Study identifies need to improve patient retention in the National TB Elimination Programme, highlights patients’ trust relationship with private providers

Researchers found long delays in care access, with patients shuttling back and forth between providers and health sectors (private vs. public) before they are eventually enrolled on effective treatment.

Given the complexity of Multi Drug Resistance – Tuberculosis MDR-TB diagnosis and care, a new study sought to address key knowledge gaps in MDR risk factors, care delays, and drivers of delay to help guide disease control.

Researchers found long delays in care access, with patients shuttling back and forth between providers and health sectors (private vs. public) before they are eventually enrolled on effective treatment.

Additional evidence for recent transmission of drug-resistant TB in crowded localities/slum areas was also found, researchers said in their study “Tuberculosis Pathways to Care and Transmission of Multidrug-Resistance in India” published in a top ranked – American Journal of Respiratory and Critical Care Medicine on October 27 this year

The research team, including Dr. Sachin Atre of Pune based D. Y. Patil Medical College and the Johns Hopkins Center for Clinical Global Health Education and Dr. Maha Reda Farhat, assistant Professor of Biomedical Informatics at Harvard Medical School, Boston, USA.

“We believe these findings are of current interest to the Indian public given that Covid-19 has further limited testing and diagnosis capacity for TB in India over the last 18 months,” Dr Atre said.

Researchers conducted interviews with adults registered with the National TB Elimination Program (NTEP) for MDR (n=128) and non-MDR-TB (n=269) treatment to quantitatively and qualitatively study care pathways. The study conducted in 2018-19 was funded by Harvard-Dubai Centre for Global Health Delivery and it was done among patients who are registered with the National TB Elimination Control Program (NTEP) in Maharashtra.

They collected treatment records and GeneXpert-TB/RIF diagnostic reports. MDR-TB was associated with young age, and crowded residence. GeneXpert rifampicin resistance diversity was measured at 72.5% .Delay decreased with wider access to GeneXpert testing. Pathways to care were complex with a median of 4 providers. Of MDR-TB patients, 68% had their first encounter in the private sector and this was associated with a larger number of subsequent healthcare encounters and huge expenditures.

The association of MDR with young age, crowded locality and low genotypic diversity (means many patients have the same resistant TB strain which may cause an epidemic situation) raise concerns of ongoing MDR-TB transmission which is fueled by long delays in care.

Delays are decreasing with GeneXpert use, suggesting the need for routine use in presumptive TB and provision for that. The study identified the need to improve patient retention in the NTEP and highlight patients’ trust relationship with private providers.

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