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INH Preventive Therapy (IPT) substantially reduces the risk of incidence of TB disease in pediatric household contacts of TB patients. The National TB Elimination Program (NTEP) of India prescribes a daily regimen of Isoniazid to all under-6 pediatric contacts for 6 months duration. We conducted, this exploratory prospective study (June to Nov' 2020) to assess adherence to IPT and reasons for nonadherence among child contacts of microbiologically confirmed, drug sensitive, non-PLHIV Tuberculosis patients in Delhi, India. The study outcomes included the initiation, adherence and completion of IPT. The caregivers of the child TB contacts were interviewed face to face by the field investigator. The data were entered on EpiData 3.1 and analysed with IBM SPSS 25. The INH adherence was assessed in a total of 86 household child TB contacts. IPT had been initiated in 62 (72.1%) child TB contacts of which 61 (98.4%) received INH within 1 month of starting of ATT-DOTS therapy in the index TB patient of the household. Furthermore, the failure to initiate IPT was reported by 24 (27.9%) child TB contacts. Within the cohort of child TB contacts who were not initiated with IPT, the ATT-DOTS duration in the index-TB patient was ≥5 months in 18 (75%) cases, 1-2 months in 3 (12.5%) cases, and1 month in also 3 (12.5%) cases. Reasons for non-initiation (n = 24) were reported as refusal by the family in 12 (50%) cases mostly due to concern over side-effects of the drug, while non-provision of the drug by the DOTS provider was also observed in 12 (50%) cases. The mean (SD) INH adherence in the INH initiated cohort was 5.6 (2.0) (n = 62). Reasons for INH non-adherence were attributed to forgetfulness (n = 23, 37.1%), carelessness (n = 24, 38.7%), and intermittent stopping of the medication (n = 17, 27.4%) on the child falling sick, perceived drug side effects, and running out of drug stocks. INH non-adherence defined as at-least two missed INH doses in the previous 7 days was observed in 47 (54.7%) participants (n = 86). On bivariate analysis, none of the household sociodemographic characteristics showed any statistically significant association with the rate of INH non-adherence in the child TB contacts. The findings of the present study indicate the need to periodically assess adherence and persistence to IPT in the child TB contacts as high intermittent missed dosing rates can undermine the effectiveness of IPT in preventing incident disease.

The Covid-19 pandemic has caused millions of cases and deaths worldwide and has caused a massive global economic contraction. Governments, policymakers, and medical professionals have been confronted with several complex bioethical dilemmas during these exceptional circumstances. In developing countries like India, having a large population base, inadequate preexisting public health infrastructure, and a multi-level government system with complex administrative mechanisms imposes enormous barriers and challenges in the effective and ethical management of the pandemic. Furthermore, endemic corruption, limited bureaucratic and organisational accountability, and weak oversight, especially among stakeholders in the vast private and non-government health and allied services sector, complicate the assessment of their adherence to ethical public health practices. All this constitutes a moral imperative for practitioners of medical ethics in India to develop a framework for ethical preparedness during a pandemic. Failure to do so runs the grave risk of moral and ethical chaos from ad-hoc decision making that is deprived of ethical guidance when confronted with an unprecedented public health crisis. In this narrative, we provide some of the building blocks for a comprehensive ethical framework for decision making and shaping public health responses to pandemic situations and associated challenges.

A significant proportion of patients with coronavirus disease 2019 (COVID‐19) require timely hospitalization to reduce the risk of complications and mortality. We describe the trends of the age and gender stratified outcomes among hospitalized COVID‐19 patients with moderate to severe illness at the largest dedicated tertiary care COVID‐19 government hospital in New Delhi, India. A retrospective cohort study through secondary data analysis from in‐patient hospital data of patients admitted from April 1 to November 15, 2020 was conducted. The data of 10,314 laboratory‐confirmed patients with COVID‐19 was analyzed, of which 8899 (86.28%) were discharged after recovery, and 1415 (13.72%) died. The mean (SD) age of the hospitalized patients was 46.43 (18.74) years (n = 10,309) including 6031 (58.50%) male and 4278 (41.50%) female patients (n = 10,309). On bivariate analysis, increasing age was associated with significantly higher odds of mortality in both gender (p, Highlights 1We analyzed data from 10,314 COVID‐19 patients with moderate‐severe illness.2A total of 8899 (86.28%) patients were discharged after recovery and 1415 (13.72%) died.3Mortality rate in female patients was lower (11.92%) compared to males (15.75%) (p = .675).4Elderly women (>=70) had a 16.77 times higher odds of mortality compared to younger (age

