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Background The ongoing coronavirus disease 2019 (COVID-19) calls for setting up of well-equipped and dedicated health facilities to manage sick patients while protecting healthcare workers and the environment. An ideal high-level isolation unit requires a high level of administrative commitment, availability of space, human resource and logistics. Method The experience of setting up COVID-19 care facilities on a noticeably short period in a tertiary TB and respiratory diseases institute in wake of the COVID-19 pandemic is being shared here. Result All the essential COVID-19 services were set up in record time of 8 days. A total of 115 COVID-19 patients were admitted. Out of these 89 patients were discharged in a satisfactory condition. There were 19 deaths, and 4 patients became critical and had to be referred to level 3 facility for ICU care. Conclusion This experience will help other hospitals in planning out the strategies and solve the difficulties they may face while opening a COVID-19 care facility under limited resources on an urgent basis.

Background The study aimed to analyze frequency and severity of adverse events (AEs) and other reasons for interruption of treatment and loss to follow up (LTFU) during first six months of treatment among tuberculosis patients on bedaquiline containing regimens. Methods This pilot exploratory observational study included 275 patients enrolled consecutively over two years who received bedaquiline containing regimen under programmatic conditions in India. Results Among 275 patients with median age of 25 years, 86 (31.3%) patients had at least one interruption with 122 total episodes of interruption. Among these 70 were temporary, 35 were permanent interruptions and 17 were LTFU. The AEs due to drugs were the commonest reason for interruption observed in 81.4% of temporary interruption group and 97.1% of permanent interruption group. Among a total 192 adverse event episodes, (49.5%) were minor (grade 1–2) and (50.5%) were serious (grade 3–5). Personal factors were the commonest reason for interruption observed in LTFU (94.1%) group. The most common temporarily interrupted drug was bedaquiline in 8.7% and permanently stopped drug was linezolid in 5% of patients. Conclusions Our study observed that drug related AEs are important risk factors associated with treatment interruptions in bedaquiline containing regimens. Bedaquiline is the most common temporarily interrupted drug due to AEs.

Extra-pulmonary tuberculosis (EPTB) is known to cause for 8%-24% of all tuberculosis (TB) cases in the world.[1] The commonest extra-pulmonary sites to be affected in EPTB are lymph nodes and pleura, other sites being urogenital system, central nervous system, eye, cutaneous tissue and skeletal system. GUTB is insidious in onset and manifests most commonly as infertility sometimes present with chronic pelvic pain, dysmenorrhoea, bladder dysfunction and renal failure. We are discussing two case reports of GUTB, first one was an isolated case of tuberculous epididymo-orchitis in a 20 year old male and second a 29 year old male with TB involving the kidney along with genital organs. The cases were unique because of the atypical presentation and delayed effective treatment (in one case), despite the best diagnostic approach used.

Microstomia is a clinical condition of reduced mouth opening that can be acquired or congenital in origin. Problems associated with microstomia can be related to function, esthetics, or both. Management of microstomia due to facial burns is complex due to the presence of hypertrophic and contracture scars. Available treatment options can be broadly classified as surgical, nonsurgical, or both. Splints can be used to prevent the contraction of perioral musculature or to recuperate lost mouth opening. Various intraoral or extraoral, tooth-borne or tissue-borne, and static or dynamic appliances are in clinical use, but their designs are case specific. This case report explains the management of microstomia secondary to facial burns by using a dynamic splint in combination with intralesional injections of triamcinolone acetonide and hyaluronidase.

Background & objectives: The increase in the burden of multidrug-resistant tuberculosis (MDR-TB) is a matter of grave concern. The present study was undertaken to describe MDR-TB treatment outcome trends in Delhi and their epidemiological correlates, to assess the adequacy of treatment records and to also generate evidence towards influencing and improving practices related to the MDR-TB control programme. Methods: A retrospective record-based study (2009-2014) was conducted in three major drug resistance TB treatment centres of Delhi. Treatment outcomes and adverse effects were extracted from the existing programme records including patients' treatment cards and laboratory registers. Results: A total of 2958 MDR-TB patients were identified from the treatment cards, of whom 1749 (59.12%) were males. The mean (±standard deviation) age was 30.56±13.5 years. Favourable treatment outcomes were reported in 1371 (53.28%) patients, but they showed a declining trend during the period of observation. On binomial logistic regression analysis, patients with age ≥35 yr, male sex and undernourishment (body mass index

