The prevalence of multi-drug resistant tuberculosis (MDR-TB) in different clinical settings [Primary health center (PHC), District tuberculosis center (DTC) and tertiary care center (Medical college )] had not been systematically worked out. There is a need to estimate the magnitude of problem and to define the factors responsible for its emergence.
A prospective study of risk factors of MDR-TB among patients seen at three sites during period of two years, 2000-2002. Patients included from PHC, Ballabhgarh, DTC, Faridabad and tertiary care center, All India Institute of Medical Sciences, (AIIMS), New Delhi. Total 1467 patients with pulmonary TB recruited from three sites and on whom the drug susceptibility results were available after adequate quality control. Of these 678 patients were enrolled at AIIMS, 346 at PHC and 443 at the DTC.
Overall, 123 (18.9, 95%CI: 11.9-25.8%) patients had MDR-TB. Of the 329 patients without history of anti tuberculosis treatment (ATT) in the past, 28 (8.5,95%CI: 5.4-11.5%) patients had MDR organisms. The corresponding proportion amongst those with past history of ATT was 95 (29.7, 95%CI: 24.6-34.7%) out of 319. There was considerable variation in the proportion of patients with MDR organisms (without past history of ATT) at three sites (6.9-11.8%). The prevalence of MDR-TB in patients with past history of ATT at AIIMS hospital was 44.7, 95%CI: 35.5-53.8%, PHC 23.1, 95%CI: 14.6-31.5% and DTC was 20.0, 95%CI: 12.5-27.4%. Of the risk factors studied for MDR-TB, bacillary load and previous treatment of TB were found significant (p<0.05).34 had pauci-bacillary disease (smear negative but culture positive). The prevalence of HIV amongst these patients was 2.77%. HIV status, tobacco smoking, excessive alcohol intake, age, sex, education and socio-economic status had no relation to infection with MDR organism.
This study highlights important differences in the prevalence of MDR-TB at three different clinical settings.
The findings of this study have major implications for the TB program in India.
Sanjeev Sinha, None.