Background
Methods
Study Setting
General Setting
PMDT services
New case – A patient with TB who has never had treatment for TB or has taken anti-TB drugs for less than one month |
Previously treated patients (received one month or more of anti-TB drugs in the past) |
Recurrent TB – A patient with TB previously treated and declared as successfully treated (cured/treatment completed) and is subsequently found to be microbiologically confirmed TB case |
Treatment after failure – Previously treated and whose treatment failed at the end of their most recent course of treatment |
Treatment after loss to follow up – A previously treated patient and was declared loss to follow up in their most recent course of treatment and subsequently found microbiologically confirmed TB case |
Others – A previously treated patient with TB but whose outcome after their most recent course of treatment is unknown or undocumented. (This subgroup mostly refers to previously treated patients who are smear negative) |
Follow-up smear-positives (FUS+) – A patient with TB whose follow up sputum is positive during any of the routine follow up |
HIV associated with TB/HIV-TB co-infected cases – A patient with TB who is a previous known case of HIV or gets diagnosed as HIV during diagnosis of TB or anytime during TB treatment |
Study design and study population
Data variables, sources of data and data collection
Variables | Source | Operational definition |
---|---|---|
Date of eligibility for DST, presumptive MDR-TB patient criteria, age in completed years, sex, TB registration number, year of registration, DMC name, baseline smear status | Treatment register | Under ‘previously treated’ criterion, for smear positive patient, date of smear examination was the date of eligibility. For smear negative patient, date of treatment initiation was the date of eligibility. Under TB/HIV, those with HIV first and TB later, date of eligibility depended on whether the patient was smear positive or negative and we followed the above mentioned definition. For those with TB first and then HIV, date of HIV testing was considered. For patients with known MDR-TB contacts, date of TB registration was considered. Follow up smear positive at 5 months was considered as ‘previously treated’ and included as eligible patient if the date of eligibility under ‘previously treated’ criterion was in 2014. |
Whether referred for DST, date of referral for DST | Referral for DST register (DTC) or copy of request for DST form (DMC) | If there was a record for referral maintained at DTC or DMC then it was considered as ‘identified/referred’. In case of discrepancy in dates, earlier date was considered. |
Sputum received at NRL, date of sputum received at NRL, whether DST was performed, type of DST, date of DST, DST result, date of DST result, date of dispatch of DST result to DTC | DST register at NRL | Eligible patients with presumptive MDR-TB were tracked through their TB registration numbers; in cases where it was not entered, name and address of the patient was used. If NRL DST register showed ‘contaminated’ as the result and no further sample was received then it was recorded as ‘sample received; DST not done’. |
Whether patient referred to DRTB center from DTC. date of referral to DRTB center | Referral for DST register (DTC) | - |
