2. Department of Healthcare, Family welfare and Human services (HC, FW&HS), Govt of Sikkim, India.
3. Regional Medical Research Centre (RMRC), ICMR- North East Region, Lahowal, Dibrugarh, Assam, India.
Background: Sikkim, India has maintained the global targets of 70% detection and 85% cure of the new smear positive cases since 2003; however, the rate of retreatment cases have become a matter of concern. An accurate analysis of the retreatment cases and their treatment outcome is needed to ascertain the strengths and weaknesses in the management of retreatment.
Methods: Diagnosis, classification, chemotherapy and outcomes following treatment were noted. Treatment details were updated regularly and the patient's final outcome was recorded at the end of their treatment. Annual notification and treatment outcome analysis was conducted for retreatment cases as a whole as well as for each sub-category of retreatment independently. The Chi square test was used to assess the statistical significance of each rate ratio. A statistical test was considered significant when the P value was <0.005.
Results and discussion: Overall relapse cases (63.8%) were the most common; followed by failure cases (20.8%) and treatment after default cases (15.2%). Overall cohort analysis of retreatment cases shows treatment cure rate of 62.4% and treatment failure of 22.1%. Stratified cohort analysis highlights treatment cure rate of 70.4% and 34.1% among relapses and failures. The treatment failure rate for failures was 45.2%, strongly suggesting multi drug resistance (MDR); this highlights the need to implement measures to reduce the number of failures. Among the treatment after default the default rate was 6.7%; strict treatment adherence and positive patient's attitude and behaviour towards the disease is the main solution to avoid defaulting.
Conclusion: In the retreatment category relapse cases were the most common retreatment category however these patients were more likely to be cured with the Category II retreatment regimen; patients who failed the Category I treatment were most likely to wound up as failures on the Category II retreatment regimen, and first time defaulters had a significant risk of defaulting from the Category II retreatment regimen. Controlling the need for retreatment is the best known strategy, apart from this continuous monitoring, adherence and treatment completion is essential in order to improve tuberculosis control.
Keywords: Retreatment category, failure, relapse, treatment after default and tuberculosis