High prevalence of rifampin-resistant tuberculosis in mountainous districts of India

Kunchok Dorjee, Tsetan D. Sadutshang, Ravinder S. Rana, S. Topgyal, Dawa Phunkyi, Tsering Choetso, Tenzin Chodon, M. Parmar, R. Singla, Z. Paster, Richard E Chaisson, Kailash C. Kaushal

Research output: Contribution to journalArticle

Abstract

Background: India accounts for quarter of global rifampin-resistant/multi-drug resistant-tuberculosis (RR/MDR-TB). Knowledge on risk-factors and distribution of MDR-TB at district level is limited. Objective: Study prevalence and risk factors of MDR-TB in tuberculosis patients in hilly districts of Himachal Pradesh, India. Methods: Between July 2012–June 2013, TB patients registered under the Revised National Tuberculosis Control Program in Kangra and Una districts suspected of MDR-TB were referred for Xpert® MTB/RIF testing at the Delek Hospital, Dharamsala by the district TB Office. Results: Of 378 patients enrolled (median age: 45 years; 85% males), 18% (n = 68) were rifampin-resistant. Among Xpert positives (n = 305), distributions of RR-TB were: 10% (n = 9/89) for recurrent cases who had received TB treatment for <2-months, 15% each for new (n = 9/59) or recurrent cases (n = 5/34) remaining smear positive between 2 and 4 months of treatment, 36% (n = 41/113) for treatment failures, and 40% (n = 2/5) for loss to follow-ups. Of the sputum-smear positives, 15% (n = 51/338) were Xpert negative. Seeking care in the private sector was associated with higher risk of RR-TB (OR:1.85; 95% CI:0.87–3.9). Conclusion: Prevalence of RR-TB is generally high in patients suspected of MDR-TB in the hilly districts of Himachal Pradesh. High prevalence during early phase of treatment can suggest primary transmission of DR-TB. Universal drug susceptibility testing and innovative case finding strategies will benefit patients living in mountain districts with inadequate access to healthcare. The high proportion of sputum-smear positive but Xpert negative cases may be due to non-tubercular mycobacterial disease.

Original languageEnglish (US)
JournalIndian Journal of Tuberculosis
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Rifampin
India
Tuberculosis
Sputum
Multidrug-Resistant Tuberculosis
Private Sector
District Hospitals
Treatment Failure
Therapeutics
Cross-Sectional Studies
Delivery of Health Care
Pharmaceutical Preparations

Keywords

  • Himachal Pradesh
  • India
  • Multidrug resistant tuberculosis
  • Tuberculosis

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Dorjee, K., Sadutshang, T. D., Rana, R. S., Topgyal, S., Phunkyi, D., Choetso, T., ... Kaushal, K. C. (Accepted/In press). High prevalence of rifampin-resistant tuberculosis in mountainous districts of India. Indian Journal of Tuberculosis. https://doi.org/10.1016/j.ijtb.2019.08.005

High prevalence of rifampin-resistant tuberculosis in mountainous districts of India. / Dorjee, Kunchok; Sadutshang, Tsetan D.; Rana, Ravinder S.; Topgyal, S.; Phunkyi, Dawa; Choetso, Tsering; Chodon, Tenzin; Parmar, M.; Singla, R.; Paster, Z.; Chaisson, Richard E; Kaushal, Kailash C.

In: Indian Journal of Tuberculosis, 01.01.2019.

Research output: Contribution to journalArticle

Dorjee, K, Sadutshang, TD, Rana, RS, Topgyal, S, Phunkyi, D, Choetso, T, Chodon, T, Parmar, M, Singla, R, Paster, Z, Chaisson, RE & Kaushal, KC 2019, 'High prevalence of rifampin-resistant tuberculosis in mountainous districts of India', Indian Journal of Tuberculosis. https://doi.org/10.1016/j.ijtb.2019.08.005
Dorjee, Kunchok ; Sadutshang, Tsetan D. ; Rana, Ravinder S. ; Topgyal, S. ; Phunkyi, Dawa ; Choetso, Tsering ; Chodon, Tenzin ; Parmar, M. ; Singla, R. ; Paster, Z. ; Chaisson, Richard E ; Kaushal, Kailash C. / High prevalence of rifampin-resistant tuberculosis in mountainous districts of India. In: Indian Journal of Tuberculosis. 2019.
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abstract = "Background: India accounts for quarter of global rifampin-resistant/multi-drug resistant-tuberculosis (RR/MDR-TB). Knowledge on risk-factors and distribution of MDR-TB at district level is limited. Objective: Study prevalence and risk factors of MDR-TB in tuberculosis patients in hilly districts of Himachal Pradesh, India. Methods: Between July 2012–June 2013, TB patients registered under the Revised National Tuberculosis Control Program in Kangra and Una districts suspected of MDR-TB were referred for Xpert{\circledR} MTB/RIF testing at the Delek Hospital, Dharamsala by the district TB Office. Results: Of 378 patients enrolled (median age: 45 years; 85{\%} males), 18{\%} (n = 68) were rifampin-resistant. Among Xpert positives (n = 305), distributions of RR-TB were: 10{\%} (n = 9/89) for recurrent cases who had received TB treatment for <2-months, 15{\%} each for new (n = 9/59) or recurrent cases (n = 5/34) remaining smear positive between 2 and 4 months of treatment, 36{\%} (n = 41/113) for treatment failures, and 40{\%} (n = 2/5) for loss to follow-ups. Of the sputum-smear positives, 15{\%} (n = 51/338) were Xpert negative. Seeking care in the private sector was associated with higher risk of RR-TB (OR:1.85; 95{\%} CI:0.87–3.9). Conclusion: Prevalence of RR-TB is generally high in patients suspected of MDR-TB in the hilly districts of Himachal Pradesh. High prevalence during early phase of treatment can suggest primary transmission of DR-TB. Universal drug susceptibility testing and innovative case finding strategies will benefit patients living in mountain districts with inadequate access to healthcare. The high proportion of sputum-smear positive but Xpert negative cases may be due to non-tubercular mycobacterial disease.",
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AU - Sadutshang, Tsetan D.