Several digital contact tracing smartphone applications have been developed worldwide in the effort to combat COVID-19 that warn users of potential exposure to infectious patients and generate big data that helps in early identification of hotspots, complementing the manual tracing operations. In most democracies, concerns over a breach in data privacy have resulted in severe opposition toward their mandatory adoption. This paper examines India as a noticeable exception, where the compulsory installation of such a government-backed application, the “Aarogya Setu” has been deemed mandatory in certain situations. We argue that the mandatory app requirement constitutes a legitimate public health intervention during a public health emergency.

The delay in the diagnosis and treatment initiation of patients with MDR-TB worsens individual prognosis and increases the risk of disease transmission in the community. These delays have been attributed to delay in treatment-seeking by the patient and shifting to multiple healthcare facilities before being tested and diagnosed through India's National Tuberculosis Elimination Program (NTEP).to identify treatment pathways in patients with MDR-TB from the time of onset of symptoms and treatment seeking until diagnosis at a PMDT site and subsequent treatment initiation. We also compared these characteristics with those of patients with DS-TB.We recruited a total of 168 patients with MDR-TB and DS-TB each, in Delhi. Data were analyzed using IBM SPSS Version 25.The mean (SD) patient delay for initial treatment-seeking was 20.9 (15.9) days in patients with MDR-TB, and 16.1 (17.1) days in patients with DS-TB (p 0.001). The median time from visit to the first healthcare facility (HCF) until confirmation of MDR-TB diagnosis was 78.5 days, and until treatment initiation was 102.5 days. Among patients with DS-TB, the time interval from a visit to the first HCF until the initiation of ATT-DOTS was 61.5 days.. Patients diagnosed with DS-TB, whose first source of treatment was a private facility (n = 49), reported a significant delay in the initiation of ATT-DOTS (p 0.001).Despite the introduction of universal drug sensitivity testing in individuals having presumptive MDR-TB, a significant delay in the diagnosis and initiation of effective MDR-TB treatment persists as a major public health challenge in India.

More than one in two healthcare workers (HCWs) in developing countries have latent tuberculosis infection (LTBI), an asymptomatic condition signifying persistent tubercular infection in absence of disease. Objective to evaluate the physician attitude towards LTBI preventive therapy and their perspectives regarding the potential expansion of latent TB management under the RNTCP. Material and methods We conducted a cross-sectional analysis among 60 participants of a continuing medical education program during October' 2019 in a medical college in Delhi, India. Results We enrolled a total of 30 medical officers, 15 resident doctors and 15 medical interns, comprising 27 (45%) males and 33 (55%) females. Only 9 (15%) participants were aware of existing RNTCP guidelines for programmatic management of LTBI. The median (IQR) self-rated willingness of the participants in receiving treatment for LTBI after confirmation of diagnosis on a 10 point continuous rating scale was 6 (5.8). The principal reason attributed to the treatment hesitancy were concerns over drug side effects 19 (31.7%), emergence of drug resistance 11 (18.3%) and the likelihood of reinfection 4 (6.7%). Support for expansion of preventive therapy among household TB contacts was varied, with maximum (41.2%) participants wanting it only for the comorbid patients. Conclusion LTBI preventive treatment is associated with considerable side effects and lack of long-term benefits by a majority of Indian physicians despite significant personal health concerns in treating pulmonary TB cases.

Background & objectives: The increase in the burden of multidrug-resistant tuberculosis (MDR-TB) is a matter of grave concern. The present study was undertaken to describe MDR-TB treatment outcome trends in Delhi and their epidemiological correlates, to assess the adequacy of treatment records and to also generate evidence towards influencing and improving practices related to the MDR-TB control programme. Methods: A retrospective record-based study (2009-2014) was conducted in three major drug resistance TB treatment centres of Delhi. Treatment outcomes and adverse effects were extracted from the existing programme records including patients' treatment cards and laboratory registers. Results: A total of 2958 MDR-TB patients were identified from the treatment cards, of whom 1749 (59.12%) were males. The mean (±standard deviation) age was 30.56±13.5 years. Favourable treatment outcomes were reported in 1371 (53.28%) patients, but they showed a declining trend during the period of observation. On binomial logistic regression analysis, patients with age ≥35 yr, male sex and undernourishment (body mass index

