title: Characteristics and outcomes of tuberculosis patients who fail to smear convert at two months in Sri Lanka.
abstract: METHODS
  Five districts in Sri Lanka.
  
  
  OBJECTIVE
  To determine: 1) the proportion of sputum smear-positive pulmonary tuberculosis (PTB) cases who failed to smear convert at 2 months, 2) their management, and 3) whether baseline characteristics and final treatment outcomes were different from those who did smear convert.
  
  
  METHODS
  Cross-sectional retrospective review of medical files, tuberculosis (TB) registers and TB treatment records of new smear-positive PTB patients registered from January to December 2010.
  
  
  RESULTS
  Of 925 patients, 840 were available to submit sputum at 2 months, of whom 137 (16%) were smear-positive. Baseline sputum smears showing 3+ acid-fast bacilli and missing doses of anti-tuberculosis drugs during the initial phase of treatment were significantly associated with being smear-positive at 2 months. Management was poor: of 137 patients, 46 (34%) submitted sputum for culture and drug susceptibility testing and Mycobacterium tuberculosis was cultured in six cases; 120 (88%) received a 1-month extension of the initial phase, and of the 30 patients still smear-positive at 3 months there were no culture results available. Final treatment outcomes were similar, regardless of smear conversion at 2 or 3 months.
  
  
  CONCLUSIONS
  Certain characteristics were risk factors for failure to smear convert at 2 months. However, treatment outcomes for all patients were good. These findings have implications for the modification of national programme recommendations.
authors.affiliation: National Programme for Tuberculosis Control and Chest Diseases, Colombo, Sri Lanka.
authors.forename: W
authors.initials: W
authors.lastname: Jayakody
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
authors.affiliation: All India Institute of Medical Sciences, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Malhotra
authors.affiliation: Ministry of Health, Colombo, Sri Lanka.
authors.forename: S
authors.initials: S
authors.lastname: de Alwis
authors.affiliation: National Programme for Tuberculosis Control and Chest Diseases, Colombo, Sri Lanka.
authors.forename: S
authors.initials: S
authors.lastname: Samaraweera
authors.affiliation: National Programme for Tuberculosis Control and Chest Diseases, Colombo, Sri Lanka.
authors.forename: N
authors.initials: N
authors.lastname: Pallewatta
keywords: 2-month smear conversion; Sri Lanka; operational research; pulmonary tuberculosis