Can follow-up examination of tuberculosis patients be simplified? A study in Chhattisgarh, India

Each follow-up during the course of tuberculosis treatment currently requires two sputum examinations. However, the incremental yield of the second sputum sample during follow-up of different types of tuberculosis patients has never been determined precisely

Xpert negative means no TB: A mixed-methods study into early implementation of Xpert in Puducherry, India

Introduction: Xpert MTB/RIF was implemented in 2016 as the initial diagnostic test for extrapulmonary, pediatric, and human immunodeficiency virus–associated tuberculosis (TB) and as an add-on test for sputum microscopy–negative patients under Revised National TB Control Programme, Puducherry, India. We intended to study the change in TB case notification rates (CNRs) after 2015 and explore the enablers and barriers for implementation of Xpert. Materials and Methods: Sequential mixed-methods study, quantitative phase followed by a descriptive qualitative phase (key informant interviews with healthcare providers in the program). Results: The TB (all forms) CNR increased in 2016 followed by a drop to 2015 levels in 2017. There was a reduction in patients notified as sputum-negative pulmonary TB and pediatric TB during 2016–2017. Healthcare providers used a negative Xpert result in ruling out TB among patients who would previously get diagnosed clinically. Perceived benefits of Xpert were efficiency, rapid results, and detecting resistance. Barriers included poor awareness among medical colleges and the private sector, difficulty in motivating sputum microscopy–negative patients for Xpert, and incompletely filled referral forms. Conclusion: Xpert-negative results should be interpreted cautiously after clinical assessment. Identified barriers should be addressed to ensure that all eligible undergo testing

Comparing same day sputum microscopy with conventional sputum microscopy for the diagnosis of tuberculosis : Chhattisgarh, India

CITATION: Nayak, P. et al. 2013. Comparing same day sputum microscopy with conventional sputum microscopy for the diagnosis of tuberculosis : Chhattisgarh, India. PLoS ONE, 8(9): e74964, doi:10.1371/journal.pone.0074964.The original publication is available at http://journals.plos.org/plosoneBackground The World Health Organization (WHO) recommends same day sputum microscopy (spot-spot) in preference to conventional strategy (spot-morning) for the diagnosis of smear positive tuberculosis with the view that completing diagnosis on a single day may be more convenient to the patients and reduce pre-treatment losses to follow-up. Methods We conducted a cross-sectional study in seven selected district level hospitals of Chhattisgarh State, India. During October 2012 – March 2013, two sputum specimens (spot-early morning) were collected from consecutively enrolled adult (≥18 years) presumptive TB patients as per current national guidelines. In addition, a second sample was collected (one hour after the collection of first spot sample) from the same patients. All the samples were examined by ziehl-Neelsen (ZN) microscopy. McNemar’s test was used to compare statistical differences in the proportion smear positive between the two approaches (spot-spot versus spot-morning). Results Of 2551 presumptive TB patients, 69% were male. All patients provided the first spot specimen, 2361 (93%) provided the second spot specimen, and 2435 (96%) provided an early morning specimen. 72% of specimens were mucopurulent in conventional strategy as compared to 60% in same day strategy. The proportion of smear-positive patients diagnosed by same day microscopy was 14%, as compared to 17% by the conventional method (p<0.001). A total of 73 (16.9%) potential cases were missed by the same day method compared to only 2 (0.5%) by the conventional method. Conclusion Same-day microscopy method missed 17% of smear-positive cases and contrary to prior perception, did not increase the proportion of suspects providing the second sample. These findings call for an urgent need to revisit the WHO recommendation of switching to same-day diagnosis over the current policy.http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0074964Publisher's versio

Data collection procedure during the study, Chhattisgarh, India, October 2012-March 2013.

<p>Data collection procedure during the study, Chhattisgarh, India, October 2012-March 2013.</p

Smear-positive tuberculosis patients undergoing sputum smear examinations in monitoring anti-tuberculosis (TB) treatment in 2009 in six districts of Chhattisgarh State, India, by type of tuberculosis, yield and workload required to detect an additional case.

<p>IP = Intensive Phase; CP = Continuation Phase; Rx = Treatment; Ext = Extended Intensive phase; N = Number.</p

Follow-up schedule for sputum collection and smear examinations for sputum positive TB patients.

<p>Two sputum samples are to be collected, one as early morning and the other as spot sample. (Source: Revised National Tuberculosis Control Programme’s Revised Module 1–4, April 2011).</p>*<p>The intensive Phase is extended by four weeks (12 doses) in initially smear positive PTB patients who continue to be positive at the end of the 2 months of IP.</p>#<p>Early morning and spot specimens will be collected on this day.</p>**<p>The numbers during the IP represent doses of anti-TB drugs, wheras during the CP they represent weekly blister packs of anti-TB drugs.</p><p><u>Note:</u> For “<u>New” patients</u>, the intensive phase lasts for two months (8 weeks, 24 doses) and is followed by the continuation phase of four months (18 weekly blister packs, 54 doses). For <u>“Previously Treated”</u> patients, the intensive phase consists of two months (8 weeks, 24 doses), followed by one month (4 weeks, 12 doses) and then the continuation phase of five months (22 weekly blister packs,66 doses). The doses are given thrice a week on alternate days.</p