Study participants (health care providers involved in programmatic management of drug-resistant TB) characteristics and duration of each data collection activity in Bhopal district, India (2017).

<p>Study participants (health care providers involved in programmatic management of drug-resistant TB) characteristics and duration of each data collection activity in Bhopal district, India (2017).</p

Cascade of care of patients with presumptive MDR-TB (eligible for DST) in the diagnosis pathway, district Bhopal, India*.

<p>TB–Tuberculosis; DST–drug susceptibility testing; MDR-TB–multi drug-resistant tuberculosis; DMC–designated microscopy center; DTC–district tuberculosis center; DOTS–directly observed treatment short course; NRL–national reference laboratory; IRL–Intermediate reference laboratory; DR-TB–drug-resistant TB; LT–laboratory technician; TB-HV–TB health visitor.</p

Attrition of patients with presumptive MDR-TB (eligible for DST) in the diagnosis pathway, district Bhopal, India (2014)* [16].

<p>MDR-TB: Multi drug-resistant tuberculosis, DST: Drug susceptibility testing, NRL: national reference laboratory *reproduced with permission, original publisher BioMed Central [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0196162#pone.0196162.ref016" target="_blank">16</a>].</p

Suggested solutions as perceived by programme staff to increase drug susceptibility testing among patients with presumptive MDR-TB in Bhopal district, India (2017).

<p>Suggested solutions as perceived by programme staff to increase drug susceptibility testing among patients with presumptive MDR-TB in Bhopal district, India (2017).</p

Providers’ perspectives into barriers and suggested solutions to improve DST among presumptive MDR-TB (eligible for DST) in Bhopal district, India (2017), in relation to the care pathway for diagnosis*.

<p>TB–Tuberculosis; DST–drug susceptibility testing; MDR-TB–multi drug-resistant tuberculosis; DMC–designated microscopy center (sputum collection center); DTC–district tuberculosis center; DOTS–directly observed treatment short course; NRL–national reference laboratory; IRL–Intermediate reference laboratory; DR-TB–drug-resistant TB; LT–laboratory technician of DMC; TB-HV–TB health visitor; NGO–non-Governmental organization; STLS–senior tuberculosis laboratory supervisor.</p

Case definitions as per revised national tuberculosis control programme (RNTCP), India [24].

<p>Case definitions as per revised national tuberculosis control programme (RNTCP), India [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0196162#pone.0196162.ref024" target="_blank">24</a>].</p

Patient and Provider Reported Reasons for Lost to Follow Up in MDRTB Treatment: A Qualitative Study from a Drug Resistant TB Centre in India

<div><p>Introduction</p><p>Multidrug-resistant Tuberculosis (MDR TB) is emerging public health concern globally. Lost to follow-up (LTFU) is one of the key challenge in MDRTB treatment. In 2013, 18% of MDR TB patients were reported LTFU in India. A qualitative study was conducted to obtain better understanding of both patient and provider related factors for LTFU among MDR TB treatment.</p><p>Methods</p><p>Qualitative semi-structured personal interviews were conducted with 20 MDRTB patients reported as LTFU and 10 treatment providers in seven districts linked to Nagpur Drug resistant TB Centre (DRTBC) during August 2012–February 2013. Interviews were transcribed and inductive content analysis was performed to derive emergent themes.</p><p>Results</p><p>We found multiple factors influencing MDR TB treatment adherence. Barriers to treatment adherence included drug side effects, a perceived lack of provider support, patient financial constraints, conflicts with the timing of treatment services, alcoholism and social stigma.</p><p>Conclusions</p><p>Patient adherence to treatment is multi-factorial and involves individual patient factors, provider factors, and community factors. Addressing issue of LTFU during MDRTB treatment requires enhanced efforts towards resolving medical problems like adverse drug effects, developing short duration treatment regimens, reducing pill burden, motivational counselling, flexible timings for DOT services, social, family support for patients & improving awareness about disease.</p></div

Web of multifactorial causation for lost to follow- up among MDR-TB Treatment, Nagpur.

<p>Web of multifactorial causation for lost to follow- up among MDR-TB Treatment, Nagpur.</p

Characteristics of MDR-TB suspects in a cohort of patients in Andhra Pradesh (N = 559).

<p>Characteristics of MDR-TB suspects in a cohort of patients in Andhra Pradesh (N = 559).</p

Loss of MDR-TB suspects along the diagnostic and treatment initiation pathway under RNTCP in Andhra Pradesh.

<p>Loss of MDR-TB suspects along the diagnostic and treatment initiation pathway under RNTCP in Andhra Pradesh.</p