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Jeyashree K, Thangaraj J, Rade K, Modi B, Selvaraju S, Velusamy S, Akhil S, Vijayageetha M, Sudha Rani D, Sabarinathan R, Manikandanesan S, Elumalai R, Natarajan M, Joseph B, Mahapatra A, Shamim A, Shah A, Bhardwaj A, Purty A, Vadera B, Sridhar A, Chowdhury A, Shafie A, Choudhury A, Dhrubjyoti D, Solanki H, Sirmanwar K, Khaparde K, Parmar M, Dahiya N, Debdutta P, Ahmed Q, Ramachandran R, Prasad R, Shinde R, Baruah R, Chauhan S, Bharaswadkar S, Achanta S, Sharath BN, Balakrishnan S, Chandra S, Khumukcham S, Mandal S, Chalil S, Shah V, Roddawar V, Rao R, Sachdeva K, Murhekar M. Estimation of tuberculosis incidence at subnational level using three methods to monitor progress towards ending TB in India, 2015-2020. BMJ Open 2022; 12:e060197. [PMID: 35902192 PMCID: PMC9340578 DOI: 10.1136/bmjopen-2021-060197] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India. DESIGN A community-based survey, analysis of programme data and anti-TB drug sales and utilisation data. SETTING National TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status. PARTICIPANTS Each district was divided into survey units (SU) and one village/ward was randomly selected from each SU. All household members in the selected village were interviewed. Sputum from participants with a history of anti-TB therapy (ATT), those currently experiencing chest symptoms or on ATT were tested using Xpert/Rif/TrueNat. The survey continued until 30 Mycobacterium tuberculosis cases were identified in a district. OUTCOME MEASURES We calculated a direct estimate of TB incidence based on incident cases identified in the survey. We calculated an under-reporting factor by matching these cases within the TB notification system. The TB notification adjusted for this factor was the estimate by the indirect method. We also calculated TB incidence from drug sale data in the private sector and drug utilisation data in the public sector. We compared the three estimates of TB incidence in 2020 with TB incidence in 2015. RESULTS The estimated direct incidence ranged from 19 (Purba Medinipur, West Bengal) to 1457 (Jaintia Hills, Meghalaya) per 100 000 population. Indirect estimates of incidence ranged between 19 (Diu, Dadra and Nagar Haveli) and 788 (Dumka, Jharkhand) per 100 000 population. The incidence using drug sale data ranged from 19 per 100 000 population in Diu, Dadra and Nagar Haveli to 651 per 100 000 population in Centenary, Maharashtra. CONCLUSION TB incidence in 1 state, 2 UTs and 35 districts had declined by at least 20% since 2015. Two districts in India were declared TB free in 2020.
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Affiliation(s)
| | - Jeromie Thangaraj
- ICMR- National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Kiran Rade
- World Health Organization, Country Office for India, New Delhi, India
| | - Bhavesh Modi
- GMERS Medical College & Civil Hospital, Gandhinagar, Gujarat, India
| | - Sriram Selvaraju
- ICMR - National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India
| | | | - Sasidharan Akhil
- ICMR- National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | | | | | | | | | | | - Bency Joseph
- ICMR- National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Almas Shamim
- WHO-NTEP Technical Assistance Project, New Delhi, India
| | - Amar Shah
- USAID India Mission, New Delhi, Delhi, India
| | - Ashok Bhardwaj
- MM Medical College & Hospital, Kumarhatti, Solan, Himachal Pradesh, India
| | - Anil Purty
- Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Bhavin Vadera
- Wadhwani Institute of Artificial Intelligence, Mumbai, India
| | - Anand Sridhar
- WHO-NTEP Technical Assistance Project, New Delhi, India
| | | | - Asif Shafie
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | - Avijit Choudhury
- World Health Organization, Country Office for India, New Delhi, India
| | | | | | | | | | - Malik Parmar
- World Health Organization, Country Office for India, New Delhi, India
| | - Nisha Dahiya
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | | | | | | | - Ranjeet Prasad
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | - Rohini Shinde
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | | | | | | | | | | | | | | | | | - Sudarsan Mandal
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | | | - Vaibhav Shah
- WHO-NTEP Technical Assistance Project, New Delhi, India
| | | | - Raghuram Rao
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | - Kuldeep Sachdeva
- Central TB Division, Ministry of Health & Family Welfare, New Delhi, Delhi, India
| | - Manoj Murhekar
- ICMR- National Institute of Epidemiology, Chennai, Tamil Nadu, India
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Chatla C, Jaju J, Achanta S, Samyuktha R, Chakramahanti S, Purad C, Chepuri R, Nair SA, Parmar M. Active case finding of rifampicin sensitive and resistant TB among household contacts of drug resistant TB patients in Andhra Pradesh and Telangana states of India - A systematic screening intervention. Indian J Tuberc 2018; 65:218-224. [PMID: 29933863 DOI: 10.1016/j.ijtb.2018.