Search

Introduction: Tuberculosis [TB] still accounts for millions of cases of active disease and deaths worldwide. The disease mainly affects the developing countries. Modern Anti-tubercular treatment can cure virtually all patients provided correct combination treatment is taken in amount and duration. Treatment of TB has been shifted towards daily regimen with administration of daily fixed dose combination of first-line anti Tuberculosis drugs [ATD] as per appropriate weight bands. Objectives: To study efficacy of RNTCP recommended Anti TB FDCs [Fix drug combination’ in different weight ranges of weight Bands. Materials and Methods: A Prospective cohort study was conducted involving a total of 830 patients presenting to Department of Respiratory Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai with diagnosed tuberculosis and Registered for category I[CATI] and category II [CATII] anti tuberculosis treatment [ATT].Duration of study was 21 months. Follow up was done at the end of intensive phase (2 months) [ at the end of maximum 3 months in extrapulmonary TB] and at the end of continuation phase (6 months for Cat I and 8 months for Cat II patients). Outcome of ATT was studied in different weight bands asper RNTCP. (Cure, Failure and treatment completed). Data was analyzed using SPSS version 22.0. Result: Among treatment categories, most patients (78.6%) were registered under Category I (new patients) as compared to retreatment cases (Category II and Category I Retreatment). Among PTB patients cure rate was 78.2%, while among EPTB patients treatment completion rate was 85.2%. Compliance of patients was better with FDCs due to reduced pill load, single dose administration, can be conveniently given to patients of all weights as per their weight bands. Conclusion: Among PTB patients cure rate was 78.2%, while among EPTB patients treatment completion rate was 85.2%. [ABSTRACT FROM AUTHOR]

Background & Objectives: This study was aimed to know the treatment outcome of category I tuberculosis patients under RNTCP in a tuberculosis unit of Ahmedabad Municipal Corporation. Method: It was a longitudinal (follow up) study conducted from January 2014 to October 2014 in Rakhiyal tuberculosis unit in Ahmadabad city. Total 187 patients of category I were studied. Data was collected using predesigned questionnaire by interviewing the patients thrice (1st visit on base line data second after completion of intensive phase and third after completion of continuation phase. Verbal consent was taken). Tools of study: Pre-designed questionnaire was prepared before study and two follow up visit were done at end of intensive phase first visit(at end of two month) and second at the end of continue phase (at end of six month). During study first of all basic demography profile was collected and verbal consent was taken from all patients and then all the participants were enrolled in this study. Result: The majority of study population was in reproductive age group (67.52%).The ratio of Pulmonary: Extra-pulmonary was 1.3:1.Almost half (48.12%) patients were new sputum smear positive (NSP), (43.32%) New extra-pulmonary and (8.56%) were new sputum smear negative. NSP (New sputum positive): NSN(New sputum negative) ratio was 5.6:1. In majority of patients (61.18%) DOTS was provided by TB Health workers. Sputum conversation rate was (75.56%) after two months. Majority (88.3%) completed the continuous phase. HIV coinfection was found 5.88%. Interpretation and conclusion: Study result showed that all the patients took treatment under the supervision whether in the presence of Community DOTS providers or Private practitioners and all the patients completed the intensive phase of the therapy. This reflects the responsible functioning of the healthcare providers to achieve the primary aim of the tuberculosis programme, which is to detect and cure infectious tuberculosis cases in order to reduce the transmission, morbidity and mortality. Overall sputum conversion rate (75.56%) which was low. The outcome indicates well within acceptable presence of RNTCP which reflect deep programme is being effectively implemented in Tuberculosis Unit. Increased switch over to MDR (4.81%) found in the study could be explained by HIV-TB co-infection and Diabetes. [ABSTRACT FROM AUTHOR]

Background and aims: India is a high-burden tuberculosis (TB) region and a drug-resistance hotspot. Despite numerous reports of pulmonary tuberculosis (PTB) cases, there needs to be more literature available on the importance of diagnostic methods in the case of extrapulmonary tuberculosis (EPTB). A prospective study was performed from July 2017 to June 2018 to compare the efficacy of conventional and molecular methods in detecting PTB and EPTB cases. Methods: Overall, 1000 presumptive PTB and 412 EPTB cases were subjected to staining (Ziehl- Neelsen [ZN] and fluorescent staining), culture, GeneXpert, and line probe assay (LPA). Results: The sensitivity, specificity, and strength of association [i.e., kappa (k) value of light-emitting diode-fluorescent microscopy, ZN, and GeneXpert] were calculated using standard formulae using solid culture as the gold standard. The sensitivity of GeneXpert in smear-positive/culture-positive PTB was comparable with the smear-negative/culture-positive PTB cases (95.7% vs. 87.5%) with an overall sensitivity and specificity of 90.5% and 90.1% in EPTB cases, respectively. However, sensitivity was lower for pleural fluid (75%) and tissues (85.7%). In pulmonary instances, 10% (6.7% Rifampicin [RIF] + isoniazid [INH] resistant and 3.3% INH monoresistant) drug resistance was observed, and no drug resistance was found in extra-pulmonary samples. Conclusion: Among conventional methods, fluorescent staining is more sensitive than ZN staining, while the sensitivity of GeneXpert varies w.r.t type of sample using culture positivity as the gold standard. In general, the present study suggests the promotion of universal drug susceptibility testing (DST) for all individuals with TB to control drug-resistant TB.

Introduction: A high level of community awareness and positive perception towards tuberculosis and its management is crucial for the successful outcome of any control measure. In India the Accredited Social Health Activist (ASHA) plays a key role in providing awareness and counselling on healthcare issues and management, particularly in remote areas. The tribal population is vulnerable to such infectious diseases due to resource limitations and remote locations. We assessed the knowledge, attitude, and practice (KAP) regarding directly observed therapy (DOT) among ASHA workers in the tribal belt of the Sirohi district of Rajasthan state. Material and Methods: This cross-sectional study was conducted among ASHA workers of Sirohi district from January 2021 to June 2021. A predesigned and structured questionnaire was used to gather information on knowledge, attitude, and practices regarding the management of tuberculosis and DOT. Results: A total of 95 ASHAs participated in the study with a mean age of 35.82 years. Good knowledge (Mean score = 6.2947 ± 1.08052) was observed regarding tuberculosis and DOT. 81% (n = 74) have good knowledge regarding DOT whereas most have a poor attitude and only 47% have adequate practice. A 55% of ASHAs did not adhere even a single TB patient in the last three years. Conclusion: In our study, knowledge gaps were identified which may result in substandard patient care. The structured refresher training towards DOT and also training to work in tribal areas will further improve the KAP of ASHAs. It might be needed to provide a module or curriculum regarding awareness among ASHAs for strengthening follow-up system for tuberculosis patients among the tribal population. [ABSTRACT FROM AUTHOR]

