National TB Elimination Program (NTEP) in India has planned for free of cost diagnosis and treatment for tuberculosis (TB) patients. This study is carried out to find out the deficiencies in treatment prescribed by practitioners, whether they were as per NTEP guidelines or not, and to assess the use of cartridge-based nucleic acid amplification test (CBNAAT) by practitioners for the detection of rifampicin resistance as per the current guidelines.
Aims and objectives: This study was conducted to see the deficiencies in treatment prescribed by practitioners, whether they were as per NTEP guidelines or not, and to assess the use of CBNAAT by practitioners for the detection of rifampicin resistance as per the current guidelines.
Materials and methods: The doctor's prescription of a total of 199 patients who visited the outpatient department (OPD) were assessed, and data was collected as per inclusion and exclusion criteria.
Results: Out of the total 199 prescriptions, 83.4% of patients were prescribed antitubercular treatment (ATT) under directly observed treatment short course (DOTS), while in the remaining 16.6% of patients non-DOTS ATT [57% prescribed fixed dosage combination (FDC) and 43% prescribed individual drug] were prescribed by practitioners. CBNAAT was prescribed by only 52.8% of practitioners for TB diagnosis and drug resistance.
Conclusion: The method of prescribing non-DOTS ATT prescription drugs was not as per NTEP guidelines, and CBNAAT prescription was also less.
Global TB report 2019; https://apps.who.int/iris/bitstream/handle/10665/329368/9789241565714-eng.pdf?ua=1
Dewan R, Anuradha S, Khanna A, et al. Role of cartridge-based nucleic acid amplification test (CBNAAT) for early diagnosis of pulmonary tuberculosis in HIV. J Indian Acad Clin Med 2015;16(2):114–117.
Gopi A, Madhavan SM, Sharma SK, et al. Diagnosis and treatment of tuberculous pleural effusion in 2006. Chest 2007;131(3):880–889. DOI: 10.1378/chest.06-2063
Tb M, Strategy ETB, Goals SD. Tuberculosis 18. 2020.
Helb D, Jones M, Story E, et al. Rapid detection of mycobacterium tuberculosis and rifampin resistance by use of on-demand, near-patient technology. J Clin Microbiol 2010;48(1):229–237. DOI: 10.1128/JCM.01463-09
Steingart KR, Schiller I, Horne DJ, et al. Xpert® MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane database Syst Rev 2014;2014(1):CD009593. DOI: 10.1002/14651858.CD009593.pub3
Index TB guidelines 2019; https://apps.who.int/iris/handle/10665/278953
Mathys V, van de Vyvere M, de Droogh E, et al. False-positive rifampicin resistance on Xpert® MTB/RIF caused by a silent mutation in the rpoB gene. Int J Tuberc Lung Dis 2014;18(10):1255–1257. DOI: 10.5588/ijtld.14.0297
India TB report 2020; https://tbcindia.gov.in/showfile.php?lid=3538
Bruchfeld J, Aderaye G, Palme IB, et al. Sputum concentration improves diagnosis of tuberculosis in a setting with a high prevalence of HIV. Trans R Soc Trop Med Hyg 2000;94(6):677–680. DOI: 10.1016/s0035-9203(00)90230-x
Tessema TA, Bjune G, Assefa G, et al. An evaluation of the diagnostic value of clinical and radiological manifestations in patients attending the addis ababa Addis Abeda tuberculosis centre. Scand J Infect Dis 2001;33(5):355–361. DOI: 10.1080/003655401750173986
Siddiqi K, Lambert ML, Walley J. Clinical diagnosis of smear-negative pulmonary tuberculosis in low-income countries: the current evidence. Lancet Infect Dis 2003;3(5):288–296. DOI: 10.1016/S1473-3099(03)00609-1
Sagili K, Shringarpure K, Nilgiriwala K, et al. Cost-effectiveness of GeneXpert, LED FM and chest X-ray for diagnosis of pulmonary tuberculosis: a systematic review and meta-analysis. PLoS One 2018;13(10):e0205233. DOI: 10.1371/journal.pone.0205233
World Health Organization: WHO report 2010: global tuberculosis control. Geneva, Switzerland: WHO; 2010
India TB report 2019; https://tbcindia.gov.in/WriteReadData/India%20TB%20Report%202019.pd
Geleta DA, Megerssa YC, Gudeta AN, et al. Xpert MTB/RIF assay for diagnosis of pulmonary tuberculosis in sputum specimens in remote health care facility. BMC Microbiol 2015;15(1):220. DOI: 10.1186/s12866-015-0566-6
Revised National TB Control Programme. Technical and Operational Guidelines for Tuberculosis Control. Programme in India – 2016. Available from URL: http://tbcindia.gov.in/index1.php?
National Tuberculosis Elimination. Programme MODULE 2020; https://tbcindia.gov.in/WriteReadData/NTEPTrainingModules1to4.pdf
Yadav S, Rawal G. The latest developments in the TB control program of India. IP Indian J Immunol Respir Med 2019;4(1):1–3. DOI: 10.18231/2581-4222.12019.0001
Sreekanth B, Amarendra G, Dhanalaxmi A, et al. Effectiveness of CBNAAT in the diagnosis of sputum negative tuberculosis. Natl lab med 2020;9(1):MO01–MO02. DOI: 10.7860/NJLM/2020/42558:2375
Sethumadhavan A, Konikkara KP, Paul D. Performance of cartridge based nucleic acid amplification test for the diagnosis of smear negative suspected tuberculosis - a study from a teaching hospital in Thrissur, Kerala, India. J Evolution Med Dent Sci 2021;10(16):2278–4802. DOI: 10.14260/JEMDS/2021/238
Gupta M, Purohit G, Vyas S. Prevalence of positivity of CBNAAT (cartridge based nucleic acid amplification test) in extra-pulmonary tuberculosis. Eur Res J 2018;52:PA2756. DOI: 10.1183/13993003.congress-2018.PA2756
Kandi S, Reddy V, Nagaraja, SB. Diagnosis of pulmonary and extra pulmonary tuberculosis: how best is CBNAAT when compared to conventional methods of tb detection? Pulm Res Respir Med Open J 2017;4(2):38–41. DOI: 10.17140/PRRMOJ-4-137
Kakad SS, Godbole G, Kulkarni S, et al. Study of awareness and utility of cartridge based nucleic acid amplification test (CBNAAT) amongst doctors. Indian J Appl Res 2020;10(3). DOI: 10.36106/ijar