Hemant Deepak Shewade1, Kalpita S Shringarpure2, Malik Parmar3, Nikhil Patel2, Suraj Kuriya2, Samarth Shihora2, Nittal Ninama2, Narendra Gosai2, Rahul Khokhariya2, Chetan Popat2, Hiren Thanki3, Bhavesh Modi4, Paresh Dave5, R K Baxi2, Ajay M V Kumar1,6. 1. Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India. 2. Department of Preventive and Social Medicine, Medical College, Vadodara, India. 3. World Health Organization, Country Office for India, New Delhi, India. 4. Department of Community Medicine, Gujarat Medical Education & Research Society Medical College and Hospital, Gandhinagar, India. 5. Department of Health and Family Welfare, Government of Gujarat, Gandhinagar, India. 6. Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.
Abstract
Background: Reducing delay in the diagnosis of multidrug-resistant tuberculosis (MDR-TB) by performing genotypic drug susceptibility testing (DST) among eligible patients as early as possible can improve clinical presentation and treatment outcomes and reduce transmission. We aimed to determine the delay from being eligible for DST to performing DST and factors associated with the delay. Methods: This was a retrospective cohort study involving record review among presumptive MDR-TB patients who underwent genotypic DST from five selected districts in the state of Gujarat, India (2014). Specimens were couriered from the designated microscopy centres (DMCs) to two designated genotypic DST facilities located outside the districts. Results: Of 2212 patients, the median duration from eligibility to the specimen being sent, from the specimen being sent to DST and from eligibility to DST was 3, 5 and 8 d, respectively. Patients from DMCs in teaching hospitals and with presumptive MDR-TB criteria 'follow-up smear positive' and 'TB-human immunodeficiency virus co-infection' had a significantly higher risk of delay between eligibility and testing (≥8 d). The delay in the specimen being sent after eligibility contributed to high delays in these subgroups. Conclusion: The districts were doing well in implementing timely DST among presumptive MDR-TB patients. However, there is room for improvement in reducing the delays in the sending of specimens among certain patient subgroups.
Background: Reducing delay in the diagnosis of multidrug-resistant tuberculosis (MDR-TB) by performing genotypic drug susceptibility testing (DST) among eligible patients as early as possible can improve clinical presentation and treatment outcomes and reduce transmission. We aimed to determine the delay from being eligible for DST to performing DST and factors associated with the delay. Methods: This was a retrospective cohort study involving record review among presumptive MDR-TB patients who underwent genotypic DST from five selected districts in the state of Gujarat, India (2014). Specimens were couriered from the designated microscopy centres (DMCs) to two designated genotypic DST facilities located outside the districts. Results: Of 2212 patients, the median duration from eligibility to the specimen being sent, from the specimen being sent to DST and from eligibility to DST was 3, 5 and 8 d, respectively. Patients from DMCs in teaching hospitals and with presumptive MDR-TB criteria 'follow-up smear positive' and 'TB-human immunodeficiency virus co-infection' had a significantly higher risk of delay between eligibility and testing (≥8 d). The delay in the specimen being sent after eligibility contributed to high delays in these subgroups. Conclusion: The districts were doing well in implementing timely DST among presumptive MDR-TB patients. However, there is room for improvement in reducing the delays in the sending of specimens among certain patient subgroups.
Authors: Arto Yuwono Soeroto; Bony Wiem Lestari; Prayudi Santoso; Lidya Chaidir; Basti Andriyoko; Bachti Alisjahbana; Reinout van Crevel; Philip C Hill Journal: PLoS One Date: 2019-02-28 Impact factor: 3.240