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To assess treatment outcomes in tuberculosis patients participating in support group meetings in five districts of Karnataka and Telangana states in southern India.Tuberculosis patients from five selected districts who began treatment in 2019 were offered regular monthly support group meetings, with a focus on patients in urban slum areas with risk factors for adverse outcomes. We tracked the patients' participation in these meetings and extracted treatment outcomes from the Nikshay national tuberculosis database for the same patients in 2021. We compared treatment outcomes based on attendance of the support groups meetings.Of 30 706 tuberculosis patients who started treatment in 2019, 3651 (11.9%) attended support groups meetings. Of patients who attended at least one support meeting, 94.1% (3426/3639) had successful treatment outcomes versus 88.2% (23 745/26 922) of patients who did not attend meetings (adjusted odds ratio, aOR: 2.44; 95% confidence interval, CI: 2.10-2.82). The odds of successful treatment outcomes were higher in meeting participants than non-participants for all variables examined including: age ≥ 60 years (aOR: 3.19; 95% CI: 2.26-4.51); female sex (aOR: 3.33; 95% CI: 2.46-4.50); diabetes comorbidity (aOR: 3.03; 95% CI: 1.91-4.81); human immunodeficiency virus infection (aOR: 3.73; 95% CI: 1.76-7.93); tuberculosis retreatment (aOR: 1.69; 1.22-2.33); and drug-resistant tuberculosis (aOR: 1.93; 95% CI: 1.21-3.09).Participation in support groups for tuberculosis patients was significantly associated with successful tuberculosis treatment outcomes, especially among high-risk groups. Expanding access to support groups could improve tuberculosis treatment outcomes at the population level.Évaluer les résultats des traitements contre la tuberculose chez les patients qui assistent aux réunions des groupes d'entraide dans cinq districts des États du Karnataka et du Telangana, en Inde du Sud.Dans les cinq districts sélectionnés, des patients tuberculeux ayant entamé un traitement en 2019 se sont vu proposer des réunions mensuelles organisées à intervalles réguliers. Ces réunions étaient principalement destinées aux patients vivant dans des bidonvilles urbains et présentant des facteurs augmentant le risque d'issue défavorable. Nous avons suivi leur participation aux réunions et avons extrait des informations thérapeutiques de la base de données nationale Nikshay sur la tuberculose concernant les mêmes patients en 2021. Nous avons ensuite comparé l'issue des traitements à la présence aux réunions des groupes d'entraide.Sur 30 706 patients tuberculeux ayant entamé un traitement en 2019, 3651 (11,9%) ont rejoint des groupes d'entraide. Sur l'ensemble des patients ayant assisté à au moins une réunion, 94,1% (3426/3639) ont connu une issue favorable au traitement, contre 88,2% (23 745/26 922) chez les patients qui n'y ont pas assisté (odds ratio ajusté, ORA: 2,44; intervalle de confiance de 95%, IC: 2,10-2,82). Les probabilités de réussite du traitement étaient plus élevées chez les participants aux réunions que chez les non-participants pour toutes les variables examinées, y compris pour les ≥ 60 ans (ORA: 3,19; IC de 95%: 2,26–4,51); les patients de sexe féminin (ORA: 3,33; IC de 95%: 2,46–4,50); celles et ceux présentant une comorbidité liée au diabète (ORA: 3,03; IC de 95%: 1,91–4,81); une infection au virus de l'immunodéficience humaine (ORA: 3,73; IC de 95%: 1,76–7,93); un retraitement contre la tuberculose (ORA: 1,69; 1,22–2,33); et enfin, une tuberculose pharmacorésistante (ORA: 1,93; IC de 95%: 1,21–3,09).La participation des patients atteints de tuberculose aux groupes d'entraide allait de pair avec de meilleurs résultats de traitement, surtout au sein des catégories à haut risque. Promouvoir l'accès à ces groupes d'entraide pourrait améliorer l'issue des traitements contre la tuberculose à l'échelle de la population.Evaluar los desenlaces del tratamiento en pacientes con tuberculosis que participan en reuniones de grupos de apoyo en cinco distritos de los estados de Karnataka y Telangana en el sur de la India.Se ofrecieron reuniones mensuales regulares de grupos de apoyo a los pacientes con tuberculosis de cinco distritos seleccionados que comenzaron el tratamiento en 2019, con un enfoque en los pacientes de los suburbios urbanos con factores de riesgo de desenlaces adversos. Se realizó un seguimiento de la participación de los pacientes en estas reuniones y se extrajeron los desenlaces del tratamiento de la base de datos nacional de tuberculosis Nikshay para los mismos pacientes en 2021. Se compararon los desenlaces del tratamiento en función de la asistencia a las reuniones de los grupos de apoyo.De 30 706 pacientes con tuberculosis que iniciaron el tratamiento en 2019, 3651 (11,9 %) asistieron a reuniones de grupos de apoyo. De los pacientes que asistieron al menos a una reunión de apoyo, el 94,1 % (3426/3639) presentaron desenlaces exitosos del tratamiento frente al 88,2 % (23 745/26 922) de los pacientes que no asistieron a las reuniones (razón de posibilidades ajustada, RPA: 2,44; intervalo de confianza del 95 %, IC: 2,10-2,82). Las posibilidades de obtener un desenlace satisfactorio del tratamiento fueron mayores en los participantes en las reuniones que en los no participantes para todas las variables examinadas, incluyendo: edad ≥60 años (RPA: 3,19; IC del 95 %: 2,26-4,51); sexo femenino (RPA: 3,33; IC del 95 %: 2,46-4,50); comorbilidad por diabetes (RPA: 3,03; IC del 95 %: 1,91-4,81); infección por el virus de la inmunodeficiencia humana (RPA: 3,73; IC del 95 %: 1,76-7,93); retratamiento de la tuberculosis (RPA: 1,69; IC del 95 %: 1,22-2,33); y tuberculosis resistente (RPA: 1,93; IC del 95 %: 1,21-3,09).La participación en grupos de apoyo para pacientes con tuberculosis se asoció de manera significativa con el éxito de los desenlaces del tratamiento de la tuberculosis, en especial entre los grupos de alto riesgo. Ampliar el acceso a los grupos de apoyo podría mejorar los desenlaces del tratamiento de la tuberculosis a nivel de la población.تقييم نتائج العلاج في مرضى السل المشاركين في اجتماعات مجموعة الدعم، في خمس مقاطعات من ولايتي كارناتاكا وتيلانجانا في جنوب الهند.تم عرض اجتماعات مجموعة دعم شهرية منتظمة على مرضى السل من خمس مقاطعات محددة، وكان المرضى قد بدأوا العلاج في عام 2019، مع التركيز على المرضى في منطقة الأحياء الفقيرة الحضرية مع عوامل الخطر لنتائج سلبية. قمنا بتتبع مشاركة المرضى في هذه الاجتماعات، واستخلصنا نتائج العلاج من قاعدة بيانات السل الوطنية في Nikshay لنفس المرضى في عام 2021. قمنا بمقارنة نتائج العلاج بناءً على حضور اجتماعات مجموعات الدعم.من بين 30706 مريضًا بالسل بدأوا العلاج في عام 2019، حضر 3651 مريضًا (11.9%) اجتماعات مجموعات الدعم. من بين المرضى الذين حضروا اجتماع دعم واحد على الأقل، حقق 94.1% (3426/3639) نتائج علاجية ناجحة، مقابل 88.2% (23745/26922) من المرضى الذين لم يحضروا الاجتماعات (نسبة الاحتمالات المعدلة: 2.44؛ بفاصل ثقة مقداره 95%: 2.10 إلى 2.82). كانت احتمالات نتائج العلاج الناجحة أعلى المشاركين بالاجتماعات مقارنة بغير المشاركين لجميع المتغيرات التي تم فحصها بما في ذلك: العمر أكبر من أو يعادل 60 عامًا (نسبة الاحتمالات المعدلة 3.19؛ ‏بفاصل ثقة مقداره 95%: 2.26 إلى 4.51)؛ والنسبة للإناث (نسبة الاحتمالات المعُدلة: 3.33؛ ‏بفاصل ثقة مقداره 95%: 2.46 إلى 4.50)؛ ولأمراض المصاحبة لمرض السكري (نسبة الاحتمالات المعُدلة: 3.03؛ ‏بفاصل ثقة مقداره 95%: 1.91 إلى 4.81)؛ وعدوى فيروس نقص المناعة البشرية (نسبة الاحتمالات المعُدلة: 3.73؛ ‏بفاصل ثقة مقداره 95%: 1.76 إلى 7.93)؛ وعلاج السل (نسبة الاحتمالات المعُدلة: 1.69؛ 1.22 إلى 2.33)؛ والسل المقاوم للأدوية (نسبة الاحتمالات المعُدلة: 1.93؛ ‏بفاصل ثقة مقداره 95%: 1.21 إلى 3.09).ارتبطت المشاركة في مجموعات الدعم لمرضى السل بشكل كبير بنتائج علاج السل الناجحة، خاصة بين المجموعات المعرضة للخطر. يمكن لتوسيع الوصول إلى مجموعات الدعم أن يُحسّن من نتائج علاج السل على مستوى السكان.旨在评估参加在印度南部卡纳塔克邦和特伦甘纳邦的五个县内举办的支持小组会议的结核病患者的治疗结果。.邀请五个选定县内自 2019 年起开始接受治疗的结核病患者每月定期参加支持小组会议，重点关注城市贫民区内存在不良后果风险因素的患者。2021 年，我们跟踪了患者参与这些会议的情况，并从 Nikshay 国家结核病数据库中提取了这些患者的治疗结果。我们根据支持小组会议的参与情况比较了治疗结果。.在自 2019 年起开始接受治疗的 30,706 名结核病患者中，3651 人（占 11.9%）参加了支持小组会议。至少参加过一次支持会议的患者的治疗结果成功率为 94.1% (3426/3639)，相比之下，从未参与会议的患者的治疗结果成功率为 88.2% (23,745/26,922)（调整后优势比，aOR：2.44；95％ 置信区间，CI: 2.10–2.82）。基于所有检查变量，参与会议的患者的治疗结果成功率均高于未参与会议的患者，包括：年龄≥ 60 岁 (aOR: 3.19; 95% CI: 2.26–4.51)；女性 (aOR: 3.33; 95% CI: 2.46–4.50)；糖尿病合并症 (aOR: 3.03; 95% CI: 1.91–4.81)；人类免疫缺陷病毒感染 (aOR: 3.73; 95% CI: 1.76–7.93)；结核病再治疗 (aOR: 1.69; 1.22–2.33)；以及耐多药结核病 (aOR: 1.93; 95% CI: 1.21-3.09）。.参与结核病患者支持小组与结核病治疗结果成功率存在明显相关性，特别是对于高危人群。提供更多支持小组可以全面提高结核病患者的治疗结果成功率。.Оценить результаты лечения у больных туберкулезом, участвующих в собраниях групп поддержки в пяти районах штатов Карнатака и Телангана на юге Индии.Больным туберкулезом из пяти выбранных районов, начавшим лечение в 2019 году, были предложены регулярные ежемесячные встречи группы поддержки с особым вниманием к пациентам из городских трущоб с факторами риска развития неблагоприятных исходов. Участие пациентов в этих встречах отслеживалось, и результаты лечения тех же пациентов в 2021 году были извлечены из национальной базы данных по туберкулезу Nikshay. Было проведено сравнение результатов лечения на основании посещаемости собраний групп поддержки.Из 30 706 больных туберкулезом, начавших лечение в 2019 году, 3651 (11,9%) посещали встречи групп поддержки. Среди пациентов, посетивших хотя бы одну встречу поддержки, у 94,1% (3426/3639) наблюдались успешные результаты лечения по сравнению с 88,2% (23 745/26 922) пациентов, не посещавших встречи (скорректированное отношение шансов, сОШ: 2,44; 95%-й ДИ: 2,10–2,82). Шансы на успешный исход лечения были выше у участников встреч по сравнению с теми, кто не принимал в них участия, по всем исследованным переменным, включая возраст ≥ 60 лет (сОШ: 3,19; 95%-й ДИ: 2,26–4,51), женский пол (сОШ: 3,33; 95%-й ДИ: 2,46–4,50), коморбидную патологию на фоне сахарного диабета (сОШ: 3,03; 95%-й ДИ: 1,91–4,81), инфицирование вирусом иммунодефицита человека (сОШ: 3,73; 95%-й ДИ: 1,76–7,93), повторное лечение туберкулеза (сОШ: 1,69; 95%-й ДИ: 1,22–2,33) и лекарственно-устойчивый туберкулез (сОШ: 1,93; 95%-й ДИ: 1,21–3,09).Участие в группах поддержки для больных туберкулезом было в значительной степени связано с успешными результатами лечения туберкулеза, особенно среди групп с высоким риском. Расширение доступа к группам поддержки может способствовать улучшению результатов лечения туберкулеза на уровне населения.

