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Revised National Tuberculosis Control Programme (RNTCP) Tribal Action Plan Fund Utilisation: How Does Chhattisgarh State in India Fare?

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Journal of Tuberculosis Research 2019年第1期7卷 1-10页

作者： Gayadhar Mallick Sharath Burugina Nagaraja karuna D. sagili Kshitij Khaparde Srinath Satyanarayana Sarabjit Chadha The International Union against TB and Lung Disease New Delhi India ESIC Medical College and PGIMSR Bangalore India WHO Country Office New Delhi India

Background: In India, tuberculosis remains as a major public health problem amongst the tribal population. Poor physical access to diagnosis and treatment under the Revised National TB control programme (RNTCP) still remains the problem for the population. RNTCP implements Tribal Action Plan (TAP) for tribal patients. We conducted the study to determine the trends of financial utilisation for the special provisions available under tribal action plan like patient honorarium, incentive for sputum collection and transport, incentive for programme staff and incentive for vehicle maintenance. Methods: A cross-sectional study based on mixed method study approach was conducted in Chhattisgarh, India during Nov. 16 to Jun. 17. District TB Officers implementing TAP were interviewed telephonically using a semi-structured questionnaire to ascertain and analyse the reasons for low fund utilization in their districts. Retrospective financial data for five financial years from 13 TAP districts for 2012-2013 to 2016-2017 was collected, compiled and analysed. Results: Overall, the trends on states expenditure on tribal action plan in terms of absolute numbers has increased over the past five years;however, in terms of fund utilization against received ranges from 37% - 86% with the utilization rate less than 44% in the recent years (2014-2017). Conclusion: The trends of utilisation of TAP is less than 44% over the recent years. There is an urgent need for the administrators to intervene and improve the efficiency of fund utilisation at State and district levels.

关键词： Fund Tuberculosis Tribal Action Plan RNTCP India

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Tuberculosis Treatment Completion for Tribal Patients in Kerala: Needs Constant Push!

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Journal of Tuberculosis Research 2019年第4期7卷 185-201页

作者： Jyothilakshmi Chettipparan Rajan Tanu Anand Sharath Burugina Nagaraja Sabu Kochupurackal Ulahannan karuna sagili Manu Muraleedharan Sarojini Wayanad Social Service Society Wayanad Kerala India Department of Community Medicine North Delhi Municipal Corporation Medical College Hindu Rao Hospital Delhi India Department of Community Medicine ESIC Medical College and PGIMSR Bengaluru India Institute of Public Health Bengaluru India Department of TB and communicable diseases The Union New Delhi India State TB Demonstration and Training Centre Trivandrum India

Introduction: Tuberculosis (TB) incidence among tribal patients is high owing to their social and geographic vulnerability. Ensuring adherence to TB treatment among them remains a challenging task as it is dependent on socio-cultural and environmental factors. Objective: 1) To know the individuals’ perception of TB disease and anti-TB treatment;2) To explore the personal, social, family and cultural factors influencing on patient’s treatment adherence;3) To identify the challenges faced by health care providers in delivering services to the tribal population. Material and Methods: A descriptive qualitative study conducted among tribal patients (n = 16) and health providers (n = 6) of Manathavady TB unit, Wayanad District of Kerala. The data were collected through in-depth interviews (IDIs), audio-recorded in Malayalam, transcribed verbatim and translated into English. Transcripts were analysed using manual descriptive content analysis. Results: Most of the patients were oriented about the importance of completing TB treatment though lacked awareness about its causation. The supportive attitude of the community further encouraged them to continue TB treatment. However, substance abuse emerged as the biggest challenge to treatment adherence particularly among males. While accessibility to the health system, animal confrontation, and disaster risk emerged as barriers owing to the geographic landscape of the community, health services were found to be acceptable, available and affordable to all the patients. No stigma or discrimination was perceived by the patients at family, community and health system level. However, their beliefs in herbal medicines and conduct of certain rituals delayed them for seeking care. The personal commitment of the health care staff helped the TB patients to adhere better with the treatment thereby yielding best results. Conclusion: The TB treatment adherence among the tribal population was satisfactory due to personal, social and health sys