In India, daily regimen with fixed-dose combination along with 99DOTS adherence tool and one-stop service at Anti-Retroviral Treatment (ART) centres for HIV infected Tuberculosis (TB) patients was launched in 2017. No systematic evaluation of its implementation has been done so far in a tertiary care setting in urban India.A mixed-methods study was conducted at National Institute of Tuberculosis and Respiratory Diseases, Delhi in 2018-19. Missed doses, average adherence and treatment outcomes were compared across 99DOTS dashboard and TB treatment card. In-depth interviews of patients and health care providers were conducted to explore the implementation challenges and benefits.Median of missed doses recorded during intensive and continuation phase were 56 and 68 respectively in 99DOTS as compared to 0 in the TB Treatment card (p0.0001). Average adherence was observed to be 27% in 99DOTS versus 99% in the TB treatment card (p0.0001). Technical issues like software malfunction, logistic difficulties such as missing custom envelops and patient's inability to give call were reported. Role clarity among ART and TB program staff was ambiguous, which contributed to poor information flow between them. Patient benefits such as reduced stigma, less travel costs and reduced work absenteeism were reported.Success of 99DOTS program under programmatic condition needs webtool stability, uninterrupted logistic supplies (envelops), training of staff and better coordination between TB and HIV program personnel. Despite the challenges in its implementation, the benefit of this tool in terms of greater convenience and reduced stigma for patients is encouraging.

Background Drug-Resistant Tuberculosis (DR-TB) patients for whom a WHO recommended regimen along with Bedaquiline (BDQ) cannot be prescribed, Delamanid (DLM) was added along with other drugs to provide a “Salvage Regimen”. The experience of the Institute in respect of early efficacy and safety of both drugs given together is presented. Objective To ascertain the early efficacy, safety and tolerability of Bedaquline and Delamanid given together as a part of salvage regimen. Methods BDQ and DLM were used together to make regimens along with other drugs where four effective anti TB drugs could not be prescribed as per WHO recommendations. Patients were followed up for sputum smear and culture conversion and adverse events during the treatment. Results In this cohort study, 53 DR-TB patients (Median age-24) were initiated on regimens containing both BDQ and DLM. Sputum smear conversion was seen in 35% and 94% patients at the end of 1st week and 3rd month respectively. 84% patients had culture conversion at the end of 4th month. 29 adverse events (AE) were reported among 17 patients and there were 11 deaths. QTc prolongation more than 500 MS was seen in only 1 patient. Conclusion BDQ and DLM given together in a salvage regimen is efficacious with low rate of adverse events. The combination provides hope to DR-TB patients with limited treatment options and should be provided as a life saving option.

Persistent gaps exist in healthcare workers' capacity to address HIV and tuberculosis in Asia and Africa due to constraints in resources and knowledge. Project ECHO (Extension for Community Healthcare Outcomes) leverages video-enabled technology to build workforce capacity and promote collaboration through mentorship and case-based learning. To understand current perceptions of ECHO participants and develop a comprehensive evaluation framework for ECHO implementation, we utilized modified appreciative inquiry guided focus group discussions (FGD) in India and Tanzania and called it SCORE (Strengths, Challenges, Opportunities, Results, and Evaluation). Content and thematic analysis of transcripts from FGDs and key-informant interviews triangulated perceptions of diverse stakeholders about ECHO implementation and identified key elements for development of the framework. The perceived strengths (S) were capacity building and establishing communities of practice. The perceived challenges (C) included securing resources, engaging leadership, and building systems for monitoring impact. Improved internet connectivity, addressing logistical challenges, encouraging session interactivity, and having strategic scale-up plans were perceived opportunities (O). Additionally, gathering measurable results (R) led to development of a comprehensive evaluation (E) framework. Contextualizing and facilitating SCORE with qualitative analysis of findings 6-12 months post-ECHO implementation may serve as a best practice to assess mid-course corrections to improve ECHO implementation quality.

