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

Adequacy of examining one sputum specimen in tuberculosis drug resistance surveys

Objective/background: Collection of one spot and one morning sputum specimen is recom-mended for tuberculosis [TB] drug resistance surveys. This was a retrospective analysis of Mycobacterium tuberculosis cultures isolated from two spot sputum specimens collected from smear positive TB patients in a TB drug resistance survey. It was conducted to under-stand the value of a second specimen

Methods: A TB drug resistance survey was conducted in the state of Tamil Nadu, India, to estimate the prevalence of drug resistance among new sputum smear-positive [NSP] and previously treated [PT] patients diagnosed in Revised National Tuberculosis Control Program microscopy centers. A total of 2425 patients [1524 NSP and 901 PT cases] were enrolled in the study. From these patients, two spot sputum specimens [C and D] were collected within a period of 2 h. No preservative was added to sputum. The samples were transported at ambient conditions without cold storage to the central laboratory for culture of M. tuberculosis. Culture yield from each sample was computed and analyzed. Results: The proportion of cultures retrieved from C and D specimens among NSP cases [89.3% and 89.7%] and PT cases [90.8% and 90.3%] were similar. The culture grades of C and D samples were comparable [chi-square test, 3560.135; p < .001] and the agreement was moderate [kappa test, 0.454]

Conclusion: The findings of the study reveal the adequacy of single spot sputum specimen from smear positive pulmonary TB patients for bacteriological examination in a quality-assured TB laboratory to determine precisely the level of drug resistance in a province of India