Annals of Tropical Medicine and Public Health

LETTER TO THE EDITOR
Year
: 2014  |  Volume : 7  |  Issue : 1  |  Page : 79-

Role of drug-resistant tuberculosis center in improving the treatment outcome in tuberculosis patients


Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy 
 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, 3rd floor, Thiruporur-Guduvancherry Main Road, Sembakkam Post, Kancheepuram - 603 108, Tamil Nadu
India




How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Role of drug-resistant tuberculosis center in improving the treatment outcome in tuberculosis patients.Ann Trop Med Public Health 2014;7:79-79


How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Role of drug-resistant tuberculosis center in improving the treatment outcome in tuberculosis patients. Ann Trop Med Public Health [serial online] 2014 [cited 2019 Dec 6 ];7:79-79
Available from: http://www.atmph.org/text.asp?2014/7/1/79/145046


Full Text

Dear Sir,

Under Indian circumstances, a patient is diagnosed to be suffering from multidrug-resistant tuberculosis (MDR-TB), provided sputum culture is positive for Mycobacterium tuberculosis bacilli and is resistant to isoniazid and rifampicin with or without other anti-TB drugs, presuming that the drug sensitivity test (DST) has been done in a laboratory certified by Revised National TB Control Program (RNTCP). [1] Although, the global TB report - 2013 suggest that the incidence of MDR-TB is on the rise, the exact case load is not known owing to the absence of drug resistance surveillance universally. [2] To brought about a significant reduction in the number of drug resistant TB cases in the Indian circumstances, the program managers have advocated for implementation of a good quality Directly Observed Treatment program. [3]

Research findings have revealed that multiple potential determinants (viz. duration of therapy, individual susceptibility, adverse drug reactions, family support, etc.) eventually determine the final treatment outcome. [4],[5] On account of longer treatment duration, infrastructure constraints, and need of periodic follow-up throughout the course of treatment, the program advocates for decentralization of treatment. [1] However, decentralization has its own associated challenges as it requires continuous monitoring & supervision to meet with the needs of the patients. Thus, an expert resource center called as Drug-resistant TB (DR-TB) center has been established in Indian settings to cater a wide range of services to ten million population. [1] These centers have been instituted within the premises of a government medical college hospital. [1],[2]

The functioning of the DR-TB center is executed through a DR-TB center committee, which generally comprises of a Chairperson - Medical Superintendent / Director of the institute; Vice-chairperson - Head of respiratory medicine / general medicine department; Nodal officer; Medical officer of the DR-TB center; Clinicians - Heads of Psychiatry / Gynecology / ENT / Microbiology; one pulmonologist from NGO / private sector; and local program managers. [1]

The DR-TB center has a defining role in the management of drug resistant forms of TB, namely in conducting pre-treatment evaluation (viz. a thorough clinical / laboratory evaluation by a team of doctors to ensure suitability of different patients with the line of management); initiation of treatment; maintenance of hospital wards; implementation of airborne infection control measures; management of severe adverse drug reactions; free laboratory investigations; alterations in the line of management during the course of treatment; shifting patient from intensive phase to continuation phase; transfer-in and transfer-out of patients; management of records; and outcome declaration. [1],[3]

In conclusion, the DR-TB center plays a crucial role in not only ensuring the best possible outcome for drug resistant patients started on treatment, but even acts as a resource center for providing timely guidance to the program managers.

References

1Guidelines for PMDT in India, 2012. Available from: http://www.tbcindia.nic.in/documents.html. [Last accessed on 2013 Sep 22].
2World Health Organization. Global Tuberculosis Control Report 2012. Geneva: WHO press; 2012.
3Managing the RNTCP in your area - A training course (Modules 1-4). Available from: http://www.tbcindia.nic.in/documents.html. [Last accessed on 2013 Sep 22].
4Hirpa S, Medhin G, Girma B, Melese M, Mekonen A, Suarez P, et al. Determinants of multidrug-resistant tuberculosis in patients who underwent first-line treatment in Addis Ababa: A case control study. BMC Public Health 2013;13:782.
5Sagar T, Singh NP, Kashyap B, Kaur IR. Current status of multidrug resistant tuberculosis in a tertiary care hospital of East Delhi. J Postgrad Med 2013;59:173-6.