Impact and operational feasibility of TrueNat™ MTB/Rif under India's RNTCP.

BACKGROUND: The Revised National Tuberculosis Control Programme (RNTCP) in Andhra Pradesh, India, introduced TrueNat™ MTB/Rif, a rapid molecular test for detecting Mycobacterium tuberculosis (MTB) and rifampicin (RIF) resistance at 193 TB units (TUs) in October 2018. We evaluated its impact on TB diagnosis and assessed the operational feasibility of its deployment at point-of-care (POC) settings. METHODS: We compared the number of presumptive TB cases tested and the number (proportion) of microbiologically positive before (January-August 2018) and after (January-August 2019) the deployment of TrueNat. We interviewed laboratory technicians and Senior TB Laboratory Supervisor from 25 randomly selected TUs to assess operational feasibility. RESULTS: In 2018, 10.5% (range 8.9-13.1) of 245,989 presumptive cases tested were positive. In 2019, of the 185,435 presumptive cases tested, 13.7% (range 9.6-18.9) were positive. The proportion of presumptive TB cases in whom MTB was detected using TrueNat was 14.4% (range 10.0-21.2). TrueNat significantly increased case detection (incidence rate ratio [IRR] 1.30; 95%CI 1.15-1.46), yielding an additional 18 TB cases per 100 000 population. Laboratory technicians became comfortable in performing TrueNat after a median of 10 tests (interquartile range 5-17.5). Invalid reports declined from 6.8% to 3.6%. CONCLUSION: The deployment of TrueNat as POC diagnostic test improved case detection and was operationally feasible under RNTCP.

Financial support to the poor for the detection of smear-negative pulmonary and extra-pulmonary TB in Bangladesh.

BACKGROUND: The study was conducted in BRAC-administered areas of the Bangladesh National Tuberculosis (TB) Programme (42 of 64 districts). According to the 2013-2017 financial support scheme, direct costs due to TB diagnosis were reimbursed among economically disadvantaged people with presumptive smear-negative pulmonary (PTB) and extrapulmonary TB (EPTB).OBJECTIVE: To describe the implementation of the scheme and associated changes in case notification.DESIGN: This was a descriptive study involving programme data.RESULTS: Between 2013 and 2017, persons reimbursed reduced from 125 680 to 88 763, and the case detection ratio increased from 18% to 24%. The number of patients with presumptive EPTB who were reimbursed decreased from 5024 to 3484. More than 95% were reimbursed for chest radiograph, fine-needle aspiration cytology and biopsy. However, large numbers of ancillary investigations were also reimbursed. During 2013-2017, the observed national quarterly new smear-negative PTB case notification rates (CNRs) were significantly higher than the forecasted CNRs (based on CNR trends during 2008-2012). New EPTB and all form TB CNRs increased but not significantly.CONCLUSION: Implementation of the financial support scheme was accompanied by a significant improvement in new, smear-negative PTB notification. The absence of a comparison arm was a key limitation, but comparison was not possible as the scheme was implemented in all districts.

The Role of Far Infrared Therapy in the Unassisted Maturation of Arterio-venous Fistula in Patients with Chronic Kidney Disease.

INTRODUCTION: The goal of arterio-venous fistula (AVF) creation is to achieve a well-functioning access that can be cannulated repetitively and can provide adequate flow for the dialysis. The objective of this study was to assess the role of far infrared (FIR) therapy in the unassisted maturation of newly created AVF in patients with chronic kidney disease (CKD). MATERIALS AND METHODS: In this prospective open labeled randomised control trial, 107 patients were randomized. Participants in the control arm received oral clopidogrel 75 mg once daily for 30 days along with isometric hand exercise, whereas those in the test arm received FIR therapy twice weekly, 40 min session each, for 4 weeks. A biopsy from venous end was taken during fistula surgery. Doppler study of AVF was done at the end of the 4th and 12th week to assess AVF. Vascular access guidelines proposed by National Kidney Foundation -Kidney Disease Outcomes Quality Initiative (NKF- KDOQI) in 2006 were adapted to define the maturation of AVF. RESULTS: Out of 107 patients, 51 were randomized to the test arm and 56 to the control arm. During follow-up, the blood flow rate through AVF (Qa) and the diameter of the cephalic vein draining (CVd) the AVF were measured. At the end of 3 months, Qa in Radio-Cephalic Fistula (RCF) was high in the test arm (p-0.003). The AVF failures were 5 (10.2%) and 14 (28%) in the test and control arms, respectively (p: 0.025). However, when adjusted for AVF failure within 6 h of surgery (may be related to surgical technique) this difference in AVF patency was statistically insignificant (p: 0.121). The mean Qa was high in patients with an arterial intimal medial thickness (AIMT) <0.5 mm. The IMT of the anastomosed artery had statistically significant correlation with the primary failure rate of AVF (P < 0.001). CONCLUSION: In patients with CKD, FIR therapy was effective in increasing the AVF blood flow rate at the end of 3 months, though the difference in primary failure rate was statistically insignificant.