title: Has introduction of rapid drug susceptibility testing at diagnosis impacted treatment outcomes among previously treated tuberculosis patients in Gujarat, India?
abstract: BACKGROUND
  Revised National TB Control Programme (RNTCP) in India recommends that all previously-treated TB (PT) patients are offered drug susceptibility testing (DST) at diagnosis, using rapid diagnostics and screened out for rifampicin resistance before being treated with standardized, eight-month, retreatment regimen. This is intended to improve the early diagnosis of rifampicin resistance and its appropriate management and improve the treatment outcomes among the rest of the patients. In this state-wide study from Gujarat, India, we assess proportion of PT patients underwent rapid DST at diagnosis and the impact of this intervention on their treatment outcomes.
  
  
  METHODS
  This is a retrospective cohort study involving review of electronic patient-records maintained routinely under RNTCP. All PT patients registered for treatment in Gujarat during January-June 2013 were included. Information on DST and treatment outcomes were extracted from 'presumptive DR-TB patient register' and TB treatment register respectively. We performed a multivariate analysis to assess if getting tested is independently associated with unfavourable outcomes (death, loss-to-follow-up, failure, transfer out).
  
  
  RESULTS
  Of 5,829 PT patients, 5306(91%) were tested for drug susceptibility with rapid diagnostics. Overall, 71% (4,113) TB patients were successfully treated - 72% among tested versus 60% among non-tested. Patients who did not get tested at diagnosis had a 34% higher risk of unsuccessful outcomes as compared to those who got tested (aRR - 1.34; 95% CI 1.20-1.50) after adjusting for age, sex, HIV status and type of TB. Unfavourable outcomes (particularly failure and switched to category IV) were higher among INH-resistant patients (39%) as compared to INH-sensitive (29%).
  
  
  CONCLUSIONS
  Offering DST at diagnosis improved the treatment outcomes among PT patients. However, even among tested, treatment outcomes remained suboptimal and were related to INH resistance and high loss-to-follow-up. These need to be addressed urgently for further progress.
authors: State Tuberculosis Cell, Commissionerate of Health, Medical Services and Medical Education, Ministry of Health & Family Welfare, Gandhinagar, Gujarat, India.
authors: Paresh
authors: P
authors: Dave
authors: World Health Organization (WHO) Country Office for India, New Delhi, India; State Tuberculosis Training and Demonstration Centre, Near Tuberculosis and Chest Department, Civil Hospital Campus, Asarwa, Ahmedabad, India.
authors: Bhavin
authors: B
authors: Vadera
authors: International Union against Tuberculosis and Lung Diseases (The Union), South-East Asia Regional Office, New Delhi, India.
authors: Ajay M V
authors: AM
authors: Kumar
authors: Department of Preventive & Social Medicine, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India.
authors: Palanivel
authors: P
authors: Chinnakali
authors: Department of Community Medicine, GMERS Medical College, Gandhinagar, Gujarat, India.
authors: Bhavesh
authors: B
authors: Modi
authors: Department of Pulmonary Medicine, B. J. Medical College, Ahmedabad, Gujarat, India.
authors: Rajesh
authors: R
authors: Solanki
authors: State Tuberculosis Cell, Commissionerate of Health, Medical Services and Medical Education, Ministry of Health & Family Welfare, Gandhinagar, Gujarat, India.
authors: Pranav
authors: P
authors: Patel
authors: State Tuberculosis Cell, Commissionerate of Health, Medical Services and Medical Education, Ministry of Health & Family Welfare, Gandhinagar, Gujarat, India.
authors: Prakash
authors: P
authors: Patel
authors: State Tuberculosis Cell, Commissionerate of Health, Medical Services and Medical Education, Ministry of Health & Family Welfare, Gandhinagar, Gujarat, India.
authors: Kirit
authors: K
authors: Pujara
authors: State Tuberculosis Cell, Commissionerate of Health, Medical Services and Medical Education, Ministry of Health & Family Welfare, Gandhinagar, Gujarat, India.
authors: Pankaj
authors: P
authors: Nimavat
authors: World Health Organization (WHO) Country Office for India, New Delhi, India.
authors: Amar
authors: A
authors: Shah
authors: World Health Organization (WHO) Country Office for India, New Delhi, India.
authors: Sandeep
authors: S
authors: Bharaswadkar
authors: World Health Organization (WHO) Country Office for India, New Delhi, India.
authors: Kiran
authors: K
authors: Rade
authors: World Health Organization (WHO) Country Office for India, New Delhi, India.
authors: Malik
authors: M
authors: Parmar
authors: World Health Organization (WHO) Country Office for India, New Delhi, India.
authors: Sreenivas Achuthan
authors: SA
authors: Nair
mesh_terms: D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects*; D012189:Retrospective Studies; D012293:Rifampin / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D012293:Rifampin