Whether treatment initiated, DR-TB treatment. date of treatment initiation | Treatment register at DRTB center | - |
Data management and statistical analysis
Results
Variable | Patients with presumptive MDR-TB | |
---|---|---|
Number | Percentage | |
Total | 770 | 100 |
Age (years) | ||
• <14 | 7 | 1 |
• 14-44 | 513 | 67 |
• 45-64 | 203 | 27 |
• ≥65 | 47 | 6 |
Gender | ||
• Male | 520 | 68 |
• Female | 250 | 33 |
Health facility | ||
• Primary/Secondary level | 362 | 47 |
• District level | 273 | 36 |
• Medical college | 135 | 18 |
Presumptive MDR-TB criteria | ||
• Previously treated TB | 635 | 83 |
○ Recurrent | 251 | 33 |
○ Treatment after Loss to follow up | 51 | 7 |
○ Treatment after Failure | 22 | 3 |
○ Others | 311 | 40 |
• Follow up smear positives | 132 | 17 |
• New patient with TB/HIV | 3 | 0 |
• New pulmonary TB withknown MDR-TB contact | 0 | 0 |
Site of Tuberculosis | ||
• Extra pulmonary | 89 | 12 |
Pulmonary – smear negative | 248 | 32 |
• Pulmonary – smear positive | 433 | 56 |
Quarter | ||
• January – March 2014 | 101 | 13 |
• April – June 2014b
| 238 | 31 |
• July – September 2014 | 223 | 29 |
• October – December 2014 | 208 | 27 |
Variable | Number of | Days |
---|---|---|
Patientsa
| Median (IQR) | |
Patients with presumptive MDR-TB | 770 | - |
Days to refer from date of eligibility | 353 | 2 (0,8) |
Days to receive sputum at NRL from referral | 315 | 0 (0,0) |
Days to test at NRL from sputum receipt | 310 | 0 (0,2) |
Days to dispatch result from NRL from testing | 304 | 2 (0,4) |
Days to test at NRL from date of eligibility | 310 | 4 (0,10) |
Variable | Total | Not tested for | RR (0.95 CI) | aRR (0.95 CI)a
|
---|---|---|---|---|
[n] | DST [n (%)] | |||
Total | 770 | 459 (60) | ||
Age (years) | ||||
• <14 | 7 | 4 (57) | 0.9 (0.5, 1.9) | 1.0 (0.6, 1.9) |
• 14-44 | 513 | 301 (59) | 1.0 (0.9, 1.2) | 1.0 (0.9, 1.2) |
• 45-64 | 203 | 118 (58) | Ref | Ref |
• >/= 65 | 47 | 36 (77) | 1.3 (1.1, 1.6)* | 1.3 (1.1, 1.7)* |
Gender | ||||
• Male | 520 | 314 (60) | 1.0 (0.9, 1.2) | 1.1 (1.0, 1.2) |
• Female | 250 | 145 (58) | Ref | Ref |
Health facility | ||||
• Primary/Secondary level | 362 | 208 (58) | 1.0 (0.9, 1.1) | 1.0 (0.9, 1.1) |
• District level | 273 | 159 (58) | Ref | Ref |
• Medical college | 135 | 92 (68) | 1.2 (1.00, 1.4) | 1.2 (1.02, 1.4)* |
Presumptive MDR-TB criteria | ||||
• Previously treated – recurrent | 251 | 128 (51) | 1.2 (0.9,1.5) | 1.3 (1.0, 1.6)* |
• Treatment after failure | 22 | 11 (50) | 1.2 (0.7, 1.9) | 1.3 (0.8, 2.0) |
• Treatment after loss to follow up | 51 | 33 (65) | 1.5 (1.2, 2.0)* | 1.5 (1.1, 2.1)* |
• Previously treated – others | 311 | 229 (74) | 1.7 (1.4, 2.1)* | 1.6 (1.1, 2.3)* |
• Follow up smear + | 132 | 56 (42) | Ref | Ref |
• New patient with TB-HIV | 3 | 2 (67) | 1.6 (0.7,3.6) | 1.8 (0.8, 4.2) |
Site of Tuberculosis | ||||
• Extra pulmonary | 89 | 72 (81) | 1.6 (1.4, 1.9)* | 1.5 (1.0, 2.2)* |
• Pulmonary – smear negative | 248 | 172 (69) | 1.4 (1.2, 1.6)* | 1.2 (0.8, 1.7) |
• Pulmonary – smear positive | 433 | 215 (50) | Ref | Ref |
Quarter | ||||
• January – March 2014 | 101 | 63 (62) | Ref | Ref |
• April – June 2014b
| 238 | 144 (61) | 0.97 (0.8, 1.2) | 0.8 (0.7, 0.98)* |
• July – September 2014 | 223 | 132 (59) | 0.95 (0.8, 1.1) | 0.8 (0.7, 0.99)* |
• October – December 2014 | 208 | 120 (58) | 0.9 (0.8, 1.1) | 0.8 (0.6, 0.95)* |