TB Treatment Delays in Odisha, India: Is It Expected Even after These Many Years of RNTCP Implementation?

PLoS One. 2015 Apr 30;10(4):e0125465. doi: 10.1371/journal.pone.0125465. eCollection 2015.

Abstract

Background: In India, the Revised National TB Control Programme (RNTCP) envisages initiation of TB treatment within seven days of diagnosis among smear-positive patients. After nearly two decades of RNTCP implementation, treatment delays are usually not expected.

Objectives: To determine the proportion of sputum smear-positive TB patients who were initiated on treatment after seven days and their associated risk factors.

Methods: The study was conducted in Cuttack and Rayagada districts of Odisha. It was a retrospective cohort study that involves review of TB treatment registers and laboratory registers for 2013.

Results: Among 1,800 pulmonary TB (PTB) patients, 1,074 (60%) had been initiated on treatment within seven days of diagnosis, 721 (40%) had been initiated on treatment more than seven days, and 354 (20%) had delays of more than 15 days. The mean duration between TB diagnosis and treatment initiation was 21 days with a range of 8-207 days (median = 14 days). Odds of treatment delay of more than seven days were 4.9 times (95% confidence interval [CI] 3.3-6.6) among those who had been previously treated, 6.2 times (95% CI 1.3-29.7) among those infected with HIV, and 1.8 times (95% CI 1.1-2.9) among those diagnosed outside district DMC.

Conclusion: Delay in initiation of TB treatment occurred in majority of the smear-positive patients. The RNTCP should focus on core areas of providing quality TB services with time-tested strategies. To have real-time monitoring mechanisms for diagnosed smear-positive TB patients is expected to be the way forward.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antitubercular Agents / therapeutic use
  • Child
  • Child, Preschool
  • Female
  • Humans
  • India
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / epidemiology*
  • Young Adult

Substances

  • Antitubercular Agents

Grants and funding

Funding for the operational research course was made possible by the support of the American People through the United States Agency for International Development (USAID). The contents of this paper do not necessarily reflect the views of USAID, the United States Government, or International Union Against Tuberculosis and Lung Disease (The Union). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.