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Shewade HD, Gupta V, Satyanarayana S, Kumar S, Pandey P, Bajpai UN, Tripathy JP, Kathirvel S, Pandurangan S, Mohanty S, Ghule VH, Sagili KD, Prasad BM, Singh P, Singh K, Jayaraman G, Rajeswaran P, Biswas M, Mallick G, Naqvi AJ, Bharadwaj AK, Sathiyanarayanan K, Pathak A, Mohan N, Rao R, Kumar AMV, Chadha SS. Active versus passive case finding for tuberculosis in marginalised and vulnerable populations in India: comparison of treatment outcomes. Glob Health Action 2020; 12:1656451. [PMID: 31475635 PMCID: PMC6735288 DOI: 10.1080/16549716.2019.1656451] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Community-based active case finding (ACF) for tuberculosis (TB) implemented among marginalised and vulnerable populations in 285 districts of India resulted in reduction of diagnosis delay and prevalence of catastrophic costs due to TB diagnosis. We were interested to know whether this translated into improved treatment outcomes. Globally, there is limited published literature from marginalised and vulnerable populations on the independent effect of community-based ACF on treatment outcomes when compared to passive case finding (PCF). Objectives: To determine the relative differences in unfavourable treatment outcomes (death, loss-to-follow-up, failure, not evaluated) of ACF and PCF-diagnosed people. Methods: Cohort study involving record reviews and interviews in 18 randomly selected districts. We enrolled all ACF-diagnosed people with new smear-positive pulmonary TB, registered under the national TB programme between March 2016 and February 2017, and an equal number of randomly selected PCF-diagnosed people in the same settings. We used log binomial models to adjust for confounders. Results: Of 572 enrolled, 275 belonged to the ACF and 297 to the PCF group. The proportion of unfavourable outcomes were 10.2% (95% CI: 7.1%, 14.3%) in the ACF and 12.5% (95% CI: 9.2%, 16.7%) in the PCF group (p = 0.468). The association between ACF and unfavourable outcomes remained non-significant after adjusting for confounders available from records [aRR: 0.83 (95% CI: 0.56, 1.21)]. Due to patient non-availability at their residence, interviews were conducted for 465 (81.3%). In the 465 cohort too, there was no association after adjusting for confounders from records and interviews [aRR: 1.05 (95% CI: 0.62, 1.77)]. Conclusion: We did not find significant differences in the treatment outcomes. Due to the wide CIs, studies with larger sample sizes are urgently required. Studies are required to understand how to translate the benefits of ACF to improved treatment outcomes.
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Affiliation(s)
- Hemant Deepak Shewade
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union) , Paris , France.,Department of Operational Research , The Union South-East Asia (USEA) , New Delhi, India.,Karuna Trust , Bengaluru , India
| | - Vivek Gupta
- Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS) , New Delhi , India
| | - Srinath Satyanarayana
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union) , Paris , France
| | - Sunil Kumar
- State TB Cell , Department of Health & Family Welfare, Government of Kerala, Thiruvananthapuram , India
| | - Prabhat Pandey
- Department of TB and Communicable Diseases , The Union South-East Asia (USEA), New Delhi , India
| | - U N Bajpai
- Voluntary Health Association of India (VHAI) , New Delhi , India
| | - Jaya Prasad Tripathy
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union) , Paris , France.,Department of Operational Research , The Union South-East Asia (USEA) , New Delhi, India
| | - Soundappan Kathirvel
- Department of Operational Research , The Union South-East Asia (USEA) , New Delhi, India.,Department of Community Medicine and School of Public Health , Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh , India
| | - Sripriya Pandurangan
- Department of TB and Communicable Diseases , The Union South-East Asia (USEA), New Delhi , India
| | - Subrat Mohanty
- Department of TB and Communicable Diseases , The Union South-East Asia (USEA), New Delhi , India
| | - Vaibhav Haribhau Ghule
- Joint Efforts for Elimination of TB (JEET) Project , Foundation for Innovate New Diagnostics (FIND), New Delhi , India