Background: Increasing stress has been recognized as a major public health problem in the developing world accelerated by an ongoing demographic, economic, and sociocultural transition. Our study objectives were to validate a Hindi version of the 10-item Perceived Stress Scale (PSS-10) and to also assess the extent of perceived stress and its correlates among an adult population in an urban area of Delhi. Methodology: A community-based cross-sectional study was conducted in an urban resettlement colony of Delhi among 480 adult subjects aged 25--65 years, during the period from January to December 2015. The PSS-10 was translated into Hindi and validated in the study population. Data was analyzed using IBM SPSS Version 25. Results: A total of 243 (50.6%) men and 237 (49.4%) women were enrolled. The scale had an acceptable level of internal consistency (Cronbach's alpha = 0.731). A principal component analysis was run on the PSS-10 data, based on which a three-component structure was accepted, which explained 61% of the total variance. The mean PSS score was 19.25 (SD = 4.50) years. Perceived stress was highest in the 35--50 age group. On multivariate analysis, low socioeconomic status and a white-collar occupation were found to be associated with increased perceived stress (P < 0.001) Conclusion: A high burden of perceived stress exists in residents of a low-income urban population in India.

Introduction This study aimed to determine the breakthrough infection rate of coronavirus disease 2019 (COVID-19) (severe acute respiratory syndrome coronavirus 2 {SARS-CoV-2}) infection in healthcare workers (HCWs) vaccinated with either BBV152 or AZD1222 (ChAdOx1-S) vaccine. Methods A cross-sectional analysis was conducted at a medical college and hospital complex in Delhi, India, through telephonic interviews among HCWs who had received at least one dose of a COVID-19 vaccine during January-March 2021. Breakthrough infections were operationally defined as the occurrence of COVID-19 infection >= 14 days after administration of two doses of either COV1D-19 vaccine. Data were entered in Epidata 3.1 (Odense, Denmark: EpiData Association) (single entered) and analyzed with IBM SPSS version 25 (Armonk, NY: IBM Corp.). A p-value < 0.05 was considered statistically significant. Results We enrolled 325 HCWs with a mean (SD) age of 29.1 (9.9) years including 211 (64.9%) males and 114 (35.1%) females. A total of 37 (13.3%, 95% CI 9.8, 17.7) COVID-19 breakthrough infections were observed in the HCWs. Additionally, 20 (6.1%) non-breakthrough infections were reported in the HCWs who were vaccinated with at least a single dose of a COVID-19 vaccine, or both doses, but prior to 14 days since the administration of the second dose. Most breakthrough infections were mild without needing supplemental oxygen for recovery. Conclusion Nearly one in seven HCWs experienced a COVID-19 breakthrough infection in the present study. A history of SARS-CoV-2 natural infection followed by at least one dose of COVID-19 vaccination was associated with significant protection against breakthrough infections.

Complete postexposure prophylaxis with 4 doses of anti-rabies vaccine (ARV) in a previously vaccinated (nonnaïve) individual results in administration of two extra ARV doses resulting in wastages of precious resources comprising vaccine logistics, human resources, physician, and patient time. This cross-sectional study conducted in a secondary care hospital in Delhi among 175 incident animal bite cases observed 39 (22.3%) had an animal-bite history within the previous 5 years. A total of 19 (10.8%) cases reported a history of complete ARV vaccination during a previous animal-bite exposure. However, in the absence of supportive patient medical documentation, all the animal bite cases without exception were prescribed a full course of ARV irrespective of their previous exposure status. Rabies immunoglobulins (anti rabies serum) were also re-administered in 13 (81.2%) cases. National guidelines for rabies prophylaxis should, therefore, consider the inclusion of an explicit decision-making algorithmic mechanism when the health-care provider is confronted with this situation carrying the potential for hidden vaccine wastage.

