TB Treatment Delays in Odisha, India: Is It Expected Even after These Many Years of RNTCP Implementation?
BACKGROUND
In India, the Revised National TB Control Programme (RNTCP) envisages initiation of TB treatment within seven days of diagnosis among smear-positive patients. After nearly two decades of RNTCP implementation, treatment delays are usually not expected.


OBJECTIVE
To determine the proportion of sputum smear-positive TB patients who were initiated on treatment after seven days and their associated risk factors.


METHODS
The study was conducted in Cuttack and Rayagada districts of Odisha. It was a retrospective cohort study that involves review of TB treatment registers and laboratory registers for 2013.


RESULTS
Among 1,800 pulmonary TB (PTB) patients, 1,074 (60%) had been initiated on treatment within seven days of diagnosis, 721 (40%) had been initiated on treatment more than seven days, and 354 (20%) had delays of more than 15 days. The mean duration between TB diagnosis and treatment initiation was 21 days with a range of 8-207 days (median = 14 days). Odds of treatment delay of more than seven days were 4.9 times (95% confidence interval [CI] 3.3-6.6) among those who had been previously treated, 6.2 times (95% CI 1.3-29.7) among those infected with HIV, and 1.8 times (95% CI 1.1-2.9) among those diagnosed outside district DMC.


CONCLUSIONS
Delay in initiation of TB treatment occurred in majority of the smear-positive patients. The RNTCP should focus on core areas of providing quality TB services with time-tested strategies. To have real-time monitoring mechanisms for diagnosed smear-positive TB patients is expected to be the way forward.
Health Systems Research India Initiative, Thirvananthapuram, India.
Kumaravel
K
Ilangovan
Department of Community Medicine, ESIC Medical College and PGIMSR, Bangalore, India.
Sharath Burugina
SB
Nagaraja
Resource Group for Education and Advocacy for Community Health (REACH), Chennai, India.
Ramya
R
Ananthakrishnan
International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India.
Anil G
AG
Jacob
Department of Community Medicine, School of Public Health, PGIMER, Chandigarh, India.
Jaya Prasad
JP
Tripathy
International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India.
Deepak
D
Tamang
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
D000995:Antitubercular Agents