Background Nutrition support is one of the essential factors for envisioning Tuberculosis (TB) elimination in India by 2025. In this regard, Government of India introduced Nikshay Poshan Yojana (NPY) through Direct Benefit Transfer (DBT) as monthly financial assistance towards nutrition for TB patients in April, 2018. Assessment of early implementation challenges of the scheme is essential. Objective (a) To determine the number (proportion) of TB patients who received the benefits (b) to explore the challenges encountered by the health care providers in delivering the NPY through DBT (c) to explore the ways the incentives were utilised by the patients. Material and methods It was a cross-sectional study conducted among patients registered for TB treatment at Ladosarai and Mehrauli DOTS centre between July–September, 2018.Health providers engaged in implementation of NPY at the study sites were also interviewed. The data were collected through structured questionnaires, double entered and analyzed in Epi Data. Results Out of 119 patients registered, we interviewed 57 (47.9%) patients. Of which, 30 (52.6%) had received NPY for 2 months in the fourth and fifth month of treatment. The health providers reported increased workload, lack of training and complex reporting formats as main hurdles in implementation of the scheme. While, the patients cited non-availability of bank accounts and unlinked bank account with Aadhar card as difficulties to receive NPY through DBT. Conclusion Nearly half of the interviewed TB patients received nutritional incentives of NPY through DBT for 2 months. Non-availability of bank accounts and unlinked bank accounts were some challenges faced by both health providers and patient. It is recommended to address these implementation on time in order to reap the benefit of scheme in improving nutritional status of TB patients. Further studies are needed to determine the effect of nutrition support on TB patients.

Background Bedaquiline (BDQ) was approved for treatment of drug resistant TB (DR-TB) under Conditional Access Programme (CAP) of Revised National Tuberculosis Control Programme (RNTCP) and was also implemented in the National Institute of TB and Respiratory Diseases (NITRD). We present early efficacy and safety of BDQ containing regimens for DR-TB. Objective To ascertain the early efficacy and safety of Bedaquline containing regimens in treatment of DR-TB. Methods BDQ containing regimens along with other drugs were designed as per WHO recommendations for DR-TB patients. They were followed up for sputum smear and culture conversion, adverse events during the treatment. Results A cohort of 290 DR-TB patients (Median age-29.77) were initiated on BDQ containing regimens. Of the available Sputum results, smear conversion was seen in 51% and 91% patients at the end of 1st week and 3rd month respectively. Similarly, 93% and 98% patients had culture conversion at the end of 3rd and 6th month respectively. 201 adverse events (AE) including 47 deaths were reported among 109 patients. QTc prolongation was seen in 29% patients but only 4 required discontinuation of BDQ. Lost to follow up of treatment was about 6%. Conclusion Bedaquiline along with an optimized background regimen has shown early sputum conversion in larger number of difficult to treat patients having additional resistance of second line drugs along with INH and Rifampicin. The regimen is feasible in programmatic conditions and is relatively safe.

Background This study was conducted with the objective to understand pattern and trends in drug sensitivity among MDR-TB cases in Delhi from 2009 to 2014 using existing records. Methods A retrospective record-based study was conducted at three Drug-resistant TB (DR-TB) treatment centers in Delhi. For data collection, patient treatment cards and TB registers were accessed. All multidrug-resistant (DR) TB patients registered, and initiated on treatment from January 2009 to December 2014 in three DR-TB centers were included in the study. Results A cumulative total of 2958 MDR-TB cases were registered in the three DR-TB centers during the period from Jan 2009 to December 2014. The median value time interval between culture test result and initiation of treatment was 82 days. High resistance was found against Streptomycin (70%), Ethambutol (40.1%), Ofloxacin (42.4%) and Kanamycin (12%). Favorable treatment outcomes ranged from 52.5% to 56.9% in cases resistant to only first-line anti-TB drugs but was much lower in the pre XDR-TB cases (26.3%) and XDR-TB cases (12.5%). Conclusion The proportion of cases with additional resistance to ofloxacin, kanamycin, ethionamide, and streptomycin increased over time from 2009 to 2014. Reducing the time to treatment initiation from initial diagnosis of MDR-TB could further improve treatment outcomes.

