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Objective: The aim of the in vitro study was to compare the antibacterial efficacy of sodium hypochlorite (NaOCl), chlorhexidine (CHX), chitosan and their combinations in vitro. Materials and Methods: A total of 60 extracted single-rooted teeth were selected and used for the study. After the access cavity preparation and working length determination, the apical foramina of the samples were sealed with epoxy resin to prevent bacterial leakage, and the teeth were mounted in stone blocks. Biomechanical preparation was done using crown-down technique up to master apical file size of #50. Enterococcus faecalis (ATCC 29212) was used to contaminate the root canals. After incubation, samples were divided into six groups according to the solutions used for irrigation, that is, CHX, NaOCl, chitosan, alternating solution of chitosan and hypochlorite, alternating solution of chitosan and CHX, and saline. Antibacterial efficacy was assessed by obtaining the samples from root canal before and after the irrigation using paper points, culturing them on blood agar plates, and measuring the number of colony-forming units (CFUs) formed. Results: All the statistical analysis was done using SPSS version 16. P 0.001). Maximum antibacterial activity was seen when chitosan was used alternatively with CHX and NaOCl. Independently, hypochlorite showed maximum antibacterial activity followed by CHX and chitosan which showed almost similar antibacterial activity. Conclusion: According to this study, there is synergistic antibacterial activity when chitosan is used alternatively with 2% CHX or 5% NaOCl.

Background: The Global Fund encourages operational research (OR) in all its grants; however very few reports describe this aspect. In India, Project Axshya was supported by a Global Fund grant to improve the reach and visibility of the government Tuberculosis (TB) services among marginalised and vulnerable communities. OR was incorporated to build research capacity of professionals working with the national TB programme and to generate evidence to inform policies and practices. Objectives: To describe how Project Axshya facilitated building OR capacity within the country, helped in addressing several TB control priority research questions, documented project activities and their outcomes, and influenced policy and practice. Methods: From September 2010 to September 2016, three key OR-related activities were implemented. First, practical output-oriented modular training courses were conducted (n = 3) to build research capacity of personnel involved in the TB programme, co-facilitated by The Union, in collaboration with the national TB programme, WHO country office and CDC, Atlanta. Second, two large-scale Knowledge, Attitude and Practice (KAP) surveys were conducted at baseline and mid-project to assess the changes pertaining to TB knowledge, attitudes and practices among the general population, TB patients and health care providers over the project period. Third, studies were conducted to describe the project’s core activities and outcomes. Results: In the training courses, 44 participant teams were supported to develop research protocols on topics of national priority, resulting in 28 peer-reviewed scientific publications. The KAP surveys and description of project activities resulted in 14 peer-reviewed publications. Of the published papers at least 12 have influenced change in policy or practice. Conclusions: OR within a Global Fund supported TB project has resulted in building OR capacity, facilitating research in areas of national priority and influencing policy and practice. We believe this experience will provide guidance for undertaking OR in Global Fund projects.

