title: The Multi-Drug Resistant Tuberculosis Diagnosis and Treatment Cascade in Bangladesh.
abstract: OBJECTIVE
  To determine, in areas supported by BRAC, Bangladesh i) the pre-diagnosis and pre-treatment attrition among presumptive and confirmed Multi-Drug Resistant Tuberculosis (MDR-TB) patients and ii) factors associated with attrition.
  
  
  METHODS
  This was a retrospective cohort study involving record review. Presumptive MDR-TB patients from peripheral microscopy centres serving 60% of the total population of Bangladesh were included in the study. Attrition and turnaround time for MDR-TB diagnosis by Xpert MTB/RIF and treatment initiation were calculated between July 2012 and June 2014.
  
  
  RESULTS
  Of 836 presumptive MDR-TB patients referred from 398 peripheral microscopy centres, 161 MDR-TB patients were diagnosed. The number of diagnosed MDR-TB patients was less than country estimates of MDR-TB patients (2000 cases) during the study period. Among those referred, pre-diagnosis and pre-treatment attrition was 17% and 21% respectively. Median turnaround time for MDR-TB testing, result receipt and treatment initiation was four, zero and five days respectively. Farmers (RR=2.3, p=0.01) and daily wage laborers (RR=2.1, p=0.04) had twice the risk of having pre-diagnosis attrition. Poor record-keeping and unreliable upkeep of presumptive MDR-TB patient databases were identified as challenges at the peripheral microscopy centres.
  
  
  CONCLUSIONS
  There was a low proportion of pre-diagnosis and pre-treatment attrition in patients with presumptive and confirmed MDR-TB under programmatic conditions. However, the recording and reporting system did not detect all presumptive MDR-TB patients, highlighting the need to improve the system in order to prevent morbidity, mortality and transmission of MDR-TB in the community.
authors.affiliation: TB Control Programme, BRAC, Dhaka, Bangladesh.
authors.forename: Sarder Tanzir
authors.initials: ST
authors.lastname: Hossain
authors.affiliation: MédecinsSansFrontières, Operational Research Unit, Luxembourg City, Luxembourg.
authors.forename: Petros
authors.initials: P
authors.lastname: Isaakidis
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India.
authors.forename: Karuna D
authors.initials: KD
authors.lastname: Sagili
authors.affiliation: TB Control Programme, BRAC, Dhaka, Bangladesh.
authors.forename: Shayla
authors.initials: S
authors.lastname: Islam
authors.affiliation: TB Control Programme, BRAC, Dhaka, Bangladesh.
authors.forename: Md Akramul
authors.initials: MA
authors.lastname: Islam
authors.affiliation: Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, Wardha, India.
authors.forename: Hemant Deepak
authors.initials: HD
authors.lastname: Shewade
authors.affiliation: NationalTuberculosis Reference Laboratory, NIDCH, Dhaka, Bangladesh.
authors.forename: S M Mostofa
authors.initials: SM
authors.lastname: Kamal
authors.affiliation: National Tuberculosis Control Programme, DGHS, Dhaka, Bangladesh.
authors.forename: Ashaque
authors.initials: A
authors.lastname: Husain
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000904:Antibiotics, Antitubercular / Q000627:therapeutic use*; D001459:Bangladesh; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use*; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000904:Antibiotics, Antitubercular; D012293:Rifampin