Background Tuberculosis (TB) patients often incur large costs related to illness, as well as for seeking and receiving health care. Despite TB treatment being free under RNCTP, out of pocket expenditure incurred (OOP) by patients for TB diagnosis and treatment impoverishes the households. This expenditure may turn catastrophic (more than 20% of their family income) impacting adherence and leading to poor treatment outcomes. Objective To estimate the proportion of households experiencing catastrophic expenditure due to TB and also to find out the various costs contributing to catastrophic expenditure. Methods In this cohort study, 450 TB patients (including 96 children) registered under Revised National Tuberculosis Control Programme (RNTCP) in Delhi were interviewed at three different time points (in the beginning of treatment, end of intensive phase, end of treatment). Interview schedule was used to collect information on direct medical and non-medical, and indirect costs. The TB-specific indicator of “catastrophic total costs” incorporates both, direct medical and non-medical payments for treatment such as transportation, lodging charges and indirect costs such as wage loss. Results A total of 450 patients were enrolled in this study, out of which 425 were followed up to the end of treatment. It was observed that 7% of TB patients registered under RNTCP in Delhi experienced catastrophic expenditure due to TB. The total mean cost to patients with TB was Rs. 12165 (Rs. 1406 during diagnosis and Rs. 10759 during treatment). The indirect cost was higher compared to direct cost i.e.Rs. 7564 and Rs. 4601 respectively). Conclusion This information will be useful for policy makers to design an intervention to provide financial protection to TB patients. In addition, findings of this study will aid in providing baseline evidence to periodically measure the OOP which is the one of the End TB strategy target.

Prolonged treatment of tuberculosis (TB) often leads to poor compliance, default and relapse, converting primary TB patients into category II TB (Cat IITB) cases, many of whom may convert to multi-drug resistant TB (MDR-TB). We have evaluated the immunotherapeutic potential of Mycobacterium indicus pranii (MIP) as an adjunct to Anti-Tubercular Treatment (ATT) in Cat II pulmonary TB (PTB) patients in a prospective, randomized, double blind, placebo controlled, multicentric clinical trial. 890 sputum smear positive Cat II PTB patients were randomized to receive either six intra-dermal injections (2 + 4) of heat-killed MIP at a dose of 5 × 108 bacilli or placebo once in 2 weeks for 2 months. Sputum smear and culture examinations were performed at different time points. MIP was safe with no adverse effects. While sputum smear conversion did not show any statistically significant difference, significantly higher number of patients (67.1%) in the MIP group achieved sputum culture conversion at fourth week compared to the placebo (57%) group (p = 0.0002), suggesting a role of MIP in clearance of the bacilli. Since live bacteria are the major contributors for sustained incidence of TB, the potential of MIP in clearance of the bacilli has far reaching implications in controlling the spread of the disease.

SETTING: Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases (LRS), a tertiary level tuberculosis (TB) institute in Delhi, India. OBJECTIVE: To study the profile of TB among household contacts of multidrug-resistant TB (MDR-TB) patients. DESIGN: In a cross-sectional study, contacts of MDRTB patients were traced and clinical, radiological, bacteriological and pulmonary function tests were performed for evidence of TB infection and active disease. RESULTS: Between January 2005 and December 2008, 58 of 92 index MDR-TB patients could be traced. Of 302 contacts who could be studied, 16 (5.29%) developed TB: nine had pulmonary and seven had extra- pulmonary disease; two (0.66%) had MDR-TB. Of the 302 contacts, 137 reported to the LRS Institute and were investigated. The most common symptoms observed were cough, chest pain and fever. The tuberculin skin test was positive in 109 of 135 (80.7%) contacts; among these, bacille Calmette-Guerin scar was present in 86. Pulmonary function tests revealed obstruction, restriction and mixed abnormalities. CONCLUSION: The majority of contacts of MDR-TB patients had drug-susceptible TB and the rate of MDRTB was very low. Evaluation of contacts of MDR-TB cases may lead to early diagnosis and prevention of TB.

