Operational research conducted in Union courses yields national policy change in India
The Central TB Division (CTD) of India's Ministry of Health and Family Welfare has announced policy changes based on operational research (OR) conducted by participants in The Union–Médecins sans Frontières OR courses in 2011–2012.
The decisions mandating collection of a "Single specimen during follow-up smear examination for TB patients," "Single specimen during follow-up culture for MDR-TB patients," and "No mid-continuation phase follow-up sputum examination among TB patients" were taken on the basis of the findings from three scientific studies published in the peer-reviewed journal Plos One. While Union staff are among the co-authors of the papers, the lead authors – Debashish Kundu, Sharath B Nagaraja, and Mohit P Gandhi – were participants in the OR courses, who designed the research protocols, conducted the studies and wrote up the results for publication with mentoring from course leaders.
The studies investigated various aspects of the use of sputum-smear microscopy in examining and determining treatment of TB patients in India. The findings suggested that reducing sputum specimens from two to one in the follow-up examination of TB patients would save resources as well as laboratory technicians' and patients' time, since the incremental yield of a second smear examination and its utility in monitoring treatment response was negligible. Similarly, discontinuing the mid-continuation phase follow-up among new sputum smear-positive cases who become sputum smear-negative after completing the intensive phase of treatment would also reduce laboratory workloads without impacting overall early detection of treatment failure. Finally, it was found that a single sputum specimen policy in the monitoring of MDR-TB patients could also safely be implemented with negligible clinical effect on MDR-TB patients and favourable resource implications.
The CTD's decision to implement these cost- and resource-saving measures are a direct consequence of the research recommendations. Such a translation of research into policy underlines the potential of OR to assist countries in strengthening the efficiency, and therefore efficacy, of their national TB control programmes.
Click here to read the published papers:
- Can Follow-Up Examination of Tuberculosis Patients Be Simplified? A Study in Chhattisgarh, India
- Is One Sputum Specimen as Good as Two during Follow-up Cultures for Monitoring Multi Drug Resistant Tuberculosis Patients in India?
- Sputum Smear Microscopy at Two Months into Continuation-Phase: Should It Be Done in All Patients with Sputum Smear-Positive Tuberculosis?
Source: The Union
