Triaging for Severe Illness amongst Adults with Tuberculosis Followed by Referral and Inpatient Care: A Statewide Pilot in Tamil Nadu, India
Background: This research paper reports on the first statewide implementation of differentiated Tuberculosis (TB) care in routine health system settings in India and possibly globally. This pilot aimed to assess the feasibility in routine health system settings and to identify the predictors of tria...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2024-03-01
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| Series: | Preventive Medicine: Research & Reviews |
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| Online Access: | https://journals.lww.com/10.4103/PMRR.PMRR_33_23 |
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| author | Hemant D. Shewade Asha Frederick Madhanraj Kalyanasundaram Joshua Chadwick G Kiruthika T Daniel Rajasekar K Gayathri R Vijayaprabha R Sabarinathan Shri Vijay Bala Yogendra Shivakumar Kathiresan Jeyashree P K Bhavani S Aarthi K V Suma Delphina P. Pathinathan Raghavan Parthasarathy M Bhavani Nivetha Jerome G Thampi Deiveegan Chidambaram Tarun Bhatnagar S Lokesh Shanmugasundaram Devika Timothy S. Laux Stalin Viswanathan R Sridhar K Krishnamoorthy M Sakthivel S Karunakaran S Rajkumar M. Ramachandran K D Kanagaraj V P Durai R Saravanan A Sugantha S Zufire Hassan Mohamed Khan P Sangeetha R Vasudevan R Nedunchezhian M Sankari N Jeevanandam S Ganapathy V Rajasekaran T Mathavi A R Rajaprakash Lakshmi Murali U Pugal K Sundaralingam S Savithri S Vellasamy D Dheenadayal P Ashok R Sudhakar K P Rajan N Tharageshwari D Chokkalingam S M Anandrajkumar T S Selvavinayagam C Padmapriyadarshini Ranjani Ramachandran Manoj V Murhekar |
| author_facet | Hemant D. Shewade Asha Frederick Madhanraj Kalyanasundaram Joshua Chadwick G Kiruthika T Daniel Rajasekar K Gayathri R Vijayaprabha R Sabarinathan Shri Vijay Bala Yogendra Shivakumar Kathiresan Jeyashree P K Bhavani S Aarthi K V Suma Delphina P. Pathinathan Raghavan Parthasarathy M Bhavani Nivetha Jerome G Thampi Deiveegan Chidambaram Tarun Bhatnagar S Lokesh Shanmugasundaram Devika Timothy S. Laux Stalin Viswanathan R Sridhar K Krishnamoorthy M Sakthivel S Karunakaran S Rajkumar M. Ramachandran K D Kanagaraj V P Durai R Saravanan A Sugantha S Zufire Hassan Mohamed Khan P Sangeetha R Vasudevan R Nedunchezhian M Sankari N Jeevanandam S Ganapathy V Rajasekaran T Mathavi A R Rajaprakash Lakshmi Murali U Pugal K Sundaralingam S Savithri S Vellasamy D Dheenadayal P Ashok R Sudhakar K P Rajan N Tharageshwari D Chokkalingam S M Anandrajkumar T S Selvavinayagam C Padmapriyadarshini Ranjani Ramachandran Manoj V Murhekar |
| author_sort | Hemant D. Shewade |
| collection | DOAJ |
| description | Background:
This research paper reports on the first statewide implementation of differentiated Tuberculosis (TB) care in routine health system settings in India and possibly globally. This pilot aimed to assess the feasibility in routine health system settings and to identify the predictors of triaging and the burden of triage positive.
Methods/Design:
An observational study involving cross-sectional and longitudinal descriptive design. This differentiated TB care was implemented amongst all public notified adults (≥15 years) with TB (not known to be drug resistant at diagnosis) in routine health system settings involving the existing workforce in Tamil Nadu, India (except Chennai).
Results:
Of 2,382 adults with TB notified during 14-27 March 2022, 1,636 (69%) were triaged for severe illness and 290 (18%) were triage positive. Of these 298, a total of 160 (55%) were comprehensively assessed after referral. Of 136 confirmed as severely ill, 116 (85%) were admitted and 103 were discharged. The median admission duration was 4 days. From diagnosis, the median time interval to admit a severely ill patient was 1 day. Adults diagnosed by rapid molecular test, with extrapulmonary TB and transferred out of district, were less likely to be triaged.
