Evaluation of a new quality assessment strategy for blinded rechecking of random sputum smears for TB in Delhi, India.

This study was conducted at the New Delhi Tuberculosis Center, Delhi, India, from 1 January 2006 to 31 December 2007 to assess the feasibility of implementing random blinded rechecking (RBRC), a quality assurance strategy, and its impact on the performance of tuberculosis smear microscopy in Delhi, RBRC activities are carried out monthly at District Tuberculosis Centers (DTCs). Forty thousand five hundred and six slides were rechecked during the study period. RBRC, as a method of quality assurance was found to be feasible for a large application. The quality of sputum microscopy improved, with a significant reduction in the number of false positive and false negative errors in 2007 compared to 2006. The number of microscopy centers reporting high false errors decreased significantly in 2007.

Tuberculosis mortality trends in Delhi after implementation of RNTCP.

OBJECTIVES: To study the impact of Revised National TB Control Programme on mortality among tuberculosis patients in Delhi and to correlate mortality trends with programme indicators. METHODS: Record based evaluation of mortality trends from TB registers of all chest clinics of Delhi after implementation of Revised National TB Control Programme. RESULTS: The study showed a statistically significant decline in tuberculosis mortality among new smear positive cases after the implementation of Revised National TB Control Programme (z = 4.478 p < 0.05). The mortality among new smear negative and extra pulmonary cases also showed reduction, though not statistically significant. CONCLUSION: Mortality due to tuberculosis has been considerably reduced in Delhi over the years with the Revised National TB Control Programme implementation since 1997.

Efficacy of repeat sputum examination in RNTCP.

BACKGROUND: The guidelines of repeat sputum smear examination in initial smear negative patients (ISN), who also fail the antibiotic trial of three samples have been incorporated in the RNTCP diagnostic algorithm in India in 2005. This study was conducted to assess the utility of repeat sputum smear examination in symptomatic initial smear negative patients to detect new smear positives in the state of Delhi. MATERIAL AND METHODS: The monthly records of the laboratory abstracts for the six quarters for all the 24 districts of Delhi were analysed w.e.f. first of January 2006 to 30th June 2007. RESULTS: A total of 243,244 TB suspects were examined for diagnosis during the six quarters w.e.f. January 2006. Of these, 37,666 were found positive on sputum smear microscopy giving a positivity rate of 15.4%. During the same period, a total of 2,195 (1% of ISN ) TB suspects underwent repeat sputum examination, of which 272 were found positive giving a mean positivity of 12.3%. CONCLUSION: A significant number of apparently smear negative TB cases may in fact be smear positive due to various reasons and can be detected by a simple repeat sputum examination. Yield of sputum positive cases in sputum reexamination is almost the same as in initial sputum examination i.e. 10-15%. Therefore, the policy of repeat sputum examination in symptomatic initial sputum negative cases failing the antibiotic trial should be meticulously followed as advocated in the RNTCP diagnostic algorithm.

DOTS in drug addicts with TB : Delhi experience.

BACKGROUND: Drug abuse is on the rise. Drug addiction lowers the general immunity of the body. Tuberculosis is known to be one of the major infectious diseases with a high incidence among drug addicts. Treatment of drug addicts suffering from tuberculosis is a challenge to the treating physician. METHODS: An interventional prospective study which involved free de-addiction drugs and motivation along with free anti tubercular drugs under Revised National Tuberculosis Programme was undertaken among drug addicts. Sixty drug addicts suffering from tuberculosis, registered under RNTCP in SPM marg TB Clinic (Pili Kothi) between 2002-2007 and treated under DOTS along with de-addiction treatment by an NGO (Sharan) formed the study sample. OBJECTIVES: Objectives of the study were: a) To study the profile of drug addicts with tuberculosis, b) To assess the success results of DOTS in drug addicts with tuberculosis (along with de-addiction treatment). RESULTS: Extensive counselling for de-addiction and motivation of the study patients along with nutritional food supplements improved the compliance and adherence to treatment with equal success rates as in non-addict tuberculosis patients. The overall success rate in drug addicts was 83.3%. The default rate of 3.3% and failure rate of just 1.7% among study group were also within the permissible range of RNTCP (< 4%). CONCLUSION: DOTS along with supplementary intervention was observed to be quite effective in drug addicts with TB.

Study of relapse and failure cases of CAT I retreated with CAT II under RNTCP--an eleven year follow up.

