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Surie D, Sathyanarayanan MK, Lavanya J, Smith JP, Shanmugam SK, Tamilzhalagan S, Selvaraj A, Ramesh G, Tripathy S, Khaparde SD, Ho CS, Hall-Eidson PJ, Ranganathan UDK, Selvaraju S, Moonan PK. Long-term follow-up of persons diagnosed with multidrug-resistant TB in Chennai, India, 2013-2020. Int J Tuberc Lung Dis 2024; 28:54-56. [PMID: 38178300 PMCID: PMC10859871 DOI: 10.5588/ijtld.23.0272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Affiliation(s)
- D Surie
- Centers for Disease Control and Prevention, Division of Global HIV and Tuberculosis, Atlanta, GA, United States of America
| | - M K Sathyanarayanan
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai
| | - J Lavanya
- Chennai Municipal Corporation, Chennai
| | - J P Smith
- Centers for Disease Control and Prevention, Division of Global HIV and Tuberculosis, Atlanta, GA, United States of America
| | - S K Shanmugam
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai
| | - S Tamilzhalagan
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai
| | - A Selvaraj
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai
| | - G Ramesh
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai
| | - S Tripathy
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai
- Dr. D Y Patil Medical College, Hospital and Research Centre, Pune
| | - S D Khaparde
- Government of India, Ministry of Health and Family Welfare, Directorate of Health Services - Central TB Division, New Delhi, India
| | - C S Ho
- Centers for Disease Control and Prevention, Division of Global HIV and Tuberculosis, Atlanta, GA, United States of America
| | - P J Hall-Eidson
- Centers for Disease Control and Prevention, Division of Global HIV and Tuberculosis, Atlanta, GA, United States of America
| | - U D K Ranganathan
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai
| | - S Selvaraju
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai
| | - P K Moonan
- Centers for Disease Control and Prevention, Division of Global HIV and Tuberculosis, Atlanta, GA, United States of America
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2
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Mammen JJ, Asirvatham ES, Lakshmanan J, Sarman CJ, Pandey A, Ranjan V, Charles B, Mani T, Khaparde SD, Upadhyaya S, Rajan S. The clinical demand and supply of blood in India: A National level estimation study. PLoS One 2022; 17:e0265951. [PMID: 35385543 PMCID: PMC8986005 DOI: 10.1371/journal.pone.0265951] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/10/2022] [Indexed: 11/26/2022] Open
Abstract
Background Estimating the clinical demand for blood and components arising in a health facility is crucial to ensure timely availability of blood. This study aims to estimate disease-specific clinical demand, supply and utilization of whole blood and components in India. Methods We conducted a national level cross-sectional study in five randomly selected states from five regions of the country. We included 251 public and private facilities representing primary, secondary and tertiary care facilities. We collected annual disease-specific demand, supply and utilization of blood and components using a structured tool. We estimated the national demand by extrapolating the study data (demand and beds) to the total number of estimated beds in the country. Findings According to the study, the total clinical demand of 251 health facilities with 51,562 beds was 474,627 whole blood units. Based on this, the clinical demand for India was estimated at 14·6 million whole blood units (95 CI: 14·59–14·62), an equivalent of 36·3 donations per 1,000 eligible populations, which will address whole blood and component requirement. The medicine specialty accounted for 6·0 million units (41·2%), followed by surgery 4·1 million (27·9%), obstetrics and gynecology 3·3 million (22·4%) and pediatrics 1·2 million (8·5%) units. The supply was 93% which is equivalent to 33·8 donations against the demand. Conclusion The study indicated a demand and supply gap of 2.5 donations per 1,000 eligible persons which is around one million units. The gap emphasises the need for sustained and concerted efforts from all stakeholders and for increasing the awareness about repeat voluntary non-remunerated blood donation (VNRBD); optimizing the availability of blood components through efficient blood component separation units; promoting modern principles of patient blood management and strengthening capacities of human resources in the blood transfusion system in India.
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Affiliation(s)
- Joy John Mammen
- Christian Medical College, Vellore, Tamil Nadu, India
- * E-mail:
| | | | - Jeyaseelan Lakshmanan
- Professor of Biostatistics, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, DHCC, Dubai, United Arab Emirates
| | | | - Arvind Pandey
- National Institute of Medical Statistics, Ministry of Health and Family Welfare, New Delhi, India
| | - Varsha Ranjan
- Christian Medical Association of India (CMAI), New Delhi, India
| | - Bimal Charles
- Christian Medical Association of India (CMAI), New Delhi, India
| | | | - Sunil D Khaparde
- Ministry of Health and Family Welfare, Mumbai, Maharashtra, India
| | - Sunita Upadhyaya
- Division of Global HIV and TB, Center for Centers for Disease Control and Prevention (CDC), New Delhi, India
| | - Shobini Rajan
- National AIDS Control Organization (NACO), Janpath, New Delhi, India
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3
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Raizada N, McDowell A, Parija D, Sachdeva KS, Khaparde SD, Rao R, Pavani TN, Sudha S, Tyagi H, Rebecca YM, Huddart S, Salhotra VS, Nair SA, Denkinger CM, Chadha SS, Sarin S, Kalra A. Pathways to diagnosis of pediatric TB patients: A mixed methods study from India. Indian J Tuberc 2021; 68:363-373. [PMID: 34099202 DOI: 10.1016/j.ijtb.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/06/2020] [Revised: 11/11/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND A significant proportion of pediatric tuberculosis (TB) patients go unnotified due to the challenges in diagnosis of TB among children. The experiences of this vulnerable group while going through the TB care cascade remain largely undocumented. The aim of this study was to explore the experiences of pediatric TB patients and families along the pathway to TB diagnosis and appropriate treatment in four cities of India. METHODS The study used a mixed methods, single phased, embedded design. The primary qualitative and secondary quantitative data were collected simultaneously by interviewing families of 100 randomly selected Xpert MTB/RIF positive pediatric TB patients, under the pediatric TB project, in 4 Indian cities using a semi-structured questionnaire. The qualitative component was analyzed to deduce patterns and themes on the patient and family experiences. Descriptive statistics were used to quantify various events along the TB care pathway including various delays (patient, diagnosis and total) and number of providers visited by patients during the diagnostic process. RESULTS The median patient, diagnostic and total delays were 3 (IQR: 2,5), 39 (IQR: 23, 91) and 43 days (IQR: 28.5, 98.5), respectively. Patients visited a median of 3 (IQR: 2,4) providers before accessing Xpert MTB/RIF testing. On an average, 68.4% of physicians ordered any test most of them being irrelevant for TB diagnosis. Qualitative data showed considerable suffering for children and their families before and after TB diagnosis including serious concerns of stigma, disruption in education and social life and recurrence of the disease. CONCLUSION Our study highlights the significant physical and social distress that the children with TB and their families undergo along the TB care pathway. It also shows diagnostic delay in excess of a month during which multiple providers were met and the patients underwent several diagnostic tests, most of them being inappropriate. Efforts to make Xpert MTB/RIF testing more accessible and part of physicians' toolkit will be of considerable value to ease the complexity of TB diagnosis in children. In addition, communication strategy needs to be developed and implemented to generate awareness among general population around pediatric TB and its management.
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Affiliation(s)
- Neeraj Raizada
- Foundation for Innovative New Diagnostics, New Delhi, India
| | | | | | - K S Sachdeva
- Central TB Division, Government of India, New Delhi, India
| | | | - Raghuram Rao
- Central TB Division, Government of India, New Delhi, India
| | - T N Pavani
- Foundation for Innovative New Diagnostics, New Delhi, India
| | - S Sudha
- Foundation for Innovative New Diagnostics, New Delhi, India
| | | | - Y Mary Rebecca
- Foundation for Innovative New Diagnostics, New Delhi, India
| | | | | | | | | | | | - Sanjay Sarin
- Foundation for Innovative New Diagnostics, New Delhi, India
| | - Aakshi Kalra
- Foundation for Innovative New Diagnostics, New Delhi, India.