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/12/2017] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND India has the world's highest estimated burden of multi-drug-resistant tuberculosis (MDR-TB). While prevalence of MDR-TB is known to be 2-3% among new TB patients and 12-17% in previously treated patients, programmatic information on the extent of transmission of TB and MDR-TB among household contacts of known MDR-TB patients is scarce. Systematic screening of household contacts of all MDR-TB patients on treatment was implemented as an intervention in the states of Andhra Pradesh and Telangana states of India. We undertook this prospective interventional study to measure the extent of TB symptoms developed among the household contacts of the known MDR-TB patients treated under Revised National TB Control Programme (RNTCP). The extent of rifampicin sensitive or resistance TB, bacteriologically confirmed using Xpert MTB-RIF, was examined among the symptomatic household contacts. METHODS All MDR-TB patients registered and on treatment under RNTCP between July 2011 and Sep 2013 in Andhra Pradesh and Telangana States were selected for the study. They were contacted through home visit by the trained RNTCP teams during 11th Dec 2013 and 7th Jan 2014. All household contacts of MDR-TB patients were screened once for TB symptoms such as cough, fever, weight loss, night sweats, and haemoptysis and extra pulmonary site specific symptoms if any. If found symptomatic, two sputum specimen were collected (spot-morning) from each of the contact and transported for testing on Xpert MTB-RIF for detection of pulmonary TB with or without RR-TB. RESULTS A total of 1750 MDR-TB patients were registered between July 2011 and Sep 2013. Of these, 1602 (91.5%) MDR-TB patients were included in the study. A total of 4858 household contacts of these 1602 patients were identified with an average of 3 contacts per MDR-TB patient. Of these, after excluding 87 (1.8%) contacts with past history of diagnosis and/or treatment for TB, 4771 (98.2%) contacts were screened for current signs and symptoms suggestive of TB. Their mean age was 28.5 years and 2151 (45%) were females. Of the 4771 contacts screened, 793 (16.6%) had at least one of the symptoms suggestive of TB of whom 781 (98.5%) had two sputum specimen transported and tested on Xpert MTB-Rif. Specimen could not be collected during the study period in 12 symptomatic patients including 4 with symptoms of extra pulmonary TB. Among 781 symptomatic contacts examined, 34 (4.4%) were bacteriologically confirmed with TB and 15 (44%) also had Rif resistance (RR). CONCLUSIONS High extent of TB, particularly RR-TB was observed among household contacts of known MDR-TB patients with symptom screening and early diagnosis using Xpert-MTB-Rif. Regular systematic active screening for TB and MDR-TB among this highly vulnerable group using Xpert-MTB-Rif is useful in India for early diagnosis among close contacts of known MDR-TB patients.
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Affiliation(s)
| | - Jyoti Jaju
- World Health Organization, India Country Office, New Delhi, India
| | - Shanta Achanta
- World Health Organization, India Country Office, New Delhi, India
| | - Rani Samyuktha
- State TB Cell, State Health Society, Revised National Tuberculosis Control Programme, Andhra Pradesh, India
| | - Suryaprakash Chakramahanti
- State TB Cell, State Health Society, Revised National Tuberculosis Control Programme, Telangana State, India
| | - Chetan Purad
- World Health Organization, India Country Office, New Delhi, India
| | - Raju Chepuri
- World Health Organization, India Country Office, New Delhi, India
| | | | - Malik Parmar
- World Health Organization, India Country Office, New Delhi, India
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Achanta S, Verma A, Hoek JB, Vadigepalli R. PO4-15SINGLE CELL GENE EXPRESSION ANALYSIS IDENTIFIES A CHRONIC ALCOHOL-MEDIATED SHIFT IN THE DISTRIBUTION OF HEPATOCYTE MOLECULAR STATES AFTER PARTIAL HEPATECTOMY. Alcohol Alcohol 2017. [DOI: 10.1093/alcalc/agx074.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Choun K, Achanta S, Naik B, Tripathy JP, Thai S, Lorent N, Khun KE, van Griensven J, Kumar AMV, Zachariah R. Using mobile phones to ensure that referred tuberculosis patients reach their treatment facilities: a call that makes a difference. BMC Health Serv Res 2017; 17:575. [PMID: 28830542 PMCID: PMC5567436 DOI: 10.1186/s12913-017-2511-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 08/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the last decade, the availability and use of mobile phones have grown exponentially globally and in Cambodia. In the Sihanouk Hospital Centre of Hope(SHCH) in Cambodia about half of all tuberculosis patients referred out to peripheral health facilities for TB treatment initiation or continuation were lost to contact after referral ranging from 19 to 69% between 2008 and 2013. To address this, we implemented a mobile phone-based patient tracking intervention. Here, we report the number and proportion of referred TB patients who could be contacted through a mobile phone and retained in care after the introduction of mobile phone tracking. METHODS A descriptive study involving follow-up of TB patients referred out from SHCH to peripheral health facilities during May-October 2014. Standard operating procedures were used to contact individual patients and/or health facilities using a mobile phone. RESULTS Among 109 TB patients referred to peripheral health facilities, 107(98%) had access to a mobile phone of whom, 103(97%) could be contacted directly while 5(2%) were contacted through their health care providers. A total of 108(99%) of 109 referred TB patients in intervention period were thus placed on TB treatment. CONCLUSIONS This study provides preliminary, but promising evidence that using mobile phones was accompanied with improved retention of referred TB patients compared to historical cohorts. Given the limitations associated with historical controls, we need better designed studies with larger sample size to strengthen the evidence before national scale-up.
