A baseline prevalence of these populations at the state level required through Well designed state level surveys Separate sampling for new & re-treatment cases Planning for trend analysis among re- treatment cases DRS: Indian initiative
DRS: Indian Initiative India has developed a national plan to conduct nationwide surveillance of DR in different states DRS protocol as per international guidelines developed and implemented for three states this year (Gujarat, Sikkim and Maharashtra) DRS protocol under development for two more states for next year (AP and Orissa) Gradual expansion & re-survey of states over time, as has been done in China - eg: Tamilnadu State
Another objective of nationwide surveillance of drug resistance in India Strengthening of laboratory networks through; The implementation of an EQAP for smear microscopy QA of culture & DST in state laboratories DRS: Indian initiative
DRS: Requirements for India Human & financial capacity are being addressed enhanced before proficiency testing can take place & a nationwide survey could be implemented Three national reference laboratory (NRLs) 16 intermediate reference laboratories (IRLs) IRLs to be established in the remaining 18 states
Year 2005 DRS sites of India Maharashtra, 102.8 millions (9.4%), 2005 Gujarat, 53.8 millions (4.9%), 2005 Orissa, 38.2 millions (3.5%), 2005 Andhra Pradesh, 78.7 millions (7.2%), 2005 Population being covered in 2005 = 25% Resurvey – Tamilnadu DRS-Sikkim, 2005-06
DRS – Key findings in India Among new cases : No evidence of an increase in the prevalence of resistance TRC studies :Low level prevalence of MDR TB TRC studies : Pediatric & Extra-pulmonary cases low level resistance to H (5-10%) low level resistance to S (2-14%) MDR TB - Almost Nil
DRS – Key findings… Among Patients with Treatment History : Urban & Rural Settings : 10 -12% Among Chronically ill : Almost 50% Compared to global situation a lesser prevalence of primary resistance a much higher level of acquired resistance is observed
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