Before reaching the last mile'- Knowledge, attitude, practice and perceived barriers related to tuberculosis directly observed therapy among ASH A workers in Central India: a mixed method study

Introduction: Community-based direct observed treatment [DOT] providers are an important bridge for the national tuberculosis programme in India to reach the unreached. The present study has explored the knowledge, attitude, practice and barriers perceived by the community-based DOT providers. Methods: Mixed-methods study design was used among 41 community-based DOT providers [Accredited Social Health Activist [ASHAs]] working in 67 villages from a primary health center in Raisen district of Madhya Pradesh, India. The cross-sectional quantitative component assessed the knowledge and practices and three focus-group discussions explored the attitude and perceived barriers related to DOT provision

Result: 'Adequate knowledge' and 'satisfactory practice' related to DOT provision was seen in 14 [34%] and 13 [32%] ASHAs respectively. Only two [5%] received any amount of honorarium for completion of DOT in last 3 years. The focus-group discussions revealed unfavourable attitude; inadequate training and supervision, non-payment of honorarium, issues related to assured services after referral and patient related factors as the barriers to satisfactory practice of DOT

Conclusion: Study revealed inadequate knowledge and unsatisfactory practice related to DOT provision among ASHAs. Innovations addressing the perceived barriers to improve practice of DOT provision by ASHAs are urgently required

Low pre-diagnosis attrition but high pre-treatment attrition among /Bv patients with MDR-TB: An operational research from Chennai, India

Background: Worldwide, there's concern over high pre-diagnosis and pre-treatment attritions or delays in Multidrug resistant tuberculosis [MDR-TB] diagnosis and treatment pathway [DTP]. We conducted this operational research among patients with presumptive MDR-TB in north and central Chennai, India to determine attrition and turnaround times [TAT] at various steps of DTP and factors associated with attrition

Methods: Study was conducted in Revised National Tuberculosis Control Programme setting. It was a retrospective cohort study involving record review of all patients with presumptive MDR-TB [eligible for DST] in 2014

Results: Of 628 eligible for DST, 557 [88%] underwent DST and 74 [13%] patients were diagnosed as having MDR-TB. Pre-diagnosis and pre-treatment attrition was 11% [71/628] and 38% [28/74] respectively. TAT [median [IQR]] to test from eligibility for DST and initiate DR-TB treatment from diagnosis were 14 [9,27] and 18 [13,36] days respectively. Patients with smear negative TB and detected in first quarter of 2014 were less likely to undergo DST. Patients in first quarter of 2014 had significantly lower risk of pre-treatment attrition

Conclusion: There was high uptake of DST. However, urgent attention is required to reduce pre-treatment attrition, improve TAT to test from eligibility for DST and improve DST among patients with smear-negative TB