Long-term Follow-up of Multidrug Resistant Tuberculosis Patients of Delhi, Who had Received DOTS Plus Treatment along with Home Care and Counseling
Background: To realize the vision of a world free of TB, it becomes mandatory to disallow Ex-TB and Ex-MDR TB patients to have relapse or become Extremely Drug Resistant (XDR). Long follow-up of treated cases, who also received home care and counseling hasn’t been done thus far in India.
Objective: To find out whether 50% of Ex-MDR TB patients who had also received home based support with counseling are healthy after five years.
Methods: This retrospective study of 109 Ex-MDR-TB patients was carried out by Community Health Department (CHD) of a Tertiary Care Hospital in Delhi. They had received daily MDR Regimen (starting from August 2009 to August 2010 from their respective DOTS Providers) and home care and strong counseling support. They completed it by 2011 or 2012. The study period was from May to August 2015.
Result: After a long follow up of these patients in 2015 it was found that 71(65.14%) were alive & healthy, 26(23.85%) dead, 5(4.59%) defaulters, 1(0.92%) failure cases, 4(3.67%) lost to follow-up, whereas 2(1.83%) were on treatment as they had relapsed.
Conclusion: Our study concludes that more than 50% Ex-MDR TB cases who had also received home based support with counseling are alive & healthy after five years. We recommend that a mechanism for home-based care & counseling and Long Follow Up for MDR TB patients be developed.
How to cite this article:
Vaghela JF, Anand T. Long-term Follow-up of Multidrug Resistant Tuberculosis Patients of Delhi, Who had Received DOTS Plus Treatment along with Home Care and Counseling. J Commun Dis 2020; 52(2): 24-30.
Farmer P, Kim JY. Community based approaches to the control of multidrug resistant tuberculosis:
introducing “DOTS-plus”. BMJ 1998; 317: 671-674 Available from: https://www.ncbi.nlm.nih.gov/pmc/
articles/PMC1113843/ accessed on 15.5.2020.
Central Tuberculosis Division, Directorate General of Health Services, MOH & FW. RNTCP Guidelines
on Programmatic Management of Drug Resistant TB (PMDT) in India [Internet] 2012 [Accessed on
May 15]. Available from: https://tbcindia.gov.in/.../8320929355Guidelines%20for%20PMDT%20
Uplekar M, Weil D, Lonnroth K, Jaramillo E, Lienhardt C, Dias HM et al. WHO’s new End TB Strategy. Lancet
;385(9979):1799-801. http://dx.doi.org/10.1016/S0140-‐6736(15)60570-‐0. [Accessed on 2020 May
. Available from: https://pubmed.ncbi.nlm.nih.gov/25814376/.
Shin SS, Furin JJ, Alcantara F, Bayona J, Sanchez E, Mitnick CD. Long-term follow- up for multidrugresistant
tuberculosis. Emerging Infectious Diseases 2006;12:687- 88 [Accessed on 2020 May 15]. Available
Vaghela JF, Kapoor SK, Kumar A, Dass RT, Khanna A, Bhatnagar A. Home based care to multi-drug resistant
tuberculosis patients: A pilot study. IJT 2015; 62: 91-96. [Accessed on 2020 May 15]. Available from: https://
Social Science Statistics Calculator. [Accessed on 2020 May 6]. Available from: https://www.socscistatistics.
MedCalc statistical software. [Accessed on 2020 May 6]. Available from: www.medcalc.org.
Chakaroborty AK. Epidemiology of Tuberculosis-Current status in India. IJMR 2004; 20(10): 248-276. [Accessed
on 2020 May 15]. Available from: https://pubmed.ncbi.nlm.nih.gov/15520481/.
Orenstein EW, Basu S, Shah SN, Andrews JR, Friedland GH, Moll AP et. al. Treatment outcomes among
patients with multidrug-resistant tuberculosis: systematic review and meta-analysis. Lancet Infect Dis
; 9: 153-161. [Accessed on 2020 May 15]. Available from: https://www.clinicalkey.com/#!/content/
Miti S, Mfungwe V, Reijer P, Mahers D. Integration of tuberculosis treatment in a community-based home
care for persons living with HIV/AIDS in Ndola, Zambia. Int J Tubercul Lung Dis 2003; 7(9 Suppl 1): S92-98.