India adopted changes in NTEP (Erstwhile RNTCP, Revised National TB Program, renamed as National TB Elimination Program) in the recent years with an aim to End TB by 2025 way ahead of the global target of ending TB by 2030. It is taking a long time for the changes to trickle down to the grass root level to change the behavior of the ground level force to understand and adopt to the changes that are being ordered and several other changes that are being pushed to the field in tandem. This has made field workers to be on their toes to understand and implement all the changes. The logistics like referral forms, GeneXpert/CBNAAT cartridges, slides etc., required for the program need to be calculated and used as per the changes. Shortages in the procurement or indenting will result in hampering the smooth functioning of the program. Accordingly, we calculated the logistics required for the patients estimated to occur in an area depending on the previous year's patient load. The breakup of the patients was adopted from the available references given. Also, the 2019 data of the load of different type of patients in India and the world were also taken. Total logistics were calculated for two hundred patients. Based on the calculations, a generic formula was derived. When the total number of patients in the previous year/quarter/or any period is N, then below is the formula which can estimate the required logistics for the next similar period., Competing Interests: Conflicts of interest All authors have none to declare., (Copyright © 2020 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Training is the backbone of any public health program and it is true for a vast program like TB. It is urgent when the program is aiming to End TB. The strategy that is followed in India for capacity building of TB workers is presented in this article. Various types of trainings that are needed are described in detail. Also enlisted are the different trainings undertaken at NTI for the last five years. Recent times the effect of Covid-19 has resulted in the acceleration of the effort of going for digital platforms and onlinetrainings and is described., Competing Interests: Conflicts of interest The authors have none to declare., (Copyright © 2020 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Background: In April 2018, the Government of India launched ' Nikshay Poshan Yojana ' (NPY), a cash assistance scheme (500 Indian rupees [~8 USD] per month) intended to provide nutritional support and improve treatment outcomes among tuberculosis (TB) patients., Objective: To compare the treatment outcomes of HIV-infected TB patients initiated on first-line anti-TB treatment in five selected districts of Karnataka, India before (April-September 2017) and after (April-September 2018) implementation of NPY., Methods: This was a cohort study using secondary data routinely collected by the national TB and HIV programmes., Results: A total of 630 patients were initiated on ATT before NPY and 591 patients after NPY implementation. Of the latter, 464 (78.5%, 95% CI: 75.0%-81.8%) received at least one installment of cash incentive. Among those received, the median (inter-quartile range) duration between treatment initiation and receipt of first installment was 74 days (41-165) and only 16% received within the first month of treatment. In 117 (25.2%) patients, the first installment was received after declaration of their treatment outcome. Treatment success (cured and treatment completed) in 'before NPY' cohort was 69.2% (95% CI: 65.6%-72.8%), while it was 65.0% (95% CI: 61.2%-68.8%) in 'after NPY' cohort. On adjusted analysis using modified Poisson regression we did not find a statistically significant association between NPY and unsuccessful treatment outcomes (adjusted relative risk-1.1, 95% CI: 0.9-1.3)., Conclusion: Contrary to our hypothesis and previous evidence from systematic reviews, we did not find an association between NPY and improved treatment outcomes., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Family Medicine and Primary Care.)

Of patients with multidrug-resistant tuberculosis (MDR TB), <50% complete treatment. Most treatment failures for patients with MDR TB are due to death during TB treatment. We sought to determine the proportion of deaths during MDR TB treatment attributable to TB itself. We used a structured verbal autopsy tool to interview family members of patients who died during MDR TB treatment in India during January-December 2016. A committee triangulated information from verbal autopsy, death certificate, or other medical records available with the family members to ascertain the underlying cause of death. For 66% of patient deaths (47/71), TB was the underlying cause of death. We assigned TB as the underlying cause of death for an additional 6 patients who died of suicide and 2 of pulmonary embolism. Deaths during TB treatment signify program failure; accurately determining the cause of death is the first step to designing appropriate, timely interventions to prevent premature deaths.

Background: Tuberculosis (TB) patients face substantial delays prior to treatment initiation, and out of pocket (OOP) expenditures often surpass the economic productivity of the household. We evaluated the pre-diagnostic cost and health seeking behaviour of new adult pulmonary TB patients registered at Primary Health Centres (PHCs) in Vellore district, Tamil Nadu, India., Methods: This descriptive study, part of a randomised controlled trial conducted in three rural Tuberculosis Units from Dec 2012 to Dec 2015, collected data on number of health facilities, dates of visits prior to the initiation of anti-tuberculosis treatment, and direct OOP medical costs associated with TB diagnosis. Logistic regression analysis examined the factors associated with delays in treatment initiation and OOP expenditures., Results: Of 880 TB patients interviewed, 34.7% presented to public health facilities and 65% patients sought private health facilities as their first point of care. The average monthly individual income was $77.79 (SD 57.14). About 69% incurred some pre-treatment costs at an average of $39.74. Overall, patients experienced a median of 6 days (3-11 IQR) of time to treatment initiation and 21 days (10-30 IQR) of health systems delay. Age ≤ 40 years (aOR: 1.73; CI: 1.22-2.44), diabetes (aOR: 1.63; CI: 1.08-2.44) and first visit to a private health facility (aOR: 17.2; CI: 11.1-26.4) were associated with higher direct OOP medical costs, while age ≤ 40 years (aOR: 0.64; CI: 0.48-0.85) and first visit to private health facility (aOR: 1.79, CI: 1.34-2.39) were associated with health systems delay., Conclusion: The majority of rural TB patients registering at PHCs visited private health facilities first and incurred substantial direct OOP medical costs and delays prior to diagnosis and anti-tuberculosis treatment initiation. This study highlights the need for PHCs to be made as the preferred choice for first point of contact, to combat TB more efficiently.