Purpose: To describe the increase in prevalence of ethambutol-induced optic neuropathy (EON) in patients presenting to a single tertiary referral eye care center in India after introduction of weight-based fixed dose combinations and an increase in duration of ethambutol use from 2016 in the Revised National Tuberculosis Control Program. Methods: This was a retrospective, observational, referral hospital-based study of 156 patients with a diagnosis of EON presenting to a single tertiary referral eye care center between January 2016 and December 2019. The main outcome measure was to assess the increase in prevalence of EON cases presenting to our tertiary care institute. Results: During the 4-year study period, 156 new patients were diagnosed with EON. A total of 101 patients (64.7%) were males and 55 (35.3%) were females. The most common age group affected was 41–60 years. The significant complaint at presentation was decreased vision in all the patients. A rising trend in the number of patients diagnosed as EON was seen, with the prevalence increasing from 16 cases in 2016, 13 cases in 2017, and 31 cases in 2018 to 96 cases in 2019. Conclusion: The results of this study indicated an alarming increase in the trend of EON cases presenting to our tertiary care institute.

Introduction: A high level of community awareness and positive perception towards tuberculosis and its management is crucial for the successful outcome of any control measure. In India the Accredited Social Health Activist (ASHA) plays a key role in providing awareness and counselling on healthcare issues and management, particularly in remote areas. The tribal population is vulnerable to such infectious diseases due to resource limitations and remote locations. We assessed the knowledge, attitude, and practice (KAP) regarding directly observed therapy (DOT) among ASHA workers in the tribal belt of the Sirohi district of Rajasthan state. Material and Methods: This cross-sectional study was conducted among ASHA workers of Sirohi district from January 2021 to June 2021. A predesigned and structured questionnaire was used to gather information on knowledge, attitude, and practices regarding the management of tuberculosis and DOT. Results: A total of 95 ASHAs participated in the study with a mean age of 35.82 years. Good knowledge (Mean score = 6.2947 ± 1.08052) was observed regarding tuberculosis and DOT. 81% (n = 74) have good knowledge regarding DOT whereas most have a poor attitude and only 47% have adequate practice. A 55% of ASHAs did not adhere even a single TB patient in the last three years. Conclusion: In our study, knowledge gaps were identified which may result in substandard patient care. The structured refresher training towards DOT and also training to work in tribal areas will further improve the KAP of ASHAs. It might be needed to provide a module or curriculum regarding awareness among ASHAs for strengthening follow-up system for tuberculosis patients among the tribal population.

Purpose: To describe the increase in prevalence of ethambutol-induced optic neuropathy (EON) in patients presenting to a single tertiary referral eye care center in India after introduction of weight-based fixed dose combinations and an increase in duration of ethambutol use from 2016 in the Revised National Tuberculosis Control Program.Methods: This was a retrospective, observational, referral hospital-based study of 156 patients with a diagnosis of EON presenting to a single tertiary referral eye care center between January 2016 and December 2019. The main outcome measure was to assess the increase in prevalence of EON cases presenting to our tertiary care institute.Results: During the 4-year study period, 156 new patients were diagnosed with EON. A total of 101 patients (64.7%) were males and 55 (35.3%) were females. The most common age group affected was 41-60 years. The significant complaint at presentation was decreased vision in all the patients. A rising trend in the number of patients diagnosed as EON was seen, with the prevalence increasing from 16 cases in 2016, 13 cases in 2017, and 31 cases in 2018 to 96 cases in 2019.Conclusion: The results of this study indicated an alarming increase in the trend of EON cases presenting to our tertiary care institute. [ABSTRACT FROM AUTHOR]

National Tuberculosis Elimination Programme (NTEP) is a Centrally Sponsored Scheme being implemented under the aegis of the National Health Mission with resource sharing between the State Governments and the Central Government. The Government of India has committed to achieving the SDG goal of eliminating tuberculosis (TB) in the country by 2025, five years ahead of the Global Target. In light of this ambitious target and to accelerate momentum towards the ultimate goal, an appropriate and representative change in the name of the programme was imperative, and it was decided to rename the Revised National Tuberculosis Control Program (RNTCP) as NTEP [1].

Isoniazid is the most commonly used drug for treatment of tuberculosis, and is administered individually or in combination with other drugs as standard first line therapy. Offsetting its efficacy, severe adverse effects, especially peripheral neuropathy and hepatotoxicity, are associated with isoniazid therapy, limiting its use in tuberculosis. Isoniazid is acetylated in vivo producing hydrazine and acetyl hydrazine, which are responsible for hepatotoxicity. Marked pharmacogenetic differences in acetylation have been reported among different population across the globe. This study evaluates isoniazid acetylation patterns in tuberculosis patients receiving DOT therapy under the Revised National Tuberculosis Control Program (RNTCP) in a specialized tuberculosis hospital in north India. Of 351 patients from whom samples were taken for biochemical analysis of adverse events, 36 were assessed for acetylation patterns. Blood samples were taken 1 h after administration of a 600 mg dose of isoniazid, and plasma concentrations of isoniazid were determined using a validated HPLC method. Of these 36 patients, 20 (55.56%) were slow acetylators and 16 (44.44%) were fast acetylators. Our results are consistent with those of an earlier study conducted in a different region of India. Most biochemical changes produced during long-term isoniazid therapy resolve after therapy is terminated.

Background: India is amongst one of the high multidrug resistant tuberculosis (MDR-TB) burden countries globally with a huge contribution given by the state of Uttar Pradesh. Programmatic Management of Drug Resistant Tuberculosis, initiated in 2007 has taken over the disorganized and unsupervised treatment practice in India. However, regular scrutiny is required which points out both its success and failure. Aim & Objective: This study was conducted to evaluate final treatment outcomes among MDR-TB patients on standard Category IV regimen Settings and Design: Retrospective analysis was done using secondary data from medical records of all patients. Methods and Material: Data of all MDR-TB patients registered under RNTCP at King George's Medical University, Lucknow from 2013 to 2016 was collected. Demographic details along with pre-defined treatment outcomes were recorded (cured, treatment completed, death, treatment failure, treatment default and transfer to higher centre). Statistical analysis used: Descriptive statistics using numbers and percentage. Results: The records of 3580 MDR tuberculosis patients registered at drug resistant tuberculosis centre in King George's Medical University from January 2013 to December 2016 were included which consisted of 67%males and 33%female. Mean age of presentation was 31.17 years (95% CI 30.75-31.59). Mean weight of patients was 40.16 kg (95% CI 39.89-40.43). Year wise distribution of registered cases from 2013 to 2016 was 611, 799, 984 and 1186 patients respectively. Amongst 3580 patients, 30.39% were declared cured, 25.50% completed treatment, 21.39% died, 0.84% showed treatment failure, 12.54% were defaulters, 2.35% were transferred out to higher centre, 6.5% were shifted to regimen for Extensive drug resistant (EDR) TB, 0.16% patients needed to stop treatment due to ADR and 0.33% patient were still on treatment. Conclusion: The treatment success rate of MDR-TB patients is still low. Measures to improve treatment adherence as in National tuberculosis elimination programme (NTEP) attempts to further improve the success rate. [ABSTRACT FROM AUTHOR]