There are limited data of multidrug-resistant tuberculosis (MDR-TB) diagnosed in various patient categories by implementing Programmatic Management of Drug Resistant TB (PMDT) using line probe assay (LPA) from our country. Samples from presumptive MDR-TB from five districts of New Delhi were subjected to LPA from 1st October 2011 to 31st December 2014. The MDR-TB diagnosed in 4th & 5th month follow-up positives were significantly higher than other categories of the patients. Only 3/232 (2.2%) RIF resistants were diagnosed among smear negative re-treatment cases. The data suggest interim cost-benefit analysis of the program especially among smear negatives retreatment cases.

SETTING: National Institute of Tuberculosis and Respiratory Diseases (erstwhile Lala Ram Sarup Institute) in Delhi, India. OBJECTIVES: To evaluate before and after the introduction of the line Probe Assay (LPA) a) the overall time to MDR-TB diagnosis and treatment initiation; b) the step-by-step time lapse at each stage of patient management; and c) the lost to follow-up rates. METHODS: A retrospective cohort analysis was done using data on MDR-TB patients diagnosed during 2009-2012 under Revised National Tuberculosis Control Programme at the institute. RESULTS: Following the introduction of the LPA in 2011, the overall median time from identification of patients suspected for MDR-TB to the initiation of treatment was reduced from 157 days (IQR 127-200) to 38 days (IQR 30-79). This reduction was attributed mainly to a lower diagnosis time at the laboratory. Lost to follow-up rates were also significantly reduced after introduction of the LPA (12% versus 39% pre-PLA). CONCLUSION: Introduction of the LPA was associated with a major reduction in the delay between identification of patients suspected for MDR-TB and initiation of treatment, attributed mainly to a reduction in diagnostic time in the laboratory.

Background and Objectives: In pulmonary tuberculosis, bacteriological status at two months affects subsequent treatment and prognosis. The effect on treatment outcome and risk factors for sputum conversion at two months treatment in previously untreated pulmonary tuberculosis (PTB) patients was studied in the following report. Methods: A 1:1 case-control study was performed from June 2006 to February 2008 on patients in the Revised National Tuberculosis Control Program in a tertiary level institute in Delhi, India. Patients with previously untreated PTB with sputum smear positive at 2 months of treatment (cases) were compared with those who achieved conversion (controls). Results: In 74 cases and 74 controls, independent risk factors for sputum smear positive at two months were: illness for >2 months, presence of cavity or extensive disease on chest X-ray, and interruption in intensive phase of treatment. Patients with smear positive at 2 or 3 months of treatment were more likely to fail or default from treatment. Aforesaid factors were also associated with sputum culture positive status at 2 months in univariate analysis. Patients who interrupted treatment ≥3 times in the first two months were more likely to be culture positive at two months and had a higher rate of default and failure. Conclusions: Illness for more than 2 months, presence of cavity or extensive disease on chest X-ray, and interruption in intensive phase of treatment are independent risk factors for sputum smear positivity at two months, which in turn is associated with poor treatment outcomes. Patients with these factors merit special attention under the national program.

Linezolid is identified as an effective drug with which to treat patients failing multidrug-resistant (MDR)-tuberculosis (TB) treatment. However, cost and safety are the concerns. In India, the average price of a 600-mg pill of linezolid is less than one US dollar, much cheaper than most of the third-line drugs. A prospective study of 29 MDR-TB treatment failure patients (16 with laboratory-proven extensively drug-resistant (XDR)-TB and the remaining 13 with MDR-TB with resistance to any quinolone but sensitive to injectables) was carried out in Delhi, India. All patients received daily unsupervised therapy with linezolid, one injectable agent, one fluoroquinolone and two or more other drugs. Patients received a median of six anti-mycobacterial agents. Besides linezolid, capreomycin, moxifloxacin, levofloxacin and amoxycillin-clavulanic acid were used in 41.4%, 58.6%, 41.4%, and 79.3% of patients. Out of a total of 29 patients, 89.7% patients achieved sputum smear and culture conversion; 72.4% showed interim favourable outcome; 10.3% died, 6.8% failed and 10.3% patients defaulted. Linezolid had to be stopped in three (10.3%) patients due to adverse reactions. The outcome of treatment of 16 XDR-TB patients was comparable to the other 13 MDR-TB patients. Linezolid is an effective, cheap and relatively safe drug for patients failing MDR-TB treatment, including those with confirmed XDR-TB.

