Patterns of Drug-Resistant Tuberculosis in Smear Positive PulmonaryTubercular Patients Taking Drug Sensitive Anti-TubercularMedications under the DOTS or Non-DOTS Category at the TertiaryCare Hospital in Western Uttar Pradesh State

Abstract

Introduction: More than half of patients with tuberculosis in India are cared for in the non-government sector. The use of
inappropriate tuberculosis (TB) diagnostic and treatment measures is still seen among patients getting treatment with private
practitioners, which may contribute to the problem of controlling TB and may lead to the development of resistant TB strains.
Objective: To study and compare patterns of drug-resistant tuberculosis (DR-TB) among those receiving drug-sensitive
tuberculosis (DS-TB) regimens among within-DOTS and outside-DOTS cohorts.
Materials and Methods: Prospective observational type study, performed at the tertiary care center (Agra), on patients of eligible
category. Rapid molecular diagnostic-based drug resistance testing and drug susceptibility testing (DST) of colonies grown in
liquid culture media were conducted on sputum specimens.
Results: RR, MDR, Pre-XDR and XDR rates are higher in the outside-DOTS cohort (i.e., those patients under the care of private
practitioners on one or the other DS-TB regimen), while H mono/poly resistance pattern is higher in within-DOTS cohort (i.e.,
those patients under the care of the government DS-TB regimen under NTEP). The overall prevalence of DR-TB is higher
among those outside the DOTS category than within the DOTS category.
Conclusion: The overall prevalence of DR-TB with Pre-XDR and XDR forms of DR-TB is more in outside DOTS than within
the DOTS cohort and further studies to suggest better policies in public-private partnerships to achieve the goal of tuberculosis
elimination.