关键词： Treatment Adherence Kerala Qualitative Operational Research

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Threefold Increase in the Number of Drug Resistant TB Cases after Introduction of Universal Drug Susceptibility Testing: Experiences from Two South India Districts

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Journal of Tuberculosis Research 2020年第2期8卷 42-52页

作者： Sanath Kumar Gurram Krishnamurthy Sharath Burugina Nagaraja Tanu Anand karuna D. sagili Cheluve Gowda Shailaja Basavaraj Poojar Srinath Satyanarayana Department of Health and Family Tumkur District Karnataka India Department of Community Medicine ESIC Medical College and PGIMSR Bengaluru India Department of Community Medicine North Delhi Municipal Corporation Medical College Hindu Rao Hospital Delhi India Department of TB and Communicable Diseases the Union South East Asia Office New Delhi India Department of Community Medicine Sri Siddhartha Medical College Tumkur Karnataka India Department of Health and Family Belgaum District Karnataka India Department of Pharmacology Kasturba Medical College Mangalore Manipal Academy of Higher Education Manipal India The Union South East Asia Office New Delhi India

Background: In India, tuberculosis (TB) is a major public health problem, and the advent of drug resistance TB (DR-TB) has worsened the situation. The Revised National TB Control Programme (RNTCP) has introduced universal drug susceptibility testing (UDST) for all diagnosed TB cases in 2018. We conducted this study to know the advantage of implementing UDST when compared to selective testing existent in 2017 on key diagnostic cascade parameters and to identify the challenges in the implementation of UDST. Methods: The study was conducted in two districts of Karnataka, India during January 2017-December 2018. The quantitative part consisted of before-and-after design and the qualitative part consisted of descriptive design. Results: In 2017 (during selective testing/“before” period) out of the 2440 TB patients, 80 (3%) were diagnosed with Isoniazid and Rifampicin resistance patients;in contrast in 2018 (during UDST/“after” period) of the 5129 TB patients 258 (5%) were diagnosed with Isoniazid and Rifampicin resistance. However, the proportion of eligible patients tested for rifampicin resistance during the “after” period was 60% when compared to 100% during the “before” period and median turnaround time for testing was also longer during the “after” period when compared to the “before” period (32.5 days vs 27.5 days). Major reasons for these two gaps were found to be difficulties in collecting sputum specimens and transportation. Conclusion: The rollout of UDST has led to a three-fold increase in a number of DR-TB cases detected in the region. There is a need for the programme to increase the proportion tested for DST by increasing the laboratory capacity and address the challenges in sputum collection and transportation.

关键词： Operational Research Criteria C Line Probe Assay Universal Drug Susceptibility Testing Culture and Drug Susceptibility Testing

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Drug-Induced Hypothyroidism during Anti-Tuberculosis Treatment of Multidrug-Resistant Tuberculosis: Notes from the Field

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Journal of Tuberculosis Research 2016年第3期4卷 105-110页

作者： Somashekar Munivenkatappa Singarajipura Anil Balaji Naik Tyson Volkmann karuna D. sagili Jayachamarajapura S. Akshatha Shashidhar Buggi Manchenahalli A. Sharada Sudhendra Kulkarni Vineet K. Chadha Patrick K. Moonan Drug Resistant Treatment Centre Bengaluru India Sri Devarao Shivaram Tuberculosis and Rajiv Gandhi Institute of Chest Diseases Bengaluru India Revised National Tuberculosis Programme-State of Karnataka Bengaluru India World Health Organization India Country Office New Delhi India U.S. Centers for Disease Control and Prevention Atlanta GA USA International Union against Tuberculosis and Lung Disease (The Union) South-East Asia Regional Office New Delhi India National Tuberculosis Institute Bengaluru India

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

关键词： Hypothyroidism Multidrug Resistance Tuberculosis Thyroid-Stimulating

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