Observation Study among Cured Cases of Pulmonary Tuberculosis: A Long-Term Study under the Revised National Tuberculosis Control Program
AbstractBackground: Tuberculosis is one of the leading causes of mortality in India. The Revised National Tuberculosis Control Program (RNTCP) is a robust public health system to deal with Tuberculosis (TB) in India. Unless the treated patient comes back to the system with signs and symptoms of TB due to relapse or reinfection, there is no mechanism of follow-up or any method to know the relapse rate in the population. This study aimed to analysed trends in relapse tuberculosis cases and describe their associations with socio-demographic and clinical factors.Subjects dan Method: In this prospective cohort study, 750 selected sample size who were declared “Cured” in four randomly selected TB units of Gwalior district were followed up for 1–5 years through home visits by trained staff with structured data collection forms. Data Collection was done between January 2022 to June 2022 and afterwards analyzed using Microsoft excel spreadsheet.Results: The mean age of the index cases was Mean= 30.53; SD= 14.24 years, and there were 39 females and 64 males. At early stage (1-to-2-year posttreatment follow-up of 248 index cases) 199 (80.2%) were healthy and working without any symptoms of TB. Symptoms of TB were present in 49 (19.8%) cases. The after 2-year posttreatment TB Symptoms were present in 54 (19.3%) cases.Conclusion: Long-term follow-up of cured, new smear-positive TB cases reinforce the effectiveness of anti-TB treatment under the RNTCP as assessed by improved health outcomes in more than two-thirds of cases and posttreatment survival of 80.72% of index cases. Further investigation needed to continue such follow-up for all TB cases treated under the RNTCP for effective end-TB strategy. Keywords: tuberculosis treatment, follow-up, relapses, RNTCP Correspondence: Ramniwas Mahore. Department Of Community Medicine. G R Medical College Gwalior 474009 Madhya Pradesh, India. Email: Drmahore@gmail.com. Mobile: 9425334365.
Azhar G (2012). DOTS for TB relapse in India: A systematic review. Lung India. 29(2):147-53. doi: 10.4103/0970-2113.95320.
Bareilly UP, Ahmed F, Shrotriya VP, Gupta SB, Kariwal P, Imtiaz D (2015). A study on treatment outcome of tuberculosis patients registered at tuberculosis unit (TU). Int J Curr Med Appl Sci. 6(3): 174–176.
Basu R, Kundu S, Biswas D, Nath S, Sarkar A, Bhattacharya A (2021). Socio-Demographic and Clinical Profile of Drug Resistant Tuberculosis Patients in a Tertiary Care Centre of Kolkata. Indian J Community Health. 33: 608–614. doi: 10.47203/IJCH.2021.v33i04.012.
Bobokhojaev OI, Sirodjidinova UY, Djumaev RR, Makhmudzoda IS (2018). To The Issue of The Reactivation of The Tuberculosis Process. Avicenna Bulletin.
Central TB Division (2017). National Strategic Plan for Tuberculosis Elimination 2017–2025.
Chiang CY, Riley LW (2005). Exogenous reinfection in tuberculosis. Lancet Infect Dis. doi: 10.1016/S1473-3099-(05)70240-1.
Cox H, Kebede Y, Allamuratova S, Ismailov G, Davletmuratova Z, Byrnes G, Stone C, et al. (2006). Tuberculosis recurrence and mortality after successful treatment: Impact of drug resistance. PLoS Med. 3: 1836–1843. doi: 10.1371/journal.pmed.0030384.
Datiko DG, Lindtjørn B (2009). Tuberculosis recurrence in smear-positive patients cured under DOTS in south-ern Ethiopia: Retrospective cohort study. BMC Public Health. 9(348). doi: 10.1186/1471-2458-9-348.
Dave P, Rade K, Modi B, Solanki R, Patel P, Shah A, Vadera B (2013). Assessment of longterm outcome among new smear positive pulmonary Tb patients treated with intermittent regimen under Rntcp-A. Natl j community med. 4: 189–194.
Didilescu C, Ibraim E, Plopeanu D (2000). A study of the risk factors for relapse in pulmonary tuberculosis patients and the results of the retreatment. Pneumologia. 49(4):247-52.
Hooi LN, Goh KY (1995). A hospital-based audit of tuberculosis deaths. Med J Mala Asia. 50: 306–313.
Hung CL, Chien JY, Ou CY (2015). Associated factors for tuberculosis recurrence in Taiwan: A nationwide nested case-control study from 1998 to 2010. PLoS One. 10(5): e0124822. doi: 10.1371/journal.pone.0124822.
Joseph MR, Thomas RA, Nair S, Balakrishnan S, Jayasankar S (2015). Directly observed treatment short course for tuberculosis, What happens to them in the long term?. Indian J Tuberc. 62: 29–35. doi: 10.1016/j.ijtb.2015.02.005.