Background: Active case-finding is provider-initiated and implies systematic searching for TB in individuals who would not spontaneously present to a health service, and bringing them into care for diagnosis and treatment. Aim: The present study was carried out with the objective to assess the yield and feasibility of active case finding strategy among household contacts of newly diagnosed pulmonary TB cases and to determine risk factors in household contact. Methods: This community-based study with cross-sectional design was conducted among the household contacts of all newly diagnosed microbiologically confirmed pulmonary TB patients registered at Tuberculosis Unit (TU), Nuh. Investigator conducted house to house visit and met respective index case and his/her household contacts to build the rapport. Results: In the present study, there were 55 sputum smear-positive index cases and 356 household contacts of index cases. The most common symptom among screening positive household contacts was cough followed by weight loss. A substantial proportion (83.8%) of symptom positive household contacts were investigated for tuberculosis and among them, 18.9% were found to be positive for tuberculosis. The overall prevalence of TB cases among household contacts was found to be 1.97%. Conclusion: The present study concludes that household contact screening for active case finding for TB is a feasible and efficient tool that can potentially result in earlier diagnosis and treatment of active TB, thus minimizing the severity and decreasing transmission. It can also contribute toward improving treatment outcomes, health sequelae, and the social and economic consequences of TB.

Background: Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis discovered in ancient centuries still remains a major public health problem in India. Lack of awareness about the cause, risk factors, treatment and prevention of TB among rural people is a major challenge to be addressed to reduce disease transmission. Aims: To assess the knowledge of TB among rural people. To assess the awareness about RNTCP services. Settings and Design: Cross-sectional study was conducted in six randomly selected villages attached to a medical college. Methods and Materials: Houses were selected by systematic random sampling method and younger person was identified as study subject. Data were collected from a sample of 300 by predesigned pretested semi-structured questionnaire. Statistical Analysis Used: Data were presented in proportions with confidence interval and Chi-square test was applied to find the association between variables by using SPSS ver. 23. Results: The study showed that 79.6% knew that the cause of TB is bacteria. Majority of the participants 93.6% (95% CI: 90.3, 96.1) knew that TB primarily affects lungs. Subjects were aware of free diagnostic services (85.3%), free treatment services (89%) available in the govt setup. Conclusions: Although the awareness of symptoms, causative agent, mode of spread was reasonably good, knowledge on availability of DOTS centres, services offered through RNTCP is still poor among rural population.

Background: Knowing delays in treatment seeking and subsequent treatment initiation among the TB patients is important and its detailed understanding is crucial in modifying the treatment seeking behaviour which can help in reducing the TB burden and the transmission in the community. Aim & Objective: To study the treatment seeking behaviour including the delays in initiation of treatment along with its determinants; among tuberculosis patients aged > 15 years in Mehrauli area of Delhi. Settings and Design: A longitudinal follow up study conducted in two randomly selected DMC cum DOTS centres in Mehrauli area of Delhi from January 2018 to April 2018. Methods and Material: Patients of both sexes of age > 15 years, registered under RNTCP from January to April 2018 in the randomly selected DOTS centres i.e. Mehrauli DMC cum DOTS and Chattarpur DMC cum DOTS centre were included in the study. Self-designed, pretested interview schedule and records of DMC were used to collect the relevant information. Statistical analysis used: Information collected in the Performa was coded and entered in Statistical Package for Social Sciences (SPSS) version 12. Results: The mean patients delay, diagnostic delay, treatment delay, health care system delay and total delay was 48.91 ± 130.38 days, 91.09 ± 155.97 days, 6.25 ± 6.29 days, 62.72 ± 119.48 days and 97.33 ± 155.06 days respectively. The median patients delay, diagnostic delay, treatment delay, health care system delay and total delay was 15 days, 45 days, 5 days, 35 days and 54 days respectively. Conclusions: The major reasons for patient's delay were lack of awareness regarding the symptoms of TB and self-medication and for health care system delay it was treatment from private health care providers. [ABSTRACT FROM AUTHOR]

Background: Defaulting from treatment is an important challenge for tuberculosis (TB) control. As per the Revised National Tuberculosis Control Programme quarterly reports of Kamrup District (Assam), among the registered cases default rate was 13.3%(2008) & 13.1 % (2009). Objectives: To elicit reasons & factors responsible for interruption of treatment from a cohort of TB defaulters of urban & rural areas in Kamrup District. Methods: The cross-sectional study was conducted among 1/3rd of all defaulters who were put on Directly Observed Treatment Short-course chemotherapy in 2011 under 1 urban Tuberculosis Unit (TU) & 2 rural TUs of Kamrup District. From these 3 TUs, total 210 patients interrupted treatment in 2011; so 70 defaulters (35 from 1 urban TU & 35 from 2 rural TUs) were interviewed in their residences by using a pretested and predesigned schedule. Study was conducted in January - June, 2012. Results: Majority of the defaulters was illiterate (51.4%) in rural areas but in urban areas majority studied upto high school level (37.1%). Maximum defaulters were in the age group 25-44 years (55.7% in urban areas & 62.9% in rural areas). The number of defaulters decreased uniformly with increasing income in the rural areas & but not so in urban areas. More number of new cases defaulted in rural areas (82.8%) compared to urban areas (57.1%). Improvement in symptoms was found to be the most common reason (45.7% in urban areas & 40 % in rural areas), leading to treatment interruption. Conclusions: Early improvement in symptom was the most common reason leading to treatment interruption. Continuous health education should be provided to TB patients emphasizing the need to continue treatment despite early improvement in symptoms. [ABSTRACT FROM AUTHOR]