AU - Rana, Ravinder S.

AU - Topgyal, S.

AU - Phunkyi, Dawa

AU - Choetso, Tsering

AU - Chodon, Tenzin

AU - Parmar, M.

AU - Singla, R.

AU - Paster, Z.

AU - Chaisson, Richard E

AU - Kaushal, Kailash C.

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N2 - Background: India accounts for quarter of global rifampin-resistant/multi-drug resistant-tuberculosis (RR/MDR-TB). Knowledge on risk-factors and distribution of MDR-TB at district level is limited. Objective: Study prevalence and risk factors of MDR-TB in tuberculosis patients in hilly districts of Himachal Pradesh, India. Methods: Between July 2012–June 2013, TB patients registered under the Revised National Tuberculosis Control Program in Kangra and Una districts suspected of MDR-TB were referred for Xpert® MTB/RIF testing at the Delek Hospital, Dharamsala by the district TB Office. Results: Of 378 patients enrolled (median age: 45 years; 85% males), 18% (n = 68) were rifampin-resistant. Among Xpert positives (n = 305), distributions of RR-TB were: 10% (n = 9/89) for recurrent cases who had received TB treatment for <2-months, 15% each for new (n = 9/59) or recurrent cases (n = 5/34) remaining smear positive between 2 and 4 months of treatment, 36% (n = 41/113) for treatment failures, and 40% (n = 2/5) for loss to follow-ups. Of the sputum-smear positives, 15% (n = 51/338) were Xpert negative. Seeking care in the private sector was associated with higher risk of RR-TB (OR:1.85; 95% CI:0.87–3.9). Conclusion: Prevalence of RR-TB is generally high in patients suspected of MDR-TB in the hilly districts of Himachal Pradesh. High prevalence during early phase of treatment can suggest primary transmission of DR-TB. Universal drug susceptibility testing and innovative case finding strategies will benefit patients living in mountain districts with inadequate access to healthcare. The high proportion of sputum-smear positive but Xpert negative cases may be due to non-tubercular mycobacterial disease.

AB - Background: India accounts for quarter of global rifampin-resistant/multi-drug resistant-tuberculosis (RR/MDR-TB). Knowledge on risk-factors and distribution of MDR-TB at district level is limited. Objective: Study prevalence and risk factors of MDR-TB in tuberculosis patients in hilly districts of Himachal Pradesh, India. Methods: Between July 2012–June 2013, TB patients registered under the Revised National Tuberculosis Control Program in Kangra and Una districts suspected of MDR-TB were referred for Xpert® MTB/RIF testing at the Delek Hospital, Dharamsala by the district TB Office. Results: Of 378 patients enrolled (median age: 45 years; 85% males), 18% (n = 68) were rifampin-resistant. Among Xpert positives (n = 305), distributions of RR-TB were: 10% (n = 9/89) for recurrent cases who had received TB treatment for <2-months, 15% each for new (n = 9/59) or recurrent cases (n = 5/34) remaining smear positive between 2 and 4 months of treatment, 36% (n = 41/113) for treatment failures, and 40% (n = 2/5) for loss to follow-ups. Of the sputum-smear positives, 15% (n = 51/338) were Xpert negative. Seeking care in the private sector was associated with higher risk of RR-TB (OR:1.85; 95% CI:0.87–3.9). Conclusion: Prevalence of RR-TB is generally high in patients suspected of MDR-TB in the hilly districts of Himachal Pradesh. High prevalence during early phase of treatment can suggest primary transmission of DR-TB. Universal drug susceptibility testing and innovative case finding strategies will benefit patients living in mountain districts with inadequate access to healthcare. The high proportion of sputum-smear positive but Xpert negative cases may be due to non-tubercular mycobacterial disease.

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KW - India

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KW - Tuberculosis

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