Kunchok Dorjee1, Tsetan D Sadutshang2, Ravinder S Rana3, Sonam Topgyal2, Dawa Phunkyi2, Tsering Choetso2, Tenzin Chodon2, Malik Parmar4, Rupak Singla5, Zorba Paster6, Richard E Chaisson7, Kailash C Kaushal8. 1. Center for TB Research, School of Medicine Division of Infectious Diseases, Johns Hopkins University, Baltimore, USA; Division of Tuberculosis, Tibetan Delek Hospital, Dharamsala, India. Electronic address: kdorjee1@jhmi.edu. 2. Division of Tuberculosis, Tibetan Delek Hospital, Dharamsala, India. 3. Revised National TB Control Program, District TB Office, Kangra, India. 4. World Health Organization, Central TB Division, Government of India, New Delhi, India. 5. National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India. 6. Department of Family Medicine, University of Wisconsin, Wisconsin, USA. 7. Center for TB Research, School of Medicine Division of Infectious Diseases, Johns Hopkins University, Baltimore, USA. 8. World Health Organization, Revised National TB Control Program, State TB Office, Shimla, India.
Abstract
BACKGROUND: India accounts for quarter of global rifampin-resistant/multi-drug resistant-tuberculosis (RR/MDR-TB). Knowledge on risk-factors and distribution of MDR-TB at district level is limited. OBJECTIVE: Study prevalence and risk factors of MDR-TB in tuberculosis patients in hilly districts of Himachal Pradesh, India. METHODS: Between July 2012-June 2013, TB patients registered under the Revised National Tuberculosis Control Program in Kangra and Una districts suspected of MDR-TB were referred for Xpert® MTB/RIF testing at the Delek Hospital, Dharamsala by the district TB Office. RESULTS: Of 378 patients enrolled (median age: 45 years; 85% males), 18% (n = 68) were rifampin-resistant. Among Xpert positives (n = 305), distributions of RR-TB were: 10% (n = 9/89) for recurrent cases who had received TB treatment for <2-months, 15% each for new (n = 9/59) or recurrent cases (n = 5/34) remaining smear positive between 2 and 4 months of treatment, 36% (n = 41/113) for treatment failures, and 40% (n = 2/5) for loss to follow-ups. Of the sputum-smear positives, 15% (n = 51/338) were Xpert negative. Seeking care in the private sector was associated with higher risk of RR-TB (OR:1.85; 95% CI:0.87-3.9). CONCLUSION: Prevalence of RR-TB is generally high in patients suspected of MDR-TB in the hilly districts of Himachal Pradesh. High prevalence during early phase of treatment can suggest primary transmission of DR-TB. Universal drug susceptibility testing and innovative case finding strategies will benefit patients living in mountain districts with inadequate access to healthcare. The high proportion of sputum-smear positive but Xpert negative cases may be due to non-tubercular mycobacterial disease.
BACKGROUND: India accounts for quarter of global rifampin-resistant/multi-drug resistant-tuberculosis (RR/MDR-TB). Knowledge on risk-factors and distribution of MDR-TB at district level is limited. OBJECTIVE: Study prevalence and risk factors of MDR-TB in tuberculosis patients in hilly districts of Himachal Pradesh, India. METHODS: Between July 2012-June 2013, TB patients registered under the Revised National Tuberculosis Control Program in Kangra and Una districts suspected of MDR-TB were referred for Xpert® MTB/RIF testing at the Delek Hospital, Dharamsala by the district TB Office. RESULTS: Of 378 patients enrolled (median age: 45 years; 85% males), 18% (n = 68) were rifampin-resistant. Among Xpert positives (n = 305), distributions of RR-TB were: 10% (n = 9/89) for recurrent cases who had received TB treatment for <2-months, 15% each for new (n = 9/59) or recurrent cases (n = 5/34) remaining smear positive between 2 and 4 months of treatment, 36% (n = 41/113) for treatment failures, and 40% (n = 2/5) for loss to follow-ups. Of the sputum-smear positives, 15% (n = 51/338) were Xpert negative. Seeking care in the private sector was associated with higher risk of RR-TB (OR:1.85; 95% CI:0.87-3.9). CONCLUSION: Prevalence of RR-TB is generally high in patients suspected of MDR-TB in the hilly districts of Himachal Pradesh. High prevalence during early phase of treatment can suggest primary transmission of DR-TB. Universal drug susceptibility testing and innovative case finding strategies will benefit patients living in mountain districts with inadequate access to healthcare. The high proportion of sputum-smear positive but Xpert negative cases may be due to non-tubercular mycobacterial disease.
Authors: R Ramachandran; S Nalini; V Chandrasekar; P V Dave; A S Sanghvi; F Wares; C N Paramasivan; P R Narayanan; S Sahu; M Parmar; S Chadha; P Dewan; L S Chauhan Journal: Int J Tuberc Lung Dis Date: 2009-09 Impact factor: 2.373