Background: Active case-finding is provider-initiated and implies systematic searching for TB in individuals who would not spontaneously present to a health service, and bringing them into care for diagnosis and treatment. Aim: The present study was carried out with the objective to assess the yield and feasibility of active case finding strategy among household contacts of newly diagnosed pulmonary TB cases and to determine risk factors in household contact. Methods: This community-based study with cross-sectional design was conducted among the household contacts of all newly diagnosed microbiologically confirmed pulmonary TB patients registered at Tuberculosis Unit (TU), Nuh. Investigator conducted house to house visit and met respective index case and his/her household contacts to build the rapport. Results: In the present study, there were 55 sputum smear-positive index cases and 356 household contacts of index cases. The most common symptom among screening positive household contacts was cough followed by weight loss. A substantial proportion (83.8%) of symptom positive household contacts were investigated for tuberculosis and among them, 18.9% were found to be positive for tuberculosis. The overall prevalence of TB cases among household contacts was found to be 1.97%. Conclusion: The present study concludes that household contact screening for active case finding for TB is a feasible and efficient tool that can potentially result in earlier diagnosis and treatment of active TB, thus minimizing the severity and decreasing transmission. It can also contribute toward improving treatment outcomes, health sequelae, and the social and economic consequences of TB. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB), an infectious disease caused by Mycobacterium tuberculosis discovered in ancient centuries still remains a major public health problem in India. Lack of awareness about the cause, risk factors, treatment and prevention of TB among rural people is a major challenge to be addressed to reduce disease transmission. Aims: To assess the knowledge of TB among rural people. To assess the awareness about RNTCP services. Settings and Design: Cross-sectional study was conducted in six randomly selected villages attached to a medical college. Methods and Materials: Houses were selected by systematic random sampling method and younger person was identified as study subject. Data were collected from a sample of 300 by predesigned pretested semi-structured questionnaire. Statistical Analysis Used: Data were presented in proportions with confidence interval and Chi-square test was applied to find the association between variables by using SPSS ver. 23. Results: The study showed that 79.6% knew that the cause of TB is bacteria. Majority of the participants 93.6% (95% CI: 90.3, 96.1) knew that TB primarily affects lungs. Subjects were aware of free diagnostic services (85.3%), free treatment services (89%) available in the govt setup. Conclusions: Although the awareness of symptoms, causative agent, mode of spread was reasonably good, knowledge on availability of DOTS centres, services offered through RNTCP is still poor among rural population. [ABSTRACT FROM AUTHOR]

• Monitoring of liver function tests is very important in patient receiving DOT therapy. • There was no significance difference reported in the differential leucocytes count. • We define mechanisms underlying the adverse drug reactions observed following DOTS. • The plasma INH concentration was reported to be high in slow acetylation. • Plasma INH concentration greater than the antimode are slow acetylator. Isoniazid is the most commonly used drug for treatment of tuberculosis, and is administered individually or in combination with other drugs as standard first line therapy. Offsetting its efficacy, severe adverse effects, especially peripheral neuropathy and hepatotoxicity, are associated with isoniazid therapy, limiting its use in tuberculosis. Isoniazid is acetylated in vivo producing hydrazine and acetyl hydrazine, which are responsible for hepatotoxicity. Marked pharmacogenetic differences in acetylation have been reported among different population across the globe. This study evaluates isoniazid acetylation patterns in tuberculosis patients receiving DOT therapy under the Revised National Tuberculosis Control Program (RNTCP) in a specialized tuberculosis hospital in north India. Of 351 patients from whom samples were taken for biochemical analysis of adverse events, 36 were assessed for acetylation patterns. Blood samples were taken 1 h after administration of a 600 mg dose of isoniazid, and plasma concentrations of isoniazid were determined using a validated HPLC method. Of these 36 patients, 20 (55.56%) were slow acetylators and 16 (44.44%) were fast acetylators. Our results are consistent with those of an earlier study conducted in a different region of India. Most biochemical changes produced during long-term isoniazid therapy resolve after therapy is terminated. [ABSTRACT FROM AUTHOR]

Background: About 8 million cases of Tuberculosis occurs annually. With 2.5 million cases occurring in India, making it one of the high burden countries. Most of the cases go undetected resulting in a high mortality rate. With the launch of RNTCP and DOTS the awareness, diagnosis and treatment has increased considerably. Interns being the first contacts as health care providers for patients, must be sensitised to the latest diagnosis and treatment modalities. Objectives: To assess the awareness and knowledge of interns in the tertiary hospital regarding the TB disease, RNTCP and DOTS guidelines. Materials and Method: A cross sectional study was conducted among the interns of a medical college using a pre-validated, per-tested, structured questionnaire. 115 interns participated in the study. Frequencies and percentages of data collected was analysed. Results: The knowledge regarding TB, Diagnosis, RNTCP and DOTS and definitions were found to be 90.85%, 94.8%, 70.96%, 82.6% respectively. Out of which the knowledge was found to be 39.25%, 40.5%, 30.62% and 34.5% respectively among males and 51.1%, 54.2%, 40.34%, 48% respectively among females. Also, it was found that the knowledge was 67.6%, 69.5%, 51.84%, 60.8% respectively among the age group of 20-22 years and 23.9%, 25.2%, 19.14%, 21.7% among 23-25 years respectively. Conclusion: This study reveals that the awareness and knowledge of interns regarding TB disease, RNTCP and DOTS were fairly good. Further enhancement of knowledge on recent updates, guidelines and treatment is necessary. [ABSTRACT FROM AUTHOR]

Background: Although most public services provide tests and TB drugs free of charge worldwide, opportunity costs pose barriers to accessing TB services and treatment. 'Kumar Raajratna Bhimrao Ambedkar Vaidakiya Sahay Yojana (KRBAVSY)' popularly known as Free Medical Aid Scheme is in operation in Gujarat since early 70s for SC and since 1991 for SEBC to provide monetary incentive. Primary objective: Evaluation of utilization and effectiveness of Financial incentives given under Free Medical Aids scheme on RNTCP in Gujarat. Methodology: A retrospective cohort study was undertaken in which all TB patients registered under RNTCP in Gandhinagar district were evaluated for their eligibility for KRBAVSY scheme, and whether eligible patients got benefit or not. Also, treatment outcome of patients were compared. Results: Out of total 1430 patients inquired, 896 (62.7%) patients were found eligible for the scheme, while only 87 (9.7%) patients confirmed that they had got the benefit of scheme. Eligible patients who got benefit under scheme had almost five times higher odds of successful outcome of TB treatment. Conclusion: The TB patients who got benefit of KRBAVSY scheme had significantly better successful treatment outcome in comparison to the TB patients who did not get benefit. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis is not only a public health problem but also a social and an economic problem for mankind. Objective: To assess the functioning of Revised National Tuberculosis Control Programme (RNTCP) at the level of Tuberculosis Units by considering infrastructural assessment of Tuberculosis Units and Designated Microscopy Centres (DMC) for staff position and their training. Study Design: Cross-sectional study. Setting: Under District Tuberculosis Centre, Satara involving all the ten Tuberculosis Units. Participants: Fifty slides of sputum smear positive and fifty slides of sputum smear negative for tuberculosis were selected randomly. Sampling: Simple random. Study Period: From 2012 to 2014. Results: DMC were adequate in number to cater the services to the areas of jurisdiction on an average 50,000 to 60,000 population under each DMC’s in all Tuberculosis Units except Phaltan TU where each DMC’s population exceeds above one lakh. Similarly post of Laboratory Technicians (LT) were vacant in DMC’s of Patan, Vaduj and Bel-Air Tuberculosis Units. However majority of staff were trained under RNTCP except 7% of LT were not trained. Regarding DOT providers it was observed that 40% were untrained though they have been involved in giving DOTS therapy. Conclusion: DMC were adequate in number. Majority of staff were trained under RNTCP except 7% of LT were not trained. Among all the detected cases of pulmonary tuberculosis, the productive age group of 25-45years which involves the active and the earning are the victims. [ABSTRACT FROM AUTHOR]

