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Chadha VK, Praseeja P, Srivastava R, Shivashankar BA, Hemanth Kumar NK, Padmesha R, Suganthi P, Umadevi G, Narayana L, Magesh V, Nagendra N, Puttaswamy G, Jaiswal R, Somashekar N. Pre-treatment delay and out of pocket expenses by notified new tuberculosis patients in an Indian mega city. Indian J Tuberc 2022; 69:446-452. [PMID: 36460374 DOI: 10.1016/j.ijtb.2021.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/21/2021] [Accepted: 07/01/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND Study was carried out to find out delay from onset of symptoms and out of pocket expenditure (OOPE) until initiation of anti-TB treatment (ATT) by new Tuberculosis (TB) patients registered in public health facilities in Bengaluru. METHODS Notified patients (N = 228) selected purposively were interviewed at initiation of ATT regarding number and type of facilities visited and delay in initiating ATT. OOPE was elicited separately for in- and out-patient visits, towards consultation, purchase of medicines, diagnostic tests, transportation, hospitalization and food. Dissaving or money borrowed was ascertained. RESULTS Two-thirds of participants were 15-44 years of age and 56% were males, mean annual household income was $4357. About 75% first visited a private health facility; 68% and 87% respectively were diagnosed and started on ATT in public sector after visiting an average of three facilities and after a mean delay of 68 days; the median delay was 44 days. Of mean OOPE of $402, 54% was direct medical expenditure, 5% non-medical direct and 41% indirect. OOPE was higher for Extra-pulmonary TB compared to PTB and when number of health facilities visited before initiating treatment was >3 compared to those who visited ≤3 and when the time interval between onset of symptoms and treatment initiation (total delay) was >28 days compared to when this interval was ≤28 days. About 20% suffered catastrophic expenditure; 34% borrowed money and 37% sold assets. CONCLUSION Concerted efforts are needed to reduce delay and OOPE in pre-treatment period and social protection to account for indirect expenditure.
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Affiliation(s)
- V K Chadha
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India.
| | - P Praseeja
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India; Data Processing Center, National Statistical Office, Ministry of Statistics and Program Implementation, Bengaluru, India
| | - R Srivastava
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - B A Shivashankar
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - N K Hemanth Kumar
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - R Padmesha
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - P Suganthi
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - G Umadevi
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - Lakshmi Narayana
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - V Magesh
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - N Nagendra
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - G Puttaswamy
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
| | - R Jaiswal
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India; National Pharmaceutical Pricing Authority, Ministry of Chemical and Fertilizers, New Delhi, India
| | - N Somashekar
- National Tuberculosis Institute, Ministry of Health and Family Welfare, Bengaluru, India
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Chadha VK, Praseeja P. Active tuberculosis case finding in India - The way forward. Indian J Tuberc 2019; 66:170-177. [PMID: 30878064 DOI: 10.1016/j.ijtb.2018.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/29/2018] [Accepted: 05/16/2018] [Indexed: 11/19/2022]
Abstract
Community based active case finding (ACF) for tuberculosis (TB) has seen resurrection in the current armamentarium of many TB managers in their fight toward eliminating TB. This article explores the accuracy and approximate cost of various ACF algorithms currently in vogue in India or those which could be useful, while inputting the sensitivity and specificity of screening and diagnostic tools as estimated from recently conducted community based surveys. This analysis informs that ACF may be prioritized to higher prevalence settings and the diagnostic algorithm for specific setting may be chosen taking into account the expected prevalence, estimated accuracy of the algorithm and resource availability. Further, chest X-ray cannot be used alone as a diagnostic tool and can be relied upon for this purpose when at least one of the three sputum specimen is smear positive. Accuracy of Xpert MTB/RIF as a diagnostic tool in community situations needs to be investigated further. The review brings out significant proportions of initial default and default during treatment among cases detected through ACF thus emphasizing the need for heightened efforts toward preventing the same. The article rounds off emphasizing priority to addressing barriers to speedy scale up of more sensitive diagnostic tools for health center based case finding including in private sector and ACF in high risk clinical groups for early and efficient case detection. It concludes by putting forth certain research areas that would strengthen future efforts.
