Implementation efficiency of a diagnostic algorithm in sputum smear-negative presumptive tuberculosis patients

Area of Science:

• Public Health
• Infectious Disease Epidemiology
• Tuberculosis Control

Background:

• India's Revised National Tuberculosis Control Programme (RNTCP) uses a specific algorithm for smear-negative pulmonary tuberculosis (PTB).
• This algorithm involves a course of antibiotics, repeat sputum examination, and chest X-ray (CXR) for diagnosis.

Purpose of the Study:

• To determine the completion rate of the RNTCP's diagnostic algorithm for smear-negative PTB.
• To identify barriers preventing patients from completing this diagnostic pathway.

Main Methods:

• A study in Karnataka, India, interviewed 256 patients regarding adherence to the PTB diagnostic algorithm.
• In-depth interviews with 19 medical officers explored their understanding and application of the algorithm.
• Data collected included antibiotic duration, revisit frequency, sputum tests, CXR, and PTB diagnosis.

Main Results:

• Only 5.1% of participants completed the full diagnostic algorithm.
• Three patients were diagnosed with PTB despite not completing the algorithm.
• Medical officers often lacked awareness of the algorithm, prescribed short antibiotic courses, and omitted repeat sputum tests, recommending CXR prematurely.
• Patient-related factors like non-return to health centers and private sector switching also contributed to non-completion.

Conclusions:

• The study highlights significant gaps in the implementation of the smear-negative PTB diagnostic algorithm.
• Recommendations include refresher training for medical officers, enhanced patient awareness campaigns, and active patient follow-up to ensure algorithm completion.
• Improving adherence is crucial for accurate PTB diagnosis and management.