Sputum examination is the most widely used test for diagnosis of TB. Under RNTCP two samples of sputum are required for examinations which are preferably 1st spot and early morning sample or two spot samples collected on the same day. Patients usually come from far off places at the tertiary care centre and frequent visits are usually not possible. Giving an early morning sample is usually defaulted by the patient due to various reasons. The present study was aimed at studying the delay in giving the early morning sample and barriers in accessing the sputum smear microscopy services at a tertiary care hospital. In this study 300 presumptive TB patients were studied. Patients were asked to give a 1st spot sample for sputum smear examination and asked to bring early morning sputum sample. Patients who refused to give early morning sample were asked to give 2nd spot sample and the reason for not coming early morning were noted. The patients who did not come despite agreeing to come were noted. If they came after a delay of few days, then also the reason of delay were noted. It was found that nearly one third (31%) of the patients agreed and came on the next day to give early morning sample. A large number of patients (16%) did not come at all to give the early morning sample. [ABSTRACT FROM AUTHOR]

ntroduction: CBNAAT is a very useful rapid diagnostic test for the early diagnosis of DS and DR TB. Report of sample can be available in just 2 hours. But the results of these tests are not available for many days to weeks which results in delay in diagnosis and treatment initiation. Material and Method: This study was conducted for a period of 4 months from mid-April to mid-august 2018 in MMIMSR, Mullana. A total of 535 samples were sent for CBNAAT to TB Hospital, Ambala and the time taken from sending of samples to the receiving of report was analysed and time lag was calculated. Results: Out of 535 samples, 429 samples were negative, 104 were positive for MTB and 2 samples resulted as invalid/error. Out of 104 positive samples, 95 were rifampicin sensitive and 9 were rifampicin resistant MTB. The average time lag in reporting of CBNAAT samples was 11.1 days with shortest time being 2 days and longest being 33 days. Conclusion: CBNAAT is a very useful modality in TB diagnosis and should be made available to all eligible patients especially so in high DR-TB prevalence areas. But delay in reporting undermines the purpose of the test i.e. rapid diagnosis and treatment. There is an urgent need to establish more centres with CBNAAT facility throughout India so that there is no delay in reporting and early treatment can be started. [ABSTRACT FROM AUTHOR]

Abstract Background India’s Revised National Tuberculosis (TB) Control Programme (RNTCP) offers free TB diagnosis and treatment. But more than 50% of TB patients seek care from private practitioners (PPs), where TB is managed sub-optimally. In India, there is dearth of studies capturing experiences of TB patients when they navigate through health facilities to seek care. Also, there is less information available on how PPs make decisions to refer TB cases to RNTCP. We conducted this study to understand the factors influencing TB patient’s therapeutic itineraries to RNTCP and PP’s cross referral practices linked to RNTCP. Methods We conducted in-depth interviews on a purposive sample of 33 TB patients and 38 PPs. Patients were categorised into three groups: those who reached RNTCP directly, those who were referred by PPs to RNTCP and patients who took DOT from PPs. We assessed patient’s experiences in each category and documented their journey from initial symptoms until they reached RNTCP, where they were diagnosed and started on treatment. PPs were categorised into three groups based on their TB case referrals to RNTCP: actively-referring, minimally-referring and non-referring. Results Patients had limited awareness about TB. Patients switched from one provider to the other, since their symptoms were not relieved. A first group of patients, self-medicated by purchasing get rid drugs from private chemists over the counter, before seeking care. A second group sought care from government facilities and had simple itineraries. A third group who sought care from PPs, switched concurrently and/or iteratively from public and private providers in search for relief of symptoms causing important diagnostic delays. Eventually all patients reached RNTCP, diagnosed and started on treatment. PP’s cross-referral practices were influenced by patient’s paying capacity, familiarity with RNTCP, kickbacks from private labs and chemists, and even to get rid of TB patients. These trade-offs by PPs complicated patient’s itineraries to RNTCP. Conclusions India aims to achieve universal health care for TB. Our study findings help RNTCP to develop initiatives to promote early detection of TB, by involving PPs and private chemists and establish effective referral systems from private sectors to RNTCP.

India is a high burden country for tuberculosis (TB). The Stop TB strat-egy 2006-2015 of Revised National Tuberculosis Control Programme (RNTCP) aimed to engage directly with private healthcare sector to ensure patients have access to high quality DOTS. A cross-sectional study was conducted using a self-administered questionnaire to assess the knowledge and attitude of private practitioners regarding the operational component of RNTCP. Though majority of study subjects had correct knowledge and good attitude about diagnostic aspects of TB, but there were clear gaps in between. Sensitization of private practitioners regarding RNTCP needs to be intensified. [J Med Allied Sci 2019; 9(1.000): 16-18]

Background: Government of India has started NGO schemes under RNTCP since 2001. However, there are no details available to show the impact or effectiveness of such interventions. The study was conducted to evaluate the NGO partnership schemes under RNTCP and to identify challenges and probable solutions for improvement of the same. Methods: Mixed methods design: Quantitative data collection followed by Qualitative phase (personal interviews) during year 2016-17 across the Gujarat. 25% NGOs were selected from each scheme by two-stage random sampling. Results: Most NGOs were enrolled in Scheme 1 and 2 (advocacy and slum). No NGOs enrolled in Scheme 10 and 11, while only 1 NGO was enrolled in Scheme 7, 8 and 9. All the NGO have registration number, submitted financial documents and 96.5% NGO were registered in NGO portal. Only 41.4% NGOs attended regular monthly DTO meeting. Almost 80% NGO shad organized sensitization meeting among high risk groups. Sputum positivity was more than 5% in most NGO. Defaulter retrieval was high but actual number of patients was low. Conclusion: NGO scheme under RNTCP are useful to reach the objectives, however they are underutilized and focused only in selected schemes/ geographic areas. RNTCP need to revise existing schemes to ensure more NGOs involved and work in larger geographic areas.