| | - Karuna D Sagili
- Department of TB and Communicable Diseases , The Union South-East Asia (USEA), New Delhi , India
| | | | - Priyanka Singh
- MAMTA Health Institute for Mother and Child , New Delhi , India
| | - Kamlesh Singh
- Catholic Health Association of India (CHAI) , Telangana , India
| | - Gurukartick Jayaraman
- Resource Group for Education & Advocacy for Community Health (REACH) , Chennai , India
| | - P Rajeswaran
- Resource Group for Education & Advocacy for Community Health (REACH) , Chennai , India
| | - Moumita Biswas
- Department of TB and Communicable Diseases , The Union South-East Asia (USEA), New Delhi , India
| | - Gayadhar Mallick
- Department of TB and Communicable Diseases , The Union South-East Asia (USEA), New Delhi , India
| | - Ali Jafar Naqvi
- MAMTA Health Institute for Mother and Child , New Delhi , India
| | | | - K Sathiyanarayanan
- Resource Group for Education & Advocacy for Community Health (REACH) , Chennai , India
| | - Aniruddha Pathak
- Department of TB and Communicable Diseases , The Union South-East Asia (USEA), New Delhi , India
| | - Nisha Mohan
- Karuna Trust , Bengaluru , India.,IIHMR University, Jaipur , India
| | - Raghuram Rao
- Central TB Division, Revised National Tuberculosis Control Programme, Ministry of Health and Family Welfare , Government of India , New Delhi, India
| | - Ajay M V Kumar
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union) , Paris , France.,Department of Operational Research , The Union South-East Asia (USEA) , New Delhi, India.,Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru , India
| | - Sarabjit Singh Chadha
- Infectious Diseases, Foundation for Innovate New Diagnostics (FIND), New Delhi , India
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Shewade HD, Gupta V, Satyanarayana S, Kharate A, Murali L, Deshpande M, Kumar N, Pandey P, Bajpai UN, Tripathy JP, Kathirvel S, Pandurangan S, Mohanty S, Ghule VH, Sagili KD, Prasad BM, Nath S, Singh P, Singh K, Jayaraman G, Rajeswaran P, Srivastava BK, Biswas M, Mallick G, Bera OP, Jaisingh AJJ, Naqvi AJ, Verma P, Ansari MS, Mishra PC, Sumesh G, Barik S, Mathew V, Lohar MRS, Gaurkhede CS, Parate G, Bale SY, Koli I, Bharadwaj AK, Venkatraman G, Sathiyanarayanan K, Lal J, Sharma AK, Kumar AM, Chadha SS. Are we missing 'previously treated' smear-positive pulmonary tuberculosis under programme settings in India? A cross-sectional study. F1000Res 2019; 8:338. [PMID: 31297190 PMCID: PMC6600860 DOI: 10.12688/f1000research.18353.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2019] [Indexed: 11/22/2022] Open
Abstract
Background: In 2007, a field observation from India reported 11% misclassification among ‘new’ patients registered under the revised national tuberculosis (TB) control programme. Ten years down the line, it is important to know what proportion of newly registered patients has a past history of TB treatment for at least one month (henceforth called ‘misclassification’). Methods: A study was conducted among new smear-positive pulmonary TB patients registered between March 2016 and February 2017 in 18 randomly selected districts to determine the effectiveness of an active case-finding strategy in marginalised and vulnerable populations. We included all patients detected through active case-finding. An equal number of randomly selected patients registered through passive case-finding from marginalised and vulnerable populations in the same districts were included. Before enrolment, we enquired about any history of previous TB treatment through interviews. Results: Of 629 patients, we interviewed 521, of whom, 11% (n=56) had past history of TB treatment (public or private) for at least a month: 13% (34/268) among the active case-finding group and 9% (22/253) among the passive case-finding group (p=0.18). No factors were found to be significantly associated with misclassification. Conclusion: Around one in every ten patients registered as ‘new’ had previous history of TB treatment. Corrective measures need to be implemented, followed by monitoring of any change in the proportion of ‘previously treated’ patients among all registered patients treated under the programme at national level.