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Affiliation(s)
- Kimcheng Choun
- Sihanouk Hospital Centre of HOPE, Street 134, Sangkat Vealvong, Khan 7 Makara, Phnom Penh, Cambodia.
| | | | - Balaji Naik
- WHO country office for India, New Delhi, India
| | - Jaya Prasad Tripathy
- School of Public Health, PGIMER, Chandigarh, India.,International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | - Sopheak Thai
- Sihanouk Hospital Centre of HOPE, Street 134, Sangkat Vealvong, Khan 7 Makara, Phnom Penh, Cambodia
| | - Natalie Lorent
- Sihanouk Hospital Centre of HOPE, Street 134, Sangkat Vealvong, Khan 7 Makara, Phnom Penh, Cambodia.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Kim Eam Khun
- National Tuberculosis Control Programme, Phnom Penh, Cambodia
| | - Johan van Griensven
- Sihanouk Hospital Centre of HOPE, Street 134, Sangkat Vealvong, Khan 7 Makara, Phnom Penh, Cambodia.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Ajay M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | - Rony Zachariah
- Médecins Sans Frontiéres, Brussels Operational Centre (Operational research), Luxembourg city, Luxembourg
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Bairy S, Kumar AMV, Raju MSN, Achanta S, Naik B, Tripathy JP, Zachariah R. Is adjunctive naturopathy associated with improved glycaemic control and a reduction in need for medications among type 2 Diabetes patients? A prospective cohort study from India. Altern Ther Health Med 2016; 16:290. [PMID: 27534941 PMCID: PMC4989485 DOI: 10.1186/s12906-016-1264-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 08/05/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND With an estimated 65 million Diabetes Mellitus (DM) patients, India ranks second in the world in terms of DM burden. The emphasis of current medical practice has been on pharmacotherapy but, despite the best combination therapies, acheiving glycaemic control (reduction of blood sugar to desirable levels) is a challenge. 'Integrated Naturopathy and Yoga'(INY) is an alternative system of medicine that lays emphasis on the role of diet and physical exercise. We assessed the short term effect of INY as an adjunct to pharmacotherapy on glycaemic control among type 2 DM patients. METHODS In this prospective cohort study with a 3 month follow-up, DM patients consecutively admitted to a hospital in India from May-October 2014 for either 15 or 30 days were offered INY - a package of vegetarian diet with no added oil, sugar and salt, yoga-based exercise, patient counselling and rest. A 'favourable outcome' was defined as glycaemic control (glycosylated hemoglobin (HbA1c) < 7 % or absolute reduction by 1 %) along with at least 50 % reduction in antidiabetes medication at 3 months relative to baseline. Compliance to diet was scored by self-report on a scale of 0-10 and categorized into poor (0-5), moderate (6-8) and excellent (9-10). RESULTS Of 101 patients with 3-month follow-up data, 65(65 %) achieved a favourable outcome - with 19(19 %) stopping medication while sustaining glycemic control. Factors associated with favourable outcome were baseline HbA1c and compliance to diet, which showed a significant linear relationship with mean HbA1c reductions of 0.4 %, 1.1 % and 1.7 % in relation to poor, moderate and excellent dietary compliance respectively. CONCLUSION INY, adjunctive to pharmacotherapy, was associated with a significant beneficial effect on glycaemic control and reduced the overall need for antidiabetes medications. These early results are promising. Further studies with long-term follow-up and using more rigorous randomized controlled trial designs are needed.
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Satyavani K, Archana S, Kumar AM, Achanta S, Viswanathan V. Sex Differences in Cardiovascular Risk Factors among People with Diabetes in South India. J Assoc Physicians India 2015; 63:20-24. [PMID: 27666899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the sex differences in the prevalence of cardiovascular risk factors among patients with type 2 diabetes, visiting the hospital between March-December 2012. METHODS A cross-sectional study was performed among the type 2 diabetes patients attending M.V. Hospital for Diabetes, a tertiary centre specialized in diabetes care, Chennai, South India. We collected information on obesity (body mass index ≥25 kg/m2), hypertension, dyslipidemia, smoking, alcohol consumption and glycemic control (HbA1c >8% considered poor control). RESULTS Risk factors (prevalence) among 6113 (58% males; mean age 54 years) patients were obesity (68.4%), poor glycemic control (51.4%), hypertension (37.9%), dyslipidemia (34.7%), smoking (9.6%) and consumption of alcohol (10.3%), respectively. Women had a higher prevalence of obesity (75.7 vs 63.2%) and poor glycemic control while men had a higher prevalence of smoking and alcohol consumption. There were no sex differences in prevalence of hypertension and dyslipidemia. Cardiovascular risk factors were not associated with duration of diabetes. CONCLUSIONS Cardiovascular risk factors were highly prevalent among patients with type 2 diabetes attending a tertiary care centre in South India, with different risk profiles among men and women. We recommend a gender-sensitive approach in planning interventions (counseling and treatment) to reduce the risk of cardiovascular disease.
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Affiliation(s)
- Kumpatla Satyavani
- M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre [WHO Collaborating Centre for Research, Education and Training in Diabetes], Chennai, Tamil Nadu
| | - Sekar Archana
- M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre [WHO Collaborating Centre for Research, Education and Training in Diabetes], Chennai, Tamil Nadu
| | - Ajay Mv Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi
| | - Shanta Achanta
- Office of the WHO-Representative in India, Central TB Division, World Health Organization, New Delhi
| | - Vijay Viswanathan
- M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre [WHO Collaborating Centre for Research, Education and Training in Diabetes], Chennai, Tamil Nadu
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Achanta S, Sewell A, Ritchey JW, Broaddus K, Bourne DWA, Clarke CR, Maxwell LK. Anatomical and physiological basis for the allometric scaling of cisplatin clearance in dogs. J Vet Pharmacol Ther 2015; 39:224-36. [PMID: 26440900 DOI: 10.1111/jvp.12266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 07/30/2015] [Indexed: 11/26/2022]
Abstract
Cisplatin is a platinum-containing cytotoxic drug indicated for the treatment of solid tumors in veterinary and human patients. Several of the algorithms used to standardize the doses of cytotoxic drugs utilize allometry, or the nonproportional relationships between anatomical and physiological variables, but the underlying basis for these relationships is poorly understood. The objective of this proof of concept study was to determine whether allometric equations explain the relationships between body weight, kidney weight, renal physiology, and clearance of a model, renally cleared anticancer agent in dogs. Postmortem body, kidney, and heart weights were collected from 364 dogs (127 juveniles and 237 adults, including 51 dogs ≥ 8 years of age). Renal physiological and cisplatin pharmacokinetic studies were conducted in ten intact male dogs including two juvenile and eight adult dogs (4-55 kg). Glomerular filtration rate (GFR), effective renal plasma flow, effective renal blood flow, renal cisplatin clearance, and total cisplatin clearance were allometrically related to body weight with powers of 0.75, 0.59, 0.61, 0.71, and 0.70, respectively. The similar values of these diverse mass exponents suggest a common underlying basis for the allometry of kidney size, renal physiology, and renal drug handling.