Background TB is a preventable and treatable disease. Yet, successful treatment outcomes at desired levels are elusive in many national TB programs, including India. We aim to identify risk factors for unfavourable outcomes to TB treatment, in order to subsequently design a care model that would improve treatment outcomes among these at-risk patients. Methods We conducted a cohort analysis among TB patients who had been recently initiated on treatment. The study was part of the internal program evaluation of a USAID-THALI project, implemented in select towns/cities of Karnataka and Telangana, south India. Community Health Workers (CHWs) under the project, used a pre-designed tool to assess TB patients for potential risks of an unfavourable outcome. CHWs followed up this cohort of patients until treatment outcomes were declared. We extracted treatment outcomes from patient’s follow-up data and from the Nikshay portal. The specific cohort of patients included in our study were those whose risk was assessed during July and September, 2018, subsequent to conceptualisation, tool finalisation and CHW training. We used bivariate and multivariate logistic regression to assess each of the individual and combined risks against unfavourable outcomes; death alone, or death, lost to follow up and treatment failure, combined as ‘unfavourable outcome’. Results A significantly higher likelihood of death and experiencing unfavourable outcome was observed for individuals having more than one risk (AOR: 4.19; 95% CI: 2.47–7.11 for death; AOR 2.21; 95% CI: 1.56–3.12 for unfavourable outcome) or only one risk (AOR: 3.28; 95% CI: 2.11–5.10 for death; AOR 1.71; 95% CI: 1.29–2.26 for unfavourable outcome) as compared to TB patients with no identified risk. Male, a lower education status, an initial weight below the national median weight, co-existing HIV, previous history of treatment, drug-resistant TB, and regular alcohol use had significantly higher odds of death and unfavourable outcome, while age > 60 was only associated with higher odds of death. Conclusion A rapid risk assessment at treatment initiation can identify factors that are associated with unfavourable outcomes. TB programs could intensify care and support to these patients, in order to optimise treatment outcomes among TB patients.

