Management of Drug Resistant Tuberculosis in a teaching hospital before and after implementation of Programmatic Management of Drug Resistant Tuberculosis

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) is a potential threat to global tuberculosis control. Its management is recommended by WHO in a tertiary care hospital setting with a dedicated team with linkages with TB control programme in the community.Methods and Methodology: Drug Resistant TB patients were managed at LRH even before this from 1 October 2008 till the launch of PMDT on February 2012. Data during these times were saved in hard as well as in soft. For study purposes all data were converted into SPSS and analyzed the data for percentage and differences by using chi square testing. A P-value of 0.05 was considered to be statistically significant.Objective: In this study the outcome of patients of cohort of “Pre-PMDT†from Oct 2008 to Dec 2011 is compared with cohort of “Post-PMDT†implementation from2012 till Dec 2014.Results:  From 2008 to 2014, 956 MDR-TB patients were included in this study. The patients were classified into two cohorts: Pre- PMDT cohort of Non GLC patients (n = 285) and Post- PMDT cohort of GLC patients (n = 671). Statistically significant difference was found in the treatment outcomes of pre and post PMDT. Successful treatment outcome were found to be statistically significant with Post PMDT cohort patients (p = .000) while unsuccessful treatment outcome with Pre PMDT cohort patients (p =.020). Most of the Post- PMDT patients 487 (72.58%) were cured as compared to Pre-PMDT cohort 14 (5%) and found statistically significant (p = .000). Default rate was found to be high in Pre-PMDT cohort 49 (17.2%) as compared to Post-PMDT cohort 5 (0.71%) and statistically significant (p = .000). Failed 1 (0.35%), died 67 (23.50%), transfer out 20 (7%) in Pre- PMDT cohort and failed 36 (5.37%), died 118 (17.59%), transfer out 8 (1.19%) in Post-PMDT.Conclusion: The study shows significant improvement in treatment outcome of Post PMDTcohort as far as Default rate is concerned.