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4
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Raina SK, Kumar R, Natrajan S, Gilada I, Garg S, Dhariwal AC, Galvankar S, Khaparde SD, Bhatt R, Bodhankar U, Agarwal P. India's need for long-term solutions to COVID-19-like pandemics: A policy paper by Organized Medicine Academic Guild. J Family Med Prim Care 2021; 10:1508-1511. [PMID: 34123882 PMCID: PMC8144750 DOI: 10.4103/jfmpc.jfmpc_2220_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 11/04/2022] Open
Abstract
The entire world seems to have responded to COVID-19 pandemic in a knee-jerk manner with a short mindset without building on the existing strengths of public health infrastructure. National governments cannot be blamed for this as we are dealing with a crisis that comes once in a lifetime. Realising this, the Organized Medicine Academic Guild (OMAG) an association of major health associations in this country has suggested measures for long-term solutions to COVID-19-like pandemics in the form of a policy paper by OMAG.
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Affiliation(s)
- Sunil K Raina
- Department of Community Medicine, Dr. R.P. Government Medical College, Tanda, Himachal Pradesh, India
| | - Raman Kumar
- Academy of Family Physicians of India, New Delhi, India
| | - S Natrajan
- Aditya Jyot Eye Hospital, Wadala, Mumbai, India
| | - Ishwar Gilada
- India Unison Medicare and Research Centre, Alibhai Premji Marg, Grant Road-E, Mumbai, Maharashtra, India
| | - Suneela Garg
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - A C Dhariwal
- National Vector Borne Disease Control Programme (NVBDCP), Directorate General of Health Services, Ministry of Health and Family Welfare, Florida, USA
| | - Sagar Galvankar
- Department of Emergency Medicine, Sarasota Memorial Hospital Florida State University, Florida, USA
| | - Sunil D Khaparde
- Former Deputy Director General TB Control, Father Muller Medical College, Manglore, Karnataka, India
| | - Ramesh Bhatt
- Department of Dermatology, Father Muller Medical College, Manglore, Karnataka, India
| | - Uday Bodhankar
- Department of Emergency Medicine, AIIMS, New Delhi, India
| | - Praveen Agarwal
- Bodhankar Childrens Hospital, Sharhari, Central Bazaar Road, Nagpur, Maharashtra, India
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5
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Verma M, Vishwanath K, Eweje F, Roxhed N, Grant T, Castaneda M, Steiger C, Mazdiyasni H, Bensel T, Minahan D, Soares V, Salama JAF, Lopes A, Hess K, Cleveland C, Fulop DJ, Hayward A, Collins J, Tamang SM, Hua T, Ikeanyi C, Zeidman G, Mule E, Boominathan S, Popova E, Miller JB, Bellinger AM, Collins D, Leibowitz D, Batra S, Ahuja S, Bajiya M, Batra S, Sarin R, Agarwal U, Khaparde SD, Gupta NK, Gupta D, Bhatnagar AK, Chopra KK, Sharma N, Khanna A, Chowdhury J, Stoner R, Slocum AH, Cima MJ, Furin J, Langer R, Traverso G. A gastric resident drug delivery system for prolonged gram-level dosing of tuberculosis treatment. Sci Transl Med 2020; 11:11/483/eaau6267. [PMID: 30867322 PMCID: PMC7797620 DOI: 10.1126/scitranslmed.aau6267] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/01/2019] [Indexed: 12/12/2022]
Abstract
Multigram drug depot systems for extended drug release could transform our capacity to effectively treat patients across a myriad of diseases. For example, tuberculosis (TB) requires multimonth courses of daily multigram doses for treatment. To address the challenge of prolonged dosing for regimens requiring multigram drug dosing, we developed a gastric resident system delivered through the nasogastric route that was capable of safely encapsulating and releasing grams of antibiotics over a period of weeks. Initial preclinical safety and drug release were demonstrated in a swine model with a panel of TB antibiotics. We anticipate multiple applications in the field of infectious diseases, as well as for other indications where multigram depots could impart meaningful benefits to patients, helping maximize adherence to their medication.
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Affiliation(s)
- Malvika Verma
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Karan Vishwanath
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Feyisope Eweje
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Niclas Roxhed
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Micro and Nanosystems, KTH Royal Institute of Technology, Stockholm 10044, Sweden
| | - Tyler Grant
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Macy Castaneda
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Christoph Steiger
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Hormoz Mazdiyasni
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Taylor Bensel
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Daniel Minahan
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Vance Soares
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - John A F Salama
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Aaron Lopes
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Kaitlyn Hess
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Cody Cleveland
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Daniel J Fulop
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alison Hayward
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Joy Collins
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Siddartha M Tamang
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Tiffany Hua
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Chinonyelum Ikeanyi
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Gal Zeidman
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Elizabeth Mule
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Sooraj Boominathan
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Ellena Popova
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Biology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jonathan B Miller
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Andrew M Bellinger
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Cardiovascular Division, Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - David Collins
- Management Sciences for Health, Medford, MA 02155, USA.,Boston University School of Public Health, Boston, MA 02118, USA
| | - Dalia Leibowitz
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | | | | | | | | | - Rohit Sarin
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi 110030, India
| | - Upasna Agarwal
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi 110030, India
| | - Sunil D Khaparde
- Former Deputy Director General and Head of Central TB Division, Government of India, New Delhi 110011, India
| | - Neeraj K Gupta
- Department of Respiratory Medicine, Safdarjung Hospital, New Delhi 110029, India
| | - Deepak Gupta
- Division of Pulmonary and Critical Care Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anuj K Bhatnagar
- Rajan Babu Institute for Pulmonary Medicine and Tuberculosis, New Delhi 110009, India
| | | | - Nandini Sharma
- Department of Community Medicine, Maulana Azad Medical College, New Delhi 110002, India
| | - Ashwani Khanna
- Lok Nayak Hospital Chest Clinic, New Delhi 110002, India
| | | | - Robert Stoner
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,MIT Energy Initiative, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Alexander H Slocum
- Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Michael J Cima
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Robert Langer
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. .,Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Media Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Giovanni Traverso
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. .,Tata Center for Technology and Design, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.,Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.,Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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6
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Khaparde SD, Gupta D, Ramachandran R, Rade K, Mathew ME, Jaju J. Enhancing TB surveillance with mobile technology: Opportunities and challenges. Indian J Tuberc 2019; 65:185-186. [PMID: 29933857 DOI: 10.1016/j.ijtb.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sunil D Khaparde
- Deputy Director General (TB), Ministry of Health and Family Welfare, Government of India, India
| | - Devesh Gupta
- Additional Deputy Director General (TB), Ministry of Health and Family Welfare, Government of India, India
| | - Ranjani Ramachandran
- National Professional Officer (TB), World Health Organization, Country Office for India, India
| | - Kiran Rade
- National Professional Officer (TB), World Health Organization, Country Office for India, India
| | - Manu Easow Mathew
- National Consultant - RNTCP, World Health Organization, Country Office for India, India.