Protective immune responses during Mycobacterium tuberculosis (M. tuberculosis) infection are regulated at multiple levels and critically dependent on the balance in the secretion of pro-inflammatory and regulatory cytokines. A key factor that governs this balance at the cellular level is suppressors of cytokine signaling (SOCS). We recently demonstrated that toll-like receptor 2 and dendritic cell (DC)-SIGNR1 differentially regulate SOCS1 expression in DCs during M. tuberculosis infection. This consecutively regulated IL-12 production and determined M. tuberculosis survival. In this study, we characterized the role of SOCS1 in regulating effector responses from CD4(+) and CD8(+) T cells during M. tuberculosis infection. Our data indicate that T cells from M. tuberculosis-infected mice show increased and differential association of SOCS1 with CD3 and CD28, when compared with uninfected mice. While SOCS1 displays increased association with CD3 than CD28 in CD4(+) T cells; SOCS1 is associated more with CD28 than CD3 in CD8(+) T cells. Further, SOCS1 shows increased association with IL-12 and IL-2 receptors in both CD4(+) and CD8(+) T cells from infected mice when compared with naive mice. Silencing SOCS1 in T cells increased signal transduction from T cell receptor (TCR) and CD28 with enhanced activation of key signaling molecules and proliferation. Significantly, SOCS1-silenced T cells mediated enhanced clearance of M. tuberculosis inside macrophages. Finally, adoptive transfer of SOCS1-silenced T cells in M. tuberculosis-infected mice mediated significant reduction in M. tuberculosis loads in spleen. These results exemplify the negative role played by SOCS1 during T cell priming and effector functions during M. tuberculosis infection.

Sequelae of patients treated for multi-drug resistance tuberculosis (MDR-TB) remain unknown.To assess the clinical, bacteriological, radiological and functional status of MDR-TB patients after completion of treatment.In a cross-sectional study, MDR-TB patients who had initiated standardized, community based therapy from January 2002 to December 2006 at Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases were investigated for their current clinical, bacteriological, radiological and functional status.Between January 2002 to December 2006, 130 patients initiated treatment, of whom 24 died. Among rest 106 patients, 63 (59%) patients could be traced: 51 were currently alive while 12 had died. The 51 alive patients had completed a mean (+/- S.D.) post treatment period of 24 +/- 14.7 months ranging from 6 to 63 months before being enrolled in the study. Among currently alive patients who could be investigated, 78% had persistent respiratory symptoms; 98% had residual radiological sequelae with 40% having far advanced involvement. Abnormal Pulmonary Function Tests were observed in 45 (96%) patients with predominantly mixed type of ventilatory abnormality in 31 (66%) patients, while 9 (19%) had pure restriction and 5 (11%) had pure obstruction. None of the patients was found to be bacteriologically positive.Current study confirms the efficacy of the standardized regimen as none of the patients was bacteriologically positive on follow up. However, after completion of treatment significant number of cured MDR-TB patients are left with residual symptoms, abnormal X-ray chest and impairment of lung functions. These issues need to be addressed as a part of comprehensive management of MDR-TB patients under national programme.

OBJECTIVE: To assess the cost and cost-effectiveness of the Public-Private Mix DOTS (PPM-DOTS) strategy for tuberculosis (TB) control in India. METHODS: We collected data on the costs and effects of pilot PPM-DOTS projects in Delhi and Hyderabad using documentary data and interviews. The cost of PPM-DOTS was compared with public sector DOTS (i.e. DOTS delivered through public sector facilities only) and non-DOTS treatment in the private sector. Costs for 2002 in US$ were assessed for the public sector, private practitioners, and patients/attendants. Effectiveness was measured as the number of cases successfully treated. FINDINGS: The average cost per patient treated was US$ 111-123 for PPM-DOTS and public sector DOTS, and US$ 111-172 for non-DOTS treatment in the private sector. From the public sector's perspective, the cost per patient treated was lower in PPM-DOTS projects than in public sector DOTS programmes (US$ 24-33 versus US$ 63). DOTS implementation in either the public or private sectors improved treatment outcomes and substantially lowered costs incurred by patients and their attendants, compared to non-DOTS treatment in the private sector (US$ 50-60 for DOTS compared to over US$ 100 for non-DOTS). The average cost-effectiveness of PPM-DOTS and public sector DOTS was similar, at US$ 120-140 per patient successfully treated, compared to US$ 218-338 for non-DOTS private sector treatment. Incremental cost-effectiveness analysis showed that PPM-DOTS can improve effectiveness while also lowering costs. CONCLUSION: PPM-DOTS can be an affordable and cost-effective approach to improving TB control in India, and can substantially lower the economic burden of TB for patients.

