Treatment outcome of drug-resistant tuberculosis (DR-TB) following uptake of universal drug susceptibility testing: A record review from a nodal DR-TB center

Abstract

Background: There has been delay evident in diagnosing the drug resistance and non-initiation of appropriate treatment based on drug susceptibility pattern resulting in poor treatment outcome of drug-resistant tuberculosis (DR-TB). Aims and Objectives: The aims of this study were to examine the treatment outcomes for DR-TB patients following universal drug susceptibility testing (UDST) and to examine the association of sociodemographic, behavioral factors, or comorbidities with outcome. Materials and Methods: A retrospective study at a nodal DR-TB center was done for the past 2 years (2018–2019) following the district’s adoption of UDST. The study comprised patients registered between January 2018 and December 2019. Transferred out cases were excluded from the analysis. Cured or treatment completed were assigned as successful, whereas the treatment failed, lost to follow-up or died were adverse treatment outcome. Results: A total of 201 patients were initiated on suitable DOTS regime and they continued the treatment from the center, during the study period. Altogether 129 (64.2%) patients had successful treatment outcome. None of the examined variable (age, sex, SES, Body mass index, and comorbidity) is found to have statistically significant association with outcome (P>0.05). Conclusion: The UDST may be the reason for success rate shown here, higher than in literature published. Although a better stance is possible only by comparing the treatment outcome of pre- and post-uptake of UDST from same setting.

Tuberculosis epidemic in India – a systematic review

“…21,31,37 Despite the massive TB burden, India is actively spending $23 billion a year to successfully reduce the global TB burden through the World Health Organization's End Tuberculosis Strategy and the Revised National Tuberculosis Control Program (RNTCP), as well as by establishing "Nikshay, " an open web service that allows health organizations and medical councils to more easily track antibiotic use in real time as part of the Direct Observed Treatment Service. [38][39][40] However, there are still a lot of gaps in the fight against TB because of a lack of information, a lack of awareness, a lot of myths and misconceptions, and the failure to pay fees to accredited social health activists (ASHA) workers. 3,5,35 According to the National Family Health Survey-5 (NFHS-5) and several research investigations, certain social determinants are found to have the highest prevalence of TB (Fig 3).…”

“…5,29,31,37,41,42 Although it is evident that rural and urban slums areas have a comparatively greater TB incidence, the prevalence has decreased as people's socioeconomic position has improved. 31,[40][41][42][43][44]…”

“…3,5,6,64,66,67 Resistance to frequently given anti-tuberculosis medications results in extensively drug-resistant tuberculosis (XDR-TB) and MDR-TB. 7,40,64 Furthermore, XDR-TB, a subtype of MDR-TB, is resistant to isoniazid, rifampicin, and any of three second-line injectable drugs (e.g., levofloxacin, moxifloxacin, and bedaquiline), whereas MDR is only resistant to drugs of the isoniazid and rifampicin types. 33,36,45,59,64,65 Risk factors for MDR-TB include male gender, age over 60, living in crowded or congested environment using indigenous stove (Chulha), prior TB treatment, contact with an MDR patient, and being from a hilly region.…”

“…33,36,45,59,64,65 Risk factors for MDR-TB include male gender, age over 60, living in crowded or congested environment using indigenous stove (Chulha), prior TB treatment, contact with an MDR patient, and being from a hilly region. 40,45,59,[68][69][70] India is the country with the greatest rates of TB related morbidity and mortality, along with risk factors such as undernourishment, alcohol smoking, diabetes, and HIV infection (Fig. 7).…”

“…26,27,41,71 A father's history of alcohol consumption, residing in an area where illicit alcohol was being produced, and also belonging to a vulnerable segments of the population are all significant risk factors for consumption of alcohol and rising TB burden. 26,40 However, in several studies have revealed that TB patient consume alcohol mainly due to anxiety, depression, family burden, social stigma and misconceptions of TB epidemic. 12,25,62…”