Collaborative TB and HIV prevention and management activities are essential for reducing the burden of TB disease and achieving favorable outcomes by ensuring early initiation of antiretroviral therapy in the comorbid patients. The Mobile population of truckers and helpers is at higher risk of HIV and also TB infection. Objective The present study assessed the feasibility and opportunities for integrating TB screening and anti-tubercular drug dispensation services to truckers as an additional service utilizing the existing infrastructure and human resources of a targeted intervention (TI) based STI (Khushi) clinic and an integrated counseling and testing center (ICTC) operating at a transport hub and transshipment site in Delhi, India. Methods This exploratory operational research study was conducted at the Sanjay Gandhi Transport Nagar (SGTN), off the GT-Karnal highway, in North-west district of Delhi, the Indian capital city during May–Nov’ 2016. The proposed methodology for integration of comprehensive TB services within the existing STI/HIV services for the trucker population included a prevention and awareness component using interpersonal sessions, transporter meeting, one-on-one group session and IEC/BCC sessions utilizing a surround and engage technique. TB diagnostic testing and treatment services were provided through the collaboration with the TI/Khushi clinic and ICTC center staff aided by the field assistants. Results Overall, a total of 833 activity sessions were conducted during the study period among the truckers at the SGTN. During these sessions, 14644 truckers and 1444 other individuals were covered. A total of 297 truckers and 30 other people were referred for testing out of which 283 truckers and 33 others were tested for TB. Of these, ten truckers and four other individuals were found positive for TB. Discussion The present study provides the first patient (truckers) level evidence from India that routine, provider-initiated voluntary TB testing of truckers coming to avail services at STI and ICTC clinics for prevention and screening of HIV-AIDS is possible. The current practice of referral of HIV patients from the ICTC center to the chest clinic is inefficient since the opportunity costs and financial implications involved may deter patients from testing while the HIV negative but presumptive TB patients are likely to be missed. However, for this collaborative partnership to be successful, further investment regarding human and financial resources is necessary. Existing staff needs sensitization, training and proper incentives for conducting TB related IEC/BCC activities along with that for HIV-AIDS. Furthermore, the deployment of additional personnel is preferable for sputum collection and TB testing with the availability of early reporting at site.

To determine the burden of vitamin D deficiency and its determinants and to assess the relationship of 25 hydroxycholecalciferol (25-OHD) levels with biochemical parameters linked to health outcomes in women with Type 2 Diabetes Mellitus (T2DM).This was a hospital based cross-sectional study in the diabetes out-patient department clinic of a major tertiary care hospital in Delhi, India. Adult women with T2DM on treatment for at least 6 months were included in this study. The women who have been given Vitamin D supplementation during the past 6 months were excluded. We assessed Serum 25-OHD, HbA1c, lipid profile and fasting plasma glucose in the patients through standardized laboratory methods.One hundred women with T2DM were enrolled of which 22 (22%) had good glycemic control (HbA1c 7%). Vitamin D deficiency was seen among 77 (77%) and insufficiency among 16 (16%) of the recruited subjects. Younger age group (31-45 years) and illiteracy was significantly associated with vitamin D deficiency (p 0.05). No association was found between Vitamin D deficiency and HbA1c levels.Vitamin D deficiency is highly prevalent among women with T2DM. Illiteracy and young age were major determinants of vitamin D deficiency indicating they need special attention and Vitamin D supplementation.

The elimination of Tuberculosis (TB) in settings with a high dual burden of active and latent TB is one of the most important public health challenges of the 21st century. India has the highest TB burden in the world and nearly 40% of the population being infected with TB. There also exist large often overlapping socially and medically vulnerable populations like the PLHIV, pediatric TB contacts, children with protein-energy malnutrition, homeless people, workers in silica industry and adults with low BMI. A significantly higher risk of progression into active tubercular disease exists in those with compromised immune or nutritional status. It is uncertain if global TB elimination targets can be achieved in the absence of aggressive LTBI treatment strategies for interrupting the chain of transmission of the disease. India hence needs to accelerate and prioritize capacity building in latent TB research. A research agenda is outlined for generating evidence towards the evolution of critical evidence-based policy for LTBI management under Indian health settings.