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Affiliation(s)
- V K Chadha
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India.
| | - P Praseeja
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India
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Chadha VK, Anjinappa SM, Rade K, Baskaran D, Narang P, Kolappan C, Ahmed J, Praseeja P. Sensitivity and specificity of screening tools and smear microscopy in active tuberculosis case finding. Indian J Tuberc 2018; 66:99-104. [PMID: 30797292 DOI: 10.1016/j.ijtb.2018.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/30/2018] [Accepted: 05/16/2018] [Indexed: 11/19/2022]
Abstract
SETTING Community based five pulmonary tuberculosis (PTB) surveys among adults. OBJECTIVES Estimate sensitivity and specificity of screening tools for PTB and sputum microscopy. METHODS For each survey site, we estimated sensitivity and specificity of different screening criteria and microscopy against culture; pooled estimates were obtained using Random Effects Model. RESULTS Sensitivity of cough alone, screening for any symptom (persistent cough ≥2 weeks, fever or chest pain ≥1 month, hemoptysis), any symptom or history of anti-TB treatment (h/o ATT) were 56.2%, 66% and 71.2% respectively; specificities were 95.3%, 93.8% and 92.7% respectively. X-ray when used alone for primary screening had sensitivity and specificity of 76.6% and 97.3% respectively. When used along with screening for cough, these figures were 94.3% and 93.1%, and 100% and 97.3% when used with any symptom and h/o ATT. When used for secondary screening, sensitivity and specificity of X-ray was 66.8% and 87.8% respectively after primary screening for cough, 65.0% and 89.8% after screening for any symptom, and 67.1% and 86.7% when used after screening for any symptom or h/o ATT. Pooled sensitivity and specificity of smear was 46.2% and 99.3% respectively. CONCLUSION Program managers may use these estimates while evaluating algorithms for active case finding.
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Affiliation(s)
- V K Chadha
- National Tuberculosis Institute, Bangalore, Karnataka, India.
| | - S M Anjinappa
- National Tuberculosis Institute, Bangalore, Karnataka, India
| | - Kiran Rade
- World Health Organization, India Country Office, New Delhi, India; State TB Cell, Gujarat, Ahmedabad, India; Central TB Division, Government of India, New Delhi, India
| | - D Baskaran
- National Institute for Research in Tuberculosis, Chennai, India
| | - P Narang
- Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra, India
| | - C Kolappan
- National Institute for Research in Tuberculosis, Chennai, India
| | - J Ahmed
- National Tuberculosis Institute, Bangalore, Karnataka, India
| | - P Praseeja
- National Tuberculosis Institute, Bangalore, Karnataka, India
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Bhalla BB, Chadha V, Gupta J, Nagendra N, Praseeja P, Anjinappa S, Ahmed J, Srivastava R, Kumar P. Knowledge of private practitioners of Bangalore city in diagnosis, treatment of pulmonary tuberculosis and compliance with case notification. ACTA ACUST UNITED AC 2018; 65:124-129. [DOI: 10.1016/j.ijtb.2018.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 09/28/2017] [Accepted: 01/05/2018] [Indexed: 12/01/2022]
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Chadha VK, Praseeja P, Hemanthkumar NK, Shivshankara BA, Sharada MA, Nagendra N, Padmesh R, Puttuswamy G, Ahmed J, Kumar P. Are registered sputum smear-negative tuberculosis patients in Karnataka, India, diagnosed by national algorithm? Int J Tuberc Lung Dis 2015; 18:1491-5. [PMID: 25517817 DOI: 10.5588/ijtld.14.0216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Four districts of Karnataka State, India, that have implemented the National Tuberculosis Control Programme (RNTCP). OBJECTIVE To assess the proportion of patients diagnosed according to the nationally recommended algorithm among new smear-negative (NSN) PTB cases registered under the RNTCP. METHODS Information on 201 registered NSN-PTB patients as regards date of initial sputum examination, repeat sputum examination and chest X-ray (CXR) if undertaken, treatment initiation and number of days of antibiotic treatment after initial sputum examination, were collected through record review and patient interviews. In patients with negative or unknown human immunodeficiency virus (HIV) status, the algorithm was considered completed if the patient underwent initial sputum examination, antibiotic trial for ⩾10 days, repeat sputum examination ⩾10 days after initial sputum examination, CXR after repeat sputum examination and anti-tuberculosis treatment ⩾10 days after initial sputum examination. In HIV-positive patients, the algorithm was considered completed if CXR was performed after or at the same time as initial sputum examination. RESULTS Complete information was available for 170 patients. Of these, the algorithm was completed in 14 (8.2%, 95%CI 0.9-15.5): 1/140 patients with negative or unknown HIV status and 13/30 HIV-positive patients. CONCLUSION The algorithm was not completed in most patients registered for treatment. Measures are needed to improve the diagnostic process for smear-negative PTB.
