TB operational research in India - Gaps and pragmatic solutions.

Operational research (OR) plays a pivotal role in the management and improvement of national tuberculosis (TB) programs in India. This article underscores the indispensable value of OR in optimizing resource allocation, enhancing treatment protocols, improving diagnostics, ensuring patient adherence, monitoring program performance, and informing policy decisions. However, it is vital to address existing gaps in the operational research mechanisms of the National Tuberculosis Elimination Program (NTEP) in India to maximize its effectiveness.

Tuberculosis screening for pediatric household contacts in India: Time to adapt newer strategies under the National TB Elimination Programme!

Introduction: The study aimed to evaluate the effectiveness of screening pediatric household contacts (under the age of 15 years) for tuberculosis (TB) in India through verbal screening, tuberculin skin testing, and chest radiography at intervals of 0, 3, 6, 9, and 12 months. The study also aimed to determine the proportion of contacts who tested positive for TB and to describe the challenges in implementing regular follow-up. Current National TB Elimination Programme (NTEP) guidelines only require verbal screening for contacts under 6 years old at TB treatment initiation.

Estimation of tuberculosis incidence at subnational level using three methods to monitor progress towards ending TB in India, 2015-2020.

Objectives: We verified subnational (state/union territory (UT)/district) claims of achievements in reducing tuberculosis (TB) incidence in 2020 compared with 2015, in India.

Design: A community-based survey, analysis of programme data and anti-TB drug sales and utilisation data.

Setting: National TB Elimination Program and private TB treatment settings in 73 districts that had filed a claim to the Central TB Division of India for progress towards TB-free status.

Active Case Finding for Tuberculosis in India: A Syntheses of Activities and Outcomes Reported by the National Tuberculosis Elimination Programme.

India launched a national community-based active TB case finding (ACF) campaign in 2017 as part of the strategic plan of the National Tuberculosis Elimination Programme (NTEP). This review evaluated the outcomes for the components of the ACF campaign against the NTEP's minimum indicators and elicited the challenges faced in implementation. We supplemented data from completed pretested data proformas returned by ACF programme managers from nine states and two union territories (for 2017-2019) and five implementing partner agencies (2013-2020), with summary national data on the state-wise ACF outcomes for 2018-2020 published in annual reports by the NTEP.

Challenges Perceived by Health Care Providers for Implementation of Contact Screening and Isoniazid Chemoprophylaxis in Karnataka, India.

In India, challenges in pediatric TB contact screening and chemoprophylaxis initiation are still underexplored. Elucidating these challenges will help in better implementation of the programme at the grass-roots level thereby helping in early detection of pediatric cases and timely initiation of preventive therapy. This study aimed at exploring the challenges faced by the health care provider in contact screening and chemoprophylaxis initiation implementation of the pediatric household contacts.

CD38+CD27-TNF-α + on Mtb-specific CD4+ T Cells Is a Robust Biomarker for Tuberculosis Diagnosis.

Background: Early and accurate diagnosis followed by timely treatment are the key prerequisites to fight tuberculosis (TB) and reduce its global burden. Despite scientific advances, the rapid and correct diagnosis of both pulmonary and extrapulmonary tuberculosis remains a challenge because of traditional reliance on detection of the elusive bacilli. Mycobacterium tuberculosis (Mtb)-specific host immune activation and cytokine production have shown significant promise as alternative means of detecting and distinguishing active disease from latent infection.

Chasing END TB 2025: Arithmetic needed for logistics!

India adopted changes in NTEP (Erstwhile RNTCP, Revised National TB Program, renamed as National TB Elimination Program) in the recent years with an aim to End TB by 2025 way ahead of the global target of ending TB by 2030. It is taking a long time for the changes to trickle down to the grass root level to change the behavior of the ground level force to understand and adopt to the changes that are being ordered and several other changes that are being pushed to the field in tandem. This has made field workers to be on their toes to understand and implement all the changes.

Qualitative enquiry on irregular intake of antihypertensive medications to inform a model of care to improve blood pressure control.

: A large proportion of people with hypertension do not take medications regularly. There is little understanding of this complex behaviour in India.: A descriptive qualitative study was conducted in two districts of Andhra Pradesh, India, to explore the reasons for irregular intake of anti-hypertensive drugs from patient's and health care provider's (HCP) perspectives.

Does mobile phone instructional video demonstrating sputum expectoration improve the sputum sample quality and quantity in presumptive pulmonary TB cases? Protocol for a prospective pragmatic non-randomised controlled trial in Karnataka state, India.

Introduction: Sputum smear microscopy is the cornerstone of tuberculosis (TB) diagnosis under the Revised National Tuberculosis Control Programme (RNTCP) in India. Instructions on how to produce a good sputum sample are a part of RNTCP training manuals, but its assessment is not emphasised. Healthcare provider's instruction to expectorate a good sputum sample has limitations.

Is Chemoprophylaxis for Child Contacts of Drug-Resistant TB Patients Beneficial? A Systematic Review.

Background: Preventive therapy for child contacts of multidrug-resistant tuberculosis (MDR-TB) patients is poorly studied, and no consensus about the role and the rationale of chemoprophylaxis has been reached.

Objective: To conduct systematic review with an aim to determine the effectiveness of TB preventive therapy in reducing the incidence of TB disease in pediatric contacts of MDR-TB patients.

Methods: We conducted a literature search for randomized control trials, cohort studies, and case reports of chemoprophylaxis for pediatric contacts of MDR-TB patients in PubMed, EMBASE, Cochrane Databases of Systematic Reviews, metaRegister of Controlled Trials, and other clinical registries through March 2017, using appropriate search strategy.

TB Notification from Private Health Sector in Delhi, India: Challenges Encountered by Programme Personnel and Private Health Care Providers.

Objective: To identify the challenges encountered by private health care providers (PHCP) to notify tuberculosis cases through a programme developed web-based portal mechanism called "NIKSHAY." . It is a descriptive qualitative study conducted at two revised national tuberculosis control programme (RNTCP) districts of New Delhi.

Mandatory TB notification in Mysore city, India: Have we heard the private practitioner's plea?

Background: The Government of India, made TB notification by private healthcare providers mandatory from May 2012 onwards. The National TB Programme developed a case based web based online reporting mechanism called NIKSHAY. However, the notification by private providers has been very low.

How do patients who fail first-line TB treatment but who are not placed on an MDR-TB regimen fare in South India?

Setting: Seven districts in Andhra Pradesh, South India.

Objectives: To a) determine treatment outcomes of patients who fail first line anti-TB treatment and are not placed on an multi-drug resistant TB (MDR-TB) regimen, and b) relate the treatment outcomes to culture and drug susceptibility patterns (C&DST).

Design: Retrospective cohort study using routine programme data and Mycobacterium TB Culture C&DST between July 2008 and December 2009.