Background: Tuberculosis (TB) is a major public health problem in India. According to the Global TB Control Report 2012, the inci- dence of childhood TB is estimated at 191 per 100 000 population. Childhood TB (for children aged

Childhood tuberculosis does not get the attention it deserves, both in the general child health services and the TB specific services. The difficulty in identification of the organism due to lack of proper sample as well as lower sensitivity of the smear, made it harder to detect cases with ease in the community. Newer diagnostic methods like cartridge based nucleic acid amplification tests (CBNAAT) and line probe assays (LPA) have the capacity to rapidly identify Mycobacterium tuberculosis with an improved sensitivity over the smear testing and have been employed under Revised National Tuberculosis Control Programme (RNTCP) across the country. As the symptoms suggestive of TB are very common and overlapping, the final yield of TB testing is better if the microbiological confirmation is done on good quality specimen from cases suspected of TB based on clinical and radiological abnormalities. Newer tests also provide simultaneous detection of much critical Rifampicin resistance. A Rifampicin resistant case is not only unlikely to respond to first-line standard therapy but such a treatment can result in further amplification of resistance to other companion drugs. Prevention of spread of the drug resistant disease thus requires that the treatment is guided by universal drug sensitivity testing (U-DST) of all TB cases. Furthermore, several changes have come up in the treatment of TB and are discussed. The dosages of anti TB drugs have been revised upwardly for optimal drug levels and now the fixed drug combinations are used under RNTCP. With the awareness about high initial Isoniazid (INH) resistance and its contribution to failure of retreatment regime, a companion third drug (Ethambutol) has been added to the continuation phase of the first-line therapy. The standard retreatment regime, better known as category II therapy, has been replaced by specific therapy as per the resistance pattern detected. The TB control activities have thus evolved a lot and the present article discusses the evolution and the current status of diagnostics and therapy of TB in children. [ABSTRACT FROM AUTHOR]

Objectives: The study aimed to evaluate the dispensing pattern and practices of community pharmacies towards antituberculosis drugs. Materials and Methods: A cross sectional, prospective study was conducted at Belagavi, Karnataka, India based on survey of pharmaceutical outlets in the locality. A structured interview form was used to assess availability and non-availability of Anti-TB drugs, dispensing Anti-TB drugs, Community pharmacist dispensing pattern of Anti-TB drugs in weekly and monthly basis. Results: A total of 228 community pharmacists participated in the Survey. Of these, 204 community pharmacists (90.35%) were male and 22 community pharmacists (9.65%) were female. The majority of 198 community pharmacists (86.84%) Diploma in Pharmacy (D. Pharm). 86 community pharmacies (37.72%) were dispensing Anti-TB drugs. The majority (37.04%) of the community pharmacies were expecting to dispense Anti-TB drugs for 2 to 3 tuberculosis patients monthly. Community pharmacies located near Government civil hospital, 108 to 137 tuberculosis patients seeking Anti-TB drugs monthly. 53 community pharmacies (61.62%) dispensing Anti-TB drugs through Private Physicians prescriptions. Conclusion: Tuberculosis patients are neglecting where Revised National Tuberculosis Control Programme (RNTCP) facility for free treatment are available. Violation of the guidelines and regulations of dispensing Anti-TB potentially contribute to emergence of drug- resistant Mycobacterium tuberculosis. The community pharmacist should be encouraged to participate Directly observed treatment, short course (DOTS) program through RNTCP training. [ABSTRACT FROM AUTHOR]

The Revised National Tuberculosis Control programme has continuously innovative and progressive in addressing issues related to Tuberculosis control in India. With the implementation of RNTCP, India has taken huge stride in reduction of mortality and morbidity due to TB. The programme has actively incorporated various new ideas, innovations and information communication technology to curb this menace. These newer initiatives provide unprecedented opportunities to control Tuberculosis more efficiently if it implemented effectively. India has made enormous progress towards TB control through their honest effort. Innovations will effectively leverage India’s endeavour. Programme must continue and sustain these efforts to make India TB free.

Background: Tuberculosis (TB) has remained a major public health threat worldwide and considering this, Govt. of India declared TB as notifiable disease in year 2012. Objectives: To assess the trend of TB in Satara district, India and to evaluate outcome of new sputum positive TB cases registered under district Revised National Tuberculosis Control Programme (RNTCP). Materials and Methods: A retrospective record based cross-sectional study was conducted in District Tuberculosis Centre (DTC), Satara district, Maharashtra, India during March 2013. All Registered TB cases under DTC from the year 2002 to 2012 were included as study subjects. The district RNTCP records since the year 2002-2012, for all TB cases were viewed and analyzed by investigator according to RNTCP outcome evaluation indicators. The trend of TB was statistically analyzed for the period of eleven years by using chi-square trend test. Results: Annual the total TB case detection rate was 117.94/ lakh for year 2002 which decreased to 98.30 / lakh for year 2012. The proportions of pulmonary TB cases decreased from 92.23% to 81.0% since year 2002 to 2012 whereas proportions of HIV-reactive TB cases increased from 3.11% to 25.3% since year 2009 to 2011.Proportions of male TB cases were almost the double of females; however child TB cases increased continuously with maximum TB cases belonged to pulmonary type. The proportional trend of New Sputum Positive (NSP) cases showed periodic fluctuations ranging from 34% to 50% since year 2002 to 2012. The performance of outcome evaluation indicators of NSP cases during evaluation period as viz., cure rate ranging from 79.91% to 87.02% with periodic fluctuations, sputum conversion rate continuously increased from 78.5% to 93.5%,treatment success rate ranging from 82.7% to 90% with apparent difference, whereas defaulter rate decreased from 7.5% to 3.8% by year 2011, treatment failure rate continuously decreased to 2.1% whereas Death rate ranging from 5.2% to 10.4%. The proportional trends of outcome evaluation indicators of NSP-TB cases showed statistically significant difference over period of year 2002 to 2012. Conclusion: Data indicates that TB is still big problem in rural area of western Maharashtra, India and need to strengthen the awareness programme about TB and involvement of private health sector to control the burden of TB.

Objective: Half of the TB patients in India seek care from private providers resulting in incomplete notification, varied quality of care and out-of-pocket expenditure. The objective of this study was to describe the characteristics of TB patients who remain outside the coverage of treatment in public health services.Methods: Cross-sectional data from National Family Health Survey-4 (2015-16) were analysed using logistic regression analysis. TB treatment was the dependent variable. Sociodemographic factors and place where households generally seek treatment were independent variables.Results: Prevalence of self-reported TB was 308.17/100 000 population (95% CI: 309.44-310.55/100 000 population) and 38.8% (95% CI: 36.5-41.1%) of TB patients were outside care of public health services - 3.3% did not seek treatment and 35.3% accessed treatment from private sector. Factors associated with not seeking treatment were age <10 years [OR = 3.43; 95% CI (1.52-7.77); P = 0.00]; no/preschool education [OR = 1.82; 95% CI (1.10-3.34); P = 0.02]; poorest wealth index [OR = 1.86; 95% CI (1.01-3.34); P = 0.04] and household's general rejection of the public sector when seeking health care [OR = 1.69; 95% CI (1.69-2.26); P = 0.00]. Factors associated with seeking treatment from private providers were female sex [OR = 1.29; 95% CI (1.11-1.50); P = 0.001], younger age of the patient [OR = 2.39; 95% CI (1.62-3.53); P = 0.00], higher education [OR = 1.82; 95% CI (1.11-2.98); P = 0.02] and household's general rejection of the public sector when seeking health care [OR = 4.56; 95% CI (3.95-5.27); P = 0.00]. Patients from households reporting 'poor quality of care' as the reason for not generally preferring public health services were more likely (OR = 1.48, 95% CI = 1.19-1.65; P = 00) to access private treatment.Conclusion: The study provides insights for efforts to involve the private health sector for accurate surveillance and patient groups requiring targeted interventions for linking them to the national programme. [ABSTRACT FROM AUTHOR]