Conclusion:
To reduce TB deaths, the losses in the care cascade should be reduced and the admission duration increased. The findings of this pilot exercise guided the eventual implementation starting 01 April 2022. |
| format | Article |
| id | doaj-art-859481e6dc5c48d9908cf3a3b05e5214 |
| institution | Kabale University |
| issn | 2950-5828 2950-5836 |
| language | English |
| publishDate | 2024-03-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Preventive Medicine: Research & Reviews |
| spelling | doaj-art-859481e6dc5c48d9908cf3a3b05e52142025-08-20T03:31:11ZengWolters Kluwer Medknow PublicationsPreventive Medicine: Research & Reviews2950-58282950-58362024-03-01129410110.4103/PMRR.PMRR_33_23Triaging for Severe Illness amongst Adults with Tuberculosis Followed by Referral and Inpatient Care: A Statewide Pilot in Tamil Nadu, IndiaHemant D. ShewadeAsha FrederickMadhanraj KalyanasundaramJoshua ChadwickG KiruthikaT Daniel RajasekarK GayathriR VijayaprabhaR SabarinathanShri Vijay Bala Yogendra ShivakumarKathiresan JeyashreeP K BhavaniS AarthiK V SumaDelphina P. PathinathanRaghavan ParthasarathyM Bhavani NivethaJerome G ThampiDeiveegan ChidambaramTarun BhatnagarS LokeshShanmugasundaram DevikaTimothy S. LauxStalin ViswanathanR SridharK KrishnamoorthyM SakthivelS KarunakaranS RajkumarM. RamachandranK D KanagarajV P DuraiR SaravananA SuganthaS Zufire Hassan Mohamed KhanP SangeethaR VasudevanR NedunchezhianM SankariN JeevanandamS GanapathyV RajasekaranT MathaviA R RajaprakashLakshmi MuraliU PugalK SundaralingamS SavithriS VellasamyD DheenadayalP AshokR SudhakarK P RajanN TharageshwariD ChokkalingamS M AnandrajkumarT S SelvavinayagamC PadmapriyadarshiniRanjani RamachandranManoj V MurhekarBackground: This research paper reports on the first statewide implementation of differentiated Tuberculosis (TB) care in routine health system settings in India and possibly globally. This pilot aimed to assess the feasibility in routine health system settings and to identify the predictors of triaging and the burden of triage positive. Methods/Design: An observational study involving cross-sectional and longitudinal descriptive design. This differentiated TB care was implemented amongst all public notified adults (≥15 years) with TB (not known to be drug resistant at diagnosis) in routine health system settings involving the existing workforce in Tamil Nadu, India (except Chennai). Results: Of 2,382 adults with TB notified during 14-27 March 2022, 1,636 (69%) were triaged for severe illness and 290 (18%) were triage positive. Of these 298, a total of 160 (55%) were comprehensively assessed after referral. Of 136 confirmed as severely ill, 116 (85%) were admitted and 103 were discharged. The median admission duration was 4 days. From diagnosis, the median time interval to admit a severely ill patient was 1 day. Adults diagnosed by rapid molecular test, with extrapulmonary TB and transferred out of district, were less likely to be triaged. Conclusion: To reduce TB deaths, the losses in the care cascade should be reduced and the admission duration increased. The findings of this pilot exercise guided the eventual implementation starting 01 April 2022.https://journals.lww.com/10.4103/PMRR.PMRR_33_23differentiated tuberculosis carehospitalisationindiaoperational researchsevere tuberculosistriaging |
| spellingShingle | Hemant D. Shewade Asha Frederick Madhanraj Kalyanasundaram Joshua Chadwick G Kiruthika T Daniel Rajasekar K Gayathri R Vijayaprabha R Sabarinathan Shri Vijay Bala Yogendra Shivakumar Kathiresan Jeyashree P K Bhavani S Aarthi K V Suma Delphina P. Pathinathan Raghavan Parthasarathy M Bhavani Nivetha Jerome G Thampi Deiveegan Chidambaram Tarun Bhatnagar S Lokesh Shanmugasundaram Devika Timothy S. Laux Stalin Viswanathan R Sridhar K Krishnamoorthy M Sakthivel S Karunakaran S Rajkumar M. Ramachandran K D Kanagaraj V P Durai R Saravanan A Sugantha S Zufire Hassan Mohamed Khan P Sangeetha R Vasudevan R Nedunchezhian M Sankari N Jeevanandam S Ganapathy V Rajasekaran T Mathavi A R Rajaprakash Lakshmi Murali U Pugal K Sundaralingam S Savithri S Vellasamy D Dheenadayal P Ashok R Sudhakar K P Rajan N Tharageshwari D Chokkalingam S M Anandrajkumar T S Selvavinayagam C Padmapriyadarshini Ranjani Ramachandran Manoj V Murhekar Triaging for Severe Illness amongst Adults with Tuberculosis Followed by Referral and Inpatient Care: A Statewide Pilot in Tamil Nadu, India Preventive Medicine: Research & Reviews differentiated tuberculosis care hospitalisation india operational research severe tuberculosis triaging |
| title | Triaging for Severe Illness amongst Adults with Tuberculosis Followed by Referral and Inpatient Care: A Statewide Pilot in Tamil Nadu, India |
| title_full | Triaging for Severe Illness amongst Adults with Tuberculosis Followed by Referral and Inpatient Care: A Statewide Pilot in Tamil Nadu, India |
| title_fullStr | Triaging for Severe Illness amongst Adults with Tuberculosis Followed by Referral and Inpatient Care: A Statewide Pilot in Tamil Nadu, India |
| title_full_unstemmed | Triaging for Severe Illness amongst Adults with Tuberculosis Followed by Referral and Inpatient Care: A Statewide Pilot in Tamil Nadu, India |
| title_short | Triaging for Severe Illness amongst Adults with Tuberculosis Followed by Referral and Inpatient Care: A Statewide Pilot in Tamil Nadu, India |
| title_sort | triaging for severe illness amongst adults with tuberculosis followed by referral and inpatient care a statewide pilot in tamil nadu india |
| topic | differentiated tuberculosis care hospitalisation india operational research severe tuberculosis triaging |
| url | https://journals.lww.com/10.4103/PMRR.PMRR_33_23 |
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