Faculty of Public Health - Andalas University - OCS, 13th IEA SEA Meeting and ICPH - SDev

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Presumptive DR-TB patients offered DST under PMDT include non-converters and failures of first line treatment, previously treated TB patients at diagnosis, TB-HIV patients and TB patients who are contacts of MDR-TB patients.
Quazi Toufique Ahmed

Last modified: 2018-08-09

Abstract


Background:Sikkim,a remote state in India bordering China and Nepal with high levels of DR-TB(15.5 DR-TB cases/100,000 reported in 2016 against the national estimate of 11 cases/100,000),in-spite of good treatment-success-rates among

TB-patients treated since 2002 under Revised National TB program(RNTCP).Here, we report the treatment-outcomes of DR-TB patients treated in Sikkim.


Materials
and methods:Programatic-Management of DRTB(PMDT)was launched in Sikkim in 2012 with 2 year DR-TB-regimen comprising 6 drugs-Kanamycin, Levofloxacin,Ethionamide,Pyrazinamide,Ethambutol,Cycloserine for 6-9 months(Intensive Phase)and 18 months Continuous-Phase with Levofloxacin,Ethionamide,Ethambutol,Cycloserine.Presumptive DR-TB patients offered DST under PMDT include non-converters and failures of first line treatment,previously treated TB-patients at diagnosis,TB-HIV and MDR-TB contacts.

Results
:Treatment-outcomes have been reported from 2012, 2013, 2014 and 2015 cohorts till date.In spite of the high DR-TB settings good treatment success outcomes were reported were 67% in 2012), 61% in 2013 ,65% in 2014, 68% in 2015 which is above national average~50%.


Conclusions:Sikkim has higher treatment success rates compared to national average in
-spite of high DR-TB rates.However, high death rates, failures and LFU is a cause of concern. Interventions like universal DST, baseline SL-LPA, shorter MDR-TB regimen, introduction of Bedaquiline, counselling, social protection and adherence monitoring may further improve the treatment success rates.

Long-term follow-up is necessary to ensure relapse free cure.