Objectives: To assess a multicomponent intervention to improve private practitioners (PPs) involvement in referral of presumptive pulmonary TB (PTB) cases to the Revised National TB Control Programme (RNTCP) for sputum examination.Methods: Randomised controlled trial. We randomly allocated all 189 eligible PPs in Tumkur city, South India, to intervention or control arm. The intervention, implemented between December 2014 and January 2016, included two sets of activities, one targeted at health system strengthening (building RNTCP staff capacity to collaborate with PPs, provision of feedback on referrals through SMS) and one targeted at intervention PPs (training in RNTCP, provision of referral pads and education materials and monthly visits to PPs by RNTCP staff). Crude and adjusted referral and PTB case-finding rate ratios were calculated with negative binomial regression.Results: PPs referred 836 individuals (548 from intervention and 169 from control arm PPs) of whom 176 were diagnosed with bacteriologically confirmed PTB. The proportion (95% confidence interval) of referring PPs [0.59 (0.49, 0.68) vs. 0.42 (0.32, 0.52) in the intervention and control arm, respectively], mean referral rate per PP-year [(5.7 (3.8, 8.7) vs. 1.8 (1.2, 2.8)] and smear-positive PTB case-finding rate per PP-year [(1.5 (0.9, 2.2) vs. 0.6 (0.3, 0.9)] were significantly higher in the intervention than the control arm. Stratifying by qualification, a statistically significant difference in the above indicators remained only among GPs and internists. Overall, surgeons, paediatricians and gynaecologists referred few patients. PP referrals contributed to 20% of the sputum smear positive PTB cases detected by RNTCP in Tumkur city (14% were from intervention arm PPs).Conclusions: We demonstrated the effectiveness of a health system-oriented intervention to improve PP's referrals of presumptive PTB cases to RNTCP. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tuberculosis (TB) is one of the top 10 causes of death worldwide. In 2015, 10.4 million people fell ill with TB and 1.8 million died from the disease (including 0.4 million among people with HIV). Six countries account for 60% of the total, with India leading the count, followed by Indonesia, China, Nigeria, Pakistan and South Africa. Directly Observed Treatment Short course (DOTS) has been declared as the global strategy for tuberculosis (TB) control by the World Health Organization (WHO) since 1991. The aim of the study was to assess the knowledge and practices of community DOTS providers regarding DOTS services in selected primary health centres and sub centres of district Faridkot. METHODS: A descriptive research design was used. Study setting was CHC Bajakhana, Faridkot. Sample size was 100. Purposive sampling technique was used. A socio demographic sheet, a structured knowledge questionnaire and a self reported checklist were used for data collection. RESULTS: Mean knowledge score was 15.9700 and S.D was 2.4390. 36% of community DOTS providers had adequate knowledge, whereas 64% had inadequate knowledge. Mean practice score was 10.6000, and S.D was 1.3999. 80% of the participants had good practice in providing DOTS services, whereas 20% had average practice. 100% of the participants ensure collection of empty blister packs. The least percentage (74%) checks for medication side effects. A statistically significant association was found between knowledge and source of information. Practice was significantly associated with number of DOTS cases completed. CONCLUSION: In-service training programmes should be organized to make the community DOTS providers aware about DOTS services, hence further promote the practices of delivering DOTS services to render the TB treatment more effective to combat the deadly disease. [ABSTRACT FROM AUTHOR]

Background: ‘RETREATMENT’ for Tuberculosis (TB) has long been a neglected area in global TB control. While other components of the Stop TB Strategy have garnered appropriate focus and, increasingly, sufficient resources, issues related to the TB of patients previously treated for tuberculosis remain under examined and under-resourced. Methods: A longitudinal study was designed and the patients registered under Revised National Tuberculosis Control Programme (RNTCP) category II from June 2010 to December 2011.Out of total 607 patients registered during this period under category II of RNTCP in Chandigarh (India), 545 consented to participate in the study. These were followed up to September 2012 till the completion of treatment. Statistical Analysis: The analysis was done by using SPPS18 statistical software package. Chi- square test was used for testing association of different characteristics. Results: Four Hundred Thirty (78.9%) of the patients had pulmonary TB and 115(21.1%) of the patients had extra pulmonary TB. In the study cohort of category II patients 264(48.4%) were relapse patients,167(30.6%) belonged to others category, 75(13.8%) were on treatment after default, 39(7.2%) were failure cases. The mean age of patients was 35.92±15.42 (p = 0.928). Maximum patients belonged to age group of 25-34 years (25.3%). Seventy Three (13.4%) were Illiterate. In treatment after default group only 65.3% patients were cured. Maximum deaths 8% were seen in treatment after default group of patients. The overall default in the study was 5.9%. Conclusion: The findings of this study suggest that it is essential to monitor re-treatment patients with same vigour to reduce default and improve their treatment outcome.

Backgroud: Tuberculosis (TB) is the second leading cause of death worldwide amongst communicable diseases. TB kills approximately 1 million women every year and is responsible for more deaths in women in the reproductive age group. Aims and Objectives: The present study was aimed to delineate the burden of disease in women in rural area. Results: High incidence of TB is reported in females of reproductive age group. Conclusion: Routine TB screening should be incorporated into maternal and child health programs in countries where TB is endemic. Revised National Tuberculosis Control Program (RNTCP) should mobilise interventions at rural level to eliminate stigma and ultimately eliminate TB’s impact on women.

