TB Treatment Delays in Odisha, India: Is It Expected Even after These Many Years of RNTCP Implementation?

Ilangovan, Kumaravel; Nagaraja, Sharath Burugina; Ananthakrishnan, Ramya; Jacob, Anil G.; Tripathy, Jaya Prasad; Tamang, Deepak Dorje

doi:10.1371/journal.pone.0125465

Cited by 7 publications

(8 citation statements)

References 5 publications

(8 reference statements)

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“…In addition, we analyzed "timely HIV diagnosis" as follow: "early" when CD4þ T-cell count was 500 cells/mm 3 or a clinical stage of HIV infection was A1 or B1, and "late" with CD4 < 500 cells/mm 3 or all the remaining clinical stages. 4.…”

Section: Delay In Tb Treatment Initiation Due To the Systemmentioning

confidence: 99%

“…1 Risk factors that have been reported as associated with prolonged delay (>35 days from onset of symptoms to receipt of TB treatment) in TB diagnosis in patients co-infected with HIV are unemployment, alcohol consumption, crowding index, seeking prior treatment, cotrimoxazole treatment, and World Health Organization (WHO) stage 4 disease. 2 In addition, HIV-positive TB patients have higher risk for delay in TB treatment compared to HIVnegative TB patients, 3 and for delay in HIV treatment initiation due to lower baseline CD4 cell count, TB drug intolerance, nondisclosure of HIV infection, 4 immune reconstitution inflammatory syndrome, 5,6 and drug interactions of concomitant use of TB and HIV treatment.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, HIV-positive TB patients have higher risk for delay in TB treatment compared to HIV-negative TB patients, 3 and for delay in HIV treatment initiation due to lower baseline CD4 cell count, TB drug intolerance, nondisclosure of HIV infection, 4 immune reconstitution inflammatory syndrome, 5,6 and drug interactions of concomitant use of TB and HIV treatment.…”

Section: Introductionmentioning

confidence: 99%

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Delays in HIV and TB diagnosis and treatment initiation in co-infected patients in Colombia

et al. 2020

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We investigated the delays in the diagnosis of tuberculosis and/or HIV, their treatment initiation, and factors associated with each delay. All drug-susceptible tuberculosis cases diagnosed in 2014 and 2015 in Colombia, with a confirmed diagnosis of HIV were included. A total of 1909 patients were registered with tuberculosis/HIV co-infection. Seventy-nine percent of patients were men, 50% had sputum smear-negative tuberculosis, culture was done in 50% of cases, 68.5% had <200 CD4 cell count at diagnosis, and 35% had concurrent tuberculosis/HIV diagnosis. Delays in the tuberculosis diagnosis were identified in 54.8% of the patients, and delays in tuberculosis and HIV treatment initiation in 41.8% and 27.4%, respectively. The risk factors associated with delay in tuberculosis diagnosis were age between 15–34 and ≥45 years, and those patients who received tuberculin skin test. The risk factor associated with antiretroviral therapy initiation delay was previously-treated tuberculosis patients after failure. It is necessary to implement strategies for early detection and treatment initiation of HIV and to use rapid test for tuberculosis diagnosis in this population.

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Section: Delay In Tb Treatment Initiation Due To the Systemmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Delays in HIV and TB diagnosis and treatment initiation in co-infected patients in Colombia

et al. 2020

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“…Four qualitative studies mentioned self-perception of health, and unconvinced of the diagnosis and the need for TB treatment, and the perceived low effectiveness of TB treatment led to a delay in TB treatment initiation [44,94,117,139]. We also found that retreatment cases were more likely to delay TB treatment initiation [92][93][94][95][96].…”

Section: Treatment Delaymentioning

confidence: 63%

Determinants of delayed diagnosis and treatment of tuberculosis in high-burden countries: a mixed-methods systematic review and meta-analysis