Background:Tuberculosis Health Action Learning Initiative (THALI) funded by USAID is a person-centered initiative, supporting vulnerable urban populations to gain access to TB services. THALI trained and placed 112 Community health workers (CHWs) to detect and support individuals with TB symptoms or disease within urban slums in two cities, Hyderabad and Bengaluru, covering a population of about 3 Million. Method: CHWs visited the slums once in a fortnight. They conducted TB awareness activities. They referred individuals with TB symptoms for sputum testing to nearest public sector labs. They visited those testing TB positive, once a fortnight in the intensive phase, and once a month thereafter. They supported TB patients and families with counselling, contact screening and social scheme linkages. They complemented the shortfall in urban TB government field staff numbers and their capacity to engage with TB patients. Data on CHWs’ patient referral for TB diagnosis and treatment support activities was entered into a data-base and analyzed to examine CHWs’ role in the cascade of TB care. We compared achievements of six monthly referral cohorts from September 2016 to February 2019.Results:Overall, 31617 (approximately 1%) of slum population were identified as TB symptomatic and referred for diagnosis. Among the referred persons, 23976 (76%) underwent testing of which 3841 (16%) were TB positive. Overall, 3812 (99%) were initiated on treatment and 2760(72%) agreed for regular followed up by CHWs. Fifty-seven percent of 2952 referred were tested in the first cohort, against 86% of 8315 in the last cohort. The annualized case detection rate through CHW referrals in Bengaluru increased from 5.5 to 52.0 per 100000 during the period, while in Hyderabad it was 35.4 initially and increased up to 118.9 per 100000 persons. The treatment success rate was 87.1% among 193 in the first cohort versus 91.3% among 677 in the last cohort. Conclusions CHWs in urban slums augment TB detection to care cascade. Their performance and TB treatment outcomes improve over time. It would be important to examine the cost per TB case detected and successfully treated.