| | - Jyoti Jaju
- National Consultant - RNTCP, World Health Organization, Country Office for India, India
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7
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Sarin S, Huddart S, Raizada N, Parija D, Kalra A, Rao R, Salhotra VS, Khaparde SD, Boehme C, Denkinger CM, Sohn H. Cost and operational impact of promoting upfront GeneXpert MTB/RIF test referrals for presumptive pediatric tuberculosis patients in India. PLoS One 2019; 14:e0214675. [PMID: 30933997 PMCID: PMC6443160 DOI: 10.1371/journal.pone.0214675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/18/2019] [Indexed: 12/03/2022] Open
Abstract
Background Outreach and promotion programs are essential to ensuring uptake of new public health interventions and guidelines. We assessed the costs and operation dynamics of outreach and promotion efforts for up front Xpert MTB/RIF (Xpert) testing for pediatric presumptive tuberculosis (TB) patients in four major Indian cities. Methods Xpert test costs were assessed as weighted average per-test costs based on the daily workload dynamics matched by test volume specific Xpert unit cost at each study site. Costs of outreach programs to recruit health providers to refer pediatric patients for Xpert testing were assessed as cost per referral for each quarter based on total program costs and referral data. All costs were assessed in the health service provider’s perspective and expressed in 2015 USD. Results Weighted average per-test costs ranged from $14.71 to $17.81 at the four laboratories assessed. Differences between laboratories were associated with unused testing capacity and/or frequencies of overtime work to cope with increasing demand and same-day testing requirements. Outreach activities generated between 825 and 2,065 Xpert testing referrals on average each quarter across the four study sites, translating into $0.63 to $2.55 per patient referred. Overall outreach costs per referral decreased with time, stabilizing at an average cost of $1.10, and demonstrated a clear association with increased referrals. Conclusions Xpert test and outreach program costs within and across study sites were mainly driven by the dynamics of Xpert testing demand resulting from the combined outreach activities. However, these increases in demand required considerable overtime work resulting in additional costs and operational challenges at the study laboratories. Therefore, careful laboratory operational adjustment should be evaluated at target areas in parallel to the anticipated demand from the Xpert referral outreach program scale-up in other Indian regions.
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Affiliation(s)
- Sanjay Sarin
- Foundation for Innovative New Diagnostics, New Delhi, India
| | - Sophie Huddart
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- McGill International TB Centre, Montreal, Quebec, Canada
| | - Neeraj Raizada
- Foundation for Innovative New Diagnostics, New Delhi, India
| | | | - Aakshi Kalra
- Foundation for Innovative New Diagnostics, New Delhi, India
| | - Raghuram Rao
- Central TB Division, Government of India, New Delhi, India
| | | | | | | | | | - Hojoon Sohn
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
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8
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Moonan PK, Nair SA, Agarwal R, Chadha VK, Dewan PK, Gupta UD, Ho CS, Holtz TH, Kumar AM, Kumar N, Kumar P, Maloney SA, Mase SR, Oeltmann JE, Paramasivan CN, Parmar MM, Rade KK, Ramachandran R, Rao R, Salhorta VS, Sarin R, Sarin S, Sachdeva KS, Selvaraju S, Singla R, Surie D, Tonsing J, Tripathy SP, Khaparde SD. Tuberculosis preventive treatment: the next chapter of tuberculosis elimination in India. BMJ Glob Health 2018; 3:e001135. [PMID: 30364389 PMCID: PMC6195150 DOI: 10.1136/bmjgh-2018-001135] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 01/07/2023] Open
Abstract
The End TB Strategy envisions a world free of tuberculosis—zero deaths, disease and suffering due to tuberculosis by 2035. This requires reducing the global tuberculosis incidence from >1250 cases per million people to <100 cases per million people within the next two decades. Expanding testing and treatment of tuberculosis infection is critical to achieving this goal. In high-burden countries, like India, the implementation of tuberculosis preventive treatment (TPT) remains a low priority. In this analysis article, we explore potential challenges and solutions of implementing TPT in India. The next chapter in tuberculosis elimination in India will require cost-effective and sustainable interventions aimed at tuberculosis infection. This will require constant innovation, locally driven solutions to address the diverse and dynamic tuberculosis epidemiology and persistent programme monitoring and evaluation. As new tools, regimens and approaches emerge, midcourse adjustments to policy and practice must be adopted. The development and implementation of new tools and strategies will call for close collaboration between local, national and international partners—both public and private—national health authorities, non-governmental organisations, research community and the diagnostic and pharmaceutical industry. Leading by example, India can contribute to global knowledge through operational research and programmatic implementation for combating tuberculosis infection.
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Affiliation(s)
- Patrick K Moonan
- Global Tuberculosis Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Reshu Agarwal
- CDC India Country Office, U.S. Centers for Disease Control and Prevention, New Delhi, India
| | - Vineet K Chadha
- Department of Epidemiology and Research, National Tuberculosis Institute, Bangalore, India
| | - Puneet K Dewan
- Global Health, Bill and Melinda Gates Foundation, Seattle, USA
| | - Umesh D Gupta
- National JALMA Institute for Leprosy and other Mycobacterial Diseases, Agra, India
| | - Christine S Ho
- CDC India Country Office, U.S. Centers for Disease Control and Prevention, New Delhi, India
| | - Timothy H Holtz
- CDC India Country Office, U.S. Centers for Disease Control and Prevention, New Delhi, India
| | - Ajay M Kumar
- Department of Research, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Nishant Kumar
- Revised National Tuberculosis Control Programme, India Ministry of Health and Family Welfare, New Delhi, India
| | | | - Susan A Maloney
- Global Tuberculosis Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sundari R Mase
- WHO India Country Office, World Health Organization, New Delhi, India
| | - John E Oeltmann
- Global Tuberculosis Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - C N Paramasivan
- India Country Office, Foundation for Innovative New Diagnostics, New Delhi, India
| | - Malik M Parmar
- India Country Office, World Health Organization, New Delhi, India
| | - Kiran K Rade
- India Country Office, World Health Organization, New Delhi, India
| | | | - Raghuram Rao
- Revised National Tuberculosis Control Programme, India Ministry of Health and Family Welfare, New Delhi, India
| | - Virendra S Salhorta
- Revised National Tuberculosis Control Programme, India Ministry of Health and Family Welfare, New Delhi, India
| | - Rohit Sarin
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Sanjay Sarin
- India Country Office, Foundation for Innovative New Diagnostics, New Delhi, India
| | - Kuldeep S Sachdeva
- Revised National Tuberculosis Control Programme, India Ministry of Health and Family Welfare, New Delhi, India
| | - Sriram Selvaraju
- Department of Epidemiology, National Institute for Research in Tuberculosis, Chennai, India
| | - Rupak Singla
- Department of Tuberculosis and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Diya Surie
- Global Tuberculosis Branch, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jamhoih Tonsing
- South-east Asia Office, International Union Against Tuberculosis and Lung Disease, New Delhi, India
| | | | - Sunil D Khaparde
- Revised National Tuberculosis Control Programme, India Ministry of Health and Family Welfare, New Delhi, India
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9
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Raizada N, Khaparde SD, Rao R, Kalra A, Sarin S, Salhotra VS, Swaminathan S, Khanna A, Chopra KK, Hanif M, Singh V, Umadevi KR, Nair SA, Huddart S, Tripathi R, Surya Prakash CH, Saha BK, Denkinger CM, Boehme C. Upfront Xpert MTB/RIF testing on various specimen types for presumptive infant TB cases for early and appropriate treatment initiation. PLoS One 2018; 13:e0202085. [PMID: 30161142 PMCID: PMC6116934 DOI: 10.1371/journal.pone.0202085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 07/29/2018] [Indexed: 11/18/2022] Open
Abstract
Background Diagnosis of tuberculosis (TB) in infants is challenging due to non-specific clinical presentations of the disease in this age-group and low sensitivity of widely available TB diagnostic tools, which in turn delays prompt access to TB treatment. Upfront access to Xpert/MTB RIF (Xpert) testing, a highly sensitive and specific rapid diagnostic tool, could potentially address some of these challenges. Under the current project, we assessed the utility and feasibility of applying upfront Xpert for diagnosis of tuberculosis in infants, including for testing of non-sputum specimens. Methods A high throughput lab was established in each of the four project cities, and linked to various health care providers across the city, through rapid specimen transportation and electronic reporting linkages. Free Xpert testing was offered to all infant (<2 years of age) presumptive TB cases (both pulmonary and extra-pulmonary) seeking care at public and private health facilities. Results A total of 7,994 presumptive infant TB cases were enrolled in the project from April 2014 to October 2016, detecting 465 (5.8%, CI: 5.3–6.4) TB cases. The majority (93.9%; CI: 93.4–94.4) of patient specimens were non-sputum and TB positivity was higher amongst non-sputum specimens. Further, a high proportion (5.6% CI 3.8–8.1) of infant TB cases were found to be rifampicin resistant. Covering large cities with a single lab per city over more than two years, the project demonstrated the feasibility of same-day diagnosis with upfront Xpert testing. This in turn led to prompt treatment initiation, with a two-day median turnaround time to treatment initiation. Case mortality observed in the project cohort of diagnosed TB cases was 11.0% (CI 8.4–14.1), the majority of which was pre- or early treatment mortality, in spite of prompt access to treatment for most diagnosed cases. Conclusion The current project demonstrated the feasibility of applying rapid and upfront Xpert testing for presumptive infant TB cases. Rapid TB diagnosis in turn facilitates prompt and appropriate treatment initiation. Further, levels of rifampicin resistance observed in infants TB cases highlight the additional benefit of upfront resistance testing. However, high rates of early case mortality, in spite of prompt diagnosis and treatment initiation, highlight the need for further research in infant patient pathways for overall improvement in TB care for infant populations.
