title: From where are tuberculosis patients accessing treatment in India? Results from a cross-sectional community based survey of 30 districts.
abstract: BACKGROUND
  Tuberculosis (TB) notification in India by the Revised National TB Control Programme (RNTCP) provides information on TB patients registered for treatment from the programme. There is limited information about the proportion of patients treated for TB outside RNTCP and where these patients access their treatment.
  
  
  OBJECTIVE
  To estimate the proportion of patients accessing TB treatment outside the RNTCP and to identify their basic demographic characteristics.
  
  
  METHODS
  A cross sectional community-based survey in 30 districts. Patients were identified through a door-to-door survey and interviewed using a semi-structured questionnaire.
  
  
  RESULTS
  Of the estimated 75,000 households enumerated, 73,249 households (97.6%) were visited. Of the 371,174 household members, 761 TB patients were identified (∼205 cases per 100,000 populations). Data were collected from 609 (80%) TB patients of which 331 [54% (95% CI: 42-66%)] were determined to be taking treatment 'under DOTS/RNTCP'. The remaining 278 [46% (95% CI: 34-57%)] were on treatment from 'outside DOTS/RNTCP' sources and hence were unlikely to be part of the TB notification system. Patients who were accessing treatment from 'outside DOTS/RNTCP' were more likely to be patients from rural areas [adjusted Odds Ratio (aOR) 2.5, 95% CI (1.2-5.3)] and whose TB was diagnosed in a non-government health facility (aOR 14.0, 95% CI 7.9-24.9).
  
  
  CONCLUSIONS
  This community-based survey found that nearly half of self-reported TB patients were missed by TB notification system in these districts. The study highlights the need for 1) Reviewing and revising the scope of the TB notification system, 2) Strengthening and monitoring health care delivery systems with periodic assessment of the reach and utilisation of the RNTCP services especially among rural communities, 3) Advocacy, communication and social mobilisation activities focused at rural communities with low household incomes and 4) Inclusive involvement of all health-care providers, especially providers of poor rural communities.
authors.affiliation: International Union against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India. ssrinath@theunion.org
authors.forename: Srinath
authors.initials: S
authors.lastname: Satyanarayana
authors.forename: Sreenivas Achutan
authors.initials: SA
authors.lastname: Nair
authors.forename: Sarabjit Singh
authors.initials: SS
authors.lastname: Chadha
authors.forename: Roopa
authors.initials: R
authors.lastname: Shivashankar
authors.forename: Geetanjali
authors.initials: G
authors.lastname: Sharma
authors.forename: Subhash
authors.initials: S
authors.lastname: Yadav
authors.forename: Subrat
authors.initials: S
authors.lastname: Mohanty
authors.forename: Vishnuvardhan
authors.initials: V
authors.lastname: Kamineni
authors.forename: Nevin Charles
authors.initials: NC
authors.lastname: Wilson
authors.forename: Anthony David
authors.initials: AD
authors.lastname: Harries
authors.forename: Puneet Kumar
authors.initials: PK
authors.lastname: Dewan
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D057566:Self Report; D014376:Tuberculosis / Q000628:therapy*