BACKGROUND: There are over 12,000 chemists registered in the capital city, Delhi to support patient health needs. A study was conducted to improve the tuberculosis (TB) notification rates as conceptualized by the Revised National Tuberculosis Control Program (RNTCP). As part of the end TB mission, the feasibility of capturing data of TB patients coming to buy anti-TB drugs at the licensee level (chemists and drug shop owners) in Central Delhi area was assessed. MATERIALS AND METHODS: The prospective study was conducted from July 2017 to March 2018. TB notification through a paper-based system and self-notification through online mode were the operational modality used for engagement with chemists. A team of paramedical workers was deployed for data collection from those pharmacists who chose to notify through the paper mode. Self-notification through online mode was through the RNTCP's NIKSHAY web-based reporting platform. RESULTS: From the 330 chemists sensitized, 871 TB notifications were received during the study. Younger age groups comprised a majority of these cases with 198 (37.5%) from 21 to 30 years and 122 (23.1%) from 11 to 20 years. By the end of six visits, 28 (46%) of the 61 pharmacies that were eventually successfully sensitized had started returning the Folio cards with filled patient details. A total of 581 (66.6%) prescriptions received by the pharmacists were from government hospitals. The annual TB case notification in Central Delhi showed a significant increase from 271 TB patients/100,000 population to 871 TB patients/100,000 population during the study period when compared with expected trends in the past year (P < 0.05). CONCLUSION: Self-notification of TB engenders successful TB notifications from chemists. This progenitor approach to TB notification in the capital emphasizes the need to categorize pharmacists as an independent private care provider for improving TB notification across high-burden settings.

Objective To determine perspectives on reasons for non-adherence to antihypertensive therapy and its socioeconomic determinants among patients attending a primary care center in a low-income area in Delhi, India. Methods We conducted in-depth interviews with a total of 30 patients having hypertension at a primary care facility located in a low-income urban area in Delhi. Results All the participants were aware that hypertension was a serious illness, and medication intake was necessary throughout life to prevent uncontrolled hypertension. All participants in varying quantities practiced salt restriction, but the consumption of fresh fruit and vegetables was low primarily due to economic reasons. The participants were unable to differentiate the concept of exercise from physical activity. Medication adherence was suboptimal, and significant reasons for non-adherence were forgetfulness, carelessness and running out of drug stocks. Blood pressure control was also suboptimal in a majority of the participants, but combination therapy was restricted due to limited medical armamentarium at the clinic. Laboratory investigations for monitoring target end-organ damage were either delayed or not conducted in most participants. Discussion Hypertensive patients undergoing treatment at primary care facilities often report suboptimal medical adherence and treatment outcomes, with socioeconomic causes being a major driver of non-adherence.

Minimizing vaccine wastage and associated costs is considered a key target for appropriate vaccine management. In India, the Rotavirus Vaccine (RVV) (2019) and the fractionated injectable polio vaccine (f-IPV) (2016) are more prone to wastage with high procurement costs. In this operational research study, we determined the effectiveness of a (self-designed) dose based reporting tool (DBRT) in reducing vaccine (f-IPV and RVV) wastage at primary care facilities in India during December 2019 to March’ 2020. Data reports of all the immunization sessions conducted at three primary care facilities were analyzed to calculate the wastage rates of the RVV and the f-IPV for the following periods: (1). Period of initiation (August-November’ 2019) (2). Pre-intervention with sensitization of healthcare providers (December’ 2019-January’ 2020) (3). Post-intervention after application of the DBRT. Intervention: The DBRT is a paper-based reporting format that assigns a unique code to each RVV and IPV vial. The health facility is required to report the total doses administered from each coded vial during every immunization session by updating it on the assigned reporting format. Pre-intervention, the average monthly wastage of f-IPV was 23.5% and of the RVV ranged from 18%-31%. Post-intervention, on using the DBRT, the monthly wastage of both RVV and f-IPV dropped significantly to 8.6% and 11.4%, respectively. During the subsequent month, the IPV wastage further decreased to only 4.7%. In conclusion, the DBRT reduces vaccine wastage in government primary care facilities by enabling a paper audit trail that promotes responsiveness and accountability among healthcare workers directly involved in vaccine administration.

Nearly a million Indian women lack access to safe and dignified abortion services from public healthcare facilities and instead opt to induce abortions by themselves or with the help from unskilled and unauthorized practitioners. Unsafe abortions account for an estimated 9% of all maternal deaths in India despite the legalization of abortion on all grounds since 1971 via the MTP Act. However, the Act technically does not make any provision for abortion based on a woman's request alone, subjecting her decision to the approval of her healthcare provider, limiting reproductive autonomy. Moreover, the problem of female feticide through sex-selective abortions has also contributed to a conflicting public agenda that prioritizes preventing the former over allowing women access to abortion services for other reasons. Women who are socio-economically, culturally, and educationally vulnerable and minors may experience further abortion related stigmatization. These ethico-legal considerations highlight the need for transition from a provider-centered to a woman-centered abortion service model.

