RESUMO
Setting: Revised National Tuberculosis Control Programme emphasizing on DOTS in the metropolitan city of Bangalore. Objective: 1) To evaluate the treatment outcome of new smear positive patients supported with pre and post-treatment bacteriological profile 2) To assess their bacteriological and clinical status two and half years after treatment initiation. Design: A prospective cohort study of 271 new smear and culture positive patients initiated on Cat I from April to December 1999 and followed up till treatment outcome and 21/2 years thereafter. Results: Treatment success (cured and treatment completed) of the study group was 67.9% as 24.7% patients defaulted from treatment. Treatment failures and deaths during treatment were 5.2% and 2.2% respectively. Initial drug susceptibility status did not influence the treatment outcome of the study group except in six patients, who were multi-drug resistant. The development of drug resistance during treatment was seen in 1.3%. The proportion of bacteriological positivity and mortality during follow up was significantly higher among patients who defaulted from treatment. Relapses during the intervening period were 11.4%. Conclusion: Fully intermittent CAT I regimen was effective in programme conditions, irrespective of the pre-treatment drug susceptibility status. Treatment success of the cohort was vitiated by a high proportion of defaults in a metropolitan city, where the programme was recently implemented. The study findings underscore the importance of strict adherence to the programme guidelines for successful treatment completion and a lasting cure.
RESUMO
Background & Objectives: The level of initial drug resistance (IDR) and its trend is a sensitive indicator of the programme efficiency and provides indirect reflection of the quality of tuberculosis services in the area. Studies from some parts of India have reported an increase in the level of IDR to INH and Rifampicin. There is paucity of information on age specific pattern of IDR from India. Frequency of drug resistance in the younger age group provides a precise evaluation of the current situation. The published data from Bangalore (1985-86) pertaining to patients under the National TB programme reported an IDR of 20.6% to any drug. Subsequently, the RNTCP with DOTS strategy to achieve high cure rate was implemented in the area in late 1998. The present study was undertaken in a cohort of 324 new smear positive patients initiated on Cat-I regimen under RNTCP in Bangalore Mahanagara Palike from April to December 1999 to study the pattern of IDR among them, soon after RNTCP implementation in the area. This information would serve as a useful baseline data for the area to assess the impact of DOTS strategy on the levels of IDR subsequently. Material & Methods: Two pre-treatment sputum samples were collected from these patients and subjected to microscopy, culture & susceptibility testing at the National Tuberculosis Institute. The susceptibility testing was done by economic version of proportion method, as per IUATLD guidelines. Information regarding the previous treatment was elicited using a pre-tested semi-structured schedule based on the WHO questionnaire for IDR surveillance and scrutiny of available records. Results: Among the 271 correctly categorized new patients, 27.7% were resistant to one or more drugs. The resistance to streptomycin was highest (22.5%) followed by INH (13.7%), and MDR was 2.2%. The age specific resistance was highest in <25 years and declined significantly in the higher age groups, being lowest (17.7%) in >45 years. Effective RNTCP implementation is expected to show declining trends in the IDR, particularly in the younger age group during the subsequent surveys.