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Initial D: Second Stage Episode 6

The second stage involved in-depth interviews of identified TB patients who were treated for pulmonary TB in Mumbai and had completed their anti-TB treatment in the past six months. A total of 82 patients consented to being interviewed using a pre-tested open-ended semi-structured interview schedule ( Supplementary File 1). Pre-testing was conducted as per study protocol on six known TB cases from K/East ward who were excluded from the final study sample. Of the 82 patients that consented to be interviewed, 23 DR-TB patients were identified (28%), and only these interviews were included in the present analysis. The data from the remaining 59 patients has been previously published 5 . Patients were identified as DR-TB cases if they had completed their anti-DR-TB treatment in Mumbai within the past six months of the interview. Besides patient information, diagnosis and treatment records of patients were obtained and seen by the researchers. Photographs of these were taken and shown to our clinical consultant on the study (YD), on whose opinion, the cases were classified as DR-TB. Two were identified as extensively drug resistant (XDR) cases based on their line probe assay (LPA) (Hain Lifescience, Nehren-Germany) results. Monoresistance to Isoniazid (INH) could not be identified as drug sensitivity testing (DST) through the line probe assay LPA was not available for all cases at the time of the study.

Initial D: Second Stage Episode 6


Since it is more likely for a retreatment patient to be resistant at their second episode, DST testing is mandated at the time of diagnosis. However, the failure in undertaking this in over 70% of patients in the present study, exceeded the proportion (45%) reported in another study conducted in Andhra Pradesh, India 7 . This calls for a more stringent implementation of the diagnostic algorithms for standards of care in DR-TB at field level. This is particularly important for areas with high prevalence of DR-TB such as Mumbai.

2. Response: We have modified Figure 1. to give the number of cases excluded for various reasons. Only 14 did not consent to participate (refusals) whereas others either did not meet the inclusion criteria or were unable to be interviewed. The inclusion criteria for the second stage was more stringent as opposed to a more broader criteria used in selection at stage 1. Unfortunately demographic details for patients that did not consent or not included in the study were not collected as it did not fall in the purview of the study objective. 041b061a72


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