Sputum conversion at the end of intensive phase of Category-1 regimen in the treatment of pulmonary tuberculosis patients with diabetes mellitus or HIV infection: An analysis of risk factors.

BACKGROUND & OBJECTIVE: New smear-positive pulmonary tuberculosis (PTB) patients in the Revised National Tuberculosis Control Programme (RNTCP) are treated with a 6-month short-course chemotherapy (SCC) regimen irrespective of co-morbid conditions. We undertook this retrospective analysis to compare sputum conversion rates (smear, culture) at the end of intensive phase (IP) of Category-1 regimen among patients admitted to concurrent controlled clinical trials: pulmonary tuberculosis alone (PTB) or with type 2 diabetes mellitus (DM-TB) or HIV infection (HIV-TB), and to identify the risk factors influencing sputum conversion. METHODS: In this retrospective analysis sputum conversion rates at the end of intensive phase (IP) in three concurrent studies undertaken among PTB, DM-TB and HIV-TB patients, during 1998 - 2002 at the Tuberculosis Research Centre (TRC), Chennai, were compared. Sputum smears were examined by fluorescent microscopy. HIV infected patients did not receive anti-retroviral treatment (ART). Patients with DM were treated with oral hypoglycaemic drugs or insulin (sc). RESULTS: The study population included 98, 92 and 88 patients in the PTB, DM-TB and HIV-TB studies. At the end of IP the smear conversion (58, 61, and 62%) and culture conversion (86, 88 and 92%) rates were similar in the three groups respectively. The variables associated with lack of sputum smear or culture conversion were age >45 yr, higher pre-treatment smear and culture grading, and extent of the radiographic involvement. INTERPRETATION & CONCLUSION: Our findings confirm that the current policy of the control programme to treat all pulmonary TB patients with or with out co-morbid conditions with Category-I regimen appears to be appropriate.

Evaluation of an intermittent six-month regimen in new pulmonary tuberculosis patients with diabetes mellitus.

BACKGROUND: The treatment of tuberculosis (TB) with category I regimen of the Revised National Tuberculosis Control Programme (RNTCP) for patients with diabetes mellitus (DM) needs evaluation. OBJECTIVE: To assess the cure and relapse rates in 3 years, among the new smear-positive TB patients with Type-2 DM (DMTB) treated with CAT-I regimen (2E3H3R3Z3/4R3H3) of RNTCP. METHODOLOGY: TB suspects attending the diabetology units and the TB research centre (TRC) Chennai, were investigated. Eligible DMTB cases were enrolled. Baseline estimation of cardiac, renal, liver function tests and glycosylated-HBA1c were undertaken. All patients received 2E3H3R3Z3/4R3H3 under supervision at TRC. Clinical and sputum (smear and culture) examinations and monitoring of diabetic status were undertaken every month up to 24 months, then once in 3 months up to 36 months. RESULTS: Of 100 patients admitted, 7 were excluded for various reasons from analysis. Of 93 patients, 87 (94%) had a favourable response at the end of treatment. Pre and post treatment mean glycosylated-HBA1c were 9.7% and 8.4% (>7% poor control). During follow-up period, 6 died and one lost to follow-up. Of the remaining, four relapsed. CONCLUSION: Category-I regimen, recommended for all the new smear-positive patients in the Indian TB programme, is effective in the treatment of DMTB patients, despite poor control of diabetes.

Identifying effective communication channels in a rural community: A field report from south India.

Background: There is scarcity of information on communication channels in rural areas where about 38% of people are illiterate. Objective: To identify the channels of communication available in rural areas by interviewing key informants. Method: This study was conducted in 51 villages of Ellapuram block, Tiruvallur district, Tamil Nadu in the year 2004. Key informants selected from the villages were interviewed by a Medical Social Worker. The questionnaire included information on modes of communication channels, availability of markets, public facilities, and local associations. Result: The study block included 9893 households covering a population of 39255. Their main occupation was agriculture (86%). Electricity was available in all the villages. More than 80% of the villagers had community TV/cable connections, >50% of the villages had cinema star fan associations, mahila mandals, youth clubs, self-help groups, anganwadi centres and ration shops. The main source of communication as per interview was television (100%), wallposters (55%); publicity through panchayat office meetings (53%) and dandora or beat of drums(43%). Conclusion: Main communication channels, commonly used to disseminate information were TV and wall posters. More than 50% of villages had local associations which can be used for effective communication. This information is vital for disseminating important information on public health programmes and educating the rural community.

Costs to patients with Tuberculosis treated under DOTS Programme.

Background: The economic burden of TB in India is enormous as TB perpetuates and exacerbates poverty. Revised National Tuberculosis Control Programme (RNTCP) based on DOTS strategy is currently being implemented in India. The purpose of this study is to estimate the costs incurred by tuberculosis patients treated under RNTCP in a district in Tamilnadu where services are decentralized for diagnosis and treatment. Method: In all, 455 patients registered under RNTCP between June and December 2000, in Tiruvallur district were interviewed to collect the following information: Demographic, socio-economic characteristics of patients, expenditure incurred due to illness and effect of illness on employment. Based on the data collected, various costs (direct medical, nonmedical, indirect and total costs incurred on account of tuberculosis before and during treatment) were estimated. In addition Standard of Living Index (SLI) was calculated for patients. Results: Of 455 patients, 62% had low SLI. The median direct, indirect and total costs for 343 patients who successfully completed treatment were as follows: pre treatment direct costs were Rs 340, during treatment direct costs Rs 100; more than 50% of patients did not incur any indirect costs in both pre treatment and during treatment periods and overall total costs were Rs 1398. About 12% of patients lost more than 60 workdays and after completing treatment, 88% returned to work. Conclusion: For patients registered under RNTCP in Tiruvallur district in Tamilnadu, the findings that the total patient costs were Rs 1398/- and also the patients returned to work early establishes the economic benefits to patients treated under DOTS and lend support to rapid expansion of DOTS programme, particularly in low-income countries.