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Affiliation(s)
- Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, 75006, France.,The Union South East Asia, New Delhi, 110016, India
| | - Vivek Gupta
- All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, 75006, France
| | - Atul Kharate
- State TB Cell, Department of Health & Family Welfare, Government of Madhya Pradesh, Bhopal, 462004, India
| | - Lakshmi Murali
- State TB Cell, Department of Health & Family Welfare, Government of Tamil Nadu, Chennai, 600006, India
| | - Madhav Deshpande
- State TB Cell, Department of Health & Family Welfare, Government of Chattisgarh, Raipur, 492002, India
| | - Naresh Kumar
- State TB Cell, Department of Health & Family Welfare, Government of Punjab, Chandigarh, 160022, India
| | | | - U N Bajpai
- Voluntary Health Association of India (VHAI), New Delhi, 110016, India
| | - Jaya Prasad Tripathy
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, 75006, France.,The Union South East Asia, New Delhi, 110016, India
| | - Soundappan Kathirvel
- The Union South East Asia, New Delhi, 110016, India.,Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | | | | | | | | | | | - Sudhi Nath
- The Union South East Asia, New Delhi, 110016, India
| | - Priyanka Singh
- MAMTA Health Institute for Mother and Child, New Delhi, 110048, India
| | - Kamlesh Singh
- Catholic Health Association of India (CHAI), Secunderabad, 500009, India
| | - Gurukartick Jayaraman
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, 600014, India
| | - P Rajeswaran
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, 600014, India
| | | | | | | | | | | | - Ali Jafar Naqvi
- MAMTA Health Institute for Mother and Child, New Delhi, 110048, India
| | - Prafulla Verma
- MAMTA Health Institute for Mother and Child, New Delhi, 110048, India
| | | | - Prafulla C Mishra
- Catholic Bishops' Conference of India-Coalition for AIDS and Related Diseases(CBCI-CARD), New Delhi, 110001, India
| | - G Sumesh
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, 600014, India
| | - Sanjeeb Barik
- Emmanuel Hospital Association (EHA), New Delhi, 110019, India
| | - Vijesh Mathew
- Catholic Health Association of India (CHAI), Secunderabad, 500009, India
| | | | | | - Ganesh Parate
- MAMTA Health Institute for Mother and Child, New Delhi, 110048, India
| | - Sharifa Yasin Bale
- Catholic Health Association of India (CHAI), Secunderabad, 500009, India
| | - Ishwar Koli
- Catholic Health Association of India (CHAI), Secunderabad, 500009, India
| | | | - G Venkatraman
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, 600014, India
| | - K Sathiyanarayanan
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, 600014, India
| | - Jinesh Lal
- Catholic Health Association of India (CHAI), Secunderabad, 500009, India
| | | | - Ajay Mv Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, 75006, France.,The Union South East Asia, New Delhi, 110016, India.,Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, 575018, India
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3
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Shewade HD, Gupta V, Satyanarayana S, Pandey P, Bajpai UN, Tripathy JP, Kathirvel S, Pandurangan S, Mohanty S, Ghule VH, Sagili KD, Prasad BM, Nath S, Singh P, Singh K, Singh R, Jayaraman G, Rajeswaran P, Srivastava BK, Biswas M, Mallick G, Bera OP, Sahai KN, Murali L, Kamble S, Deshpande M, Kumar N, Kumar S, Jaisingh AJJ, Naqvi AJ, Verma P, Ansari MS, Mishra PC, Sumesh G, Barik S, Mathew V, Lohar MRS, Gaurkhede CS, Parate G, Bale SY, Koli I, Bharadwaj AK, Venkatraman G, Sathiyanarayanan K, Lal J, Sharma AK, Rao R, Kumar AMV, Chadha SS. Patient characteristics, health seeking and delays among new sputum smear positive TB patients identified through active case finding when compared to passive case finding in India. PLoS One 2019; 14:e0213345. [PMID: 30865730 PMCID: PMC6415860 DOI: 10.1371/journal.pone.0213345] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 02/20/2019] [Indexed: 11/18/2022] Open
Abstract