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Affiliation(s)
- S Achanta
- Departments of Physiological Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, 74078, USA
| | - A Sewell
- Departments of Physiological Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, 74078, USA
| | - J W Ritchey
- Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, 74078, USA
| | - K Broaddus
- Department of Veterinary Clinical Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, 74078, USA
| | - D W A Bourne
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, USA
| | - C R Clarke
- Departments of Physiological Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, 74078, USA
| | - L K Maxwell
- Departments of Physiological Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, 74078, USA
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Chang YP, Duo L, Kumar AMV, Achanta S, Xue HM, Satyanarayana S, Ananthakrishnan R, Srivastava S, Qi W, Hu SY. Retention and HIV seroconversion among drug users on methadone maintenance treatment in Yunnan, China. Public Health Action 2015; 4:28-34. [PMID: 26423758 DOI: 10.5588/pha.13.0101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/17/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING Thirteen methadone maintenance treatment (MMT) clinics across Yunnan, the province with the highest human immunodeficiency virus (HIV) burden in China. OBJECTIVES To determine, among HIV-negative participants on MMT, the proportion lost to follow-up (defined as those who missed the 6-monthly follow-up examination), factors associated with loss to follow-up (LFU), HIV seroconversion rate and factors associated with seroconversion. DESIGN Prospective cohort study from October 2008 to April 2011. All participants were administered a pre-tested structured questionnaire to capture associated factors and offered HIV testing every 6 months. χ(2) test and log-binomial regression were used for data analysis. RESULTS Of 1146 participants, 541 (47%) were lost to follow-up in 2.5 years. Factors associated with higher LFU proportion include <6 months of previous MMT, inconvenient location of the MMT clinic and average methadone dose ⩽60 mg/day, with adjusted relative risks (RRs) of respectively 1.4 (95%CI 1.2-1.5), 1.2 (95%CI 1.0-1.4) and 1.1 (95%CI 1.0-1.3). The overall HIV seroconversion rate was 6.6 (95%CI 3.7-11.0) per 1000 person-years. Not living with a partner contributed to higher HIV rates, with an adjusted RR of 3.6 (95%CI 1.0-12.8). CONCLUSION The retention rate of MMT participants in Yunnan was not satisfactory. Decentralising service delivery in the community and making directly observed treatment more convenient has the potential to improve retention.
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Affiliation(s)
- Y-P Chang
- The Red Cross Hospital of Yunnan Province, Kunming, China
| | - L Duo
- The Red Cross Hospital of Yunnan Province, Kunming, China ; HIV/AIDS Asia Regional Programme, Kunming, China
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | - S Achanta
- World Health Organization India Country Office, New Delhi, India
| | - H-M Xue
- HIV/AIDS Asia Regional Programme, Kunming, China
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | | | - S Srivastava
- Public Health Foundation of India, New Delhi, India
| | - W Qi
- Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - S-Y Hu
- School of Public Health, Fudan University, Shanghai, China
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Denisiuk O, Smyrnov P, Kumar AMV, Achanta S, Boyko K, Khogali M, Naik B, Zachariah R. Sex, drugs and prisons: HIV prevention strategies for over 190 000 clients in Ukraine. Public Health Action 2015; 4:96-101. [PMID: 26399206 DOI: 10.5588/pha.13.0110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 03/20/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING One hundred and forty non-governmental organisations implementing human immunodeficiency virus (HIV) prevention programmes among clients, including people who inject drugs, prisoners, female sex workers, men who have sex with men and street children in Ukraine, 2010-2011. OBJECTIVE Among enrolled clients, to assess factors associated with HIV testing, HIV retesting within a year of initial testing and HIV seroconversion. DESIGN Retrospective cohort study involving record reviews. RESULTS Of 192 487 clients, 42 109 (22%) underwent an initial HIV test (22% were positive). Among HIV-negative clients at baseline, 10 858 (27%) were retested within a year: 317 (3%) of these were HIV-positive. HIV testing and retesting rates were lower among prisoners (0.3%) and others (street children and partners of those in risk groups, 6%), and those who did not receive counselling or services such as condom and needle distribution. Individuals who were not counselled were more likely to seroconvert. CONCLUSIONS In this large cohort of high-risk groups from Eastern Europe, HIV testing was low and HIV sero-conversion was high. This is of public health concern, bringing into question the overall quality of counselling and how well it is tailored to the specific needs of various risk groups. Qualitative studies to understand the reasons for non-testing are urgently required for designing client-specific interventions.
