Epidemiological and behavioural correlates of drug-resistant tuberculosis in a Tertiary Care Centre, Delhi, India

Background: Multidrug-resistant tuberculosis (MDR-TB) is a major public health challenge in India. It is associated with poor treatment outcomes, multiple adverse effects to treatment and involves enormous social and economic losses. The objective of the study was to ascertain the epidemiological and behavioural correlates contributing to drug resistance among patients admitted in a tertiary hospital in Delhi with drug-resistant TB (DR-TB).

Methodology: A descriptive cross-sectional study was carried out during the period of July-November 2013 at the Rajan Babu Institute of Pulmonary Medicine and Tuberculosis (RBIPMT), Delhi. All patients admitted with DR-TB for treatment were interviewed regarding social, demographic, and treatment aspects, using a semi-structured questionnaire. Their medical records were also reviewed.

Results: A total of 250 patients were included in the study; 198 (79.2%) with multidrug-resistant (MDR-TB) and 52 (20.8%) with extensively drug-resistant TB (XDR-TB). Of these, 66% patients were male and 46% came from poor socioeconomic background. All the patients had history of receiving anti-tubercular treatment (a mean of 2.3 times, range 1-6 times) before the current diagnosis of DR-TB. While 81 (32%) took treatment from private practitioner during the first episode of TB, 146 (58%) received treatment exclusively at government health facilities. Almost 87% of DR-TB patients were previously treated with category-II under RNTCP. Irregularity of treatment was reported by 88 (35%) patients.

Conclusion: The study explores the epidemiological and behavioural correlates among the patients with drug-resistant TB. History of previous treatments for TB was a common feature among all the enrolled patients. The fact that more than half of DR-TB patients received anti-tubercular treatment exclusively in government facilities is a matter of concern. There is an urgent need to ensure treatment adherence through improved quality in service delivery in public sector and strong linkage with the private sector. Health education and patient counseling is needed to address personal level risk factors and to ensure treatment adherence.