OBJECTIVE: To analyse the treatment outcome of Cat I smear positive relapse and failure cases and their fate when treated with Cat II regimen under RNTCP. METHODS: All Cat I smear positive relapse and failure TB patients treated with Category II regimen from 1994 to 2005 in a chest clinic of Delhi were analysed in this retrospective study. The re-treatment outcome data for relapse and failure cases of Cat I when treated with Cat II regimen was reviewed. RESULTS: The study population included 5576 registered as Cat I sputum positive cases in Gulabi Bagh chest clinic from 1994 to 2005. A total of 190 (3.4%) failed on Cat I regimen. Further out of 4905 (87.9%) successfully treated Cat I patients, 442 (9%) presented as relapses. The treatment success rate for relapse and failure cases of Cat I when subsequently treated with Cat II regimen were 76.4% and 48.8% respectively, with a significantly higher failure rate (27.6%) among Cat I failures subsequently treated with Cat II regimen. CONCLUSION: The failure cases of Cat I subsequently treated with Cat II were observed to have a significantly lower success rates (p < 0.05) as compared to relapse cases. The need for reappraisal of Cat II re-treatment regimen for failure cases among Cat I is suggested.

The impact of an IEC campaign on tuberculosis awareness and health seeking behaviour in Delhi, India.

OBJECTIVE: To study the impact of an intensive IEC campaign regarding the Revised National Tuberculosis Control Programme launched by the Government of Delhi on awareness generation among the general population and improvement in self-reporting by symptomatic cases in Delhi, India. DESIGN: Cross-sectional study. RESULTS: A pilot study wherein 1008 persons selected by systematic random sampling from the general population and 1012 patients selected from symptomatic cases reporting to DOTS centres were interviewed. Among the general population, 716 (71.0%) had been exposed to one or more IEC message through the media. The core message regarding symptoms, diagnosis, treatment centre and free treatment was recalled correctly by 144 (14.3%), 449 (44.5%), 659 (65.4%) and 900 (89.2%), respectively. In the post IEC period, a significant increase (P < 0.01) was seen in individuals self-reporting with symptoms to DOTS centres: the media message reportedly encouraged 36.3% of these to self-report. Prior to the IEC campaign only 49 (9.8%) patients had chosen a DOTS centre as first source of treatment, which increased significantly (P < 0.0001) to 104 (20.4%) post IEC. CONCLUSION: The IEC campaign launched by the Government of Delhi has been effective in raising awareness and improving self-reporting, but it requires intensification with suitable modification to reach all sectors.

Trends of HIV infection in the blood donors of Delhi.

Screening of HIV Infection was made mandatory for every unit of blood collected for transfusion in Delhi, India since 1989. Ten Zonal Blood Testing Centres have been identified which test all the blood collected for HIV by 29 blood blanks for the city. Reports from these testing centres have been analysed yearwise to find out the magnitude and trends of HIV infection in different groups of blood donors. Although initially there was no difference in HIV Sero-reactivity in different blood donors categories (between 1 & 2 per 1000 blood donors samples tested) but subsequently there is significant increase (5.24/1000 in 1992 & 7.48/1000 in 1993) in the HIV sero-reactivity in replacement donor category possibly because professional donors donate blood in the guise of being replacement donors. The fact which comes out clearly is that HIV infection is present in all sections of the population in Delhi and mandatory HIV Screening of all blood collected for transfusion is justified.

PIP: Since 1989, screening of all blood collected for transfusion for HIV has been mandatory in Delhi, India. Blood collected at Delhi's 29 blood banks is sent to 1 of 10 zonal blood testing centers. About 90% of blood donors are men 20-40 years of age. Only about 20% of donors are voluntary; 35% of blood is contributed by paid professional donors and the remaining 45% by replacement donors. The HIV seropositivity rates per 1000 samples screened among voluntary donors were 0.63, 0.45, 1.9, 3.03, and 3.87 in 1989, 1990, 1991, 1992, and 1993, respectively. Among replacement donors, these rates were 0.46, 0.50, 1.9, 5.24, and 7.48, respectively. Among professional donors, these rates were 1.50, 0.90, 1.3, 3.28, and 3.76, respectively. Notable is the significant increase in HIV infection in replacement donors. It is speculated that this trend represents a tendency for many professional donors to present as replacement donors to obtain payment directly from a patient's family rather than the blood bank. If voluntary blood donors are representative of the general male adult population, HIV prevalence appears to be steadily increasing in Delhi and continued blood screening is certainly warranted.