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Affiliation(s)
- V K Chadha
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India
| | - P Praseeja
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India
| | - N K Hemanthkumar
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India
| | - B A Shivshankara
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India
| | - M A Sharada
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India
| | - N Nagendra
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India
| | - R Padmesh
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India
| | - G Puttuswamy
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India
| | - J Ahmed
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India
| | - P Kumar
- Office of the Director, National Tuberculosis Institute, Bangalore, Karnataka, India
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Chadha VK, Praseeja P, Gupta J, Ahmed J, Sharada MA, Srivastava R, Gowda U, Magesh V, Singh S, Suganthi P, Lakshminarayana K, Kumar P. A descriptive study of tuberculosis case finding in private health care facilities in a South Indian district. Int J Tuberc Lung Dis 2015; 18:1455-8. [PMID: 25517811 DOI: 10.5588/ijtld.14.0228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING A South Indian district providing anti-tuberculosis services through the Revised National TB Control Programme (RNTCP) and private health care facilities. OBJECTIVE To ascertain the profile of tuberculosis (TB) patients diagnosed and/or treated in private health care facilities. METHODS Data on TB cases diagnosed and/or treated in all clinical departments of the medical college, 83 nursing homes and RNTCP health care facilities were collected prospectively. RESULTS About 83% of new TB cases recorded in the private medical college, 47% in nursing homes and 24.5% in RNTCP TB registers were extra-pulmonary. The proportion of retreatment cases was respectively 5.5%, 9.6% and 19.8%. The proportion of males and those in the economically productive age group were similar in the three data sources. About 94% of cases diagnosed in the medical college and 55% in nursing homes were registered for treatment under the RNTCP. About 11% of the smear-positive patients diagnosed in RNTCP were initial defaulters. CONCLUSION The proportion of extra-pulmonary cases was higher in the medical college and nursing homes and that of retreatment cases was lower than in the RNTCP.
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Affiliation(s)
- V K Chadha
- Epidemiology & Research Division, National Tuberculosis Institute, Bangalore, India
| | - P Praseeja
- Epidemiology & Research Division, National Tuberculosis Institute, Bangalore, India
| | - J Gupta
- Epidemiology & Research Division, National Tuberculosis Institute, Bangalore, India
| | - J Ahmed
- Epidemiology & Research Division, National Tuberculosis Institute, Bangalore, India
| | - M A Sharada
- Epidemiology & Research Division, National Tuberculosis Institute, Bangalore, India
| | - R Srivastava
- Epidemiology & Research Division, National Tuberculosis Institute, Bangalore, India
| | - U Gowda
- Epidemiology & Research Division, National Tuberculosis Institute, Bangalore, India
| | - V Magesh
- Epidemiology & Research Division, National Tuberculosis Institute, Bangalore, India
| | - S Singh
- Epidemiology & Research Division, National Tuberculosis Institute, Bangalore, India
| | - P Suganthi
- Epidemiology & Research Division, National Tuberculosis Institute, Bangalore, India
| | - K Lakshminarayana
- Epidemiology & Research Division, National Tuberculosis Institute, Bangalore, India
| | - P Kumar
- Office of the Director, National Tuberculosis Institute, Bangalore, India
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Chadha VK, Praseeja P, Hemanthkumar NK, Shivshankara BA, Sharada MA, Nagendra N, Padmesh R, Puttaswamy G, Magesh V, Thomas B, Kumar P. Implementation efficiency of a diagnostic algorithm in sputum smear-negative presumptive tuberculosis patients. Int J Tuberc Lung Dis 2015; 18:1237-42. [PMID: 25216839 DOI: 10.5588/ijtld.14.0218] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For the diagnosis of smear-negative pulmonary tuberculosis (PTB), India's Revised National Tuberculosis Control Programme (RNTCP) recommends a course of broad-spectrum antibiotics after negative smear on initial sputum examination, followed by repeat sputum examination and chest X-ray (CXR). OBJECTIVES 1) To ascertain the proportion of presumptive PTB patients smear-negative on initial sputum examination who completed the diagnostic algorithm, and 2) to investigate barriers to the completion of the algorithm. METHODS In Karnataka State, India, 256 study participants were interviewed in 2012 to ascertain the number of days antibiotics had been prescribed and consumed, the number of re-visits to health centre(s), whether repeat sputum examinations had been performed, whether or not CXR had been performed and when, and whether PTB had been diagnosed. In-depth interviews were conducted with 19 medical officers. RESULTS The diagnostic algorithm was completed in 13 (5.1%) of 256 participants; three were diagnosed with PTB without completing the algorithm. Most medical officers were unaware of the algorithm, had trained 5-10 years previously, prescribed antibiotics for <10 days and advised CXR without repeat sputum examination, irrespective of the number of days of antibiotic treatment. Other main reasons for non-completion of algorithm were patients not returning to the health centres and a proportion switching to the private sector. CONCLUSION Refresher training courses, raising patient awareness and active follow-up of patients to complete the algorithm are suggested.