Background and aims to determine the oral health practices in patients with DM and to identify their perspectives on treatment-seeking for oral health. Methods We conducted a cross-sectional study in the diabetes clinic of a government hospital in Delhi, India. Data was collected through face-face interviews with the patients. Results We enrolled a total of 339 participants having a mean (SD) age of 46.1 (5.4) years. An optimal glycemic control was present in 109 (32.2%) participants. Self-reported poor or very poor condition of teeth and gums was reported by 161 (47.5%) and 69 (20.35%) participants, respectively. The awareness that DM worsens oral health was correctly reported by 15.2% participants. The prevalence of twice-daily brushing was 18.6%, and 15.6% participants underwent a dental examination in the previous 12 months. Conclusion There exists a high prevalence of poor oral care despite unsatisfactory oral health status among patients with DM in India. Summary We recruited 339 patients with DM in Delhi, India. Twice-daily brushing was practiced by 18.6% participants. Self-reported poor or very poor condition of teeth and gums was reported by 47.5% and 20.3% participants, respectively. Patients avoided dental visits when asymptomatic, if not referred and due to fatalistic health beliefs.

It is now well established that non-communicable diseases (NCD), like diabetes mellitus, hypertension,, respiratory and heart disease, particularly among the elderly, increase the susceptibility to COVID-19 disease. Mortality in 60%-90% of the COVID-19 cases is attributed to either one or more of these comorbidities. However, healthcare management for control of COVID-19 involves public health and policy decisions that may critically undermine the existing health needs of the most vulnerable NCD patients. Temporary closure of outpatient health facilities in some secondary and tertiary care hospitals have deprived millions of NCD patients of their regular medication and diagnostic health needs. The lack of robust primary healthcare facilities in most states, and the failure to maintain physical distancing norms due to inadequate infrastructure is also problematic. In the absence of effective public health interventions, socioeconomically vulnerable patients are likely to become non-adherent increasing manifold their risk of disease complications. In this context, the feasibility of dispensing longer than usual drug refills for chronic NCD conditions at functional government health facilities, home delivery of essential drugs, running dedicated NCD clinics at PHCs, and utilisation of telemedicine opportunities for care and support to patients warrant aggressive exploration. Keywords: Covid-19, NCDs, Medical ethics, epidemic, India.

Background There is emerging evidence that patients with Latent Tuberculosis Infection(LTBI) and Tuberculosis(TB) disease have an increased risk of the SARS-CoV-2 infection and predisposition towards developing severe COVID-19 pneumonia. In this study we attempted to estimate the number of TB patients infected with SARS-CoV-2 and have severe disease during the COVID-19 epidemic in Delhi, India. Methods Susceptible-Exposed-Infectious-Recovered (SEIR) model was used to estimate the number of COVID-19 cases in Delhi. Assuming the prevalence of TB in Delhi to be 0.55%, 53% of SARS-CoV2 infected TB cases to present with severe disease we estimated the number of SARS-CoV2 infected TB cases and the number of severe patients. The modelling used estimated R0 for two scenarios, without any intervention and with public health interventions. Results We observed that the peak of SARS-CoV-2-TB co-infected patients would occur on the 94th day in absence of public health interventions and on 138th day in presence of interventions. There could be 20,880 SARS-CoV-2 infected TB cases on peak day of epidemic when interventions are implemented and 27,968 cases in the absence of intervention. Among them, there could be 14,823 patients with severe disease when no interventions are implemented and 11,066 patients with severe disease in the presence of intervention. Conclusion The importance of primary prevention measures needs to be emphasized especially in TB patients. The TB treatment centres and hospitals needs to be prepared for early diagnosis and management of severe COVID-19 in TB patients., Highlights • Study of its kind estimating the number of SARS-CoV2 infected TB cases during the COVID-19 epidemic in Delhi. • A mathematical modelling study which used Susceptible-Exposed-Infectious-Recovered (SEIR) model to estimate the number of patients infected with COVID-19. • The modelling used the estimated R0 for two scenarios, (i) without any intervention and (ii) with public health interventions like lockdown, social distancing, contacts quarantine and case isolation. • The model estimated that there could be 20,880 SARS-CoV-2 infected TB cases on peak day of epidemic when interventions are implemented and 27,968 cases in the absence of interventions. • Assuming 53% of the SARS-CoV-2 infected TB cases present with severe disease, it is estimated that there could be 14,823 patients with severe disease when no interventions are implemented and 11,066 patients with severe disease in the presence of intervention.

