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Prevalence and Outcomes of Tuberculosis Treatment in a Primary Care Center in Karachi, Pakistan

Fatima Jehangir, Rizwana Hashmi, Tooba Khalid Khan Alizay Lateef, Maha Zubair, Abeer Tasleem, Arwa Giani, Ahmed Ghaffar and Jawed Usman

Background: Tuberculosis (TB) still remains a major health issue in Pakistan, despite the introduction of directly observed treatment short course strategy (DOTS) by World Health Organization (WHO) in 1995. Major progress towards the disease control, however is achieved after the revival of national tuberculosis control (NTP) program in 2001. Between 2002 and 2007, DOTS coverage increased from 44% to 99%, but there are still large and persistent gaps in detection and treatment. We conducted this study, to see prevalence and treatment outcome among TB patients who completed treatment under DOTS strategy over 15 years. Primary endpoint: To determine treatment outcome of all types of TB from 2004 till 2018 in a primary health center (PHC) in Karachi. Secondary endpoint: To determine the prevalence, predominant site, and number of new versus retreatment cases of TB.

Methods: It is a cross-sectional descriptive study, conducted at a PHC, affiliated with Family medicine department of Ziauddin University Hospital, Clifton, Karachi. This Center also functions as Basic Management Unit (BMU) for tuberculosis control under DOTS strategy since 2004, in collaboration with NTP, Pakistan. Data was collected from January 1st 2004 till December 31st 2018. Among all subjects who visited the center, those who had cough for more than 2 weeks, were screened for pulmonary tuberculosis (PTB). Extrapulmonary Tuberculosis (EPTB) was diagnosed on relevant investigations. After treatment completion, their outcome was analyzed.

Results: Out of 41615 patients who visited PHC center, 454 patients (1.1%) had TB. 74.7% subjects were diagnosed having PTB while 25.3% had EPTB. 81% subjects completed TB treatment, 1.32% failed to respond to the treatment, 1.1% subjects died during the course of the disease, 15% were lost to follow up and 1.32% moved to another facility. 94.9% (431) subjects were new patients, while 5% (23) were retreatment patients. 88% subjects of PTB were Sputum Smear Positive (SSP) and 12% had Sputum Smear Negative (SSN) PTB.

Conclusion: In conclusion, this study documented the prevalence of TB in a slum community of 100,000 inhabitants, who visited the PHC in their locality. Standard DOTS guidelines were used for screening, diagnosis and treatment of the subjects. Strengthening screening methods and diagnostic procedures, will bring about more confirmed cases of TB and under reporting will be reduced. Strict surveillance of subjects on treatment will improve treatment outcome, and will decrease future development of multi drug resistant TB (MDR TB).