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DOST Model’ for DR-tb Patients, New delhi: Perspectives of Healthcare Providers

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Journal of Tuberculosis Research 2022年第4期10卷 187-198页

作者： Vindhya Vatsyayan Theresa Pattery Khasim Sayyad Jason Williams Arnab Pal Vikas Panibatla Ashwani Khanna Clinton Health Access Initiative (CHAI) Delhi India Johnson & Johnson Global Public Health R & D Breese Belgium tb Alert India Hyderabad India delhi state tb control office Delhi India

Introduction: In India, tuberculosis continues to be a major public health problem and there is a growing concern about drug-resistant tuberculosis as most of the patients are from private sector. The National tb Elimination Programme (NTEP) in collaboration with tb Alert, India (tbAI) and Clinton Health Association of India (CHAI) had implemented a collaborative project to strengthen the network between the private practitioners and public healthcare facilities in New delhi during 2019 and 2020. Methods: A study was conducted to understand the enablers and challenges encountered by them during the implementation of the project. This is a qualitative exploration of the “healthcare providers” on a project linking DR-tb patients in private sector with government health facilities. The process of data collection involved face-to-face in-depth interviews of healthcare providers, the Doctors mainly from private and public health facilities, the paramedical workers from general health system and paramedical from the project using an interview guide administered through a trained researcher. Results: The study findings revealed that all healthcare providers were completely aware of the DOST project in the health system, the model led to early diagnosis and initiation of quality treatment. There were no major challenges to the implementation of the project. The healthcare providers wish to have this project implemented for a longer duration. Conclusion: The perspectives of healthcare providers towards the “DOST” project were optimistic and call for re-initiating the project in the area.

关键词： DOST Drug-Resistant Tuberculosis Patients India Health Care Providers

Enhancing Childhood tb Notifications by Strengthening Linkages with Large Hospitals in Pakistan<br/>—Childhood tb in Large Hospitals, Pakistan

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Journal of Tuberculosis Research 2018年第1期6卷 63-67页

作者： Ali Saeed Mirza Razia Fatima Aashifa Yaqoob Ejaz Qadeer Ahmed Wali Afshan Khurshid Mahboob Ul Haq Ajay M. V. Kumar National tb control Program Islamabad Pakistan Provincial tb control Program Quetta Pakistan Provincial tb control Program Sindh Pakistan International Union against Tuberculosis and Lung Disease Paris France International Union against Tuberculosis and Lung Disease South-East Asia Office New Delhi India

To improve childhood Tuberculosis management, the National Tuberculosis Program implemented a package of interventions Hospital DOTS linkages (HDL) in 2015 in 144 tertiary and secondary care hospitals across Pakistan. This included systematic engagement of hospital administration and all specialist doctors, staff training and regular facility-based review meetings. HDL was associated with 35% increase in childhood tb notifications in 2015 (versus 2014) in HDL sites as compared to 16% increase in non-HDL sites. The increase was seen across provinces, age-groups and sexes, but did not correlate with presence of Xpert Mtb/RIF®?or “screeners” (health workers deployed to screen children for tb).

关键词： Tuberculosis Childhood Tuberculosis Hospital DOTS Linkages Pakistan SORT IT

Can Intensified Tuberculosis Case Finding Efforts at Nutrition Rehabilitation Centers Lead to Pediatric Case Detection in Bihar, India?

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Journal of Tuberculosis Research 2016年第1期4卷 46-54页

作者： Rajeev R. Pathak Bal Krishna Mishra Patrick K. Moonan Sreenivas A. Nair Ajay M. V. Kumar Mohit P. Gandhi Shamim Mannan Smita Ghosh WHO Country office for India New Delhi India state Tuberculosis Training and Demonstration Centre Patna India US Centers for Disease control and Prevention Division of TB Elimination Atlanta USA International Union Against Tuberculosis and Lung Disease (The Union) South-East Asia Regional Office New Delhi India

Introduction: Seven district-level Nutritional Rehabilitation Centres (NRCs) in Bihar, India provide clinical and nutritional care for children with severe acute malnutrition (SAM). Aim: To assess whether intensified case finding (ICF) strategies at NRCs can lead to pediatric case detection among SAM children and link them to tb treatment under the Revised National Tuberculosis control Programme (RNTCP). Materials and Methods: A retrospective cohort study was conducted that included medical record reviews of SAM children registered for tb screening and RNTCP care during July-December 2012. Results: Among 440 SAM children screened, 39 (8.8%) were diagnosed with tb. Among these, 34 (87%) initiated tb treatment and 18 (53%) were registered with the RNTCP. Of 16 children not registered under the RNTCP, nine (56%) weighed below six kilo-grams—the current weight requirement for receiving drugs under RNTCP. Conclusion: ICF approaches are feasible at NRCs;however, screening for tb entails diagnostic challenges, especially among SAM children. However, only half of the children diagnosed with tb were treated by the RNTCP. More effort is needed to link this vulnerable population to tb services in addition to introducing child-friendly drug formulations for covering children weighing less than six kilo-grams.