With an increase in life expectancy and the resultant elderly population, there has been an increase in the number of tuberculosis (TB) cases including those in geriatric age as well. However using Directly Observed Treatment-Short Course (DOTS), all categories of TB patients have been sucessfully treated within the country. A need was felt to study the profile of geriatric TB patients under the Revised National Tuberculosis Control Programme (RNTCP).A retrospective study of 7439 patients enrolled under DOTS from January 1996 to March 2001 was carried out in a tertiary care referral institute in Delhi and the profile was analysed in terms of the gender, type of TB and ratio of sputum smear-positive to negative patients for both the younger and geriatric age groups. Further, treatment outcomes of the two age groups were analysed and compared for the 2655 new sputum smear patients.The male : female ratio of 315 geriatric TB patients enrolled under DOTS was observed to be 3 : 1 as against the 1.4 : 1 in younger TB patients. The occurrence of pulmonary TB was significantly higher than extra-pulmonary TB in geriatric age group (16:1) as compared to the younger age group (4:1). The ratio of new smear-positive to smear-negative patients was almost similar in the two age groups. Further, the treatment outcomes of new smear-positive geriatric TB patients in comparison to younger TB patients showed significantly lower sputum conversion (75.3% vs 85.7% respectively) and cure rates (69.2% vs 80.7% respectively), significantly higher exclusion rates from DOTS (2.3% vs 0.15% respectively) and relatively higher default and treatment failure rates.The present study has identified certain issues in the Indian TB patients of geriatric age. These include a lower reported prevalence amongst females, poor sputum conversion as well as cure rates and higher exclusion as well as default rates. Further studies are needed to address the issues under operational conditions of Indian RNTCP.

From the authors: We read with interest the comments by M.S. Bolhuis and co-workers on our article discussing the role of linezolid in treating multidrug-resistant (MDR) tuberculosis (TB) failures in India [1]. First, we would like to underline that our study was carried out in field conditions in a country with a high burden of MDR-TB cases and limited resources. We thank M.S. Bolhuis and co-workers for the opportunity to discuss the different perspectives of the Indian setting and those of a high-level tertiary hospital in a high-income country (India has one of the best existing TB control programmes). M.S. Bolhuis and co-workers correctly conclude that only a randomised trial comparing linezolid versus a placebo, in addition to an adequate background regimen using drug susceptibility testing (DST) and therapeutic drug monitoring (TDM), would provide comprehensive results on …

Background : India is high TB burden, high HIV burden and high MDR TB burden country. Nurses are the backbone of any health care delivery system. Nurses knowledge and attitude is crucial for achievement of targets of TB control. Objectives : To assess the knowledge and attitude of nurses for tuberculosis, MDR, RNTCP. To see co-relation between knowledge and attitude. Methods : A pre-experimental research approach was used. Study was taken on 30 nurses working in various government hospitals of Delhi. Tools used for data collection were structured knowledge questionnaire and "Likert Scale for Attitude". . Tools were validated for content and reliability was established before data collection. Data was collected. Training was imparted. Post Test after training was also administered Finding : Mean knowledge score in pretest was 21.60 for a total of 50 question and maximum score of 50. Mean knowledge score in post test was 31.73. This difference was statistically significant at 95% confidence interval. Attitude score improved little toward positive attitude and was statistically significant at marginal level (P value = .052). This pilot study found positive relationship between knowledge and attitude. (r=.309).

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.