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Affiliation(s)
- Neeraj Raizada
- Foundation for Innovative New Diagnostics, New Delhi, India
| | | | - Raghuram Rao
- Central TB Division, Government of India, New Delhi, India
| | - Aakshi Kalra
- Foundation for Innovative New Diagnostics, New Delhi, India
| | - Sanjay Sarin
- Foundation for Innovative New Diagnostics, New Delhi, India
| | | | | | | | | | - M. Hanif
- New Delhi TB Centre, New Delhi, India
| | - Varinder Singh
- Lady Hardinge Medical College and assoc Kalawati Saran Children's Hospital, New Delhi, India
| | - K. R. Umadevi
- National Institute of research in Tuberculosis, Chennai, India
| | | | | | | | | | - B. K. Saha
- Intermediate Reference Laboratory, Kolkata, India
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10
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Velayutham B, Chadha VK, Singla N, Narang P, Gangadhar Rao V, Nair S, Ramalingam S, Narayanan Sivaramakrishnan G, Joseph B, Selvaraju S, Shanmugam S, Narang R, Pachikkaran P, Bhat J, Ponnuraja C, Bajaj Bhalla B, Shivashankara BA, Sebastian G, Yadav R, Kumar Sharma R, Sarin R, Myneedu VP, Singla R, Khayyam K, Mrithunjayan SK, Jayasankar SP, Sanker P, Viswanathan K, Viswambharan R, Mathuria K, Bhalla M, Singh N, Tumane KB, Dawale A, Tiwari CP, Bansod R, Jayabal L, Murali L, Khaparde SD, Rao R, Jawahar MS, Natrajan M. Recurrence of tuberculosis among newly diagnosed sputum positive pulmonary tuberculosis patients treated under the Revised National Tuberculosis Control Programme, India: A multi-centric prospective study. PLoS One 2018; 13:e0200150. [PMID: 29979738 PMCID: PMC6034867 DOI: 10.1371/journal.pone.0200150] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/20/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction There is lack of information on the proportion of new smear—positive pulmonary tuberculosis (PTB) patients treated with a 6-month thrice-weekly regimen under Revised National Tuberculosis Control Programme (RNTCP) who develop recurrent TB after successful treatment outcome. Objective To estimate TB recurrence among newly diagnosed PTB patients who have successfully completed treatment and to document endogenous reactivation or re-infection. Risk factors for unfavourable outcomes to treatment and TB recurrence were determined. Methodology Adult (aged ≥ 18 yrs) new smear positive PTB patients initiated on treatment under RNTCP were enrolled from sites in Tamil Nadu, Karnataka, Delhi, Maharashtra, Madhya Pradesh and Kerala. Those declared “treatment success” at the end of treatment were followed up with 2 sputum examinations each at 3, 6 and 12 months after treatment completion. MIRU-VNTR genotyping was done to identify endogenous re-activation or exogenous re-infection at TB recurrence. TB recurrence was expressed as rate per 100 person-years (with 95% confidence interval [95%CI]). Regression models were used to identify the risk factors for unfavourable response to treatment and TB recurrence. Results Of the1577 new smear positive PTB patients enrolled, 1565 were analysed. The overall cure rate was 77% (1207/1565) and treatment success was 77% (1210 /1565). The cure rate varied from 65% to 86%. There were 158 of 1210 patients who had TB recurrence after treatment success. The pooled TB recurrence estimate was 10.9% [95%CI: 0.2–21.6] and TB recurrence rate per 100 person–years was 12.7 [95% CI: 0.4–25]. TB recurrence per 100 person–years varied from 5.4 to 30.5. Endogenous reactivation was observed in 56 (93%) of 60 patients for whom genotyping was done. Male gender was associated with TB recurrence. Conclusion A substantial proportion of new smear positive PTB patients successfully treated with 6 –month thrice-weekly regimen have TB recurrence under program settings.
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Affiliation(s)
| | | | - Neeta Singla
- National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Pratibha Narang
- Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, Wardha, Maharashtra, India
| | - Vikas Gangadhar Rao
- ICMR-National Institute for Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Sanjeev Nair
- Thiruvananthapuram Medical College, Thiruvananthapuram (TMCT), Kerala, India
| | | | | | - Bency Joseph
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Sriram Selvaraju
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | | | - Rahul Narang
- Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, Wardha, Maharashtra, India
| | | | - Jyothi Bhat
- ICMR-National Institute for Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | | | | | | | - George Sebastian
- National Tuberculosis Institute (NTI), Bangalore, Karnataka, India
| | - Rajiv Yadav
- ICMR-National Institute for Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Ravendra Kumar Sharma
- ICMR-National Institute for Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Rohit Sarin
- National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Vithal Prasad Myneedu
- National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Rupak Singla
- National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Khalidumer Khayyam
- National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | | | | | | | | | | | - Kapil Mathuria
- National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Manpreet Bhalla
- National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Nitu Singh
- District TB Centre, Malviya Nagar, India
| | | | | | | | | | | | | | | | | | | | - Mohan Natrajan
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, India
- * E-mail:
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11
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Sachdeva KS, Deshmukh RD, Seguy NS, Nair SA, Rewari BB, Ramchandran R, Parmar M, Vohra V, Singh S, Ghedia M, Agarwal R, Shah AN, Balasubramanian D, Bamrotiya M, Sikhamani R, Gupta RS, Khaparde SD. Tuberculosis infection control measures at health care facilities offering HIV and tuberculosis services in India: A baseline assessment. Indian J Tuberc 2018; 65:280-284. [PMID: 30522613 DOI: 10.1016/j.ijtb.2018.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/11/2018] [Accepted: 04/09/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Tuberculosis (TB) is one of world's oldest infectious disease and ranks alongside HIV as leading infectious killer. Tuberculosis infection control especially in HIV and TB care facilities has warranted attention after the recent health care-associated outbreaks in South Africa. The aim of this study was to describe the tuberculosis infection control measures implemented by HIV and TB care facilities in five high HIV burden provinces in India. METHODS Baseline assessment of 30 high burden Antiretroviral centers and TB facilities was conducted during Oct 2015-Dec 2015 by AIC trained staff using a structured format. RESULTS Thirty HIV and TB care facilities in five high HIV burden provinces were enrolled. Facility infrastructure and airborne infection control practices were highly varied between facilities. TB screening and fast tracking at ART centers is happening at majority of centers however inadequate TB infection control training, poor compliance to administrative and personal protective measures and lack of mechanism for health care workers surveillance need attention. CONCLUSIONS Local specific TB infection control interventions to be designed and implemented at HIV and TB care facilities including implementation of administrative, environmental and use of personal protective equipment's with the training of staff members. Health care workers surveillance needs to be prioritized considering the rising instances of tuberculosis among Health care workers.
