Financial incentive- Does this have impact on outcome of Tuberculosis?

Background: Although most public services provide tests and TB drugs free of charge worldwide, opportunity costs pose barriers to accessing TB services and treatment. 'Kumar Raajratna Bhimrao Ambedkar Vaidakiya Sahay Yojana (KRBAVSY)' popularly known as Free Medical Aid Scheme is in operation in Gujarat since early 70s for SC and since 1991 for SEBC to provide monetary incentive. Primary objective: Evaluation of utilization and effectiveness of Financial incentives given under Free Medical Aids scheme on RNTCP in Gujarat. Methodology: A retrospective cohort study was undertaken in which all TB patients registered under RNTCP in Gandhinagar district were evaluated for their eligibility for KRBAVSY scheme, and whether eligible patients got benefit or not. Also, treatment outcome of patients were compared. Results: Out of total 1430 patients inquired, 896 (62.7%) patients were found eligible for the scheme, while only 87 (9.7%) patients confirmed that they had got the benefit of scheme. Eligible patients who got benefit under scheme had almost five times higher odds of successful outcome of TB treatment. Conclusion: The TB patients who got benefit of KRBAVSY scheme had significantly better successful treatment outcome in comparison to the TB patients who did not get benefit

Air nicotine levels in public places in Ahmedabad, India: Before and after implementation of the smoking ban

Aim: To compare air nicotine levels in public places in Ahmedabad, India, before (June 2008) and after (January, 2010) the implementation of a comprehensive smoking ban which was introduced in October 2008. Materials and Methods: Air nicotine concentrations were measured by sampling of vapor-phase nicotine using passive monitors. In 2008 (baseline), monitors were placed for 5-7 working days in 5 hospitals, 10 restaurants, 5 schools, 5 government buildings, and 10 entertainment venues, of which 6 were hookah bars. In 2010 (follow-up), monitors were placed in 35 similar venues for the same duration. Results: Comparison of the overall median nicotine concentration at baseline (2008) (0.06 μg/m 3 Interquartile range (IQR): 0.02-0.22) to that of follow-up (2010) (0.03 μg/m 3 IQR: 0.00-0.13), reflects a significant decline (% decline = 39.7, P = 0.012) in exposure to second-hand smoke (SHS). The percent change in exposure varied by venue-type. The most significant decrease occurred in hospitals, from 0.04 μg/m [3] at baseline to concentrations under the limit of detection at follow-up (%decline = 100, P < 0.001). In entertainment venues, government offices, and restaurants, decreases in SHS exposure also appeared evident. However, in hookah bars, air nicotine levels appeared to increase (P = 0.160). Conclusion: Overall, SHS exposure was significantly reduced in public places after the smoke-free legislation came into force. However, nicotine concentrations were still detected in most of the venues indicating imperfect compliance with the comprehensive ban

Direct Observation of Treatment Provided by a Family Member as Compared to Non-Family Member among Children with New Tuberculosis: A Pragmatic, Non-Inferiority, Cluster-Randomized Trial in Gujarat, India.

BACKGROUND:The World Health Organization recommends direct observation of treatment (DOT) to support patients with tuberculosis (TB) and to ensure treatment completion. As per national programme guidelines in India, a DOT provider can be anyone who is acceptable and accessible to the patient and accountable to the health system, except a family member. This poses challenges among children with TB who may be more comfortable receiving medicines from their parents or family members than from unfamiliar DOT providers. We conducted a non-inferiority trial to assess the effect of family DOT on treatment success rates among children with newly diagnosed TB registered for treatment during June-September 2012. METHODS:We randomly assigned all districts (n = 30) in Gujarat to the intervention (n = 15) or usual-practice group (n = 15). Adult family members in the intervention districts were given the choice to become their child's DOT provider. DOT was provided by a non-family member in the usual-practice districts. Using routinely collected clinic-based TB treatment cards, we compared treatment success rates (cured and treatment completed) between the two groups and the non-inferiority limit was kept at 5%. RESULTS:Of 624 children with newly diagnosed TB, 359 (58%) were from intervention districts and 265 (42%) were from usual-practice districts. The two groups were similar with respect to baseline characteristics including age, sex, type of TB, and initial body weight. The treatment success rates were 344 (95.8%) and 247 (93.2%) (p = 0.11) among the intervention and usual-practice groups respectively. CONCLUSION:DOT provided by a family member is not inferior to DOT provided by a non-family member among new TB cases in children and can attain international targets for treatment success. TRIAL REGISTRATION:Clinical Trials Registry-India, National Institute of Medical Statistics (Indian Council of Medical Research) CTRI/2015/09/006229

Baseline characteristics of districts by intervention, year 2011 [23].

<p>Baseline characteristics of districts by intervention, year 2011 [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0148488#pone.0148488.ref023" target="_blank">23</a>].</p

Comparison of baseline characteristics among children with newly diagnosed TB, by treatment strategy, registered in Gujarat State, India, June-September 2012.

<p>Comparison of baseline characteristics among children with newly diagnosed TB, by treatment strategy, registered in Gujarat State, India, June-September 2012.</p

Flow diagram of study cohort of children with newly diagnosed TB registered in Gujarat State, India during June-September 2012.

<p>Flow diagram of study cohort of children with newly diagnosed TB registered in Gujarat State, India during June-September 2012.</p

Comparison of treatment outcomes among children with newly diagnosed TB, stratified by disease classification and treatment strategy, registered in Gujarat State, India, June-September 2012.

<p>Comparison of treatment outcomes among children with newly diagnosed TB, stratified by disease classification and treatment strategy, registered in Gujarat State, India, June-September 2012.</p

Comparison of treatment outcomes across clinical and demographic factors of previously treated smear-positive TB patients registered in Gujarat from January-June 2013 (n = 5,829).

<p>Comparison of treatment outcomes across clinical and demographic factors of previously treated smear-positive TB patients registered in Gujarat from January-June 2013 (n = 5,829).</p

Treatment outcomes of previously-treated smear-positive TB patients, by INH resistance, registered under RNTCP in Gujarat, India, January-June 2013 (N = 3743).

<p>Treatment outcomes of previously-treated smear-positive TB patients, by INH resistance, registered under RNTCP in Gujarat, India, January-June 2013 (N = 3743).</p

Comparison of individual level factors among children successfully treated for TB, by treatment strategy, registered in Gujarat State, India, June-September 2012.

<p>Comparison of individual level factors among children successfully treated for TB, by treatment strategy, registered in Gujarat State, India, June-September 2012.</p