title: Operational challenges in diagnosing multi-drug resistant TB and initiating treatment in Andhra Pradesh, India.
abstract: BACKGROUND
  Revised National TB Control Programme (RNTCP), Andhra Pradesh, India. There is limited information on whether MDR-TB suspects are identified, undergo diagnostic assessment and are initiated on treatment according to the programme guidelines.
  
  
  OBJECTIVE
  To assess i) using the programme definition, the number and proportion of MDR-TB suspects in a large cohort of TB patients on first-line treatment under RNTCP ii) the proportion of these MDR-TB suspects who underwent diagnosis for MDR-TB and iii) the number and proportion of those diagnosed as MDR-TB who were successfully initiated on treatment.
  
  
  METHODS
  A retrospective cohort analysis, by reviewing RNTCP records and reports, was conducted in four districts of Andhra Pradesh, India, among patients registered for first line treatment during October 2008 to December 2009.
  
  
  RESULTS
  Among 23,999 TB patients registered for treatment there were 559 (2%) MDR-TB suspects (according to programme definition) of which 307 (55%) underwent diagnosis and amongst these 169 (55%) were found to be MDR-TB. Of the MDR-TB patients, 112 (66%) were successfully initiated on treatment. Amongst those eligible for MDR-TB services, significant proportions are lost during the diagnostic and treatment initiation pathway due to a variety of operational challenges. The programme needs to urgently address these challenges for effective delivery and utilisation of the MDR-TB services.
authors.affiliation: International Union against Tuberculosis and Lung Disease, The Union, South-East Asia Regional Office, New Delhi, India. schadha@theunion.org
authors.forename: Sarabjit S
authors.initials: SS
authors.lastname: Chadha
authors.forename: B N
authors.initials: BN
authors.lastname: Sharath
authors.forename: Kishore
authors.initials: K
authors.lastname: Reddy
authors.forename: Jyothi
authors.initials: J
authors.lastname: Jaju
authors.forename: P H
authors.initials: PH
authors.lastname: Vishnu
authors.forename: Sreenivas
authors.initials: S
authors.lastname: Rao
authors.forename: Malik
authors.initials: M
authors.lastname: Parmar
authors.forename: Srinath
authors.initials: S
authors.lastname: Satyanarayana
authors.forename: Kuldeep Singh
authors.initials: KS
authors.lastname: Sachdeva
authors.forename: Nevin
authors.initials: N
authors.lastname: Wilson
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents
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