Treatment outcomes and its trends amongst drug - resistant Mycobacterium tuberculosis patients treated under programmatic conditions in Bengaluru city (2017 – 2020)

Background: India is having 27% of the world’s drug resistant TB burden. To address this emerging public health concern PMDT services were rolled out in the year 2007 and the nationwide coverage was achieved in the year 2013. In India, MDR RR TB patients started on se cond - line treatment in the years 2018 and 2020 under PMDT had favorable treatment outcomes of 56% and 57% respectively. Therefore, th is study was conducted to determine the treatment outcomes in patients of DR TB & MDR RR TB in Bengaluru city Karnataka, In dia. Methods: This was a descriptive cross - sectional study using programmatic data among the notified TB cases during the year 2017 - 2020 under NTEP of Bengaluru city. Socio - demographic data, clinical characteristics and diagnostic data were studied. Data analysis was conducted in Python (version 3.9.4) to ascertain the treatment outcomes and its trend in the study area. Results: A total of 689 patients were identified as DR TB cases having resistance to any first line anti TB drug during the year 2017 - 2020 . The mean age of the DR TB patients was observed as 36.7 years (95% CI: 22.3 - 51.1). Among them 434(63.0%) were male, 254(36.9%) were female and 01(0.1%) were transgender. The study revealed the favourable treatment outcomes of 56.6% among the overall DR T B patients and 42.2% among the MDR RR TB patients in Bengaluru city. Conclusion: The study depicted trends of improvements in the successful treatment outcomes among overall DR TB patients from the year 2017 to 2020, but on the other hand the same among th e MDR RR TB patients is a cause of concern. The study highlights adopting a multipronged scheme focusing on End TB strategy by improving diagnostic capability, assuring high - quality treatment and averting drug resistance propagation among

A Clinico-Radiological Presentation Of Pulmonary Tuberculosis In Hiv Positive Patients In A Tertiary Care Hospital

Background: The deadliest combination of the two devastating and killer disease TB & HIV has been closely linked since the emergence of AIDS contributing the progress and pathogenecity of each other, and as half of the HIV patients are likely to be infected with tuberculosis, the twin challenge of this CURSED DUETseems to be daunting. There has been increase rate of DR TB, MDR TB, XDR TB, which are difcult to treat and contribute to increase mortality. Objectives:To study and co-relate clinical and radiological features of Pulmonary TB in HIVpositive patients, comparison with degree of immune suppression. To compare the CD T-cell count and sputum status before and after ATT4 treatment completion. Material and Methods: This was a prospective cohort study conducted on 50 patients under Department of Radiology, Saraswati Medical College, Unnao from Jan 2018 to Dec 2018. The patients included in the study were all TB patients of age >18 years with strong clinical suspicion of HIV/AIDS. Pulmonary TB was diagnosed either with sputum smear positive or Chest x-ray. When EPTB was suspected as a possible diagnosis, every attempt was made to procure tissue/relevant body uid for diagnostic testing. Rapid tests are in vitro qualitative tests for the detection of antibodies to Human Immunodeciency Virus (HIV) types 1 &2 in human serum, plasma, whole blood, urine, saliva was used for diagnosis of HIV. Patients with only extra Pulmonary Tuberculosis and no evidence of pulmonary tuberculosis and Patients with PCP, fungal infection and sepsis were not included because these conditions cause lymphopenia and decreases CD T-cell count. Results: Out of these 50 patients, most of the HIV-TB co-infected patients (62.5%) were seen among sexually active age group of 25-44 yrs. 80% of the patients were male and 20% were females. Most frequently encountered symptoms were fever (80%), cough (70%), loss of appetite (70%) and loss of weight (60%). About 80% cases were moderately or far advanced disease on the chest radiograph. The typical radiological ndings of post primary TB, i.e. upper zone inltrate, brosis and cavities were found in 24%, 4% and 6% cases respectively. Cavitary lesions were more in CD4 count above 100. Overall sputum positive PTB was 76% and sputum negative PTB was 24%. Conclusion: Treatment of HIV-TB co infection requires strong commitment and a focused approach. A strong coordination between the national TB and AIDS control programmes is required for effective management of TB-HIVpatients

Surveillance, Evaluation of Programmatic Management of Drug Resistant Tuberculosis (PMDT) at DR-TB Centre, NITRD, New Delhi

Background: PMDT was launched in 2007 in our country but drug resistant TB remains to be a public health problem. Effective surveillance is the backbone for success of any programme and true stands for PMDT. Aim & Objectives: To identify the strengths and constraints of the surveillance evaluation system. Material & Methods: A cross sectional study was conducted in January 2015 at DR-TB Centre of NITRD, New Delhi which caters to a population of 29 lacs. PMDT surveillance system was evaluated using attributes like simplicity, data quality, acceptability, positive predictive value, representativeness and timeliness defined by CDC, USA guidelines. Relevant information was collected using data abstraction form and interview with stakeholders. Data was analysed using EpiInfo 07 version. Results: Nodal officer and District TB officer are responsible for surveillance system activities of PMDT at DR-TB centre and district level, respectively. All the reports (100%) were submitted on time and all the districts were reporting to DR-TB centre. 75% of TB-HIV coordinators found reporting formats to be simple but all the quarterly reports were found to be complete. Data quality was not found to be optimal. Conclusion: Private sector needs to be taken on board as they have no to minimal involvement in PMDT. For data quality improvement time to time training of medical officers and health workers should be organized.