Background Axshya SAMVAD is an active tuberculosis (TB) case finding (ACF) strategy under project Axshya (Axshya meaning ‘free of TB’ and SAMVAD meaning ‘conversation’) among marginalized and vulnerable populations in 285 districts of India. Objectives To compare patient characteristics, health seeking, delays in diagnosis and treatment initiation among new sputum smear positive TB patients detected through ACF and passive case finding (PCF) under the national TB programme in marginalized and vulnerable populations between March 2016 and February 2017. Methods This observational analytic study was conducted in 18 randomly sampled Axshya districts. We enrolled all TB patients detected through ACF and an equal number of randomly selected patients detected through PCF in the same settings. Data on patient characteristics, health seeking and delays were collected through record review and patient interviews (at their residence). Delays included patient level delay (from eligibility for sputum examination to first contact with any health care provider (HCP)), health system level diagnosis delay (from contact with first HCP to TB diagnosis) and treatment initiation delays (from diagnosis to treatment initiation). Total delay was the sum of patient level, health system level diagnosis delay and treatment initiation delays. Results We included 234 ACF-diagnosed and 231 PCF-diagnosed patients. When compared to PCF, ACF patients were relatively older (≥65 years, 14% versus 8%, p = 0.041), had no formal education (57% versus 36%, p<0.001), had lower monthly income per capita (median 13.1 versus 15.7 USD, p = 0.014), were more likely from rural areas (92% versus 81%, p<0.002) and residing far away from the sputum microscopy centres (more than 15 km, 24% versus 18%, p = 0.126). Fewer patients had history of significant loss of weight (68% versus 78%, p = 0.011) and sputum grade of 3+ (15% versus 21%, p = 0.060). Compared to PCF, HCP visits among ACF patients was significantly lower (median one versus two HCPs, p<0.001). ACF patients had significantly lower health system level diagnosis delay (median five versus 19 days, p = 0.008) and the association remained significant after adjusting for potential confounders. Patient level and total delays were not significantly different. Conclusion Axshya SAMVAD linked the most impoverished communities to TB care and resulted in reduction of health system level diagnosis delay.
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Affiliation(s)
- Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- * E-mail:
| | - Vivek Gupta
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Prabhat Pandey
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - U. N. Bajpai
- Voluntary Health Association of India (VHAI), New Delhi, India
| | - Jaya Prasad Tripathy
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Soundappan Kathirvel
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sripriya Pandurangan
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - Subrat Mohanty
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - Vaibhav Haribhau Ghule
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - Karuna D. Sagili
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - Banuru Muralidhara Prasad
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - Sudhi Nath
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - Priyanka Singh
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Kamlesh Singh
- Catholic Health Association of India (CHAI), Telangana, India
| | - Ramesh Singh
- Voluntary Health Association of India (VHAI), New Delhi, India
| | - Gurukartick Jayaraman
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | - P. Rajeswaran
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | | | - Moumita Biswas
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - Gayadhar Mallick
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - Om Prakash Bera
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - K. N. Sahai
- State TB Cell, Department of Health & Family Welfare, Government of Bihar, Patna, India
| | - Lakshmi Murali
- State TB Cell, Department of Health & Family Welfare, Government of Tamil Nadu, Chennai, India
| | - Sanjeev Kamble
- State TB Cell, Health Department, Government of Maharashtra, Pune, India
| | - Madhav Deshpande
