Uptake of universal drug susceptibility testing among people with TB in a south Indian district: How are we faring?

Abstract

Background India implements universal drug susceptibility testing (UDST) using rapid genotypic tests (cartridge-based nucleic acid amplification test CBNAAT - and line probe assay - LPA). to bridge the gap of diagnosis of multidrug/rifampicin-resistant TB. There is limited evidence assessing the implementation of UDST in India. We assessed the implementation among people with pulmonary TB notified from public facilities in October 2019 from Raichur (Karnataka), India. Methods A cohort study involving secondary data in routine programme settings was conducted. All people with TB underwent a rapid genotypic DST for rifampicin resistance followed by first line-LPA (FL-LPA) if sensitive and second line-LPA (SL-LPA) if resistant. Results Of 217 people, 15.7% (n=34) did not undergo rapid genotypic DST. Of 135 who were rifampicin-sensitive detected on CBNAAT, 68.1% (n=92) underwent FL-LPA, and out of the six rifampicin-resistant cases, 66.7% (n=4) underwent SL-LPA. Overall, 65.4% (142/217) completed the UDST algorithm. Children (aged <15 y) and people with bacteriological non-confirmation on microscopy were less likely to undergo rapid genotypic DST. Of 183 patients who underwent both rapid genotypic DST and sputum smear microscopy, 150 were bacteriologically confirmed and, of them, 9 (6%) were ‘rapid DST-negative’. Conclusion We found gaps at various steps. There were a significant number of ‘rapid DST-negative, smear-positive’ patients.

Status of universal drug-susceptibility testing among sputum smear-positive tuberculosis patients diagnosed at a tertiary care centre

“…The mean±standard deviation age and weight of the participants were 46.9±13.8 yr and 45.4±10.5 kg, respectively with 74 per cent (n=159) being males ( Table ). It was found that 34.4 per cent (n=74) (95% CI: 28.1-41.2) of sputum smear-positive TB patients did not undergo UDST, which was similar to the findings of the studies conducted in Karnataka where 33 and 34.6 per cent did not undergo UDST in 2018 and 2019, respectively 6 , 7 which has further increased to 42 per cent 2 in 2020. NIKSHAY ID at the time of sputum smear microscopy and its application to establish cohort-wise tracking will significantly decrease the attrition rate 8 .…”

“…Usually, the patient turnaround time for drug-susceptibility testing (DST) is about four days 4 . However, after the implementation of this strategy, there is limited literature related to its evaluation 5 , 6 . The study was aimed to ( i ) estimate the proportion of TB-diagnosed patients who did not undergo UDST, ( ii ) assess the sociodemographic and morbidity-related factors associated with it, ( iii ) ascertain their reasons for not getting tested, and ( vi ) estimate the proportion with any DR.…”

Barriers to engagement in the care cascade for tuberculosis disease in India: A systematic review of quantitative studies

“…Across 3 studies reporting adjusted analyses, people >64 years [ 47 ], with extrapulmonary or smear–negative pulmonary disease (as compared to smear–positive pulmonary disease [ 47 – 49 ]), with an indication for NAAT other than treatment failure [ 47 ], and who were evaluated at medical colleges [ 47 ] had higher NAAT non-completion (Fig F in the S6 Appendix and Table D in the S2 Appendix ). Extrapulmonary TB had a nonsignificant association in 1 study [ 48 ].…”

Practices and challenges in implementing tuberculosis program at medical colleges in Karnataka, India

“…The challenges faced by these institutions are multi-faceted, including human resource constraints, infrastructural deficits, and limited training and research activities. [10][11][12] Addressing these challenges requires a multi-pronged approach, involving not only medical colleges but also policy-makers, funding agencies, and other stakeholders. The lessons drawn from this study can provide a roadmap to strengthen the RNTCP/NTEP integration across medical colleges, ultimately accelerating India's journey towards TB elimination.…”