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 language | English (US) |
|---|---|
| Journal | Indian Journal of Tuberculosis |
| DOIs | |
| State | Accepted/In press - Jan 1 2019 |
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Keywords
- Himachal Pradesh
- India
- Multidrug resistant tuberculosis
- Tuberculosis
ASJC Scopus subject areas
- Infectious Diseases
Cite this
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 journal › Article
}
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, 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.
PY - 2019/1/1
Y1 - 2019/1/1
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
UR - http://www.scopus.com/inward/record.url?scp=85071883217&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071883217&partnerID=8YFLogxK
U2 - 10.1016/j.ijtb.2019.08.005
DO - 10.1016/j.ijtb.2019.08.005
M3 - Article
AN - SCOPUS:85071883217
JO - Indian Journal of Tuberculosis
JF - Indian Journal of Tuberculosis
SN - 0019-5707
ER -