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Affiliation(s)
- K S Sachdeva
- National Institute of TB and Respiratory Diseases, Sri Aurobindo Marg, Near Qutub Minar, New Delhi 110030, India
| | - R D Deshmukh
- National AIDS Control Organization, Ministry of Health and Family Welfare, Basic Services Division, 6th Floor, Chandralok Building, 36-Janpath, New Delhi 110001, India; World Health Organization, Country Office for India, 532, A Wing, Nirman Bhavan, Maulana Azad Road, New Delhi 110001, India.
| | - N S Seguy
- World Health Organization, Country Office for India, 532, A Wing, Nirman Bhavan, Maulana Azad Road, New Delhi 110001, India
| | - S A Nair
- World Health Organization, Country Office for India, 532, A Wing, Nirman Bhavan, Maulana Azad Road, New Delhi 110001, India
| | - B B Rewari
- National AIDS Control Organization, Ministry of Health and Family Welfare, Basic Services Division, 6th Floor, Chandralok Building, 36-Janpath, New Delhi 110001, India; World Health Organization, Country Office for India, 532, A Wing, Nirman Bhavan, Maulana Azad Road, New Delhi 110001, India
| | - R Ramchandran
- World Health Organization, Country Office for India, 532, A Wing, Nirman Bhavan, Maulana Azad Road, New Delhi 110001, India
| | - M Parmar
- World Health Organization, Country Office for India, 532, A Wing, Nirman Bhavan, Maulana Azad Road, New Delhi 110001, India
| | - V Vohra
- National Institute of TB and Respiratory Diseases, Sri Aurobindo Marg, Near Qutub Minar, New Delhi 110030, India
| | - S Singh
- National TB Institute, 8, Avalon, Bellary Road, Bengaluru, Karnataka 560003, India
| | - M Ghedia
- World Health Organization, Country Office for India, 532, A Wing, Nirman Bhavan, Maulana Azad Road, New Delhi 110001, India; Central TB Division, Ministry of Health and Family Welfare, Nirman Bhavan, Maulana Azad Road, New Delhi 110001, India
| | - R Agarwal
- Public Health Foundation of India, Plot no 47, Sec 44, Institutional Area Gurgaon, 122002 Haryana, India
| | - A N Shah
- World Health Organization, Country Office for India, 532, A Wing, Nirman Bhavan, Maulana Azad Road, New Delhi 110001, India; Central TB Division, Ministry of Health and Family Welfare, Nirman Bhavan, Maulana Azad Road, New Delhi 110001, India
| | - D Balasubramanian
- World Health Organization, Country Office for India, 532, A Wing, Nirman Bhavan, Maulana Azad Road, New Delhi 110001, India
| | - M Bamrotiya
- National AIDS Control Organization, Ministry of Health and Family Welfare, Basic Services Division, 6th Floor, Chandralok Building, 36-Janpath, New Delhi 110001, India
| | - R Sikhamani
- National AIDS Control Organization, Ministry of Health and Family Welfare, Basic Services Division, 6th Floor, Chandralok Building, 36-Janpath, New Delhi 110001, India
| | - R S Gupta
- National AIDS Control Organization, Ministry of Health and Family Welfare, Basic Services Division, 6th Floor, Chandralok Building, 36-Janpath, New Delhi 110001, India
| | - S D Khaparde
- National AIDS Control Organization, Ministry of Health and Family Welfare, Basic Services Division, 6th Floor, Chandralok Building, 36-Janpath, New Delhi 110001, India
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12
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Parmar MM, Sachdeva KS, Dewan PK, Rade K, Nair SA, Pant R, Khaparde SD. Unacceptable treatment outcomes and associated factors among India's initial cohorts of multidrug-resistant tuberculosis (MDR-TB) patients under the revised national TB control programme (2007-2011): Evidence leading to policy enhancement. PLoS One 2018; 13:e0193903. [PMID: 29641576 PMCID: PMC5894982 DOI: 10.1371/journal.pone.0193903] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 02/21/2018] [Indexed: 11/23/2022] Open
Abstract
Background Globally, India has the world’s highest burden of multidrug-resistant tuberculosis (MDR-TB). Programmatic Management of Drug Resistant TB (PMDT) in India began in 2007 and nationwide coverage was achieved in early 2013. Poor initial microbiological outcomes under the Revised National Tuberculosis Control Programme (RNTCP) prompted detailed analysis. This is the first study on factors significantly associated with poor outcomes in MDR-TB patients treated under the RNTCP. Objective To evaluate initial sputum culture conversion, culture reversion and final treatment outcomes among MDR-TB patients registered in India from 2007 to early 2011 who were treated with a standard 24-month regimen under daily-observed treatment. Methods This is a retrospective cohort study. Clinical and microbiological data were abstracted from PMDT records. Initial sputum culture conversion, culture reversion and treatment outcomes were defined by country adaptation of the standard WHO definitions (2008). Cox proportional hazards modeling with logistic regression, multinomial logistic regression and adjusted odds ratio was used to evaluate factors associated with interim and final outcomes respectively, controlling for demographic and clinical characteristics. Results In the cohort of 3712 MDR-TB patients, 2735 (73.6%) had initial sputum culture conversion at 100 median days (IQR 92–125), of which 506 (18.5%) had culture reversion at 279 median days (IQR 202–381). Treatment outcomes were available for 2264 (60.9%) patients while 1448 (39.0%) patients were still on treatment or yet to have a definite outcome at the time of analysis. Of 2264 patients, 781 (34.5%) had treatment success, 644 (28.4%) died, 670 (29.6%) were lost to follow up, 169 (7.5%) experienced treatment failure or were changed to XDR-TB treatment. Factors significantly associated with either culture non-conversion, culture reversion and/or unfavorable treatment outcomes were baseline BMI < 18; ≥ seven missed doses in intensive phase (IP) and continuation phase (CP); cavitary disease; prior treatment episodes characterized by re-treatment regimen taken twice, longer duration and more episodes of treatment; any weight loss during treatment; males and additional resistance to first line drugs (Ethambutol, Streptomycin). In a subgroup of 104 MDR-TB patients, 62 (59.6%) had Ofloxacin resistance among whom only 25.8% had treatment success, half of the success (54.8%) seen in Ofloxacin sensitive patients. Baseline susceptibility to Ofloxacin (HR 2.04) and Kanamycin (HR 4.55) significantly doubled and quadrupled the chances for culture conversion respectively while baseline susceptibility to Ofloxacin (AOR 0.37) also significantly reduced the odds of unfavorable treatment outcomes (p value ≤0.05) in multinomial logistic regression model. Conclusion India’s initial MDR-TB patients’ cohort treated under the RNTCP experienced poor treatment outcomes. To address the factors associated with poor treatment outcomes revealed in our study, a systematic multi-pronged approach would be needed. A series of policies and interventions have been developed to address these factors to improve DR-TB treatment outcomes and are being scaled-up in India.
