Framework for implementing collaborative TB-silicosis activities in India: insights from an expert panel

Abstract Tuberculosis (TB) treatment is more challenging for patients with silicosis, as it complicates the diagnosis of both diseases and increases mortality risk. Silicosis, an incurable occupational disease, confounds the diagnosis of TB and vice versa, making it more difficult to accurately identify and treat either condition. Moreover, TB appears to accelerate the progression of silicosis. Exposure to silica dust, a common cause of silicosis, can also trigger latent TB to become active TB. This correspondence outlines a proposed framework for implementing collaborative TB-silicosis activities in India, aimed at improving early diagnosis and management for both diseases. An expert panel of medical professionals developed this framework through online consultations in October and November 2022. The panel's goal was to establish a consensus on integrating TB-silicosis activities, with a focus on early detection and proper management. The framework suggests testing all patients with silicosis for active TB and screening workers exposed to silica dust for latent TB infection. It also recommends that patients with TB who have a history of occupational exposure to silica dust should be tested for silicosis. Reliable diagnostic tools, such as chest X-rays, are emphasized, providing guidance on their use for both diseases. The proposed collaborative TB-silicosis framework offers a structured approach to identifying and managing these two diseases, contributing to the global goal of eliminating silicosis by 2030 and aligning with the World Health Organization’s targets for reducing TB incidence and mortality. It recommends specific strategies for implementation, including testing, referral systems, and workplace-based interventions. The framework also underscores the need for coordinated efforts among stakeholders, including the ministries of health, labor, industry, and environment. This correspondence provides valuable insights into how India can successfully implement collaborative TB-silicosis activities, serving as a model for other regions with similar challenges

A step up to end tuberculosis: Lessons from a community-based death review of patients with tuberculosis from western India

Understanding factors leading to death following the onset of symptoms of tuberculosis (TB) is important to predict prognosis among patients with TB. With aiming the End TB strategy, mortality is declining not as expected globally and in India. Although India is one of the highest incidence countries globally, India lacks evidence of understanding of the factors for TB death. Thus, this study aims to document the characteristics of deaths due to TB in the Western state of India, Gujarat.About 74 deaths were randomly documented from 7 different geographic regions of Gujarat through a community-based death review from Oct 2021 to February 2022. The trained researchers administered a semi-structured questionnaire to capture the demographic, socioeconomic, history of comorbidity and addiction, medical history, case records, and chronology of events preceding death.Most deaths happened within 24 weeks from the onset of symptoms, which reduced to half (12 weeks) in the other cascades, i.e., diagnosis and treatment initiation to the death. Out of 74 reviewed deaths, 47 (64%) deaths had the cause of death as TB, with an average duration of 87 days from onset of symptoms to death. The study observed the time, place, and person distribution on different epidemiological parameters. While analyzing narratives from the relative, the gaps between the system (service provider) and demand (patient perspective) sides were synthesized.It is recommended to conduct such kind of community-based death reviews in the routine practices of the National TB Elimination Program to ensure the appropriate review of the underlying causes of deaths due to TB. The matrix developed in this study is easy to replicate in any other death reviews to understand the intercept of the supply-demand side determinants for the deaths

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

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 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

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

Baseline characteristics of previously-treated smear-positive TB patients, by DST status, registered under RNTCP in Gujarat, India, January-June 2013.

<p>Baseline characteristics of previously-treated smear-positive TB patients, by DST status, registered under RNTCP in Gujarat, India, January-June 2013.</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

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