Is physical access an impediment to tuberculosis diagnosis and treatment? A study from a rural district in North India

Tripathy, Jaya Prasad; Srinath, Sirish Chandra; Naidoo, Paramespri; Ananthakrishnan, Ramya; Bhaskar, R.

doi:10.5588/pha.13.0044

Cited by 30 publications

(33 citation statements)

References 9 publications

(9 reference statements)

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“…Of these, six studies contain relevant data on the proportion of chest symptomatics who failed to provide a second sputum sample [23,38,60–63]. Three studies contain data on the proportion of patients undergoing evaluation for smear-negative TB who fail to get a chest X-ray, which is the final step in the diagnostic workup [38–40].…”

Section: Resultsmentioning

confidence: 99%

The Tuberculosis Cascade of Care in India’s Public Sector: A Systematic Review and Meta-analysis

et al. 2016

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BackgroundIndia has 23% of the global burden of active tuberculosis (TB) patients and 27% of the world’s “missing” patients, which includes those who may not have received effective TB care and could potentially spread TB to others. The “cascade of care” is a useful model for visualizing deficiencies in case detection and retention in care, in order to prioritize interventions.Methods and FindingsThe care cascade constructed in this paper focuses on the Revised National TB Control Programme (RNTCP), which treats about half of India’s TB patients. We define the TB cascade as including the following patient populations: total prevalent active TB patients in India, TB patients who reach and undergo evaluation at RNTCP diagnostic facilities, patients successfully diagnosed with TB, patients who start treatment, patients retained to treatment completion, and patients who achieve 1-y recurrence-free survival. We estimate each step of the cascade for 2013 using data from two World Health Organization (WHO) reports (2014–2015), one WHO dataset (2015), and three RNTCP reports (2014–2016). In addition, we conduct three targeted systematic reviews of the scientific literature to identify 39 unique articles published from 2000–2015 that provide additional data on five indicators that help estimate different steps of the TB cascade. We construct separate care cascades for the overall population of patients with active TB and for patients with specific forms of TB—including new smear-positive, new smear-negative, retreatment smear-positive, and multidrug-resistant (MDR) TB.The WHO estimated that there were 2,700,000 (95%CI: 1,800,000–3,800,000) prevalent TB patients in India in 2013. Of these patients, we estimate that 1,938,027 (72%) TB patients were evaluated at RNTCP facilities; 1,629,906 (60%) were successfully diagnosed; 1,417,838 (53%) got registered for treatment; 1,221,764 (45%) completed treatment; and 1,049,237 (95%CI: 1,008,775–1,083,243), or 39%, of 2,700,000 TB patients achieved the optimal outcome of 1-y recurrence-free survival.The separate cascades for different forms of TB highlight different patterns of patient attrition. Pretreatment loss to follow-up of diagnosed patients and post-treatment TB recurrence were major points of attrition in the new smear-positive TB cascade. In the new smear-negative and MDR TB cascades, a substantial proportion of patients who were evaluated at RNTCP diagnostic facilities were not successfully diagnosed. Retreatment smear-positive and MDR TB patients had poorer treatment outcomes than the general TB population. Limitations of our analysis include the lack of available data on the cascade of care in the private sector and substantial uncertainty regarding the 1-y period prevalence of TB in India.ConclusionsIncreasing case detection is critical to improving outcomes in India’s TB cascade of care, especially for smear-negative and MDR TB patients. For new smear-positive patients, pretreatment loss to follow-up and post-treatment TB recurrence are considerable points of attrition...