Mathur N, Chatla C, Syed S, Patel Y, Pattnaik S, Mathai D, Rajesham A (2019). Prospective 1-year follow-up study of all cured, new sputum smear positive tuberculosis patients under the Revised National Tuberculosis Control Program in Hyderabad, Telangana State, India. Lung India. 36(6):519-524. doi:10.4103/lungindia.lungindia_143_19.
Millet JP, Shaw E, Orcau À, Casals M, Miró JM, Caylà JA, Vidal R et al. (2013). Tuberculosis Recurrence after Completion Treatment in a European City: Reinfection or Relapse? PLoS One. 8. doi: 10.1371/journal.pone.0064898.
MoHFW (2014). Standards for TB care in india. Central TB Division Ministry of Health and Family Welfare Government of India and World Health Organization.
Mukherjee P, Ray KP, Kumar LS (2015). Sociodemographic and clinical profile of multi drug resistant tuberculosis patients: a study at drug resistant tuberculosis centers of Kolkata. IOSR-JDMS. 14: 2279–861. doi:10.9790/0853-14845258.
Palmieri F, Girardi E, Pellicelli AM, Rianda A, Bordi E, Busi RE, Petrosillo N et al. (2002. Pulmonary tuberculosis in HIV-infected patients presenting with normal chest radiograph and negative sputum smear. Infection. 30:68–74. doi: 10.1007/s15010-002-2062-9.
Piparva KG (2017). Treatment Outcome of Tuberculosis Patients on Dots Therapy for Category 1 And 2 At District Tuberculosis Centre. Int J Pharm Sci Res. 8: 207–212. doi: 10.13040/IJPS-R.0975-8232.8(1).207-12.
Prasad R, Verma S, Shrivastava P, Kant S, Kushwaha RAS, Kumar S (2008). A follow up study on revised national tuberculosis control programme (RNTCP): Results from a single centre study. Lung India. 25(4):142-4. doi: 10.4103/0970-2113.45277.
Sadacharam K, Gopi PG, Chandrasekaran V, Eusuff SI, Subramani R, Santha T, Narayanan PR (2007). Status of smear-positive TB patients at 2-3 years after initiation of treatment under a DOTS programme. Indian J Tuberc. 54: 199–203.
Shao Y, Song H, Li G, Li Y, Li Y, Zhu L, Lu W et al. (2021). Relapse or Re-Infection, the Situation of Recurrent Tuberculosis in Eastern China. Front Cell Infect Microbiol. 11(200). doi: 10.3389/FCIMB.2021.638990/BIBTEX.
Sharma R, Prajapati S, Patel P, Patel B, Gajjar S, Bapat N (2019). An outcome-based follow-up study of cured category i Pulmonary Tuberculosis Adult Cases from Various Tuberculosis Units under Revised National Tuberculosis Control Program from a Western Indian City. IJCM. 44: 48–52. doi: 10.4103/ijcm.IJCM_310_18.
Sonnenberg P, Murray J, Glynn JR, Shearer S, Kambashi B, Godfrey-Faussett P (2001). HIV-1 and recurrence, relapse, and reinfection of tuberculosis after cure: A cohort study in South African mineworkers. Lancet. 358: 1687–1693. doi: 10.1016/S0140-6736(01)06712-5.
Thomas A, Gopi PG, Santha T, Chandra-sekaran V, Subramani R, Selvakumar N, Eusuff SI et al. (2005). Predictors of relapse among pulmonary tuberculosis patients treated in a DOTS programme in South India. Int J Tuberc Lung Dis. 9.
Saha TK (2013). A Follow-up Study on the Performance, Outcome, and present status of patients treated Under ‘RNTCP’ in a slum area of Kolkata. IOSR-JDMS. 6: 63–67. doi: 10.9790/0853-0636367.
Verver S, Warren RM, Beyers N, Richardson M, Spuy GDVD, Borgdorff MW, Enarson DA, et al. (2005). Rate of reinfection tuberculosis after successful treatment is higher than rate of new tuberculosis. Am J Respir Crit Care Med. 171:1430–1435. doi:10.1164/rccm.200409-1200OC.
WHO (2019). Global tuberculosis report 2019. World Health Organization.
Yusupova S, Nurullayeva S, Sadikov U, Gadoev J, Alikhanova N, Zachariah R, Harries A (2016). Characteristics And Treatment Outcomes of New Pulmonary Tuberculosis Patients with Comorbidities In The Samarkand Region, Uzbekistan. Public health panorama. 02 (01): 57-64.
Zong Z, Huo F, Shi J, Jing W, Ma Y, Liang Q, Jiang G et al. (2018). Relapse versus reinfection of recurrent tuberculosis patients in a national tuberculosis specialized hospital in Beijing, China. Front Microbiol. 9. doi: 10.3389/FMICB.2018.01858/BIBTEX.