Global efforts are being made to eliminate tuberculosis (TB) as a public health problem by 2030. These efforts are being thwarted by the challenge of effective management to minimise the progression of latent TB infection (LTBI) to TB, thereby interrupting the chain of transmission. Approximately 5%-10% LTBI cases eventually develop TB in their lifetime with the risk being higher in children, people living with HIV/AIDS (PLHIV), undernourished people, and patients with diabetes, chronic kidney disease, silicosis, and other comorbid conditions. Apart from operational barriers, complex ethical issues govern decision-making processes in either retaining current LTBI management practices or advocating implementation of the latest World Health Organization guidelines, which suggest extending treatment to vulnerable groups who have a higher risk of progression to TB. Newer LTBI treatment regimens have a diminished risk of toxicity that allays threats to patient safety. Public health justification for treating LTBI can also override patient autonomy, but the lack of a patient-centred approach is associated with poor adherence and treatment outcomes. Cost-effectiveness studies need to evaluate the gains and losses accruing from funding treatment of LTBI versus similar costs in nutritional interventions for managing undernutrition. Similarly, the impact of diverting resources available for management of the existing active TB control programmes to expanding LTBI treatment also needs to be assessed. In conclusion, a comprehensive LTBI treatment strategy built on the basis of high-quality evidence is the best way forward for resolving the ethical considerations at the heart of LTBI management in the developing world. Keywords: Tuberculosis; India; Latent TB; Medical ethics.

AIM To assess the adherence to self-care practices, glycemic status and influencing factors in diabetes patients. METHODS This was a cross-sectional observational analysis of baseline data from a quasi-experimental study conducted among 375 diabetic patients aged between 18 to 65 years at a major public tertiary care centre in New Delhi, India during February-September’ 2016. The Summary of Diabetes Self-care activities measure was used to assess medical adherence in diabetic patients. Open ended questions were used to identify facilitators and inhibitors of medical adherence. RESULTS Mean age of the study subjects was 49.7 ± 10.2 years. A total of 201 men and 174 women were enrolled in the study. Three hundred nine (82.4%) subjects were adherent to their intake of anti-diabetic medication. On binary logistic regression, education level below primary school completion and absence of hypertension comorbidity were found to be independent predictors of medication non-adherence. Sociocultural resistance was an important factor impeding outdoor exercise among younger women. Knowledge of diabetes in the study subjects was low with mean score of 3.1 ± 2 (maximum score = 10). Suboptimal glycemic control was found in 259 (69%) subjects which was significantly more likely in patients on Insulin therapy compared to those on Oral Hypoglycemic agents alone (P < 0.006). DISCUSSION Our study found a large gap existed between self-reported medication adherence and glycemic control. This suggests the need for enhanced physician focus for diabetic patient management.

India has approximately 73 million people living with diabetes and another 37 million with prediabetes while nearly 47% of the diabetes cases are undiagnosed. The high burden of poor glycemic control and early onset of complications with associated economic costs indicates a high prevalence of poor self-management practices. It is well-established that achieving patient-centered primary care consistent with a chronic care model ensures optimum diabetes self-management support and improves long-term clinical and health outcomes in diabetes patients. The public sector primary care system in India provides services free of cost to beneficiaries but lacks patient-centered care that undermines diabetes self-management education and support. Furthermore, factors like poor patient knowledge of diabetes, suboptimal medication adherence, persistent clinical inertia, lack of data for monitoring and evaluation through clinical audit worsens the standards of diabetes care in primary care settings of India. There is a need for government initiatives to be directed towards the provision of comprehensive outpatient care that is inclusive of uninterrupted supply of drugs, provision of essential laboratory investigators, training and availability of qualified diabetes educators and availability of specialist support when required. Furthermore, the integration of depression screening and smoking cessation services at the primary care level is warranted.

