title: Follow-up examinations: are multidrug-resistant tuberculosis patients in Uttar Pradesh, India, on track?
abstract: METHODS
  All multidrug-resistant tuberculosis (MDR-TB) patients who had completed 6 months of treatment under the Revised National Tuberculosis Control Programme (RNTCP) in Uttar Pradesh, the largest state in northern India.
  
  
  OBJECTIVE
  To determine the proportion of MDR-TB patients with regular follow-up examinations, and underlying provider and patient perspectives of follow-up services.
  
  
  METHODS
  A retrospective cohort study was undertaken involving record reviews of 64 eligible MDR-TB patients registered during April-June 2013 in 11 districts of the state. Patients and programme personnel from the selected districts were interviewed using a semi-structured questionnaire.
  
  
  RESULTS
  A total of 34 (53.1%) patients underwent follow-up sputum culture at month 3, 43 (67.2%) at month 4, 36 (56.3%) at month 5 and 37 (57.8%) at month 6. Themes associated with irregular follow-up that emerged from the interviews were multiple visits, long travel distances, shortages of equipment at the facility and lack of knowledge among patients regarding the follow-up schedule.
  
  
  CONCLUSIONS
  The majority of the MDR-TB patients had irregular follow-up visits. Provider-related factors outweigh patient-related factors on the poor follow-up examinations. The programme should focus on the decentralisation of follow-up services and ensure logistics and patient-centred counselling to improve the regularisation of follow up.
authors.affiliation: World Health Organization (WHO), Revised National Tuberculosis Control Programme (RNTCP) Technical Support Network, Lucknow, India.
authors.forename: U C
authors.initials: UC
authors.lastname: Tripathi
authors.affiliation: Employees State Insurance Corporation Medical College and Post Graduate Institute of Medical Sciences & Research, Bangalore, India.
authors.forename: S B
authors.initials: SB
authors.lastname: Nagaraja
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: J P
authors.initials: JP
authors.lastname: Tripathy
authors.affiliation: Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondicherry, India.
authors.forename: S K
authors.initials: SK
authors.lastname: Sahu
authors.affiliation: WHO Country Office for India, New Delhi, India.
authors.forename: M
authors.initials: M
authors.lastname: Parmar
authors.affiliation: WHO-RNTCP Technical Support Network, Central TB Division (CTD), Directorate General of Health Services, New Delhi, India.
authors.forename: K
authors.initials: K
authors.lastname: Rade
authors.affiliation: State TB Demonstration and Training Centre, Agra, India.
authors.forename: S
authors.initials: S
authors.lastname: Bhatnagar
authors.affiliation: State TB Cell, Medical & Health Directorate, Lucknow, India.
authors.forename: A
authors.initials: A
authors.lastname: Ranjan
authors.affiliation: CTD, Directorate General of Health Services, New Delhi, India.
authors.forename: K S
authors.initials: KS
authors.lastname: Sachdeva
keywords: India; MDR-TB; SORT IT; follow-up