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Affiliation(s)
- Malik M. Parmar
- World Health Organization–Country Office for India, New Delhi, India
- * E-mail:
| | - Kuldeep Singh Sachdeva
- National AIDS Control Organization, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Puneet K. Dewan
- Bill & Melinda Gates Foundation, India Country Office, New Delhi, India
| | - Kiran Rade
- World Health Organization–Country Office for India, New Delhi, India
| | - Sreenivas A. Nair
- World Health Organization–Country Office for India, New Delhi, India
| | - Rashmi Pant
- Public Health Foundation of India, Hyderabad, India
| | - Sunil D. Khaparde
- Central TB Division, Ministry of Health and Family Welfare, Government of India, New Delhi, India
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McDowell A, Raizada N, Khaparde SD, Rao R, Sarin S, Kalra A, Salhotra VS, Nair SA, Boehme C, Denkinger CM. "Before Xpert I only had my expertise": A qualitative study on the utilization and effects of Xpert technology among pediatricians in 4 Indian cities. PLoS One 2018; 13:e0193656. [PMID: 29547642 PMCID: PMC5856339 DOI: 10.1371/journal.pone.0193656] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/15/2018] [Indexed: 11/21/2022] Open
Abstract
Background Diagnosing tuberculosis (TB) in children presents considerable challenges. Upfront testing on Xpert® MTB/RIF (‘Xpert’)—a rapid molecular assay with high sensitivity and specificity—for pediatric presumptive TB patients, as recommended by India’s Revised National Tuberculosis Control Program (RNTCP), can pave the way for early TB diagnosis. As part of an ongoing project implemented by Foundation for Innovative New Diagnostics (FIND) dedicated to providing upfront free-of-cost (FOC) Xpert testing to children seeking care in the public and private sectors, a qualitative assessment was designed to understand how national guidelines on TB diagnosis and Xpert technology have been integrated into the pediatric TB care practices of different health providers. Methods We conducted semi-structured interviews with a sample of health providers from public and private sectors engaged in the ongoing pediatric project in 4 major cities of India. Providers were sampled from intervention data based on sector of practice, number of Xpert referrals, and TB detection rates amongst referrals. A total of 55 providers were interviewed with different levels of FOC Xpert testing uptake. Data were transcribed and analyzed inductively by a medical anthropologist using thematic content analysis and narrative analysis. Results It was observed that despite guidance from RNTCP on the use of Xpert and significant efforts by FIND and state authorities to disseminate these guidelines, there was notable diversity in their implementation by different health care providers. Xpert, apart from being utilized as intended, i.e. as a first diagnostic test for children, was utilized variably–as an initial screening test (to rule out TB), confirmatory test (once TB diagnosis is established based on antibiotic trial or clinically) and/or only for drug susceptibility testing after TB diagnosis was confirmed. Most providers who used Xpert frequently reported that Xpert was an important tool for managing pediatric TB cases, by reducing the proportion of cases diagnosed only on clinical suspicion and by providing upfront information on drug resistance, which is seldom suspected in children. Despite non-standard use, these results showed that Xpert access helped raise awareness, aided in antibiotic stewardship, and reduced dependence on clinical diagnosis among those who diagnose and treat TB in children. Conclusion Access to free and rapid Xpert testing for all presumptive pediatric TB patients has had multiple positive effects on pediatricians’ diagnosis and treatment of TB. It has important effects on speed of diagnosis, empirical treatment, and awareness of drug resistance among TB treatment naive children. In addition, our study shows that access to public sector Xpert machines may be an important way to encourage Public-Private integration and facilitate the movement of patients from the private to public sector for anti-TB treatment. Despite availability of rapid and free Xpert testing, our study showed an alarming diversity of Xpert utilization strategies across different providers who may be moving toward suggested practice over time. The degree of diversity in TB diagnostic approaches in children reported here highlights the urgent need for concerted efforts to place Xpert early in diagnostic algorithms to positively impact the pediatric TB care pathway. A positive change in diagnostic algorithms may be possible with continued advocacy, time, and increased access.
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Affiliation(s)
- Andrew McDowell
- Institut National de la Santé et Recherché Medical, Paris, France
- Harvard Medical School Center for Global Health Delivery, Dubai, United Arab Emirates
| | - Neeraj Raizada
- Foundation for Innovative New Diagnostics, New Delhi, India
| | | | - Raghuram Rao
- Central TB Division, Government of India, New Delhi, India
| | - Sanjay Sarin
- Foundation for Innovative New Diagnostics, New Delhi, India
| | - Aakshi Kalra
- Foundation for Innovative New Diagnostics, New Delhi, India
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14
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Raizada N, Khaparde SD, Swaminathan S, Sarin S, Salhotra VS, Kalra A, Khanna A, Chopra KK, Hanif M, Umadevi KR, Hissar S, Nair SA, Prakash CHS, Saha BK, Rao R, Denkinger C, Boehme C. Catalysing progressive uptake of newer diagnostics by health care providers through outreach and education in four major cities of India. PLoS One 2018; 13:e0193341. [PMID: 29509803 PMCID: PMC5839557 DOI: 10.1371/journal.pone.0193341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/08/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Unlike in adults, diagnosis of TB can be challenging in children, as signs and symptoms of paediatric TB can be very non-specific and similar to other common childhood chest infections, which may lead to under or delayed diagnosis of TB disease. In spite of the increasing availability of rapid high-sensitivity diagnostics in public and private sectors, majority of paediatric TB cases are empirically diagnosed, without laboratory confirmation. To address these diagnostic challenges, World Health Organization (WHO) has recommended upfront Xpert MTB/RIF (Xpert) testing for the diagnosis of TB in paediatric presumptive pulmonary and extra-pulmonary TB (EPTB) cases. However, in spite of the increasing availability of rapid high-sensitivity diagnostics, a significant gap exists in its application with Xpert being rarely used as an upfront diagnostic among patients presumed to have TB. Under an ongoing paediatric project since April 2014, which provided free-of-cost upfront Xpert testing, several low-cost outreach and education interventions were undertaken to increase the diagnostic uptake by different providers catering to the paediatric population, thereby increasing adherence to global guidance. METHODS Providers catering to paediatric population in the project cities were systematically mapped and contacted using different outreach strategies. The focus of outreach efforts was to increase provider literacy and increase their awareness of the availability of free rapid diagnostic services with the goal of changing their diagnostic approaches. RESULTS From April 2014 to June 2016, more than 5,700 providers/facilities were mapped and 3,670 of them were approached. The number of providers/facilities engaged under the project increased more than 10-fold (43 in April, 2014 to 466 in June, 2016), with significant increase in project uptake, both from public and private sector. Overall 42,238 paediatric presumptive TB cases were enrolled in the project, across the four cities. Over the project period, quarterly diagnostic uptake and paediatric TB cases detection rates increased more than two-fold. TB detection rates were similar in patients from public and private sectors. CONCLUSIONS Ongoing efforts in scaling up new rapid diagnostics involves significant investments. These efforts need to be complemented with proactive provider engagement to ensure provider-literacy and awareness, for maximizing impact of this scale-up. The current project demonstrated the usefulness of outreach and education interventions for the effective uptake of newer diagnostics.
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Affiliation(s)
- Neeraj Raizada
- Foundation for Innovative New Diagnostics, New Delhi, India
| | | | | | - Sanjay Sarin
- Foundation for Innovative New Diagnostics, New Delhi, India
| | | | - Aakshi Kalra
- Foundation for Innovative New Diagnostics, New Delhi, India
- * E-mail:
| | | | | | - M. Hanif
- New Delhi TB Centre, New Delhi, India
| | - K. R. Umadevi
- National Institute for research in Tuberculosis, Chennai, India
| | - Syed Hissar
- National Institute for research in Tuberculosis, Chennai, India
| | | | | | - B. K. Saha
- Intermediate Reference Laboratory, Kolkata, India
| | - Raghuram Rao
- Central TB Division, Government of India, New Delhi, India
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15
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Rupert S, Vassall A, Raizada N, Khaparde SD, Boehme C, Salhotra VS, Sachdeva KS, Nair SA, Hoog AHV. Bottom-up or top-down: unit cost estimation of tuberculosis diagnostic tests in India. Int J Tuberc Lung Dis 2018; 21:375-380. [PMID: 28284251 DOI: 10.5588/ijtld.16.0496] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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 Of 18 sites that participated in an implementation study of the Xpert® MTB/RIF assay in India, we selected five microscopy centres and two reference laboratories. OBJECTIVE To obtain unit costs of diagnostic tests for tuberculosis (TB) and drug-resistant TB. DESIGN Laboratories were purposely selected to capture regional variations and different laboratory types. Both bottom-up and the top-down methods were used to estimate unit costs. RESULTS At the microscopy centres, mean bottom-up unit costs were respectively US$0.83 (range US$0.60-US$1.10) and US$12.29 (US$11.61-US$12.89) for sputum smear microscopy and Xpert. At the reference laboratories, mean unit costs were US$1.69 for the decontamination procedure, US$9.83 for a solid culture, US$11.06 for a liquid culture, US$29.88 for a drug susceptibility test, and US$18.18 for a line-probe assay. Top-down mean unit cost estimates were higher for all tests, and for sputum smear microscopy and Xpert these increased to respectively US$1.51 and US$13.58. The difference between bottom-up and top-down estimates was greatest for tests performed at the reference laboratories. CONCLUSION These unit costs for TB diagnostics can be used to estimate resource requirements and cost-effectiveness in India, taking into account geographical location, laboratory type and capacity utilisation.
