Sharing Five Years Experience of Delivering DRTB Services from a Tertiary Care Setting-A Descriptive Study
Abstract
Background: The estimated global annual mortality from Tuberculosis (TB) is close to 2 million. Although management of TB has faced many challenges in the past, the emergence of multidrug resistant (MDR) and extremely drug resistant (XDR) tuberculosis has taken the role of adding oil to fire phenomenon jeopardising the efforts of a proper tuberculosis control programme. In a country like India where the prevalence of the disease as well as the population density are factors aiding the maintenance of a constant pool of Tuberculosis patients, Programmatic Management of Drug resistant Tuberculosis (PMDT) is projected as the only solution for managing MDR & XDR patients. Five years of our experience in dealing with these patients has been really rewarding. This paper aims to share the experience we had in managing these challenging cases which were a constant threat to the community.
Aim: To analyze the profile and management aspects of multidrug resistant and extremely drug resistant tuberculosis started on second line medications from the DOTs plus site at Kozhikode Government Medical College over a period of five years.
Methodology: The study was a descriptive analysis conducted in the Department of Pulmonary Medicine in 512 MDR-TB patients and 24 XDR patients enrolled under DOTs Plus programme during the period between February 2009 and June 2014 and analysing the profile and management aspects of patient care under the Drug resistant TB (DRTB) services offered from our DOTs plus site to patients coming from the northern seven districts of Kerala.
Results: The pattern of patient inflow from all the northern districts was uniform except Wynad and Lakshadweep where the total population is much lower than the other districts. Males accounted for 78.9% cases registered. There were 34% cases of diabetics amongst the MDR-TB patients. Only 1.8% cases had co existent HIV infection.56.4% cases belonged to the more than 45 kg weight band. Only 1.6% cases had proven extra pulmonary MDR TB. 5.7% cases registered had definite contact history. 41.4% cases amongst the contact positive group belonged to the category of health care worker. The success rates in outcomes were to the tune of 64.2% and no patients waiting for treatment initiation after instituting decentralisation of DRTB services which is a first time initiative at the Kozhikode DRTB site and the results are well in accordance with international standards of care in managing MDR-Tuberculosis.
Conclusion: This study showed that despite implementing DOTs programme throughout the state, there was a uniform rate of emergence noted in the number of multi drug resistant tuberculosis. There were a high proportion of diabetics among these patients and pulmonary form of drug resistance was much more common than extra pulmonary. In a properly functioning DRTB centre decentralising the services to its peripheral centres has not compromised in the standards of care as evidenced by the success rate reported. However 5.3% cases developed XDR-TB which poses a major threat to the community as well as the policy makers as we are not left with newer potent molecules to curtail this menace.
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