关键词： Tuberculosis Children Malnutrition India Screening

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

Adding Sputum Collection and Transportation Services for Early Identification tb Cases in Hard-to-Reach Difficult Terrain—Will It Help?

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Journal of Tuberculosis Research 2017年第4期5卷 220-228页

作者： Badri Thapa Banuru Muralidhara Prasad Sarabjit Singh Chadha Subrat Mohanty Deepak R. Mishra Jamie Tonsing tb and Communicable Disease Department International Union against Tuberculosis and Lung Disease South-East Asia Regional Office New Delhi India

A community engagement project was designed and implemented to reach 10.6 million population in 13 districts of Uttarakhand state—India, to identify presumptive tb patients (PtbPs) and link to free diagnostics services, either through referral or sputum collection and transportation (SCT). The objective of this study is to determine additional yield of tb patients achieved by providing SCT services in comparison to referrals of PtbPs identified in hard-to-reach areas. This was before and after comparative study conducted between April-June 2014 (2Q2014-before) to July-September 2014 (3Q2014-after). SCT was advised for all PtbPs identified from community level interventions between July-September 2014 (3Q2014-after). In 3Q2014, additional 279 (34%) PtbPs were examined in the microscopy centre with an additional 36 (51%) new smear positive (NSP) patient diagnosed. A total of 46 NSP (128%) were contributed by SCT alone. Higher proportion (94%) of tb patients was initiated on treatment in 3Q2014 in comparison to 2Q2014 (91%). SCT as a strategy for early case detection in hard-to-reach difficult terrain yields positive results in comparison to mere referral of PtbPs.

关键词： Hard-to-Reach Sputum Collection and Transportation India Tuberculosis Project Axshya

Did “Screeners” Increase Pediatric Tuberculosis Case Notification in Sindh, Pakistan?

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Journal of Tuberculosis Research 2017年第1期5卷 81-86页

作者： Afshan Khurshid Sven Gudmund Hinderaker Einar Heldal Razia Fatima Mahboobul Haq Aashifa Yaqoob Amanullah Ansari Kashif Anwar Ejaz Qadeer Ajay M. V. Kumar Provincial tb control Program Sindh Pakistan University of Bergen Bergen Norway Norwegian Institute of Public Health Oslo Norway National tb control Program Islamabad Pakistan National tb control Program Research Islamabad Pakistan Pakistan Institute of Medical Sciences Islamabad Pakistan International Union against Tuberculosis and Lung Disease Paris France International Union against Tuberculosis and Lung Disease South-East Asia Office New Delhi India

To identify missing childhood Tuberculosis (tb) cases, “screeners” (hospital-based health workers trained to screen accompanying contacts of tb patients for symptoms) were introduced in eight tertiary care hospitals of Sindh, Pakistan in 2013. There was a 55% increase in childhood tb notifications in 2014 compared to 2012 in facilities with screeners (n = 8) compared to 40% increase in facilities without screeners (n = 22). This apparent association disappeared when stratified by presence of “trained pediatrician” whose introduction was associated with a massive increase in notifications while transfer was associated with a marked decrease. In conclusion, screeners were not associated with increase in pediatric tb case notifications.

关键词： Childhood Tuberculosis Pediatricians Screener Xpert Mtb/RIF SORT IT

Need for operational simplicity and timely disbursal of benefits—a qualitative exploration of the implementation of a direct benefit transfer scheme for persons with tuberculosis in India

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Infectious Diseases of Poverty 2024年第3期13卷 58-72页

作者： Malu Mohan Jeromie W.V.Thangaraj Sumit Pandey G.Sri Lakshmi Priya Sivavallinathan Arunachalam Rahul Sharma Hemant Deepak Shewade B.Aishwarya K.Afeeq Afsana Khatoon B.Gokulvijay Gude Sireesha Kavita Chandra S.Nandhakumar Prince Samuel C.Nanditha Viswanathan Devika Shanmugasundaram Raghuram Rao Manoj V.Murhekar Kathiresan Jeyashree Indian Council of Medical Research-National Institute of Epidemiology R-127TNHBAyapakkamChennaiTamil Nadu 600077India tb Support Network WHO Country Office for IndiaNew DelhiIndia Central Tuberculosis Division Government of IndiaNew DelhiIndia

Background Ni-kshay Poshan Yojana(NPY)is a direct benefit transfer scheme of the Government of India introduced in 2018 to support the additional nutritional requirements of persons with tb(Pwtb).Our recent nationwide evaluation of implementation and utilization of NPY using programmatic data of Pwtb from nine randomly selected Indian states,reported a 70%coverage and high median delay in benefit *** undertook a qualitative study between January and July 2023,to understand the detailed implementation process of NPY and explore the enablers and barriers to effective implementation and utilization of the NPY *** We followed a grounded theory approach to inductively develop theoretical explanations for social phenomena through data generated from multiple *** conducted 36 in-depth interviews of national,district and field-level staff of the National Tuberculosis Elimination Programme(NTEP)and NPY beneficiaries from 30 districts across nine states of India,selected using theoretical *** analytical framework developed through inductive coding of a set of six interviews,guided the coding of the subsequent *** and themes emerged through constant comparison and the data collection continued until theoretical *** Stakeholders perceived NPY as a beneficial *** political commitment from the state administration,mainstreaming of NTEP work with the district public healthcare delivery system,availability of good geographic and internet connectivity and state-specific grievance redressal mechanisms and innovations were identified as enablers of ***,the complex,multi-level benefit approval process,difficulties in accessing banking services,perceived inadequacy of benefits and overworked human resources in the NTEP were identified as barriers to implementation and *** The optimal utilization of NPY is enabled by strong political commitment and challenged by its length