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Affiliation(s)
- V K Chadha
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India
| | - P Praseeja
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India
| | - N K Hemanthkumar
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India
| | - B A Shivshankara
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India
| | - M A Sharada
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India
| | - N Nagendra
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India
| | - R Padmesh
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India
| | - G Puttaswamy
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India
| | - V Magesh
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India
| | - B Thomas
- Department of Social and Behavioural Research, National Institute for Research in Tuberculosis, Chennai, India
| | - P Kumar
- Office of the Director, National Tuberculosis Institute, Bangalore, India
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Somashekar N, Chadha VK, Praseeja P, Sharada MA, Chandrakala GR, Srivastava R, Kumar P, Japananda S. Role of pre-Xpert® screening using chest X-ray in early diagnosis of smear-negative pulmonary tuberculosis. Int J Tuberc Lung Dis 2015; 18:1243-4. [PMID: 25216840 DOI: 10.5588/ijtld.14.0141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In a sub-district level hospital in South India, the proportion of patients with abnormal chest X-ray (CXR) was evaluated among smear-negative, Xpert® MTB/RIF (Xpert) positive individuals with pulmonary tuberculosis (PTB) symptoms; 384 smear-negative PTB individuals with PTB symptoms and without a history of anti-tuberculosis treatment underwent CXR and Xpert testing of one sputum specimen. Of 378 individuals with both Xpert and CXR results available, 14 were positive for Mycobacterium tuberculosis. Of these, 13 (92.9%) had an abnormal CXR and one was normal. This study highlights the usefulness of CXR before Xpert testing, which needs further validation.
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Affiliation(s)
- N Somashekar
- National Tuberculosis Institute, Bangalore, India
| | - V K Chadha
- National Tuberculosis Institute, Bangalore, India
| | - P Praseeja
- National Tuberculosis Institute, Bangalore, India
| | - M A Sharada
- National Tuberculosis Institute, Bangalore, India
| | - G R Chandrakala
- Swami Vivekananda Integrated Rural Health Centre, Pavagada, India
| | - R Srivastava
- National Tuberculosis Institute, Bangalore, India
| | - P Kumar
- National Tuberculosis Institute, Bangalore, India
| | - Swami Japananda
- Swami Vivekananda Integrated Rural Health Centre, Pavagada, India
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Subramaniyam S, Chadha VK, Manuvel C, Praseeja P, Sharada MA, Nagendra N, Gupta J. Treatment outcome of tuberculosis patients in a clinic of Bangalore. Indian J Tuberc 2014; 61:189-194. [PMID: 25241566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A total of 112 cases (New = 101, previously treated = 11) were diagnosed as suffering from tuberculosis (TB) at a private clinic in Bangalore city. The clinic identified TB suspects, established diagnosis of TB, administered direct observation of treatment (DOT), maintained treatment cards and undertook defaulter retrieval actions as and when required. The Revised National Tuberculosis Control Programme (RNTCP) provided support in terms of sputum microscopy supply of patient-wise drug boxes and registration of patients. Ninety six (95.1%) of new cases and 10 (90.9%) of previously treated cases had successful treatment outcome. Most patients completed treatment within the prescribed period. No TB deaths were reported during the period of treatment.
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