title: Are registered sputum smear-negative tuberculosis patients in Karnataka, India, diagnosed by national algorithm?
abstract: METHODS
  Four districts of Karnataka State, India, that have implemented the National Tuberculosis Control Programme (RNTCP).
  
  
  OBJECTIVE
  To assess the proportion of patients diagnosed according to the nationally recommended algorithm among new smear-negative (NSN) PTB cases registered under the RNTCP.
  
  
  METHODS
  Information on 201 registered NSN-PTB patients as regards date of initial sputum examination, repeat sputum examination and chest X-ray (CXR) if undertaken, treatment initiation and number of days of antibiotic treatment after initial sputum examination, were collected through record review and patient interviews. In patients with negative or unknown human immunodeficiency virus (HIV) status, the algorithm was considered completed if the patient underwent initial sputum examination, antibiotic trial for ⩾10 days, repeat sputum examination ⩾10 days after initial sputum examination, CXR after repeat sputum examination and anti-tuberculosis treatment ⩾10 days after initial sputum examination. In HIV-positive patients, the algorithm was considered completed if CXR was performed after or at the same time as initial sputum examination.
  
  
  RESULTS
  Complete information was available for 170 patients. Of these, the algorithm was completed in 14 (8.2%, 95%CI 0.9-15.5): 1/140 patients with negative or unknown HIV status and 13/30 HIV-positive patients.
  
  
  CONCLUSIONS
  The algorithm was not completed in most patients registered for treatment. Measures are needed to improve the diagnostic process for smear-negative PTB.
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India.
authors.forename: V K
authors.initials: VK
authors.lastname: Chadha
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India.
authors.forename: P
authors.initials: P
authors.lastname: Praseeja
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India.
authors.forename: N K
authors.initials: NK
authors.lastname: Hemanthkumar
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India.
authors.forename: B A
authors.initials: BA
authors.lastname: Shivshankara
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India.
authors.forename: M A
authors.initials: MA
authors.lastname: Sharada
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India.
authors.forename: N
authors.initials: N
authors.lastname: Nagendra
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India.
authors.forename: R
authors.initials: R
authors.lastname: Padmesh
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India.
authors.forename: G
authors.initials: G
authors.lastname: Puttuswamy
authors.affiliation: Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India.
authors.forename: J
authors.initials: J
authors.lastname: Ahmed
authors.affiliation: Office of the Director, National Tuberculosis Institute, Bangalore, Karnataka, India.
authors.forename: P
authors.initials: P
authors.lastname: Kumar
mesh_terms: D000465:Algorithms; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use; D001431:Bacteriological Techniques / Q000592:standards; D060085:Coinfection; D019091:Critical Pathways; D019983:Guideline Adherence; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic / Q000592:standards; D012042:Registries; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology*; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology
chemical_list: D000904:Antibiotics, Antitubercular