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Section: Resultsmentioning

confidence: 99%

The Tuberculosis Cascade of Care in India’s Public Sector: A Systematic Review and Meta-analysis

et al. 2016

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“…Hence, the findings are representative and present a true picture of the program. We used google maps for calculating the distance [13], as this was not routinely recorded in program.…”

Section: Discussionmentioning

confidence: 99%

Early infant diagnosis of HIV in Myanmar: call for innovative interventions to improve uptake and reduce turnaround time

Thiha¹,

Shewade²,

Philip

et al. 2017

Global Health Action

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Background: In collaboration with the national AIDS program, early infant diagnosis (EID) is implemented by Integrated HIV Care (IHC) program through its anti-retroviral therapy (ART) centers across 10 cities in five states and regions of Myanmar. Blood samples from the ART centers are sent using public transport to a centralized PCR facility. Objectives: Among HIV-exposed babies <9 months at enrolment into IHC program (2013–15), to describe the EID cascade (enrolment, sample collection for PCR, result receipt by mother, HIV diagnosis and ART initiation) and factors associated with delayed (>8 weeks of age) or no blood sample collection for EID. Methods: Retrospective cohort study involving record review. A predictive poisson regression model with robust variance estimates was fitted for risk factors of delayed or no sample collection. Results: Of 1349 babies, 523 (39%) of the babies’ mothers were on ART before pregnancy. Timely uptake of EID (<8 weeks of age) was 47% (633/1349); sample collection was delayed in 27% (367/1349) and not done in 26% (349/1349) babies. Among samples collected (n = 1000), 667 results were received by the mother; 52 (5%) were HIV-infected; among them 42 (81%) were initiated on ART. Median (IQR) turnaround time from sample collection to result receipt by mother and time to initiate ART from result receipt by mother was 7 (4,12) and 8.5 (6,16) weeks, respectively. Mothers not on ART before pregnancy and distance of ART center from PCR facility (more than 128 km) were the risk factors of delayed or no sample collection. Conclusions: Improving provision of ART to mothers (through universal ‘test and treat’) is urgently required, which has the potential to improve the timely uptake of EID as well. Interventions to reduce turnaround times, like point of care EID testing and/or systematic use of mobile technology to communicate results, are needed.

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“…A quarter of the respondents mentioned having needed to return to the Casais five times, and waiting for more than 30 days to get conclusive diagnosis, similarly to reports from rural areas in India and from interior regions of Brazil. [24][25][26][27] Traditional indigenous medicine appeared among the treatment options, but without excluding biomedicine. Both use of medicinal plants and prayer and/or shamanism, either on their own or in association with use of Western medicine, were considered in treatment.…”

Section: Discussionmentioning

confidence: 99%

Acesso aos serviços de saúde para o diagnóstico e tratamento da tuberculose entre povos indígenas do estado de Rondônia, Amazônia Brasileira, entre 2009 e 2011: um estudo transversal*

Malacarne

Gava

Escobar

et al. 2019

Epidemiologia e Serviços de Saúde

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Objective: to investigate access to health services for tuberculosis (TB) diagnosis and treatment among indigenous peoples in Rondônia State, Brazil, 2009-2011. Methods: we conducted a cross-sectional study with indigenous people attending Indigenous Health Care Units (Casai) between October 2009 and February 2011; geographical, economical and functional dimensions of access to TB services were evaluated through interviews and then described. Results: 52 indigenous people with TB were interviewed; in the geographical dimension, lack of transportation, distance and lack of health professionals were the main obstacles; in the economic dimension, 15 indigenous people reported cost/expense as a barrier to access; in the functional dimension, 21 arrived at the Casai using their own means; 24 reported that the time between first symptoms and arriving at the Casai was > 30days; 25 reported that time between first consultation and starting treatment was >30 days; treatment was supervised in 22 cases. Conclusion: the difficulties found in accessing health services in the dimensions we analyzed can contribute to TB continuing to be transmitted in indigenous villages.

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Is physical access an impediment to tuberculosis diagnosis and treatment? A study from a rural district in North India

Cited by 30 publications

References 9 publications

The Tuberculosis Cascade of Care in India’s Public Sector: A Systematic Review and Meta-analysis

The Tuberculosis Cascade of Care in India’s Public Sector: A Systematic Review and Meta-analysis

Early infant diagnosis of HIV in Myanmar: call for innovative interventions to improve uptake and reduce turnaround time

Acesso aos serviços de saúde para o diagnóstico e tratamento da tuberculose entre povos indígenas do estado de Rondônia, Amazônia Brasileira, entre 2009 e 2011: um estudo transversal*

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