Teo¹,

Singh

Prem

et al. 2020

Preprint

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Background: Globally, 30 countries with the highest tuberculosis (TB) burden bears 87% of the world’s TB cases. Delayed diagnosis and treatment are detrimental to TB prognosis and sustain TB transmission in the community, making TB elimination a great challenge, especially in these countries. Our objective was to elucidate the determinants and duration of delayed diagnosis and treatment of pulmonary TB in high TB burden countries. Methods: We conducted a systematic review and meta-analysis of quantitative and qualitative studies by searching four databases for literature published between 2008 and 2018 following PRISMA guidelines. For quantitative studies, we performed narrative synthesis of the covariates that were significantly associated with patient, health system, treatment, and total delays. The pooled median duration of delay and effect sizes of covariates were estimated using random-effects meta-analyses. We identified key qualitative themes using thematic analysis. Results: We included 124 articles from 14 low-and lower-middle-income countries (LIC and LMIC) and five upper-middle-income countries (UMIC) in this review. The pooled median duration of patient, health system, and treatment delay were 28 days (95%CI 20–30), 11.5 days (95%CI 3.9–24.7), and six days (95%CI 1–28.4), respectively. We found that the duration of delays was consistently shorter among UMIC compared to LIC and LMIC. There was consistent evidence that being female and rural residence was associated with longer patient delay. Furthermore, patient delay was also associated with other individual, interpersonal, and community risk factors such as poor TB knowledge, long chains of care-seeking through private/multiple providers, perceived stigma, financial insecurities, and poor access to healthcare. Health system and treatment delay were mediated by organizational and policy factors. These factors included the lack of resources and complex administrative procedures and systems at the health facilities. We identified data gaps in 11 high burden countries. Conclusions: This review detailed the determinants of delayed TB diagnosis and treatment in high burden countries. The gaps identified at different socio-ecological levels could be addressed through tailored approaches, education, and at a higher level, through health system strengthening and provision of universal health coverage to reduce delays and improve access to TB diagnosis and care.

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“…The DOTS-based RNTCP has been remarkably successful in achieving the global targets of detecting 70% of the estimated TB cases and curing 85% of them [ 3 , 4 ]. The RNTCP since its inclusion as a national TB control program has given good results, as evident by the detailed WHO global annual reports, yet the TB elimination looks a far-sighted dream [ 4 , 5 ]. There are a number of issues that are hampering the ongoing RNTCP progress in India.…”

Section: Essaymentioning

confidence: 99%

The organizational challenges in the management of the revised national tuberculosis control program of India: an overview

Yadav¹,

Rawal²

2020

Pan Afr Med J

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The developing world is facing a serious problem of tuberculosis (TB) since ages. The condition is really profound in resource-constrained countries. The situation in some of the high TB burden countries is so grave that there are huge numbers of TB patients and deaths due to TB. TB control in most of the countries is done by the national TB control programs. In India, this is popularly known as the Revised National Tuberculosis Control Program (RNTCP). The RNTCP comes under the umbrella of the national health mission. The main components of RNTCP are directly observed treatment, short-course (DOTS) and DOTS-Plus. The effective and adequate implementation of the RNTCP is the most effective solution to control the ever growing cases of TB. The present situation, as detailed in the WHO global annual TB report, with ever-rising cases of various categories of TB is really scary and demands prompt attention. In this paper, the authors highlight the important issues related to the RNTCP in India. The main motto of writing this paper was to address the challenges associated with the organizational structure of the national TB control program of India and to suggest solutions for the same. The authors believe that these challenges could pose a serious threat to the efforts aimed at TB elimination from India. Besides, this paper will serve as a tool to modify and/or to formulate new guidelines for the betterment of the program. Also, the challenges detailed here are usually common in the other high TB burden countries of the world and this will help the program managers worldwide.

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TB Treatment Delays in Odisha, India: Is It Expected Even after These Many Years of RNTCP Implementation?

Cited by 7 publications

References 5 publications

Delays in HIV and TB diagnosis and treatment initiation in co-infected patients in Colombia

Delays in HIV and TB diagnosis and treatment initiation in co-infected patients in Colombia

Determinants of delayed diagnosis and treatment of tuberculosis in high-burden countries: a mixed-methods systematic review and meta-analysis

The organizational challenges in the management of the revised national tuberculosis control program of India: an overview

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