- State TB Cell, Department of Health & Family Welfare, Government of Chattisgarh, Raipur, India
| | - Naresh Kumar
- State TB Cell, Department of Health & Family Welfare, Government of Punjab, Chandigarh, India
| | - Sunil Kumar
- State TB Cell, Department of Health & Family Welfare, Government of Kerala, Thiruvananthapuram, India
| | | | - Ali Jafar Naqvi
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Prafulla Verma
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | | | - Prafulla C. Mishra
- Catholic Bishops’ Conference of India-Coalition for AIDS and Related Diseases (CBCI-CARD), New Delhi, India
| | - G Sumesh
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | - Sanjeeb Barik
- Emmanuel Hospital Association (EHA), New Delhi, India
| | - Vijesh Mathew
- Catholic Health Association of India (CHAI), Telangana, India
| | | | | | - Ganesh Parate
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | | | - Ishwar Koli
- Catholic Health Association of India (CHAI), Telangana, India
| | | | - G. Venkatraman
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | - K. Sathiyanarayanan
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | - Jinesh Lal
- Catholic Health Association of India (CHAI), Telangana, India
| | | | - Raghuram Rao
- Central TB Division, Revised National Tuberculosis Control Programme, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Ajay M. V. Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Sarabjit Singh Chadha
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
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Sagili KD, Satyanarayana S, Chadha SS, Wilson NC, Kumar AMV, Moonan PK, Oeltmann JE, Chadha VK, Nagaraja SB, Ghosh S, Q Lo T, Volkmann T, Willis M, Shringarpure K, Reddy RC, Kumar P, Nair SA, Rao R, Yassin M, Mwangala P, Zachariah R, Tonsing J, Harries AD, Khaparde S. Operational research within a Global Fund supported tuberculosis project in India: why, how and its contribution towards change in policy and practice. Glob Health Action 2018; 11:1445467. [PMID: 29553308 PMCID: PMC5912428 DOI: 10.1080/16549716.2018.1445467] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The Global Fund encourages operational research (OR) in all its grants; however very few reports describe this aspect. In India, Project Axshya was supported by a Global Fund grant to improve the reach and visibility of the government Tuberculosis (TB) services among marginalised and vulnerable communities. OR was incorporated to build research capacity of professionals working with the national TB programme and to generate evidence to inform policies and practices. OBJECTIVES To describe how Project Axshya facilitated building OR capacity within the country, helped in addressing several TB control priority research questions, documented project activities and their outcomes, and influenced policy and practice. METHODS From September 2010 to September 2016, three key OR-related activities were implemented. First, practical output-oriented modular training courses were conducted (n = 3) to build research capacity of personnel involved in the TB programme, co-facilitated by The Union, in collaboration with the national TB programme, WHO country office and CDC, Atlanta. Second, two large-scale Knowledge, Attitude and Practice (KAP) surveys were conducted at baseline and mid-project to assess the changes pertaining to TB knowledge, attitudes and practices among the general population, TB patients and health care providers over the project period. Third, studies were conducted to describe the project's core activities and outcomes. RESULTS In the training courses, 44 participant teams were supported to develop research protocols on topics of national priority, resulting in 28 peer-reviewed scientific publications. The KAP surveys and description of project activities resulted in 14 peer-reviewed publications. Of the published papers at least 12 have influenced change in policy or practice. CONCLUSIONS OR within a Global Fund supported TB project has resulted in building OR capacity, facilitating research in areas of national priority and influencing policy and practice. We believe this experience will provide guidance for undertaking OR in Global Fund projects.