Background India’s National Strategy to ‘End TB by 2025’ aims to reduce unfavourable TB treatment outcomes. There is need for innovative approaches to improve TB treatment outcomes. Methods Under a USAID-THALI, Community Health Workers using a pre-designed tool assessed TB patients in three states in south India for risks of non-adherence and risk of unfavourable outcomes. We examined whether those with identified risk had higher levels of two unfavourable treatment outcomes; death and unfavourable outcome including death, lost to follow up and failure, as compared to no risk. Bivariate and multivariate logistic regression was used to assess each of the individual risks and the combined risk, for experiencing death or unfavourable outcome as described earlier, after initiation of TB. Results A significantly higher likelihood of death and experiencing unfavourable outcomes was observed for individuals having one risk (AOR: 3.28; 95% CI: 2.11-5.10 for death; AOR 1.71; 95% CI: 1.29-2.26 for unfavourable outcome) and more than one risk (AOR: 4.19; 95% CI: 2.47-7.11 for death; AOR 2.21; 95% CI: 1.56-3.12) as compared to TB patients with no identified risk. In addition to the risk characterisation, TB patients with initial weight below the national median weight were 2.1 times and 2.0 times more likely to die and experience unfavourable outcomes, as compared to patients with initial weight equal to the median or higher. Conclusion The results of our analysis point to the need for a ‘differentiated care model’, beginning with a risk and needs assessment and continuing with tailored care and support for TB patients, based on their identified risk. While all TB patients require a minimum package of care and support there are a substantial proportion who require more specific interventions and services in order to successfully complete their treatment. We identified a number of important risk factors that could be predictive of an unfavourable outcome and which could be used by TB programs in order to optimize patient treatment outcomes.

