title: Implementation efficiency of a diagnostic algorithm in sputum smear-negative presumptive tuberculosis patients.
abstract: BACKGROUND
  For the diagnosis of smear-negative pulmonary tuberculosis (PTB), India's Revised National Tuberculosis Control Programme (RNTCP) recommends a course of broad-spectrum antibiotics after negative smear on initial sputum examination, followed by repeat sputum examination and chest X-ray (CXR).
  
  
  OBJECTIVE
  1) To ascertain the proportion of presumptive PTB patients smear-negative on initial sputum examination who completed the diagnostic algorithm, and 2) to investigate barriers to the completion of the algorithm.
  
  
  METHODS
  In Karnataka State, India, 256 study participants were interviewed in 2012 to ascertain the number of days antibiotics had been prescribed and consumed, the number of re-visits to health centre(s), whether repeat sputum examinations had been performed, whether or not CXR had been performed and when, and whether PTB had been diagnosed. In-depth interviews were conducted with 19 medical officers.
  
  
  RESULTS
  The diagnostic algorithm was completed in 13 (5.1%) of 256 participants; three were diagnosed with PTB without completing the algorithm. Most medical officers were unaware of the algorithm, had trained 5-10 years previously, prescribed antibiotics for <10 days and advised CXR without repeat sputum examination, irrespective of the number of days of antibiotic treatment. Other main reasons for non-completion of algorithm were patients not returning to the health centres and a proportion switching to the private sector.
  
  
  CONCLUSIONS
  Refresher training courses, raising patient awareness and active follow-up of patients to complete the algorithm are suggested.
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India.
authors.forename: V K
authors.initials: VK
authors.lastname: Chadha
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India.
authors.forename: P
authors.initials: P
authors.lastname: Praseeja
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India.
authors.forename: N K
authors.initials: NK
authors.lastname: Hemanthkumar
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India.
authors.forename: B A
authors.initials: BA
authors.lastname: Shivshankara
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India.
authors.forename: M A
authors.initials: MA
authors.lastname: Sharada
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India.
authors.forename: N
authors.initials: N
authors.lastname: Nagendra
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India.
authors.forename: R
authors.initials: R
authors.lastname: Padmesh
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India.
authors.forename: G
authors.initials: G
authors.lastname: Puttaswamy
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, India.
authors.forename: V
authors.initials: V
authors.lastname: Magesh
authors.affiliation: Department of Social and Behavioural Research, National Institute for Research in Tuberculosis, Chennai, India.
authors.forename: B
authors.initials: B
authors.lastname: Thomas
authors.affiliation: Office of the Director, National Tuberculosis Institute, Bangalore, India.
authors.forename: P
authors.initials: P
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D013183:Sputum / Q000382:microbiology*; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy; D055815:Young Adult
chemical_list: D000904:Antibiotics, Antitubercular