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Affiliation(s)
- O Denisiuk
- International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine
| | - P Smyrnov
- International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India
| | - S Achanta
- World Health Organization India Country Office, New Delhi, India
| | - K Boyko
- International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine
| | - M Khogali
- Médecins Sans Frontières (MSF), Operational Centre Brussels, Medical Department, Operational Research Unit (LUXOR), MSF-Luxembourg, Luxembourg
| | - B Naik
- World Health Organization India Country Office, New Delhi, India
| | - R Zachariah
- Médecins Sans Frontières (MSF), Operational Centre Brussels, Medical Department, Operational Research Unit (LUXOR), MSF-Luxembourg, Luxembourg
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Kumpatla S, Sekar A, Achanta S, Sharath BN, Kumar AMV, Harries AD, Viswanathan V. Characteristics of patients with diabetes screened for tuberculosis in a tertiary care hospital in South India. Public Health Action 2015; 3:S23-8. [PMID: 26393064 DOI: 10.5588/pha.13.0035] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 07/17/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING Tertiary care hospital for diabetes mellitus (DM) in Tamil Nadu, South India. OBJECTIVE To compare the socio-demographic, clinical and biochemical characteristics in DM patients with and without tuberculosis (TB). DESIGN A descriptive study involving a review of routinely maintained records to capture the results of screening of DM patients for TB between March and December 2012. DM patients were first asked whether they already had TB, and if not they were screened for TB symptoms, followed by investigations for and possible diagnosis of TB. RESULTS Of 7083 DM patients, 38 already had TB. Of the remainder, 125 (1.8%) had TB symptoms; 71 were investigated and 12 were newly diagnosed with TB. Of the 50 TB patients, 64% had smear-positive pulmonary TB (PTB). DM-TB patients were older, and had lower education level and economic status, a higher frequency of alcohol use, lower body mass index, a longer duration of DM, a greater likelihood of receiving insulin and poorer glycaemic control. CONCLUSION Screening of DM patients for TB was feasible in a tertiary care hospital. The yield of new TB cases was low and merits further investigation. Socio-demographic and clinical characteristics were different in patients with DM and TB compared to those with DM only.
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Affiliation(s)
- S Kumpatla
- MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre, Chennai, India (World Health Organization Collaborating Centre for Research, Education and Training in Diabetes)
| | - A Sekar
- MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre, Chennai, India (World Health Organization Collaborating Centre for Research, Education and Training in Diabetes)
| | - S Achanta
- World Health Organization Country Office in India, New Delhi, India
| | - B N Sharath
- World Health Organization Country Office in India, New Delhi, India ; Department of Community Medicine, Employees State Insurance Corporation (ESIC) Medical College, Bangalore, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - A D Harries
- The Union, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - V Viswanathan
- MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre, Chennai, India (World Health Organization Collaborating Centre for Research, Education and Training in Diabetes)
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Harries AD, Satyanarayana S, Kumar AMV, Nagaraja SB, Isaakidis P, Malhotra S, Achanta S, Naik B, Wilson N, Zachariah R, Lönnroth K, Kapur A. Epidemiology and interaction of diabetes mellitus and tuberculosis and challenges for care: a review. Public Health Action 2015; 3:S3-9. [PMID: 26393066 DOI: 10.5588/pha.13.0024] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 07/15/2013] [Indexed: 12/11/2022] Open
Abstract
The global burden of diabetes mellitus (DM) is immense, with numbers expected to rise to over 550 million by 2030. Countries in Asia, such as India and China, will bear the brunt of this unfolding epidemic. Persons with DM have a significantly increased risk of developing active tuberculosis (TB) that is two to three times higher than in persons without DM. This article reviews the epidemiology and interactions of these two diseases, discusses how the World Health Organization and International Union Against Tuberculosis and Lung Disease developed and launched the Collaborative Framework for the care and control of TB and DM, and examines three important challenges for care. These relate to 1) bi-directional screening of the two diseases, 2) treatment of patients with dual disease, and 3) prevention of TB in persons with DM. For each area, the gaps in knowledge and the priority research areas are highlighted. Undiagnosed, inadequately treated and poorly controlled DM appears to be a much greater threat to TB prevention and control than previously realised, and the problem needs to be addressed. Prevention of DM through attention to unhealthy diets, sedentary lifestyles and childhood and adult obesity must be included in broad non-communicable disease prevention strategies. This collaborative framework provides a template for action, and the recommendations now need to be implemented and evaluated in the field to lay down a firm foundation for the scaling up of interventions that work and are effective in tackling this dual burden of disease.
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Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | | | - A M V Kumar
- The Union South-East Asia Office, New Delhi, India
| | - S B Nagaraja
- Office of the WHO Representative in India, World Health Organization, New Delhi, India ; Department of Community Medicine, Employees State Insurance Corporation (ESIC) Medical College, Bangalore, India
| | - P Isaakidis
- Médecins Sans Frontières, Brussels Operational Centre, Mumbai, India
| | - S Malhotra
- All India Institute of Medical Sciences, New Delhi, India
| | - S Achanta
- Office of the WHO Representative in India, World Health Organization, New Delhi, India
| | - B Naik
- Office of the WHO Representative in India, World Health Organization, New Delhi, India
| | - N Wilson
- The Union South-East Asia Office, New Delhi, India
| | - R Zachariah
- Medical Department, Operational Research Unit, Médecins Sans Frontières, Brussels Operational Centre, Luxembourg, Luxembourg
| | - K Lönnroth
- Stop TB Department, World Health Organization, Geneva, Switzerland
| | - A Kapur
- World Diabetes Foundation, Gentofte, Denmark
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Achanta S, Tekumalla RR, Jaju J, Purad C, Chepuri R, Samyukta R, Malhotra S, Nagaraja SB, Kumar AMV, Harries AD. Screening tuberculosis patients for diabetes in a tribal area in South India. Public Health Action 2015; 3:S43-7. [PMID: 26393069 DOI: 10.5588/pha.13.0033] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 07/02/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING Ten peripheral health institutions of a tribal tuberculosis unit, Saluru, Vizianagaram District, South India. OBJECTIVE To assess among tuberculosis (TB) patients: 1) the feasibility of screening for diabetes mellitus (DM), 2) the prevalence of DM, 3) the demographic and clinical features associated with DM, and 4) the number needed to screen (NNS) to find one new case of DM. DESIGN Cross-sectional study: all TB patients registered from January to September 2012 were screened for DM using a screening questionnaire and random blood glucose, followed by fasting blood glucose (FBG) measurements using a glucometer. DM was diagnosed if FBG was ≥126 mg/dl. RESULTS Of 381 patients, 374 (98%) were assessed for DM, suggesting feasibility of screening, and 19 (5%) were found to have DM (12 were newly diagnosed and 7 had a previous diagnosis of DM). The only characteristic associated with DM was age ≥40 years. The NNS to detect a new case of DM among all TB patients was 31; among those aged ≥40 years, the NNS was 20, and among current smokers it was 21. CONCLUSION Screening of TB patients for DM was feasible and effective, and this should inform national scale-up. Other key considerations include the continued provision of free TB-DM screening, with co-location and integration of services.