Additional file 1. Tool for risk and needs assessment (RANA).

Additional file 2. Prevention Care and Support Card (PCS).

Of patients with multidrug-resistant tuberculosis (MDR TB)

For certain subgroups within people living with the human immunodeficiency virus (HIV) [active tuberculosis (TB), pregnant women, children

We followed 188 euthyroidic persons undergoing treatment for multidrug resistant tuberculosis (MDR-TB) in the state of Karnataka, India to determine the incidence of hypothyroidism during anti-tuberculosis treatment. Overall, among MDR-TB patients with valid thyroid stimulating hormone (TSH) values, about 23% developed hypothyroidism (TSH value ≥10 mIU/ml) during anti-tuberculosis treatment; the majority (74%) occurring after 3 months of treatment. Among 133 patients who received a regimen that contained ethionamide, 42 (32%) developed hypothyroidism. Among 17 patients that received a regimen that contained para-aminosalicylate sodium, 6 (35%) developed hypothyroidism. Among 9 HIV positive patients on anti-retroviral treatment, 4 (44%) developed hypothyroidism. These results differ from previously reported 4% incidence of hypothyroidism amongst patients who passively reported thyroidal symptoms during treatment, suggesting routine serologic monitoring of TSH throughout the course of treatment for MDR-TB is warranted.

Annex S1. Operational definitions used for assessing compliance of DR-TB centers towards AIC measures in Karnataka, India, 2016-17. Annex S2. Operational definitions used to assess Knowledge about Cough Hygiene and Sputum Disposal of the patients admitted in DR-TB wards of DR-TB centers, Karnataka, India, 2016-17. Annex S3. Interview guides used for key informant interviews at Drug Resistant Tuberculosis (DR-TB) centres of Karnataka, India, 2016-17. (DOCX 25 kb)

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