Independent predictors of acquired resistance to isoniazid and rifamycins in multivariable regression analysis.

<p>Abbreviation: CI = confidence interval, DST = drug susceptibility test, DOT = directly observed therapy.</p

Selection of cases included in analysis.

<p>Abbreviations: TB = tuberculosis, DST = drug susceptibility test, AR = acquired resistance.</p

Sociodemographic and clinical factors associated with acquired resistance to rifamycins (N = 4,005).

*<p>Regions defined by World Health Organization <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0083006#pone.0083006-World3" target="_blank">[37]</a>.</p><p>Missing values not reported in table.</p><p>Abbreviations: PR = prevalence ratio, CI = confidence interval, DST = drug susceptibility test, AFB = acid-fast bacilli, DOT = directly observed therapy.</p

Associations between <i>M. tuberculosis</i> complex lineage and acquired resistance to isoniazid, rifamycins, second-line injectables, and fluoroquinolones.

*<p>Adjusted for HIV status.</p>†<p>Adjusted for homelessness, HIV status, initial resistance to isoniazid, site of disease, and administration of therapy.</p><p>Abbreviations: CI = confidence interval, – = no prevalence ratio calculated because no cases had acquired resistance.</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

Total number of TB cases, number of deaths, and odds of death by clinical and demographic characteristics, United States, 1993–2008.

*<p>Pearson’s chi-square p-value <.0001 for all categories.</p>**<p>adjusted for TST, sex, age, HIV status, origin of birth, anatomic site of disease, cavitation on chest radiograph, sputum smear status at baseline, and drug susceptibility class,</p

Flow diagram of cases included in the analysis.

<p>Flow diagram of cases included in the analysis.</p

Characteristics of all TB cases reported, United States, 1993–2008 and cases excluded or included in the analysis.

<p>Characteristics of all TB cases reported, United States, 1993–2008 and cases excluded or included in the analysis.</p

Characteristics of private providers based on reported exposure to RNTCP training in Pune Municipal Corporation, India, 2010.

<p>*Exposure to RNTCP was defined as participating in a RNTCP training module of at least 4 hours at any time from 1999 through 2010.</p><p>**Revised National TB Control Programme of India.</p>+<p>Allopathy practitioner (Bachelor of Medicine and Bachelor of Surgery).</p>++<p>Doctors practicing homeopathy, Ayurveda, Unani.</p>+++<p>Number of years in clinical practice after completion of medical training.</p>†<p>Information not available for two study participants.</p

Association between exposure of private providers to Public Private Mix (PPM) and self-reported TB clinical treatment and diagnostic practices that are in accordance with international standards-Pune Municipal Corporation, India 2010.

<p>*Exposed to RNTCP training- Attended training programme.</p><p>**International Standards of TB Care.</p>†<p>Odds ratio relates to doctors who adhered to guidelines, by attendance of training relative to those who did not attend.</p