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Affiliation(s)
- Karuna D Sagili
- a Department of Tuberculosis and Communicable Diseases , International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office , New Delhi , India
| | - Srinath Satyanarayana
- b Centre for Operational Research , International Union Against Tuberculosis and Lung Disease , Paris , France
| | - Sarabjit S Chadha
- a Department of Tuberculosis and Communicable Diseases , International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office , New Delhi , India
| | - Nevin C Wilson
- c Independent Senior Public Health Consultant , Nilgiris , Tamil Nadu , India
| | - Ajay M V Kumar
- b Centre for Operational Research , International Union Against Tuberculosis and Lung Disease , Paris , France
| | - Patrick K Moonan
- d Division of Global HIV and Tuberculosis , US Centers for Disease Control , Atlanta , GA , USA
| | - John E Oeltmann
- d Division of Global HIV and Tuberculosis , US Centers for Disease Control , Atlanta , GA , USA
| | - Vineet K Chadha
- e Epidemiology and Research Division , National Tuberculosis Institute , Bangalore , India
| | | | - Smita Ghosh
- d Division of Global HIV and Tuberculosis , US Centers for Disease Control , Atlanta , GA , USA
| | - Terrence Q Lo
- d Division of Global HIV and Tuberculosis , US Centers for Disease Control , Atlanta , GA , USA
| | - Tyson Volkmann
- d Division of Global HIV and Tuberculosis , US Centers for Disease Control , Atlanta , GA , USA
| | - Matthew Willis
- d Division of Global HIV and Tuberculosis , US Centers for Disease Control , Atlanta , GA , USA
| | - Kalpita Shringarpure
- g Department of Community Medicine , Government Medical College and SSG Hospital , Vadodara , India
| | | | - Prahlad Kumar
- h National Tuberculosis Institute , Bangalore , India
| | - Sreenivas A Nair
- i World Health Organisation India Country Office , New Delhi , India
| | - Raghuram Rao
- j Central Tuberculosis Division , Ministry of Health and Family Welfare, Government of India
| | - Mohammed Yassin
- k The Global Fund to fight AIDS , Tuberculosis and Malaria , Geneva , Switzerland
| | - Perry Mwangala
- k The Global Fund to fight AIDS , Tuberculosis and Malaria , Geneva , Switzerland
| | - Rony Zachariah
- l Médecins sans Frontières , Brussels Operational Center (LuxoR) , Luxembourg City , Luxembourg
| | - Jamhoih Tonsing
- m International Union Against Tuberculosis and Lung Disease , South-East Asia Regional Office , New Delhi , India
| | - Anthony D Harries
- b Centre for Operational Research , International Union Against Tuberculosis and Lung Disease , Paris , France
| | - Sunil Khaparde
- j Central Tuberculosis Division , Ministry of Health and Family Welfare, Government of India
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5
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Shewade HD, Gupta V, Satyanarayana S, Kharate A, Sahai K, Murali L, Kamble S, Deshpande M, Kumar N, Kumar S, Pandey P, Bajpai U, Tripathy JP, Kathirvel S, Pandurangan S, Mohanty S, Ghule VH, Sagili KD, Prasad BM, Nath S, Singh P, Singh K, Singh R, Jayaraman G, Rajeswaran P, Srivastava BK, Biswas M, Mallick G, Bera OP, Jaisingh AJJ, Naqvi AJ, Verma P, Ansari MS, Mishra PC, Sumesh G, Barik S, Mathew V, Lohar MRS, Gaurkhede CS, Parate G, Bale SY, Koli I, Bharadwaj AK, Venkatraman G, Sathiyanarayanan K, Lal J, Sharma AK, Rao R, Kumar AM, Chadha SS. Active case finding among marginalised and vulnerable populations reduces catastrophic costs due to tuberculosis diagnosis. Glob Health Action 2018; 11:1494897. [PMID: 30173603 PMCID: PMC6129780 DOI: 10.1080/16549716.2018.1494897] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/25/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND There is limited evidence on whether active case finding (ACF) among marginalised and vulnerable populations mitigates the financial burden during tuberculosis (TB) diagnosis. OBJECTIVES To determine the effect of ACF among marginalised and vulnerable populations on prevalence and inequity of catastrophic costs due to TB diagnosis among TB-affected households when compared with passive case finding (PCF). METHODS In 18 randomly sampled ACF districts in India, during March 2016 to February 2017, we enrolled all new sputum-smear-positive TB patients detected through ACF and an equal number of randomly selected patients detected through PCF. Direct (medical and non-medical) and indirect costs due to TB diagnosis were collected through patient interviews at their residence. We defined costs due to TB diagnosis as 'catastrophic' if the total costs (direct and indirect) due to TB diagnosis exceeded 20% of annual pre-TB household income. We used concentration curves and indices to assess the extent of inequity. RESULTS When compared with patients detected through PCF (n = 231), ACF patients (n = 234) incurred lower median total costs (US$ 4.6 and 20.4, p < 0.001). The prevalence of catastrophic costs in ACF and PCF was 10.3 and 11.5% respectively. Adjusted analysis showed that patients detected through ACF had a 32% lower prevalence of catastrophic costs relative to PCF [adjusted prevalence ratio (95% CI): 0.68 (0.69, 0.97)]. The concentration indices (95% CI) for total costs in both ACF [-0.15 (-0.32, 0.11)] and PCF [-0.06 (-0.20, 0.08)] were not significantly different from the line of equality and each other. The concentration indices (95% CI) for catastrophic costs in both ACF [-0.60 (-0.81, -0.39)] and PCF [-0.58 (-0.78, -0.38)] were not significantly different from each other: however, both the curves had a significant distribution among the poorest quintiles. CONCLUSION ACF among marginalised and vulnerable populations reduced total costs and prevalence of catastrophic costs due to TB diagnosis, but could not address inequity.