Background This study was conducted with the objective to understand pattern and trends in drug sensitivity among MDR-TB cases in Delhi from 2009 to 2014 using existing records. Methods A retrospective record-based study was conducted at three Drug-resistant TB (DR-TB) treatment centers in Delhi. For data collection, patient treatment cards and TB registers were accessed. All multidrug-resistant (DR) TB patients registered, and initiated on treatment from January 2009 to December 2014 in three DR-TB centers were included in the study. Results A cumulative total of 2958 MDR-TB cases were registered in the three DR-TB centers during the period from Jan 2009 to December 2014. The median value time interval between culture test result and initiation of treatment was 82 days. High resistance was found against Streptomycin (70%), Ethambutol (40.1%), Ofloxacin (42.4%) and Kanamycin (12%). Favorable treatment outcomes ranged from 52.5% to 56.9% in cases resistant to only first-line anti-TB drugs but was much lower in the pre XDR-TB cases (26.3%) and XDR-TB cases (12.5%). Conclusion The proportion of cases with additional resistance to ofloxacin, kanamycin, ethionamide, and streptomycin increased over time from 2009 to 2014. Reducing the time to treatment initiation from initial diagnosis of MDR-TB could further improve treatment outcomes.

Diabetes-related health education promotes patient efficacy for diabetes self-management. However, sub-optimal knowledge of diabetes in people with diabetes is recognized as a challenge in overcrowded public health facilities in India. We aimed to determine the effect of health education through mobile phone text messages (short messaging service [SMS]) on diabetes-related knowledge of patients with diabetes.. From February 2016 to February 2017, we recruited adult patients with diabetes for this quasi-experimental study done in the outpatient setting of a major tertiary care government hospital in Delhi, India. Participants in the intervention group received a text message on diabetes self-care practices every alternate day for 90 days. We evaluated the patients' knowledge of diabetes using the Spoken Knowledge in Low Literacy in Diabetes (SKILL-D) questionnaire and a self-designed diabetes knowledge questionnaire.. We enrolled 190 men and 160 women, of whom 52 (13.7%) were lost to follow-up. At baseline, mean diabetes knowledge scores were higher in the intervention group compared to the control group. After the intervention period of 3 months, the diabetes knowledge scores for SKILL-D and the patient diabetes knowledge questionnaire showed a statistically significant increase in the intervention group (mean difference 0.7 and 0.5, respectively; p0.001, but there was no increase in the control group).. The use of mobile phone technology for diabetes-related health education through mobile text-message (SMS) technology is an effective method for health promotion.

Background Primary health centers (PHCs) represent the first tier of the Indian health care system, providing a range of essential outpatient services to people living in the rural, suburban, and hard-to-reach areas. Diversion of health care resources for containing the coronavirus disease (COVID-19) pandemic has significantly undermined the accessibility and availability of essential health services. Under these circumstances, the preparedness of PHCs in providing safe patient-centered care and meeting the current health needs of the population while preventing further transmission of the severe acute respiratory syndrome coronavirus 2 infection is crucial. Objective The aim of this study was to determine the primary health care facility preparedness toward the provision of safe outpatient services during the COVID-19 pandemic in India. Methods We conducted a cross-sectional study among supervisors and managers of primary health care facilities attached to medical colleges and institutions in India. A list of 60 faculties involved in the management and supervision of PHCs affiliated with the community medicine departments of medical colleges and institutes across India was compiled from an accessible private organization member database. We collected the data through a rapid survey from April 24 to 30, 2020, using a Google Forms online digital questionnaire that evaluated preparedness parameters based on self-assessment by the participants. The preparedness domains assessed were infrastructure availability, health worker safety, and patient care. Results A total of 51 faculties responded to the survey. Each medical college and institution had on average a total of 2.94 (SD 1.7) PHCs under its jurisdiction. Infrastructural and infection control deficits at the PHC were reported in terms of limited physical space and queuing capacity, lack of separate entry and exit gates (n=25, 49%), inadequate ventilation (n=29, 57%), and negligible airborne infection control measures (n=38, 75.5%). N95 masks were available at 26 (50.9%) sites. Infection prevention and control measures were also suboptimal with inadequate facilities for handwashing and hand hygiene reported in 23.5% (n=12) and 27.4% (n=14) of sites, respectively. The operation of outpatient services, particularly related to maternal and child health, was significantly disrupted (P Conclusions Existing PHC facilities in India providing outpatient services are constrained in their functioning during the COVID-19 pandemic due to weak infrastructure contributing to suboptimal patient safety and infection control measures. Furthermore, there is a need for effective planning, communication, and coordination between the centralized health policy makers and health managers working at primary health care facilities to ensure overall preparedness during public health emergencies.