MDR-TB screening in a setting with molecular diagnostic techniques: who got tested, who didn't and why?
Objective: To determine pre-diagnostic and pre-treatment attrition among presumptive multidrug-resistant tuberculosis (MDR-TB) patients and reasons for attrition.
Methods: In this mixed-methods study, the quantitative component consisted of retrospective cohort analysis through record review of all presumptive MDR-TB patients recorded between October 2012 and September 2013. The qualitative component included in-depth interviews with key informants involved in programmatic management of drug-resistant tuberculosis services.
Results: Of 341 eligible presumptive MDR-TB patients, pre-diagnostic and pre-treatment attrition was respectively 45.5% (155/341) and 29% (2/7). Patients with extra-pulmonary TB (RR = 2.3), those with human immuno-deficiency and TB co-infection (RR = 1.7), those registered during October–December 2012 (RR = 1.3) and those identified from primary/secondary health centres (RR = 1.8) were less likely to be tested. Themes that emerged during the analysis of the qualitative data were ‘lack of a systematic mechanism to track referrals for culture and drug susceptibility testing’, ‘absence of courier service to transport sputum’, ‘lack of knowledge and ownership among staff of general health system’, ‘shortage of diagnostic kits’ and ‘patient non-adherence’.
Conclusion: Despite the introduction of molecular diagnostic techniques, operational issues in MDR-TB screening remain a concern and require urgent attention.
Keywords: India; SORT IT; delayed diagnosis; multidrug-resistant tuberculosis; operational research
Document Type: Research Article
Affiliations: 1: Department of Community Medicine, Indira Gandhi Medical College and Research Institute, Puducherry, India 2: State Tuberculosis Cell, Directorate of Health Services, Puducherry, India 3: Department of Community Medicine, Employees' State Insurance Corporation Medical College, Bengaluru, India 4: Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India 5: Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India 6: International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India 7: World Health Organization Country Office for India, New Delhi, India
Publication date: 21 June 2015
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