1. R Nagar 1, Debashish Kundu2, S Chandra2 , A Khanna1
1 Directorate of Health Services, Delhi, India; 2 WHO Country Office for India
Does type of Tuberculosis treatment regimen, daily or intermittent, taken in the past affect recurrence of TB? A study in GTB Chest Clinic, Delhi, India
Background
Results
Goals of TB treatment are to stop transmission of disease, save life and to have relapse free cure to prevent drug resistance.
In India, Tuberculosis (TB) patients are treated with short-course intermittent regimen (Thrice-weekly) following DOTS guideline under the Revised National TB Control Programme (RNTCP) and private sector follows daily regimen without DOTS.
The patients once treated, are not followed-up unless they come to the health care provider, in public or private setting, again with symptoms mainly due to recurrence of TB disease.
Recurrent TB is considered to be an important measure of the efficacy of TB treatment, has lower treatment success rate as compared to new TB patients and is associated with drug resistance.
There is limited evidence under the programmatic setting on recurrence of TB after completion of treatment.
Of 214 recurrent TB patients registered in 2012, 148(69%) had source of previous treatment through intermittent regimen in RNTCP and 66 (31%) had taken daily regimen privately (Non-RNTCP).
119 (80%) TB patients recurred within 5 years of last completed TB treatment with intermittent regimen in comparison to 32 (48%) with daily regimen.
Also, 11 (7%) TB cases recurred after 10 years in comparison to 31 (47%) with daily regimen.
Table 1: Comparison between last TB treatment taken from RNTCP or Non RNTCP source and recurrence of TB symptoms in years
Source of previous treatment
Recurrence after last successfully TB Treatment Taken (in years)
Total
< 5 years
Between 5 years to 10 years
> 10 years
RNTCP (Intermittent Regimen)
119 (80%)
18 (12%)
11 (7%)
148
Non RNTCP (Daily Regimen from private or public)
32 (48%)
3 (5%)
31 (47%) 66
Objective
This study was conducted to know the proportion of recurrence of TB disease after treatment completion from source of previous treatment - RNTCP and non-RNTCP in Guru Teg Bahadur (GTB) Chest Clinic of Delhi, India.
Discussions
Design/ Methods
Among a cohort of recurrent TB cases registered under RNTCP, majority had previous treatment with intermittent regimen.
Recurrence was much sooner among those patients received intermittent regimen compared to daily regimen.
A cross sectional study design was used.
After the diagnosis of TB, every TB patient was asked by the treating medical officer about the history of TB treatment, duration since last TB treatment taken and occurrence of current symptoms in months, age, sex and source of previous treatment – RNTCP, following intermittent regimen, or non-RNTCP, following daily regimen.
All registered recurrent TB patients from 1st January to 31st December 2012 were recruited for the study purpose. The data variables were collected by Senior TB Treatment Supervisors (STS) using a structured proforma and analyzed using Microsoft Excel.
Conclusions
Observed high recurrence of TB with intermittent regimen
Recommendations for the TB Programme
RNTCP in line with the Standards of TB Care in India (STCI) could consider offering daily regimen to all TB patients. 1