TY - JOUR
T1 - High prevalence of rifampin-resistant tuberculosis in mountainous districts of India
AU - Dorjee, Kunchok
AU - Sadutshang, Tsetan D.
AU - Rana, Ravinder S.
AU - Topgyal, Sonam
AU - Phunkyi, Dawa
AU - Choetso, Tsering
AU - Chodon, Tenzin
AU - Parmar, Malik
AU - Singla, Rupak
AU - Paster, Zorba
AU - Chaisson, Richard E.
AU - Kaushal, Kailash C.
N1 - Funding Information:
We thank the Tibetan Delek Hospital's administration for making the GeneXpert facility available to the TB patients under RNTCP in Himachal Pradesh and for providing Xpert testing free of cost to the patients. We thank the STOP TB PARTNERSHIP and the Johns Hopkins University for the TB REACH wave 2 grant that supported Xpert cartridge supplies for the Delek Hospital.
Funding Information:
We thank the Tibetan Delek Hospital's administration for making the GeneXpert facility available to the TB patients under RNTCP in Himachal Pradesh and for providing Xpert testing free of cost to the patients. We thank the STOP TB PARTNERSHIP and the Johns Hopkins University for the TB REACH wave 2 grant that supported Xpert cartridge supplies for the Delek Hospital.
Publisher Copyright:
© 2019 Tuberculosis Association of India
PY - 2020/1
Y1 - 2020/1
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.
KW - Himachal Pradesh
KW - India
KW - Multidrug resistant tuberculosis
KW - Tuberculosis
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U2 - 10.1016/j.ijtb.2019.08.005
DO - 10.1016/j.ijtb.2019.08.005
M3 - Article
C2 - 32192619
AN - SCOPUS:85071883217
SN - 0019-5707
VL - 67
SP - 59
EP - 64
JO - Indian Journal of Tuberculosis
JF - Indian Journal of Tuberculosis
IS - 1
ER -