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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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