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Free Content Initial default among diagnosed sputum smear-positive pulmonary tuberculosis patients in Andhra Pradesh, India

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BACKGROUND: Under the Indian Revised National TB Control Programme (RNTCP), smear-positive pulmonary tuberculosis (PTB) patients not confirmed as starting treatment are reported as ‘initial defaulters’.

SETTING: Twenty districts of Andhra Pradesh State, India.

OBJECTIVE: To evaluate reasons for treatment non-initiation in smear-positive PTB patients diagnosed and reported as initial defaulters by the NTP.

DESIGN: A cross-sectional survey conducted of all reported initial defaulters during the period July–September 2006.

RESULTS: Of 1304 reported initial defaulters, 619 (47.5%) had been placed on treatment, having been incorrectly reported due to poor documentation of patients referred for treatment in the same district or whose treatment initiation was delayed until the subsequent quarter. Of the 685 (4.5% of the total diagnosed) who were confirmed initial defaulters, 350 (51%) were untraceable, 152 (22%) had died before treatment initiation, 38 (5.5%) were treated privately, 93 (13.5%) had other reasons (e.g., refusal of treatment, chronic case, etc.) and no data were available for 52 (8%).

CONCLUSIONS: Nearly 5% of smear-positive PTB patients diagnosed in the study period were confirmed as not having initiated treatment under the RNCTP. Improvements in address recording may assist efforts to retrieve these patients for treatment. Additional evaluations are needed of improved counselling of TB suspects to prevent initial default, and of reasons for death before treatment initiation.
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Keywords: India; initial default; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Health, State Government of Andhra Pradesh, Hyderabad, Andhra Pradesh, India 2: Office of the World Health Organization Representative to India, New Delhi, India 3: Central TB Division, Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, New Delhi, India

Publication date: 2008-09-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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