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Affiliation(s)
- S Achanta
- World Health Organization Country Office in India, New Delhi, India
| | - R R Tekumalla
- District TB Centre, Ministry of Health and Family Welfare, Government of Andhra Pradesh, Visakhapatnam, India
| | - J Jaju
- World Health Organization Country Office in India, New Delhi, India
| | - C Purad
- World Health Organization Country Office in India, New Delhi, India
| | - R Chepuri
- World Health Organization Country Office in India, New Delhi, India
| | - R Samyukta
- State TB Cell, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of Andhra Pradesh, Hyderabad, India
| | - S Malhotra
- All India Institute of Medical Sciences, New Delhi, India
| | - S B Nagaraja
- World Health Organization Country Office in India, New Delhi, India ; Department of Community Medicine, Employees State Insurance Corporation (ESIC) Medical College, Bangalore, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - A D Harries
- The Union, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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Zam K, Kumar AMV, Achanta S, Bhat P, Naik B, Zangpo K, Dorji T, Wangdi Y, Zachariah R. A first country-wide review of Diabetes Mellitus care in Bhutan: time to do better. BMC Health Serv Res 2015; 15:389. [PMID: 26384311 PMCID: PMC4573946 DOI: 10.1186/s12913-015-1026-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 08/27/2015] [Indexed: 11/20/2022] Open
Abstract
Background There is an increasing trend of non-communicable diseases in Bhutan including Diabetes Mellitus (DM). To address this problem, a National Diabetes Control Programme was launched in 1996. There is anecdotal evidence that many patients do not visit the DM clinics regularly, but owing to lack of cohort monitoring, the magnitude of such attrition from care is unknown. Knowledge of the extent of this problem will provide a realistic assessment of the situation on the ground and would be helpful to initiate corrective actions. In this first country-wide audit, we thus aimed to determine among type 2 DM patients registered for care the i) pre-treatment attrition ii) one-year programme outcomes including retention in care, died and Lost–to-follow-up (LTFU, defined as not having visited the clinic at least once within a year of registration) iii) factors associated with attrition from care (death + LTFU) and iv) quality of follow-up care, measured by adherence to recommended patient-monitoring protocols including glycaemic control. Methods A retrospective cohort study involving a review of records routinely maintained under the National Diabetes Control Programme. All type 2 DM patients registered between 1st January and 31st December 2012 in 18 district hospitals of Bhutan were included. Glycaemic control was defined as glycosylated haemoglobin of <7 % or [Fasting Blood Sugar of <130 mg/dl and, Post-prandial Blood Sugar of <180 mg/dl]. Results Of 350 registered DM patients (52 % female, median age 55 years), 63(18 %) were LTFU before treatment initiation (pre-treatment attrition). Of the remaining 287 individuals who started treatment, 226(79 %) were retained in care while 61(21 %) either died or were LTFU. Glycaemic control was achieved in 85(38 %) patients retained in care. Between 7 and 98 % of monitoring parameters had missing data. Conclusion Nearly one-third of DM patients were LTFU and there were short comings in monitoring. Qualitative research is urgently needed to find out the reasons for high attrition. Given the high political commitment by the Royal Government of Bhutan, the findings provide ample grounds for instituting corrective measures and propelling DM care further. It is time to do better!
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Affiliation(s)
- Kinley Zam
- Policy and Planning Division, Ministry of Health, Thimphu, Bhutan.
| | - Ajay M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India.
| | | | | | - Balaji Naik
- WHO Country Office for India, New Delhi, India.
| | - Kado Zangpo
- Policy and Planning Division, Ministry of Health, Thimphu, Bhutan.
| | - Tandin Dorji
- Department of Public Health, Ministry of Health, Thimphu, Bhutan.
| | - Yeshey Wangdi
- National Diabetes Control Programme, Department of Medical Services, Ministry of Health, Thimphu, Bhutan.
| | - Rony Zachariah
- Medecins Sans Frontieres, Brussels Operational Center(Operational Research), Luxembourg City, Luxembourg.
