title: Screening retreatment tuberculosis patients for drug resistance in mid-west Nepal: how well are we doing?
abstract: METHODS
  Multidrug-resistant tuberculosis (MDR-TB, defined as resistance to isoniazid and rifampicin) is poorly detected in Nepal; one reason may be poor functioning of culture and drug susceptibility testing (CDST) services for retreatment tuberculosis (TB) patients.
  
  
  OBJECTIVE
  To determine, among retreatment TB patients in mid-west Nepal, 1) the number of patients registered for treatment between July 2011 and July 2012; 2) the number submitting sputum specimens for CDST to the Central Reference Laboratory (CRL), Kathmandu, along with the results; and 3) the length of time for submission and receipt of specimens.
  
  
  METHODS
  Retrospective cohort study involving the review of treatment and laboratory registers from the Nepalgunj TB Referral Centre and the CRL.
  
  
  RESULTS
  Of 431 retreatment patients, 66 (15%) submitted sputum samples, of which 63 reached the CRL. Of these, 39 (62%) were culture-positive; 13 (33%) patients had MDR-TB. The CDST results of 19 patients were received back at the TB Referral Centre. The median turnaround time from sending specimens to receipt of results at the TB Referral Centre was 119 days.
  
  
  CONCLUSIONS
  Less than 10% of retreatment TB patients in mid-West Nepal had CDST results recorded, leading to the underdiagnosis of MDR-TB in the region. Urgent solutions are needed to rectify this problem.
authors.affiliation: International Nepal Fellowship, Pokhara, Nepal.
authors.forename: M B
authors.initials: MB
authors.lastname: Tharu
authors.affiliation: International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: S
authors.initials: S
authors.lastname: Goel
authors.affiliation: Public Health Foundation of India, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Srivastava
authors.affiliation: The Union, South-East Asia Regional Office, New Delhi, India.
authors.forename: A M V
authors.initials: AM
authors.lastname: Kumar
authors.affiliation: International Nepal Fellowship, Pokhara, Nepal.
authors.forename: M
authors.initials: M
authors.lastname: Adhikari
authors.affiliation: Nepal Anti Tuberculosis Association, GENETUP Central Reference Laboratory, Kathmandu, Nepal.
authors.forename: B
authors.initials: B
authors.lastname: Shrestha
authors.affiliation: Nepal Anti Tuberculosis Association, GENETUP Central Reference Laboratory, Kathmandu, Nepal.
authors.forename: B
authors.initials: B
authors.lastname: Maharjan
authors.affiliation: International Nepal Fellowship, Pokhara, Nepal.
authors.forename: H
authors.initials: H
authors.lastname: Khadka
keywords: Nepal; central reference laboratory; culture and drug susceptibility testing; multidrug-resistant tuberculosis; operational research; retreatment tuberculosis