关键词： National Tuberculosis Elimination Programme Nutritional status Direct benefit transfer Implementation Cash transfer scheme Grounded theory India

Causes of Death among HIV-Infected Adults Registered in Selected Anti-Retroviral Therapy Centers in North-Eastern India

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World Journal of AIDS 2015年第2期5卷 90-99页

作者： Chiranjeev Bhattacharjya Damodar Sahu Sangram Kishor Patel Niranjan Saggurti Arvind Pandey Assam state AIDS control Society National AIDS Control Organization Guwahati India National Institute of Medical Statistics ICMR New Delhi India HIV and AIDS Program Population Council New Delhi India

Background: Causes of death related studies in HIV infected population are necessary to devise disease specific preventive interventions at both state and national level HIV programs. This study examines the causes of death among HIV-infected individuals registered at selected Anti-Retroviral Therapy (ART) centers in the era of treatment in north-eastern India. Data and Methods: A retrospective chart review of causes of death was undertaken among HIV-infected patients who were treated between January 2006 and November 2012 at three selected ART centers in Assam, a north-eastern state of India. Reported causes of death were coded as per the guidelines of the International Classification of Diseases (ICD-10) to determine the deaths to standard definitions. Results: Among 5612 HIV-infected patients registered over a period of 71 months, 370 deaths have occurred. Tuberculosis (28%) was the leading cause of death followed by death due to AIDS related complex (11%), wasting syndrome and multiple infections (9% each). Deaths due to selected causes were significantly associated with patient’s use of alcohol, WHO clinical stage, CD4 count at the time of diagnosis, presence of opportunistic infections during treatment and ART adherence. Median survival duration was shortest among patients who had CD4 count tb program will be crucial to reduce the AIDS-related deaths attributed to tuberculosis.

关键词： Causes of Death HIV AIDS Tuberculosis ART Assam Northeastern India

Pulmonary Tuberculosis in HIV-infected Patients Presenting with Normal Chest Radiograph and Negative Sputum Smear

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Journal of Health Science 2016年第3期4卷 125-130页

作者： Mounika Arrabelli Raghuram Reddy Adidala Chakrapani Chatla Sireesha Tanniru Suryaprakash Chakramahanty Malathi Jojula Department of Pharmacy Sri Shivani Collage of Pharmacy Warangal Telangana State 506009 India Worm Health Organization India Country Office New Delhi India state tb Cell DM&HS Campus Koti Hyderabad 500097 Telangana State India Department of Pharmaceutical Biotechnology Sri Shivani Collage of Pharmacy Warangal Telangana State 506009 India

Deaths due to Tuberculosis （tb） are high among the tb-HIV co-infected patients. Among PLHIV most of the instances the sputum smear is found to be negative for Mtb. Chest X-rays also don＇t yield much diagnostic value mainly due to the advanced immune suppressed condition. This study makes an attempt to find out the utility of alternate staining methods such as Light Emitting Diode （LED）, Fluorescent Microscopy （FM） and solid culture in resource limited settings for effective diagnosis of tb among PLHIV. 2 sputum samples were collected from 102 successive presumptive tb cases, whose smear microscopy and X-Ray were negative for Mtb among PLHIVs visiting ICTC at MGM hospital, Warangal, Telangana state, India. All the 102 samples were repeated with ZN microscopy and X-ray. Additionally LED and FM microscopy procedures were conducted with the NALC-NAOH concentration method. All the samples were inoculated on LJ medium for solid culture and all the positive cultures were subjected for biochemical test to identify phenotypic appearance, nitrate reduction, niacin and PNB susceptibility test for all the first line anti tb drugs as per standard guidelines. Samples found positive on microscopy were cross checked with Line probe assay （LPA）. All the 102 samples collected showed negative for Mtb on ZN technique and negative for pulmonary tb on chest X-rays. 15 samples were positive for Mtb both on LED and FM. LPA reconfirmed the Mtb in all the 15 samples tested with 11 sensitive for both INH and Rifampicin, 3 INH mono resistant and I Rifmono resistance patterns. Of the 102 inoculations in LJ medium, 25 culture inoculations were positive for Mtb growth and also were confirmed as Mtb strains based on morphological, biochemical test and growth was seen after 4th week of inoculation. Of the 25 culture positives 20 were sensitive for INH and Rif, 4 INH mono resistant and 1 resistant to all first line anti tb drugs. In smear negative and chest X-ray negative presumptive tb cases, espec

关键词： Tuberculosis drug sensitivity direct AFB vs concentrated smear microscopy LED microscopy and FM Line Probe Assay culture DST.