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Background and Objective: We evaluated the DR-TB component of the National Tuberculosis Elimination Program (NTEP) in a high-burden district in Kerala to identify the programmatic gaps, if any, in screening, diagnosis, treatment, and follow-up of notified DR-TB patients. Methods: A mixed-methods design was used, and the evaluation was performed in two steps. In the first step, we reviewed the program documents and conducted stakeholder interviews to develop a detailed description of the program design and developed a logical framework to evaluate program performance. Consequently, in the next step, we conducted programmatic data reviews, facility surveys, and in-depth interviews with key stakeholders to identify the programmatic gaps in implementation, guided by the logic framework. Results: Of the 494 microbiologically confirmed TB patients during 2021-22, 342 (69%) were tested for drug sensitivity, and 30 DR-TB patients were identified. There was no separate district DR-TB treatment center with airborne infection control facilities, and only 16% (66/422) of the various categories of staff were trained in recent guidelines. Only 30% (9/30) of DR-TB patients were provided with any psychological assessment. The favorable treatment outcome was 80% Interviews revealed poor readiness and motivation from the private sector for screening, contextual barriers in human resource availability, transportation, and financial barriers to the beneficiary despite providing financial benefits. Conclusion: Prioritizing the establishment of a district DR-TB treatment center and sputum transport mechanism, posting a clinical psychologist dedicated to counseling patients on therapy, and training all categories of staff on DR-TB management guidelines will significantly contribute to improving program outcomes.

In India, the incidence of mucormycosis reached high levels during 2021–2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. Patients hospitalized for mucormycosis during March–July 2021 were included. Mucormycosis was diagnosed based on mycological confirmation on direct microscopy (KOH/Calcofluor white stain), culture, histopathology, or supportive evidence from endoscopy or imaging. After consent, trained data collectors used medical records and telephonic interviews to capture data in a pre-tested structured questionnaire. At baseline, we recruited 686 patients from 26 study hospitals, of whom 72.3% were males, 78% had a prior history of diabetes, 53.2% had a history of corticosteroid treatment, and 80% were associated with COVID-19. Pain, numbness or swelling of the face were the commonest symptoms (73.3%). Liposomal Amphotericin B was the commonest drug formulation used (67.1%), and endoscopic sinus surgery was the most common surgical procedure (73.6%). At discharge, the disease was stable in 43.3%, in regression for 29.9% but 9.6% died during hospitalization. Among survivors, commonly reported disabilities included facial disfigurement (18.4%) and difficulties in chewing/swallowing (17.8%). Though the risk of mortality was only 1 in 10, the disability due to the disease was very high. This cohort study could enhance our understanding of the disease’s clinical progression and help frame standard treatment guidelines.

The patterns of concordant and discordant comorbidities of hypertension and their association with hypertension control were ascertained in this cross-sectional study. A total of 402 adults with hypertension were identified from the baseline survey of a randomized controlled trial for hypertension control among school teachers in Kerala. Chronic conditions were captured and categorized into concordant and discordant comorbidities. Nearly 57% of teachers with hypertension reported multimorbidity. Concordant morbidity was reported by 44% and discordant by 21% of participants. The odds of hypertension control was higher among those who reported at least one discordant morbidity (odds ratio [OR]: 2.76, 95% confidence interval [CI]:1.69–4.49) and those who reported at least one concordant morbidity (OR: 2.08, CI: 1.37–3.16), compared to their counterparts. Hypertension control was higher for those who reported any comorbidity (OR: 2.37, CI: 1.51–3.71) compared to those who did not report any. Well-designed large-scale mixed methods studies are required to thoroughly explore multimorbidity and its relationship with hypertension control in India.