The Indian Journal of Tuberculosis - LRS Institute of Tuberculosis ...

ABSTRACTS 177
disease) under national programme criteria.
Established chronic cough clinics are a useful setting
for recruitment of patients to ARV clinics. Attendees
should be offered HIV testing and simple clinical
screening to identify those who should be referred
for ARV treatment.
Factors affecting patient adherence to DOTS
T.S. Bam et al. Int J Tuberc Lung Dis 2006; 10(3):
270-276.
The study was conducted in an urban area
of Kathmandu, which has a population of one million,
with an annual risk of tuberculosis (TB) infection
of 4%. It is estimated that up to 200 people default
from treatment in Kathmandu annually, giving a
defaulter rate of 10%. Objective was to identify
the socio-demographic factors, availability and
accessibility of DOTS services and behavioural
factors affecting patient adherence to DOTS.
Analysis of socio-demographic, psychosocial
factors and availability and accessibility of DOTS
services was done by using a structured
questionnaire of a random sample of 234 new
smear-positive TB pattients enrolled on treatment.
Sub-analysis of non-adherent (missed >7
consecutive treatment days) vs adherent patients.
Reasons given by non-adherent patients included
61% who claimed insufficient knowledge about
the need to take daily treatment, especially after
they felt better. Directly observed treatment,
younger age, knowledge of TB and availability of
daily health education were associated with
increased adherence, Daily health education and
knowledge of TB and its treatment were
independently associated with adherence on multivariate
analysis (OR 6.27, 95% CI 2.88-13.64, P
< 0.001). Daily health education delivered at
DOTS centres is strongly associated with
improved adherence. Adherence throughout
treatment needs emphasis.
Tuberculosis drug resistance and treatment outcomes
under DOTS settings .
A. Ohkado et al. Int J Tuberc Lung Dis 2006; 10(3):
283-289.
To describe the problems of drug-resistant
tuberculosis (TB) in an urban setting, with special
emphasis on their potential impact on the treatment
services provided by the National TB Control
Programme, a cross-sectional survey and cohort
analysis of treatment outcomes was done. All patients
with positive sputum smear examination results in
Cebu and Mandaue cities during the survey period
were included. The survey procedures of the World
Health Organization and the International Union
Against Tuberculosis and Lung Diseases were strictly
applied. Treatment outcome data were also collected.
306 cases enrolled, 255 were new cases, 28 were
previously treated and for 23 treatment history was
unknown. Of the new cases, 72.2% were pansusceptible
to all four first-line anti-tuberculosis
drugs. Resistance in new cases was 16.9% to
Isoniazid (INH), 4.7% to Rifampicin (RMP), 3.1%
to Ethambutol, 18.0% to Streptomycin, and 3.9%
to at least both INH and -RMP (multi-drug-resistant
[MDR]). Over 90% of the new cases, either pansusceptible
or mono-resistant, were successfully
treated with the standard regimen, but four of nine
MDR new cases could not be cured. The drug
resistance level was high in this population, but
treatment outcome using the standard treatment
regimen was not seriously affected unless the patients
were MDR.
Representative drug susceptibility patterns for
guiding design of retreatment regimens for
MDR-TB
M.L. Rich et al. Int J Tuberc Lung Dis 2006; 10(3):
290-296.
There is no gold standard on how national
tuberculosis programs should design retreatment
regimens. Often drug susceptibility testing (DST) is
not available for all patients, and representative DST
patterns in patient populations are used to guide
therapy. To examine DST patterns in different patient
populations based on previous treatment and to
estimate the number of effective anti-tuberculosis
agents in several retreatment regimens, we reviewed
DST results from patients treated with individualized
regimens in Peru between January 1998 and July
2004. We stratified patients into four groups based
on previous treatment exposure from Group 1 who
had failed only one regimen to Group 4 who had
failed three regimens. We compared resistance
frequencies across the four groups. In Groups 1
Indian Journal of Tuberculosis