Sources of knowledge and preferences regarding mandatory TB Notification among private practitioners in Alappuzha district, Kerala, India.

<p>*Multiple responses</p><p>**Out of those who have heard about notification</p><p>Sources of knowledge and preferences regarding mandatory TB Notification among private practitioners in Alappuzha district, Kerala, India.</p

The proportion of private practitioners who ‘Agreed or Strongly Agreed’ on the importance of and ease to provide the details for mandatory TB Notification from Alappuzha district of Kerala, India.

<p>The proportion of private practitioners who ‘Agreed or Strongly Agreed’ on the importance of and ease to provide the details for mandatory TB Notification from Alappuzha district of Kerala, India.</p

Perception of private practitioners regarding government support and the actions taken in relation to mandatory TB Notification in Alappuzha district, Kerala, India.

<p>*Multiple responses</p><p>Perception of private practitioners regarding government support and the actions taken in relation to mandatory TB Notification in Alappuzha district, Kerala, India.</p

Perspectives regarding mandatory TB Notification among private practitioners in in Alappuzha district of Kerala, India.

<p>Perspectives regarding mandatory TB Notification among private practitioners in in Alappuzha district of Kerala, India.</p

Demographic and clinical characteristics of HIV infected people registered for pre-ART care in Karnataka State, India, 2012 (N = 37307).

<p>WHO-World Health Organization; ART-antiretroviral therapy; HIV-Human immunodeficiency virus;</p><p>Demographic and clinical characteristics of HIV infected people registered for pre-ART care in Karnataka State, India, 2012 (N = 37307).</p

Trends in number of HIV testing centres and ART centres established, year-wise in Karnataka, India, 2004-2011.

<div><p>HIV-Human immunodeficiency virus; ART-antiretroviral therapy.</p> <p>*The Y-axis is in the logarithmic scale.</p></div

Comparison of WHO guidelines for ART initiation among people living with HIV in the year 2010 and 2013.

<p>WHO-World Health Organization; ART-antiretroviral therapy; HIV-Human immunodeficiency virus; TB – Tuberculosis; HBV – Hepatitis B Virus.</p><p>Comparison of WHO guidelines for ART initiation among people living with HIV in the year 2010 and 2013.</p

Drug resistance pattern among different types of presumptive MDR-TB, Cambodia, 2011.

<p>Note:</p><p><b>MDR-TB</b> = Multi drug resistant tuberculosis, <b>PDR-TB</b> = Poly drug resistant tuberculosis, <b>Mono DR-TB</b> = Mono drug resistant tuberculosis, <b>H</b> = Isoniazid, <b>R</b> = Rifampicin, <b>E</b> = Ethambutol, <b>S</b> = Streptomycin.</p>1<p>New smear positive TB patient whose sputum remained smear positive at 2 months.</p>2<p>New smear positive TB patient whose sputum remained smear positive at 3 months.</p

Tuberculosis Management Practices of Private Practitioners in Pune Municipal Corporation, India

<div><p>Background</p><p>Private Practitioners (PP) are the primary source of health care for patients in India. Limited representative information is available on TB management practices of Indian PP or on the efficacy of India’s Revised National Tuberculosis Control Programme (RNTCP) to improve the quality of TB management through training of PP.</p><p>Methods</p><p>We conducted a cross-sectional survey of a systematic random sample of PP in one urban area in Western India (Pune, Maharashtra). We presented sample clinical vignettes and determined the proportions of PPs who reported practices consistent with International Standards of TB Care (ISTC). We examined the association between RNTCP training and adherence to ISTC by calculating odds ratios and 95% confidence intervals.</p><p>Results</p><p>Of 3,391 PP practicing allopathic medicine, 249 were interviewed. Of these, 55% had been exposed to RNTCP. For new pulmonary TB patients, 63% (158/249) of provider responses were consistent with ISTC diagnostic practices, and 34% (84/249) of responses were consistent with ISTC treatment practices. However, 48% (120/249) PP also reported use of serological tests for TB diagnosis. In the new TB case vignette, 38% (94/249) PP reported use of at least one second line anti-TB drug in the treatment regimen. RNTCP training was not associated with diagnostic or treatment practices.</p><p>Conclusion</p><p>In Pune, India, despite a decade of training activities by the RNTCP, high proportions of providers resorted to TB serology for diagnosis and second-line anti-TB drug use in new TB patients. Efforts to achieve universal access to quality TB management must account for the low quality of care by PP and the lack of demonstrated effect of current training efforts.</p></div

Effect of glycemic control and type of diabetes treatment on unsuccessful TB treatment outcomes among people with TB-Diabetes: A systematic review

<div><p>Background</p><p><b>S</b>tringent glycemic control by using insulin as a replacement or in addition to oral hypoglycemic agents (OHAs) has been recommended for people with tuberculosis and diabetes mellitus (TB-DM). This systematic review (PROSPERO 2016:CRD42016039101) analyses whether this improves TB treatment outcomes.</p><p>Objectives</p><p>Among people with drug-susceptible TB and DM on anti-TB treatment, to determine the effect of i) glycemic control (stringent or less stringent) compared to poor glycemic control and ii) insulin (only or with OHAs) compared to ‘OHAs only’ on unsuccessful TB treatment outcome(s). We looked for unfavourable TB treatment outcomes at the end of intensive phase and/or end of TB treatment (minimum six months and maximum 12 months follow up). Secondary outcomes were development of MDR-TB during the course of treatment, recurrence after 6 months and/or after 1 year post successful treatment completion and development of adverse events related to glucose lowering treatment (including hypoglycemic episodes).</p><p>Methods</p><p>All interventional studies (with comparison arm) and cohort studies on people with TB-DM on anti-TB treatment reporting glycemic control, DM treatment details and TB treatment outcomes were eligible. We searched electronic databases (EMBASE, PubMed, Google Scholar) and grey literature between 1996 and April 2017. Screening, data extraction and risk of bias assessment were done independently by two investigators and recourse to a third investigator, for resolution of differences.</p><p>Results</p><p>After removal of duplicates from 2326 identified articles, 2054 underwent title and abstract screening. Following full text screening of 56 articles, nine cohort studies were included. Considering high methodological and clinical heterogeneity, we decided to report the results qualitatively and not perform a meta-analysis. Eight studies dealt with glycemic control, of which only two were free of the risk of bias (with confounder-adjusted measures of effect). An Indian study reported 30% fewer unsuccessful treatment outcomes (aOR (0.95 CI): 0.72 (0.64−0.81)) and 2.8 times higher odds of ‘no recurrence’ (aOR (0.95 CI): 2.83 (2.60−2.92)) among patients with optimal glycemic control at baseline. A Peruvian study reported faster culture conversion among those with glycemic control (aHR (0.95 CI): 2.2 (1.1,4)). Two poor quality studies reported the effect of insulin on TB treatment outcomes.</p><p>Conclusion</p><p>We identified few studies that were free of the risk of bias. There were limited data and inconsistent findings among available studies. We recommend robustly designed and analyzed studies including randomized controlled trials on the effect of glucose lowering treatment options on TB treatment outcomes.</p></div