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Nagaraja SB, Achanta S, Kumar AMV, Satyanarayana S. Extending tuberculosis notification to the private sector in India: programmatic challenges? Int J Tuberc Lung Dis 2015; 18:1353-6. [PMID: 25299870 DOI: 10.5588/ijtld.13.0836] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In May 2012, the Government of India declared tuberculosis a notifiable disease, requiring all public and private health sectors throughout the country to report all cases. Until then, TB disease was notifiable only by public authorities. In India, the private sector dominates anti-tuberculosis treatment, and poorly managed cases lead to severe forms of TB. Several challenges need to be addressed for effective implementation, including the creation of an electronic case-based web-based mechanism for TB notification. Stricter enforcement backed by regulation and punitive measures for non-compliance, along with vigilant mechanisms in place to monitor private health facilities, is required. Massive campaigns and advocacy programmes for a notification drive may be the way forward.
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Affiliation(s)
- S B Nagaraja
- Employees' State Insurance Corporation Medical College and Postgraduate Institute of Medical Sciences and Research, Bangalore, India
| | - S Achanta
- World Health Organization Country Office for India, New Delhi, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | - S Satyanarayana
- Department of Epidemiology, McGill University, Montreal, Quebec, Canada
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Affiliation(s)
- Sharath Burugina Nagaraja
- Department of Community Medicine, Employees State Insurance Corporation Medical College and Post Graduate Institute of Medical Sciences and Research, Bangalore, India
| | - Shanta Achanta
- Office of World Health Organization Representative to India, New Delhi, India
| | - Avi Kumar Bansal
- National JALMA Institute for Leprosy and Mycobacterial Diseases, Agra, India
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Achanta S, Maxwell LK. Reaction phenotyping of vinblastine metabolism in dogs. Vet Comp Oncol 2014; 14:161-9. [PMID: 24502418 DOI: 10.1111/vco.12084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 11/26/2013] [Accepted: 12/13/2013] [Indexed: 11/29/2022]
Abstract
Vinblastine is a vinca alkaloid used either as a single agent or in combination therapy for the treatment of canine mast cell tumours and lymphomas. The objective of this study was to determine which isoform of cytochrome P450 enzyme is responsible for the majority of vinblastine metabolism in dogs. A panel of eight recombinant canine cytochrome P450 enzymes (CYP1A1, CYP1A2, CYP3A12, CYP3A26, CYP2B11, CYP2C41, CYP2C21 and CYP2D15) were incubated in vitro with vinblastine. Findings were confirmed by the use of canine polyclonal antibodies of cytochrome P450 enzymes (CYP1A1, CYP3A12, CYP2B11 and CYP2C21) that were pre-incubated with individual and pooled hepatic microsomes that were purified from canine liver. Substrate depletion was observed in the presence of recombinant CYP3A12, whereas depletion did not substantially occur when microsomes were pre-incubated with polyclonal antibodies against CYP3A12. These findings confirmed that CYP3A12 is the major cytochrome P450 isoform responsible for the metabolism of vinblastine in dogs.
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Affiliation(s)
- S Achanta
- Department of Physiological Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, USA
| | - L K Maxwell
- Department of Physiological Sciences, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, USA
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Dave P, Shah A, Chauhan M, Kumar AMV, Harries AD, Malhotra S, Pujara K, Patel P, Mane M, Thakkar A, Bharaswadkar S, Sharath BN, Achanta S. Screening patients with tuberculosis for diabetes mellitus in Gujarat, India. Public Health Action 2013; 3:S29-33. [PMID: 26393065 PMCID: PMC4463142 DOI: 10.5588/pha.13.0027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 06/27/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING Anklav Tuberculosis Unit, Anand, Gujarat, India. OBJECTIVE To determine in a cohort of TB patients 1) the prevalence of diabetes (DM) and impaired fasting glucose (IFG), 2) the time taken for diagnosis, 3) demographic and clinical factors associated with DM and IFG, and 4) the number needed to screen (NNS) for diagnosing new cases of DM and IFG. DESIGN Descriptive study. TB patients registered between January and September 2012 were asked whether they had a history of DM. Those with unknown DM were tested for random and fasting blood glucose (FBG). FBG of ≥126 mg/dl and 110-125 mg/dl were considered indicative of DM and IFG, respectively. RESULTS Of 556 TB patients, 553 (99%) were assessed: 36 (6.5%) had diabetes (14 had been previously diagnosed DM and 22 were newly diagnosed), and 39 (7%) had IFG. The median (interquartile range) time to DM diagnosis was 5 (1-17) days. Age ≥35 years was associated with DM. The NNS was 25 and 14 for one new case of DM and IFG, respectively, with a lower NNS in males, those aged ≥35 years, those with smear-positive pulmonary TB, retreatment patients and smokers. CONCLUSION This pilot project shows that it is feasible and valuable to screen patients with TB for DM in a routine setting, resulting in earlier identification of DM and opportunities for better management of comorbidity.