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Affiliation(s)
- Hemant Deepak Shewade
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Vivek Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Srinath Satyanarayana
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Atul Kharate
- State TB Cell, Department of Health & Family Welfare, Government of Madhya Pradesh, Bhopal, India
| | - K.N. Sahai
- State TB Cell, Department of Health & Family Welfare, Government of Bihar, Patna, India
| | - Lakshmi Murali
- State TB Cell, Department of Health & Family Welfare, Government of Tamil Nadu, Chennai, India
| | - Sanjeev Kamble
- State TB Cell, Health Department, Government of Maharashtra, Pune, India
| | - Madhav Deshpande
- State TB Cell, Department of Health & Family Welfare, Government of Chattisgarh, Raipur, India
| | - Naresh Kumar
- State TB Cell, Department of Health & Family Welfare, Government of Punjab, Chandigarh, India
| | - Sunil Kumar
- State TB Cell, Department of Health & Family Welfare, Government of Kerala, Thiruvananthapuram, India
| | - Prabhat Pandey
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - U.N. Bajpai
- Voluntary Health Association of India (VHAI), New Delhi, India
| | - Jaya Prasad Tripathy
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Soundappan Kathirvel
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- Department of Community Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sripriya Pandurangan
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Subrat Mohanty
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Vaibhav Haribhau Ghule
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Karuna D. Sagili
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Banuru Muralidhara Prasad
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Sudhi Nath
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Priyanka Singh
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Kamlesh Singh
- Catholic Health Association of India (CHAI), Telangana, India
| | - Ramesh Singh
- Voluntary Health Association of India (VHAI), New Delhi, India
| | - Gurukartick Jayaraman
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | - P. Rajeswaran
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | | | - Moumita Biswas
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Gayadhar Mallick
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - Om Prakash Bera
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | | | - Ali Jafar Naqvi
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | - Prafulla Verma
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | | | - Prafulla C. Mishra
- Catholic Bishops’ Conference of India-Coalition for AIDS and Related Diseases (CBCI-CARD), New Delhi, India
| | - G. Sumesh
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | - Sanjeeb Barik
- Emmanuel Hospital Association (EHA), New Delhi, India
| | - Vijesh Mathew
- Catholic Health Association of India (CHAI), Telangana, India
| | | | | | - Ganesh Parate
- MAMTA Health Institute for Mother and Child, New Delhi, India
| | | | - Ishwar Koli
- Catholic Health Association of India (CHAI), Telangana, India
| | | | - G. Venkatraman
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | - K. Sathiyanarayanan
- Resource Group for Education & Advocacy for Community Health (REACH), Chennai, India
| | - Jinesh Lal
- Catholic Health Association of India (CHAI), Telangana, India
| | | | - Raghuram Rao
- Central TB Division, Revised National Tuberculosis Control Programme, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Ajay M.V. Kumar
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Sarabjit Singh Chadha
- Department of TB and Communicable Diseases, International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
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