Threefold Increase in the Number of Drug Resistant TB Cases after Introduction of Universal Drug Susceptibility Testing: Experiences from Two South India Districts.
Sanath Kumar Gurram Krishnamurthy1*, Sharath Burugina Nagaraja2, Tanu Anand3, Karuna D. Sagili4, Cheluve Gowda5, Shailaja6, Basavaraj Poojar7, Srinath Satyanarayana8
1Department of Health and Family, Tumkur District, Karnataka, India
2 Department of Community Medicine, ESIC Medical College and PGIMSR, Bengaluru, India
3Department of Community Medicine, North Delhi Municipal Corporation Medical College, Hindu Rao Hospital, Delhi, India
4Department of TB and Communicable Diseases, the Union South East Asia Office, New Delhi, India
5Department of Community Medicine, Sri Siddhartha Medical College, Tumkur, Karnataka, India
6Department of Health and Family, Belgaum District, Karnataka, India
7Department of Pharmacology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India
8The Union, South East Asia Office, New Delhi, India
Citation: Krishnamurthy SKG, Nagaraja SB, Anand T, Sagili KD, Gowda C et al (2023) Threefold Increase in the Number of Drug Resistant TB Cases after Introduction of Universal Drug Susceptibility Testing: Experiences from Two South India Districts. SciTech Infectious Diseases 2023.
Received: November 21, 2023 Accepted: November 23, 2023 Published: November 23, 2023
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.
