Source of retreatment cases under the revised national TB control programme in Rajasthan, India, 2003

Three years after state-wide DOTS coverage and achievement of global targets for detection and cure, the proportion of sputum-positive retreatment cases remained high in the north Indian state of Rajasthan.

To determine source, accuracy of categorisation and treatment outcomes in Category II sputum-positive retreatment cases registered from January to March 2003 in five districts of Rajasthan.

Two hundred consecutive Category II sputum-positive retreatment cases were identified from the tuberculosis register and interviewed using a semi-structured questionnaire.

Categorisation was correct in 195 (97.5%) of retreatment cases interviewed. Treatment after default (TAD) comprised 84.6% (165/195) of interviewees, with 13.3% (n = 26) relapses and 2.1% (n = 4) failure cases. Of the TAD cases, 84.8% (n = 140) had defaulted from previous treatment in the private sector. Only 6.1% (n = 10) had defaulted from Category II DOTS treatment. The most unfavourable treatment outcome seen amongst interviewees was default, as also described in the national data.

TADs constituted the majority of interviewed retreatment cases (84.6%), and were overwhelmingly being generated by irregular treatment in the private sector. Further involvement of the private sector in the DOTS programme in Rajasthan is needed to stop the creation of further retreatment cases.