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Affiliation(s)
- S Rupert
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - A Vassall
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands, Social and Mathematical Epidemiology Group, Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - N Raizada
- Foundation for Innovative New Diagnostics, New Delhi
| | - S D Khaparde
- Central TB Division, Government of India, New Delhi
| | - C Boehme
- Foundation for Innovative New Diagnostics, New Delhi
| | - V S Salhotra
- Central TB Division, Ministry of Health and Family Welfare, New Delhi
| | - K S Sachdeva
- Central TB Division, Government of India, New Delhi
| | - S A Nair
- World Health Organization, Country Office for India, New Delhi, India
| | - A H Van't Hoog
- Academic Medical Centre, University of Amsterdam, Department of Global Health, Amsterdam, The Netherlands
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Raizada N, Khaparde SD, Salhotra VS, Rao R, Kalra A, Swaminathan S, Khanna A, Chopra KK, Hanif M, Singh V, Umadevi KR, Nair SA, Huddart S, Prakash CHS, Mall S, Singh P, Saha BK, Denkinger CM, Boehme C, Sarin S. Accelerating access to quality TB care for pediatric TB cases through better diagnostic strategy in four major cities of India. PLoS One 2018; 13:e0193194. [PMID: 29489887 PMCID: PMC5830996 DOI: 10.1371/journal.pone.0193194] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 02/06/2018] [Indexed: 11/25/2022] Open
Abstract
Background Diagnosis of TB in children is challenging, and is largely based on positive history of contact with a TB case, clinical and radiological findings, often without microbiological confirmation. Diagnostic efforts are also undermined by challenges in specimen collection and the limited availability of high sensitivity, rapid diagnostic tests that can be applied with a quick turnaround time. The current project was undertaken in four major cities of India to address TB diagnostic challenges in pediatric population, by offering free of cost Xpert testing to pediatric presumptive TB cases, thereby paving the way for better TB care. Methods A high throughput lab was established in each of the four project cities, and linked to various health care providers across the city through rapid specimen transportation and electronic reporting linkages. Free Xpert testing was offered to all pediatric (0–14 years) presumptive TB cases (both pulmonary and extra-pulmonary) seeking care at public and private health facilities. Results The current project enrolled 42,238 pediatric presumptive TB cases from April, 2014 to June, 2016. A total of 3,340 (7.91%, CI 7.65–8.17) bacteriologically confirmed TB cases were detected, of which 295 (8.83%, CI 7.9–9.86) were rifampicin-resistant. The level of rifampicin resistance in the project cohort was high. Overall Xpert yielded a high proportion of valid results and TB detection rates were more than three-fold higher than smear microscopy. The project provided same-day testing and early availability of results led to rapid treatment initiation and success rates and very low rates of treatment failure and loss to follow-up. Conclusion The current project demonstrated the feasibility of rolling out rapid and upfront Xpert testing for pediatric presumptive TB cases through a single Xpert lab per city in an efficient manner. Rapid turnaround testing time facilitated prompt and appropriate treatment initiation. These results suggest that the upfront Xpert assay is a promising solution to address TB diagnosis in children. The high levels of rifampicin resistance detected in presumptive pediatric TB patients tested under the project are a major cause of concern from a public health perspective which underscores the need to further prioritize upfront Xpert access to this vulnerable population.
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Affiliation(s)
- Neeraj Raizada
- Foundation for Innovative New Diagnostics, New Delhi, India
| | | | | | - Raghuram Rao
- Central TB Division, Government of India, New Delhi, India
| | - Aakshi Kalra
- Foundation for Innovative New Diagnostics, New Delhi, India
| | | | | | | | - M. Hanif
- New Delhi TB Centre, New Delhi, India
| | - Varinder Singh
- Lady Hardinge Medical College and assoc Kalawati Saran Children’s Hospital, New Delhi, India
| | - K. R. Umadevi
- National Institute of research in Tuberculosis, Chennai, India
| | | | | | | | - Shalini Mall
- Foundation for Innovative New Diagnostics, New Delhi, India
| | - Pooja Singh
- Foundation for Innovative New Diagnostics, New Delhi, India
| | - B. K. Saha
- Intermediate Reference Laboratory, Kolkata, India
| | | | | | - Sanjay Sarin
- Foundation for Innovative New Diagnostics, New Delhi, India
- * E-mail:
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17
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Affiliation(s)
- K K Chopra
- Director, New Delhi Tuberculosis Centre, New Delhi, India; Associate Executive Editor, Indian Journal of Tuberculosis, India.
| | - Sunil D Khaparde
- Deputy Director-General, Head, Central TB Division, India; Project Director, RNTCP, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
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18
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Kulshrestha N, Nair SA, Rade K, Moitra A, Diwan P, Khaparde SD. Public-private mix for TB care in India: Concept, evolution, progress. Indian J Tuberc 2016; 62:235-8. [PMID: 26970466 DOI: 10.1016/j.ijtb.2015.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 08/10/2015] [Accepted: 11/20/2015] [Indexed: 11/18/2022]
Abstract
To achieve "Universal access to TB care and treatment for all", Revised National Tuberculosis Control Programme (RNTCP) has taken steps to reach the unreached by synergizing the efforts of all partners and stakeholders. RNTCP is engaging with private sector partners in major cities of India with primary focus on notification through innovative partnership mechanisms. The manuscript details the concept behind the public-private mix for TB Care in RNTCP, its evolution and progress over the decades in India.
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Affiliation(s)
- Neeraj Kulshrestha
- Central TB Division, Directorate of Health Services, Ministry of Health and Family Welfare, New Delhi, India
| | - Sreenivas Achuthan Nair
- National Professional Officer - Tuberculosis, WHO Country Office for India, New Delhi, India.
| | - K Rade
- WHO Country Office for India, New Delhi, India
| | - A Moitra
- WHO Country Office for India, New Delhi, India
| | - P Diwan
- Bill and Milinda Gates Foundation, India
| | - S D Khaparde
- Central TB Division, Directorate of Health Services, Ministry of Health and Family Welfare, New Delhi, India
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19
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Nair SA, Sachdeva KS, Malik P, Chandra S, Ramachandran R, Kulshrestha N, Chopra KK, Khaparde SD. Standards for TB care in India: A tool for universal access to TB care. Indian J Tuberc 2016; 62:200-6. [PMID: 26970459 DOI: 10.1016/j.ijtb.2015.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 08/10/2015] [Accepted: 11/20/2015] [Indexed: 11/19/2022]
Abstract
In 2014, Government of India in collaboration with World Health Organization Country Office for India released the policy document on Standards for tuberculosis (TB) care in India after in-depth deliberation with national and international experts. The standards for TB care represent what is expected for quality TB care from the Indian healthcare system including both public and private systems. The details of each standard have been compiled in this review article. It is envisioned that the standards detailed in the manuscript are adapted by all TB care providers across the country.
