Prevalence, patterns, characteristics and challenges in management of multi-drug resistant tuberulosis cases under DOTS-PLUS.

BACKGROUND: Inspite of the success of RNTCP in tuberculosis control in India, the problem of drug resistant forms of tuberculosis still remains untackled. The present study focuses on the prevalence of MDR-TB, pattern of drug resistance and characteristics of MDR-TB patients in district Amritsar, Punjab in north India. The programme-related aspects studied are the challenges in effective implementation of DOTS-PLUS. MATERIAL AND METHODS: A retrospective study was conducted in the month of April, 2013. The records from November 2011 to April 2013 were analysed. RESULTS: Amongst a total of 200 MDR-suspects as per the criterion A of RNTCP, prevalence of drug resistance was 22.50% in Cat I failures and 36.25% in Cat II fourth month or later positive. Out of 67 patients who were to be initiated on Cat IV (H and R resistant or R resistant), 55 patients were put on treatment. The total time taken by the patients from identification as MDR-TB cases to initiation of Cat IV regimen at DOTS-plus site was 17.89 days. CONCLUSION: The findings of the study highlight the need for early referral, rapid diagnosis and prompt initiation of Cat IV of MDR-TB cases to decrease morbidity, mortality and disease transmission.