Introduction: Diagnosis of pulmonary tuberculosis in sputum negative patients for acid fast bacilli is challenging till today. It is a fact that 50-60% patients of pulmonary tuberculosis are sputum negative microscopically. Smear microscopy is the easiest, commonest and widely employed tool for confirmatory diagnosis of pulmonary tuberculosis, but it has low sensitivity and specificity. Sputum culture for Mycobacterium tuberculosis bacteria can increase the diagnostic yield by 20-40%, but it takes long duration of 2-8 weeks when solid media are used or 10-14 days when radiometric system in liquid media are used. Delayed diagnosis causes increased rate of disease transmission in the community. The role of newly introduced cartridge based nucleic acid amplification test (CBNAAT) in the revised national TB control program (RNTCP) is highly promising with a higher yield of bacteriological diagnosis in sputum negative pulmonary tuberculosis patients with detection of rifampicin resistance within 2 hours only. Aims and objectives: The current study is to find out efficacy of CBNAAT in diagnosis of new sputum negative pulmonary tuberculosis patients. The detection of rifampicin resistance is also done in those patients. Materials and Methods: Sputum samples of 100 sputum negative pulmonary tuberculosis patients were sent to District CBNAAT center in sterilized falcon tube container. The CBNAAT result were analyzed. Results: Mycobacterium tuberculosis was detected in thirty one patients (31%). Not a single case was detected as resistant to rifampicin. Conclusion: CBNAAT helps in increased case detection rate in lesser time in new sputum negative pulmonary tuberculosis patients. Rifampicin resistance was not detected in any patient. [ABSTRACT FROM AUTHOR]

Background and Objectives: Tuberculosis (TB) is an important cause of childhood morbidity and mortality with different clinical presentations and outcomes as compared to TB in adults. The present study was designed to compare these differences and to determine if childhood TB was an important predictor of adverse outcome following treatment under the Revised National Tuberculosis Control Program (RNTCP). Materials and Methods: Retrospective record based study of cases registered between January 2008 and December 2011, at the Amdanga TB Unit (TU), West Bengal. Results: Of the total 1,508 cases notified, 3.4% were childhood TB. Differences with adult TB were noted in the number of cases categorized as cat II and III in children (P = 0.012 and 0.000, respectively). New smear positive pulmonary TB was significantly lower (21.6%, P = 0.000), while new extra-pulmonary TB (39.2%, P = 0.000) was significantly higher in children. Smear negative cases comprised 7.8 and 11.4% of the childhood and adult cases of TB, respectively. Retreatment cases were significantly higher in adults (P = 0.012). Among the registered new smear positive cases, the differences in favourable and adverse outcomes did not have a significant statistical difference (P = .100) . Childhood TB was not a significant risk factor for adverse outcome following treatment (adjusted odds ratio [AOR] = 0.80, 95% confidence interval [CI] = 0.28-2.32). Conclusions: The registration of childhood TB under the RNTCP in the TU was low. There were differences in the clinical presentation and treatment outcomes of TB among children and adults. Childhood TB was not a significant predictor of adverse treatment following treatment.

Background: Among the global estimation of 10.4 million new cases of Tuberculosis (TB) in 2015, 27% of cases are contributed by India. Revised national TB control program (RNTCP) started in 1993, and now heading towards for universal access. Despite its achievements, the program faces number of implementation challenges. This qualitative study explored 'what is healthcare providers take on it?'. Material & Methods: A total of 28 in-depth interviews were conducted in Uttarakhand, Chhattisgarh, Delhi and Maharashtra from October 2014 to January 2015, under the thematic areas of finance, human resource, and communications. Participants included senior level policy makers like principal secretaries of health, National Health Mission Directors, Director Health Services, state TB officers and district TB officers, medical officers, community volunteers and TB consultants from international agencies. Analytic induction method was used for data analysis. Results: Participants identified many barriers in the overall management and implementation of RNTCP. Convergence of RNTCP needs to be more effective. Inadequate Human resources, issues in public private partnership, insufficient budget allocation and interrupted fund flow, inefficient Information Education and Communication strategy are a few. Conclusion: This study could gather the perspectives of senior health officials, implementers and other stakeholders on challenges in implementation of TB control programme in four states. Challenges perceived by them are vital in strategic revisions of RNTCP. [ABSTRACT FROM AUTHOR]

Background: India's Revised National Tuberculosis (TB) Control Programme (RNTCP) offers free TB diagnosis and treatment. But more than 50% of TB patients seek care from private practitioners (PPs), where TB is managed sub-optimally. In India, there is dearth of studies capturing experiences of TB patients when they navigate through health facilities to seek care. Also, there is less information available on how PPs make decisions to refer TB cases to RNTCP. We conducted this study to understand the factors influencing TB patient's therapeutic itineraries to RNTCP and PP's cross referral practices linked to RNTCP.Methods: We conducted in-depth interviews on a purposive sample of 33 TB patients and 38 PPs. Patients were categorised into three groups: those who reached RNTCP directly, those who were referred by PPs to RNTCP and patients who took DOT from PPs. We assessed patient's experiences in each category and documented their journey from initial symptoms until they reached RNTCP, where they were diagnosed and started on treatment. PPs were categorised into three groups based on their TB case referrals to RNTCP: actively-referring, minimally-referring and non-referring.Results: Patients had limited awareness about TB. Patients switched from one provider to the other, since their symptoms were not relieved. A first group of patients, self-medicated by purchasing get rid drugs from private chemists over the counter, before seeking care. A second group sought care from government facilities and had simple itineraries. A third group who sought care from PPs, switched concurrently and/or iteratively from public and private providers in search for relief of symptoms causing important diagnostic delays. Eventually all patients reached RNTCP, diagnosed and started on treatment. PP's cross-referral practices were influenced by patient's paying capacity, familiarity with RNTCP, kickbacks from private labs and chemists, and even to get rid of TB patients. These trade-offs by PPs complicated patient's itineraries to RNTCP.Conclusions: India aims to achieve universal health care for TB. Our study findings help RNTCP to develop initiatives to promote early detection of TB, by involving PPs and private chemists and establish effective referral systems from private sectors to RNTCP. [ABSTRACT FROM AUTHOR]

Introduction: Under RNTCP, the diagnosis of 25-30% tuberculosis cases with negative bacteriological report with radiographic evidence and with smear negativity due to inability to expectorate adequate amount of sputum are left untreated which ultimately increases the burden of tuberculosis. Such cases can be subjected to induction methods to improve yield of positive result in sputum. Methodology: Study was undertaken on all 538 patients who attended the Chest and Tuberculosis department in DOTS Microscopy centre of HIMS. Intervention was done only in those found smear negative but clinically and radiologically suggestive of pulmonary tuberculosis who gave written consent i.e. = 92 subjects (Chest Physiotherapy (N=92); Nebulization (N=92) & Broncho-alveolar lavage (N=14). Results: Out 362 (67%) eligible subjects 228 were sputum negative, 92 patients gave consent for induction were subjected to chest physiotherapy for sputum induction of which 38 (41.3%) subjects came out to be sputum positive. Out of 92 patients subjected to nebulization for sputum induction 40 (43.4%) subjects yield sputum positive result. 14 patients were subjected to BAL (bronchoalveolar lavage) method to collect sputum sample of which 7(50%) came out to be sputum positive. (p=0.02). Conclusion: The non-invasive and cost effective methods of sputum induction should be incorporated more commonly in national programme as they provide better yield of sputum positivity. [ABSTRACT FROM AUTHOR]