[Accessed on 2020 May 13]. Available from: https://pubmed.ncbi.nlm.nih.gov/12971660/.
Kangangi JK, Kibuga D, Muli J, Maher D, Billo N, N’gang’a L et al. Decentralisation of tuberculosis treament from the main hospitals to the peripheral health units and in the community within Machakos District, Kenya. Int J Tubercul Lung Dis 2003; 7(9 Suppl 1): S5-13. [Accessed on 2020 May 15]. Available from: https://pubmed.ncbi.
Adatu F, Odeke R, Mugenyi M, Gargioni G, McCray E, Schneider E et al. Implementation of the DOTS strategy
for tuberculosis control in rural Kiboga District, Uganda: Offering patients the option of treatment supervision
in the community, 1998-1999. Int J Tubercul Lung Dis 2003; 7(9 Suppl 1): S63-71. [Accessed on 2020 May
. Available from: https://pubmed.ncbi.nlm.nih.gov/12971656/.
He GX, Xie YG, Wang LX, Borgdorff MW, van der Werf MJ, Fan Ji H et al. Follow-Up of Patients with Multidrug
Resistant Tuberculosis Four Years after Standardized First-Line Drug Treatment. PLoS ONE 2010; 5(5):e10799. doi:10.1371/journal.pone.0010799. [Accessed on 2020 May 15]. Available from: https://pubmed.
Shringarpure KS, Isaakidis P, Sagili KD, Baxi RK. Loss-To-Follow-Up on Multidrug Resistant Tuberculosis
Treatment in Gujarat, India: The WHEN and WHO of It. PLoS ONE 2015; 10(7): e0132543. DOI:10.1371/journal.
pone.0132543. . [Accessed on 2020 May 14]. Available from: https://pubmed.ncbi.nlm.nih.gov/26167891/.
Beutler B, Greenwald D, Hulmes D, Chang M, Pan YC, Mathison J et al. Identity of tumor necrosis factor
and the macrophage-secreted factor cachectin. Nature 1985; 316: 552-554. [Accessed on 2020 May
. Available from: https://pubmed.ncbi.nlm.nih.gov/2993897/.
Sharma SK, Mohan B. Multi-Drug Resistant Tuberculosis. Ind J Med Res 2004; 120(10); 354-376. [Accessed on
May 13]. Available from: https://pubmed.ncbi.nlm.nih.gov/15520486/.
Issa BA, Yussuf AD, Kuranga SI. Depression co-morbidity among patients with tuberculosis in a university
teaching hospital outpatient clinic in Nigeria. Ment Health Fam Med 2009; 6(3): 133-138. [Accessed on
May 13]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2838651/.
Chung-Delgado K, Guillen-Bravo S, Revilla-Montag A, Bernabe-Ortiz. Mortality among MDR-TB Cases:
Comparison with Drug-Susceptible Tuberculosis and Associated Factors. PloS One 2015; 10(3): e0119332.
DOI: 10.1371/journal.pone.0119332, PMCID: PMC4366185. [Accessed on 2020 May 15]. Available
Singla N, Singla R, Fernandes S, Behera D. Post treatment sequelae of multi-drug resistant tuberculosis patients. Ind J Tuberc 2009; 56: 06-12. [Accessed on 2020 May 15]. Available from: https://pubmed.ncbi.nlm.nih. gov/20469732/.
Mitnick C, Bayona J, Palacios E, Shin S, Furin J, Alcantara F et al. Community-Based Therapy for Multidrug-
Resistant Tuberculosis in Lima, Peru. N Engl J Med 2003; 348: 119-128. [Accessed on 2020 May 15]. Available
Copyright (c) 2020 Journal of Communicable Diseases (E-ISSN: 2581-351X & P-ISSN: 0019-5138)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.