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Delay in starting therapy in drug-resistant tuberculosis – An insight

Introduction: The Revised National Tuberculosis Control Programme (RNTCP) ensures a prompt diagnosis and effective treatment of all tuberculosis (TB) patients with drug-resistant TB via decentralized drug sensitivity testing (DST). This study was taken in to find out the cause of delays in initiation of treatment. Material and Methods: This cross-sectional observational study included a questionnaire-based interview and retrospective analysis of records of the concerned patients with an aim to explore the reasons associated with this delay. Results: A delay was arbitrarily defined as a time period of more than 15 days from the date of sputum collection for DST to the date of admission. It considered of two parts, one due to lapse in system regarding implementation of program and other due to the lapses in the part of the patient. Out of 402 patients enrolled in the study, 252 (62.7%) sought treatment after the prescribed period and were categorized as delayed and comprised the Group I of study. The remaining 150 (37.3%) were those who sought treatment within the prescribed period and were and were termed in-time treatment seekers and thus comprised Group II of study. Delay in communication of results to DOTS centre and in-patient tracing was the most common reason for delay while unwillingness to avail treatment against the expectation was the least common reason. Conclusions: Undefined time for communication of DST results and patient tracing in PMDT services are the major cause of delay. Strengthening the communication skills of the care providers through expanding DST services at sub-district levels, regular training of care providers, setting district level information cells, creating mobile apps, and involving volunteers who are representatives of the local community is the need of the hour.