TB patients in an Indian mega-city: Where do they live and where are they diagnosed?
Abstract
Objective
Tuberculosis (TB) is a
major source of mortality in urban India, with many structural
challenges to optimal care delivery. In the government TB
program in Chennai, India’s fourth most populous city,
there is a 49% gap between the official number of smear-positive
TB patients diagnosed and the official number registered in TB
treatment within the city in 2014. We hypothesize that this
“urban registration gap” is partly due to rural
patients temporarily visiting the city for diagnostic
evaluation.
Methods
We collected data for one
month (May 2015) from 22 government designated microscopy
centers (DMCs) in Chennai where 90% of smear-positive TB
patients are diagnosed and coded patient addresses by location.
We also analyzed the distribution of chest symptomatics (i.e.,
patients screened for TB because of pulmonary symptoms) and
diagnosed smear-positive TB patients for all of Chennai’s
54 DMCs in 2014.
Results
At 22 DMCs in May 2015, 565
of 3,543 (15.9%) chest symptomatics and 71 of 412 (17.2%)
diagnosed smear-positive patients had an address outside of
Chennai. At the city’s four high patient volume DMCs, 54
of 270 (20.0%) smear-positive patients lived out-of-city. At one
of these high-volume DMCs, 31 of 59 (52.5%) smear-positive
patients lived out-of-city. Out of 6,135 smear-positive patients
diagnosed in Chennai in 2014, 3,498 (57%) were diagnosed at the
four high-volume DMCs. The 32 DMCs with the lowest patient
volume diagnosed 10% of all smear-positive patients.
Conclusions
TB case detection in
Chennai is centralized, with four high-volume DMCs making most
diagnoses. One-sixth of patients are from outside the city, most
of whom get evaluated at these high-volume DMCs. This calls for
better coordination between high-volume city DMCs and rural TB
units where many patients may take TB treatment. Patient
mobility only partly explains Chennai’s urban registration
gap, suggesting that pretreatment loss to follow-up of patients
who live within the city may also be a major problem.
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Source:
PLOS ONE
