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. 2011;6(11):e26659.
doi: 10.1371/journal.pone.0026659. Epub 2011 Nov 2.

Operational challenges in diagnosing multi-drug resistant TB and initiating treatment in Andhra Pradesh, India

Sarabjit S Chadha  1 , B N Sharath, Kishore Reddy, Jyothi Jaju, P H Vishnu, Sreenivas Rao, Malik Parmar, Srinath Satyanarayana, Kuldeep Singh Sachdeva, Nevin Wilson, Anthony D Harries
Affiliations

Operational challenges in diagnosing multi-drug resistant TB and initiating treatment in Andhra Pradesh, India

Sarabjit S Chadha et al. PLoS One. 2011.

Abstract

Background: Revised National TB Control Programme (RNTCP), Andhra Pradesh, India. There is limited information on whether MDR-TB suspects are identified, undergo diagnostic assessment and are initiated on treatment according to the programme guidelines.

Objectives: To assess i) using the programme definition, the number and proportion of MDR-TB suspects in a large cohort of TB patients on first-line treatment under RNTCP ii) the proportion of these MDR-TB suspects who underwent diagnosis for MDR-TB and iii) the number and proportion of those diagnosed as MDR-TB who were successfully initiated on treatment.

Methods: A retrospective cohort analysis, by reviewing RNTCP records and reports, was conducted in four districts of Andhra Pradesh, India, among patients registered for first line treatment during October 2008 to December 2009.

Results: Among 23,999 TB patients registered for treatment there were 559 (2%) MDR-TB suspects (according to programme definition) of which 307 (55%) underwent diagnosis and amongst these 169 (55%) were found to be MDR-TB. Of the MDR-TB patients, 112 (66%) were successfully initiated on treatment. Amongst those eligible for MDR-TB services, significant proportions are lost during the diagnostic and treatment initiation pathway due to a variety of operational challenges. The programme needs to urgently address these challenges for effective delivery and utilisation of the MDR-TB services.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Diagnostic and treatment initiation pathway for Multi-drug resistant TB (MDR- TB) under RNTCP.
Figure 2
Figure 2. Loss of MDR-TB suspects along the diagnostic and treatment initiation pathway under RNTCP in Andhra Pradesh.
See this image and copyright information in PMC

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