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Affiliation(s)
- P Dave
- Department of Health, Government of Gujarat, Gandhinagar, India
| | - A Shah
- World Health Organization Country Office for India, New Delhi, India
| | - M Chauhan
- Department of Health, Government of Gujarat, Gandhinagar, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - A D Harries
- The Union, Paris, France ; Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - S Malhotra
- All India Institute of Medical Sciences, New Delhi, India
| | - K Pujara
- Department of Health, Government of Gujarat, Gandhinagar, India
| | - P Patel
- Department of Health, Government of Gujarat, Gandhinagar, India
| | - M Mane
- Department of Health, Government of Gujarat, Gandhinagar, India
| | - A Thakkar
- Department of Health, Government of Gujarat, Gandhinagar, India
| | - S Bharaswadkar
- World Health Organization Country Office for India, New Delhi, India
| | - B N Sharath
- Employees State Insurance Corporation (ESIC) Medical College, Bangalore, India
| | - S Achanta
- World Health Organization Country Office for India, New Delhi, India
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Achanta S, Jaju J, Kumar AMV, Nagaraja SB, Shamrao SRM, Bandi SK, Kumar A, Satyanarayana S, Harries AD, Nair SA, Dewan PK. Tuberculosis management practices by private practitioners in Andhra Pradesh, India. PLoS One 2013; 8:e71119. [PMID: 23967158 PMCID: PMC3742777 DOI: 10.1371/journal.pone.0071119] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 06/25/2013] [Indexed: 11/19/2022] Open
Abstract
Setting Private medical practitioners in Visakhapatnam district, Andhra Pradesh, India. Objectives To evaluate self-reported TB diagnostic and treatment practices amongst private medical practitioners against benchmark practices articulated in the International Standards of Tuberculosis Care (ISTC), and factors associated with compliance with ISTC. Design Cross- sectional survey using semi-structured interviews. Results Of 296 randomly selected private practitioners, 201 (68%) were assessed for compliance to ISTC diagnostic and treatment standards in TB management. Only 11 (6%) followed a combination of 6 diagnostic standards together and only 1 followed a combination of all seven treatment standards together. There were 28 (14%) private practitioners who complied with a combination of three core ISTC (cough for tuberculosis suspects, sputum smear examination and use of standardized treatment). Higher ISTC compliance was associated with caring for more than 20 TB patients annually, prior sensitization to TB control guidelines, and practice of alternate systems of medicine. Conclusion Few private practitioners in Visakhapatnam, India reported TB diagnostic and treatment practices that met ISTC. Better engagement of the private sector is urgently required to improve TB management practices and to prevent diagnostic delay and drug resistance.
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Affiliation(s)
- Shanta Achanta
- World Health Organization (WHO) Country Office in India, New Delhi, India.
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Achanta S, Kumar AMV, Nagaraja SB, Jaju J, Shamrao SRM, Uppaluri R, Tekumalla RR, Gupta D, Kumar A, Satyanarayana S, Dewan PK. Feasibility and effectiveness of provider initiated HIV testing and counseling of TB suspects in Vizianagaram district, South India. PLoS One 2012; 7:e41378. [PMID: 22844467 PMCID: PMC3402476 DOI: 10.1371/journal.pone.0041378] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 06/20/2012] [Indexed: 11/30/2022] Open
Abstract
Background Though internationally recommended, provider initiated HIV testing and counseling (PITC) of persons suspected of tuberculosis (TB) is not a policy in India; HIV seroprevalence among TB suspects has never been reported. The current policy of PITC for diagnosed TB cases may limit opportunities of early HIV diagnosis and treatment. We determined HIV seroprevalence among persons suspected of TB and assessed feasibility and effectiveness of PITC implementation at this earlier stage in the TB diagnostic pathway. Methods All adults examined for diagnostic sputum microscopy (TB suspects) in Vizianagaram district (population 2.5 million), in November-December 2010, were offered voluntary HIV counseling and testing (VCT) and assessed for TB diagnosis. Results Of 2918 eligible TB suspects, 2465(85%) consented to VCT. Among these, 246(10%) were HIV-positive. Of the 246, 84(34%) were newly diagnosed as HIV (HIV status not known previously). To detect a new case of HIV infection, the number needed to screen (NNS) was 26 among ‘TB suspects’, comparable to that among ‘TB patients’. Among suspects aged 25–54 years, not diagnosed as TB, the NNS was 17. Conclusion The seroprevalence of HIV among ‘TB suspects’ was as high as that among ‘TB patients’. Implementation of PITC among TB suspects was feasible and effective, detecting a large number of new HIV cases with minimal additional workload on staff of HIV testing centre. HIV testing of TB suspects aged 25–54 years demonstrated higher yield for a given effort, and should be considered by policy makers at least in settings with high HIV prevalence.
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Affiliation(s)
- Shanta Achanta
- Office of the World Health Organization (WHO) Representative to India, New Delhi, India.
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Burugina Nagaraja S, Satyanarayana S, Chadha SS, Kalemane S, Jaju J, Achanta S, Reddy K, Potharaju V, Shamrao SRM, Dewan P, Rony Z, Tetali S, Anchala R, Kannuri NK, Harries AD, Singh SK. How do patients who fail first-line TB treatment but who are not placed on an MDR-TB regimen fare in South India? PLoS One 2011; 6:e25698. [PMID: 22022433 PMCID: PMC3191158 DOI: 10.1371/journal.pone.0025698] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 09/08/2011] [Indexed: 11/26/2022] Open
Abstract
Setting Seven districts in Andhra Pradesh, South India Objectives To a) determine treatment outcomes of patients who fail first line anti-TB treatment and are not placed on an multi-drug resistant TB (MDR-TB) regimen, and b) relate the treatment outcomes to culture and drug susceptibility patterns (C&DST). Design Retrospective cohort study using routine programme data and Mycobacterium TB Culture C&DST between July 2008 and December 2009. Results There were 202 individuals given a re-treatment regimen and included in the study. Overall treatment outcomes were: 68 (34%) with treatment success, 84 (42%) failed, 36 (18%) died, 13 (6.5%) defaulted and 1 transferred out. Treatment success for category I and II failures was low at 37%. In those with positive cultures, 81 had pan-sensitive strains with 31 (38%) showing treatment success, while 61 had drug-resistance strains with 9 (15%) showing treatment success. In 58 patients with negative cultures, 28 (48%) showed treatment success. Conclusion Treatment outcomes of patients who fail a first-line anti-TB treatment and who are not placed on an MDR-TB regimen are unacceptably poor. The worst outcomes are seen among category II failures and those with negative cultures or drug-resistance. There are important programmatic implications which need to be addressed.
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