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Affiliation(s)
- Sreenivas Achuthan Nair
- National Professional Officer - Tuberculosis, WHO Country Office for India, New Delhi, India.
| | - K S Sachdeva
- Central TB Division, Directorate of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | | | - S Chandra
- WHO Country Office for India, New Delhi, India
| | | | - N Kulshrestha
- Central TB Division, Directorate of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - K K Chopra
- Director, New Delhi TB Centre, New Delhi, India
| | - S D Khaparde
- Central TB Division, Directorate of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
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20
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Raizada N, Sachdeva KS, Swaminathan S, Kulsange S, Khaparde SD, Nair SA, Khanna A, Chopra KK, Hanif M, Sethi GR, Umadevi KR, Keshav Chander G, Saha B, Shah A, Parmar M, Ghediya M, Jaju J, Boehme C, Paramasivan CN. Piloting Upfront Xpert MTB/RIF Testing on Various Specimens under Programmatic Conditions for Diagnosis of TB & DR-TB in Paediatric Population. PLoS One 2015; 10:e0140375. [PMID: 26469691 PMCID: PMC4607299 DOI: 10.1371/journal.pone.0140375] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 09/24/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND India accounts for one-fifth of the global TB incidence. While the exact burden of childhood TB is not known, TB remains one of the leading causes of childhood mortality in India. Bacteriological confirmation of TB in children is challenging due to difficulty in obtaining quality specimens, in the absence of which diagnosis is largely based on clinical judgement. While testing multiple specimens can potentially contribute to higher proportion of laboratory confirmed paediatric TB cases, lack of high sensitivity tests adds to the diagnostic challenge. We describe here our experiences in piloting upfront Xpert MTB/RIF testing, for diagnosis of TB in paediatric population in respiratory and extra pulmonary specimens, as recently recommended by WHO. METHOD Xpert MTB/RIF testing was offered to all paediatric (0-14 years) presumptive TB cases (both pulmonary and extra-pulmonary) seeking care at public and private health facilities in the project areas covering 4 cities of India. RESULTS Under this pilot project, 8,370 paediatric presumptive TB & presumptive DR-TB cases were tested between April and-November 2014. Overall, 9,149 specimens were tested, of which 4,445 (48.6%) were non-sputum specimens. Xpert MTB/RIF gave 9,083 (99.2%, CI 99.0-99.4) valid results. Of the 8,143 presumptive TB cases enrolled, 517 (6.3%, CI 5.8-6.9) were bacteriologically confirmed. TB detection rates were two fold higher with Xpert MTB/RIF as compared to smear microscopy. Further, a total of 60 rifampicin resistant TB cases were detected, of which 38 were detected among 512 presumptive TB cases while 22 were detected amongst 227 presumptive DR-TB cases tested under the project. CONCLUSION Xpert MTB/RIF with advantages of quick turnaround testing-time, high proportion of interpretable results and feasibility of rapid rollout, substantially improved the diagnosis of bacteriologically confirmed TB in children, while simultaneously detecting rifampicin resistance.
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Affiliation(s)
- Neeraj Raizada
- Foundation for Innovative New Diagnostics, New Delhi, India
- * E-mail:
| | | | | | | | | | | | | | | | | | | | - K. R. Umadevi
- National Institute of research in Tuberculosis, Chennai, India
| | | | | | - Amar Shah
- Central TB Division, Government of India, New Delhi, India
| | - Malik Parmar
- World Health Organization, Country Office for India, New Delhi, India
| | - Mayank Ghediya
- Central TB Division, Government of India, New Delhi, India
| | - Jyoti Jaju
- Central TB Division, Government of India, New Delhi, India
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Srinivas V, Turlapati PL, Bhola AK, Singh AK, Rajan S, Gupta RS, Khaparde SD. Towards elimination of parent-to-child transmission of syphilis in India: a rapid situation review to inform national strategy. WHO South East Asia J Public Health 2015; 4:197-203. [PMID: 28607319 DOI: 10.4103/2224-3151.206690] [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: 06/07/2023]
Abstract
In February 2015, India's National AIDS Control Organisation, Ministry of Health and Family Welfare, launched a national strategy towards elimination of parent-to-child transmission (E-PTCT) of syphilis, with a goal to reduce the incidence of congenital syphilis to 0.3 cases per 1000 live births by 2017. As part of the development of the national strategy, a rapid situation analysis was undertaken to ascertain the current practices, challenges and barriers for E-PTCT of syphilis in India. The analysis was conducted during February and March 2014 in five states selected from five different regions of India. Key informant interviews were conducted with key stakeholders at facility, state and district level. Content analysis was used to identify the themes. Key barriers identified for E-PTCT of syphilis were: low priority for antenatal syphilis testing among providers, limited access to testing, untrained human resources, shortage of test kits and benzathine penicillin, nonadherence to the national protocol for syphilis testing, and poor recording and reporting of antenatal syphilis data. The analysis also identified opportunities for functional integration of E-PTCT within existing maternal and child health programmes. Health-care providers and programme managers expressed a need for training in the programme for E-PTCT of syphilis. The situation analysis identified that, for successful implementation of E-PTCT of syphilis, it is essential that state and district programme managers adopt this initiative; coordinate the programme; plan for an adequate budget in their programme implementation plan; ensure an uninterrupted supply of standardized diagnostics kits and drugs at all levels of health care; and adhere to E-PTCT guidelines when implementing the programme.
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Affiliation(s)
- Vani Srinivas
- Jhpiego Country Office; National AIDS Control Organisation, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Prasad Ln Turlapati
- National AIDS Control Organisation, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Anil K Bhola
- National AIDS Control Organisation, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Aman K Singh
- National AIDS Control Organisation, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Shobini Rajan
- National AIDS Control Organisation, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Radha S Gupta
- TBC India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Sunil D Khaparde
- TBC India, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India
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22
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Shah NK, Talyan A, Jain V, Khaparde SD, Bahl S, Hutin Y, Wenger J. Improving polio vaccination during supplementary campaigns at areas of mass transit in India. BMC Public Health 2010; 10:243. [PMID: 20459824 PMCID: PMC2882910 DOI: 10.1186/1471-2458-10-243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 05/11/2010] [Indexed: 12/02/2022] Open
Abstract
Background In India, children who are traveling during mass immunization campaigns for polio represent a substantial component of the total target population. These children are not easily accessible to health workers and may thus not receive vaccine. Vaccination activities at mass transit sites (such as major intersections, bus depots and train stations), can increase the proportion of children vaccinated but the effectiveness of these activities, and factors associated with their success, have not been rigorously evaluated. Methods We assessed data from polio vaccination activities in Jyotiba Phule Nagar district, Uttar Pradesh, India, conducted in June 2006. We used trends in the vaccination results from the June activities to plan the timing, locations, and human resource requirements for transit vaccination activities in two out of the seven blocks in the district for the July 2006 supplementary immunization activity (SIA). In July, similar data was collected and for the first time vaccination teams also recorded the proportion of children encountered each day who were vaccinated (a new monitoring system). Results In June, out of the 360,937 total children vaccinated, 34,643 (9.6%) received vaccinations at mass transit sites. In the July SIA, after implementation of a number of changes based on the June monitoring data, 36,475 children were vaccinated at transit sites (a 5.3% increase). Transit site vaccinations in July increased in the two intervention blocks from 18,194 to 21,588 (18.7%) and decreased from 16,449 to 14,887 (9.5%) in the five other blocks. The new monitoring system showed the proportion of unvaccinated children at street intersection transit sites in the July campaign decreased from 24% (1,784/7,405) at the start of the campaign to 3% (143/5,057) by the end of the SIA, consistent with findings from the more labor-intensive post-vaccination coverage surveys routinely performed by the program. Conclusions Analysis of vaccination data from transit sites can inform program management changes leading to improved outcomes in polio immunization campaigns. The number of vaccinated children encountered should be routinely recorded by transit teams and may provide a useful, inexpensive alternative mechanism to assess program coverage.
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Affiliation(s)
- Naman K Shah
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
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