in 62 (72.1%) child TB contacts of which 61 (98.4%) received INH within 1 month of starting of ATT-DOTS therapy in the index TB patient of the household. Furthermore, the failure to initiate IPT was reported by 24 (27.9%) child TB contacts. Within the cohort of child TB contacts who were not initiated with IPT, the ATT-DOTS duration in the index-TB patient was ≥5 months in 18 (75%) cases, 1-2 months in 3 (12.5%) cases, and <1 month in also 3 (12.5%) cases. Reasons for non-initiation (n = 24) were reported as refusal by the family in 12 (50%) cases mostly due to concern over side-effects of the drug, while non-provision of the drug by the DOTS provider was also observed in 12 (50%) cases. The mean (SD) INH adherence in the INH initiated cohort was 5.6 (2.0) (n = 62). Reasons for INH non-adherence were attributed to forgetfulness (n = 23, 37.1%), carelessness (n = 24, 38.7%), and intermittent stopping of the medication (n = 17, 27.4%) on the child falling sick, perceived drug side effects, and running out of drug stocks. INH non-adherence defined as at-least two missed INH doses in the previous 7 days was observed in 47 (54.7%) participants (n = 86). On bivariate analysis, none of the household sociodemographic characteristics showed any statistically significant association with the rate of INH non-adherence in the child TB contacts. The findings of the present study indicate the need to periodically assess adherence and persistence to IPT in the child TB contacts as high intermittent missed dosing rates can undermine the effectiveness of IPT in preventing incident disease.

Trends & treatment outcomes of multidrug-resistant tuberculosis in Delhi, India (2009-2014): A retrospective record-based study.

Background & objectives: The increase in the burden of multidrug-resistant tuberculosis (MDR-TB) is a matter of grave concern. The present study was undertaken to describe MDR-TB treatment outcome trends in Delhi and their epidemiological correlates, to assess the adequacy of treatment records and to also generate evidence towards influencing and improving practices related to the MDR-TB control programme. Methods: A retrospective record-based study (2009-2014) was conducted in three major drug resistance TB treatment centres of Delhi. Treatment outcomes and adverse effects were extracted from the existing programme records including patients' treatment cards and laboratory registers. Results: A total of 2958 MDR-TB patients were identified from the treatment cards, of whom 1749 (59.12%) were males. The mean (±standard deviation) age was 30.56±13.5 years. Favourable treatment outcomes were reported in 1371 (53.28%) patients, but they showed a declining trend during the period of observation. On binomial logistic regression analysis, patients with age ≥35 yr, male sex and undernourishment (body mass index <18.5) at the time of treatment initiation had a significantly increased likelihood of unfavourable MDR-TB treatment outcome (P <0.001). Interpretation & conclusions: The study showed an increasing burden of MDR-TB patients, especially in the young population with increased risk of transmission posing a major challenge in achieving TB elimination targets.

Partnership in tuberculosis control through involvement of pharmacists in Delhi: An exploratory operational research study.

BACKGROUND: There are over 12,000 chemists registered in the capital city, Delhi to support patient health needs. A study was conducted to improve the tuberculosis (TB) notification rates as conceptualized by the Revised National Tuberculosis Control Program (RNTCP). As part of the end TB mission, the feasibility of capturing data of TB patients coming to buy anti-TB drugs at the licensee level (chemists and drug shop owners) in Central Delhi area was assessed. MATERIALS AND METHODS: The prospective study was conducted from July 2017 to March 2018. TB notification through a paper-based system and self-notification through online mode were the operational modality used for engagement with chemists. A team of paramedical workers was deployed for data collection from those pharmacists who chose to notify through the paper mode. Self-notification through online mode was through the RNTCP's NIKSHAY web-based reporting platform. RESULTS: From the 330 chemists sensitized, 871 TB notifications were received during the study. Younger age groups comprised a majority of these cases with 198 (37.5%) from 21 to 30 years and 122 (23.1%) from 11 to 20 years. By the end of six visits, 28 (46%) of the 61 pharmacies that were eventually successfully sensitized had started returning the Folio cards with filled patient details. A total of 581 (66.6%) prescriptions received by the pharmacists were from government hospitals. The annual TB case notification in Central Delhi showed a significant increase from 271 TB patients/100,000 population to 871 TB patients/100,000 population during the study period when compared with expected trends in the past year (P < 0.05). CONCLUSION: Self-notification of TB engenders successful TB notifications from chemists. This progenitor approach to TB notification in the capital emphasizes the need to categorize pharmacists as an independent private care provider for improving TB notification across high-burden settings.

A gastric resident drug delivery system for prolonged gram-level dosing of tuberculosis treatment.

Multigram drug depot systems for extended drug release could transform our capacity to effectively treat patients across a myriad of diseases. For example, tuberculosis (TB) requires multimonth courses of daily multigram doses for treatment. To address the challenge of prolonged dosing for regimens requiring multigram drug dosing, we developed a gastric resident system delivered through the nasogastric route that was capable of safely encapsulating and releasing grams of antibiotics over a period of weeks. Initial preclinical safety and drug release were demonstrated in a swine model with a panel of TB antibiotics. We anticipate multiple applications in the field of infectious diseases, as well as for other indications where multigram depots could impart meaningful benefits to patients, helping maximize adherence to their medication.

Achieving TB elimination in India: The role of latent TB management.

The elimination of Tuberculosis (TB) in settings with a high dual burden of active and latent TB is one of the most important public health challenges of the 21st century. India has the highest TB burden in the world and nearly 40% of the population being infected with TB. There also exist large often overlapping socially and medically vulnerable populations like the PLHIV, pediatric TB contacts, children with protein-energy malnutrition, homeless people, workers in silica industry and adults with low BMI. A significantly higher risk of progression into active tubercular disease exists in those with compromised immune or nutritional status. It is uncertain if global TB elimination targets can be achieved in the absence of aggressive LTBI treatment strategies for interrupting the chain of transmission of the disease. India hence needs to accelerate and prioritize capacity building in latent TB research. A research agenda is outlined for generating evidence towards the evolution of critical evidence-based policy for LTBI management under Indian health settings.