TITLE:
Threefold Increase in the Number of Drug Resistant TB Cases after Introduction of Universal Drug Susceptibility Testing: Experiences from Two South India Districts
AUTHORS:
Sanath Kumar Gurram Krishnamurthy, Sharath Burugina Nagaraja, Tanu Anand, Karuna D. Sagili, Cheluve Gowda, Shailaja, Basavaraj Poojar, Srinath Satyanarayana
KEYWORDS:
Operational Research, Criteria C, Line Probe Assay, Universal Drug Susceptibility Testing, Culture and Drug Susceptibility Testing
JOURNAL NAME:
Journal of Tuberculosis Research,
Vol.8 No.2,
May
27,
2020
ABSTRACT: Background: In India, tuberculosis (TB) is a major public health
problem, and the advent of drug resistance TB (DR-TB) has worsened the
situation. The Revised National TB Control Programme (RNTCP) has introduced
universal drug susceptibility testing (UDST) for all diagnosed TB cases in
2018. We conducted this study to know the
advantage of implementing UDST when compared to selective testing
existent in 2017 on key diagnostic cascade parameters and to identify the
challenges in the implementation of UDST. Methods: The study was conducted in two districts of Karnataka, India during
January 2017-December 2018. The quantitative part consisted of before-and-after
design and the qualitative part consisted of descriptive design. Results: In 2017 (during selective testing/“before” period) out of the 2440 TB patients, 80 (3%) were diagnosed with Isoniazid and
Rifampicin resistance patients; in contrast
in 2018 (during UDST/“after” period) of the 5129 TB patients 258 (5%) were diagnosed with Isoniazid and Rifampicin resistance.
However, the proportion of eligible patients tested for rifampicin resistance during the “after” period was 60% when compared to
100% during the “before” period and median turnaround time for testing
was also longer during the “after” period when compared to the “before” period
(32.5 days vs 27.5 days). Major reasons for
these two gaps were found to be difficulties in collecting sputum
specimens and transportation. Conclusion: The rollout of UDST has led to a three-fold increase in a number of DR-TB cases detected in the
region. There is a need for the programme to increase the proportion
tested for DST by increasing the laboratory capacity and address the challenges
in sputum collection and transportation.