Are registered sputum smear-negative tuberculosis patients in Karnataka, India, diagnosed by national algorithm?

SETTING: Four districts of Karnataka State, India, that have implemented the National Tuberculosis Control Programme (RNTCP). OBJECTIVE: To assess the proportion of patients diagnosed according to the nationally recommended algorithm among new smear-negative (NSN) PTB cases registered under the RNTCP. METHODS: Information on 201 registered NSN-PTB patients as regards date of initial sputum examination, repeat sputum examination and chest X-ray (CXR) if undertaken, treatment initiation and number of days of antibiotic treatment after initial sputum examination, were collected through record review and patient interviews. In patients with negative or unknown human immunodeficiency virus (HIV) status, the algorithm was considered completed if the patient underwent initial sputum examination, antibiotic trial for >= 10 days, repeat sputum examination >= 10 days after initial sputum examination, CXR after repeat sputum examination and anti-tuberculosis treatment >= 10 days after initial sputum examination. In HIV-positive patients, the algorithm was considered completed if CXR was performed after or at the same time as initial sputum examination. RESULTS: Complete information was available for 170 patients. Of these, the algorithm was completed in 14 (8.2%, 95%CI 0.9-15.5): 1/140 patients with negative or unknown HIV status and 13/30 HIV-positive patients. CONCLUSION: The algorithm was not completed in most patients registered for treatment. Measures are needed to improve the diagnostic process for smear-negative PTB.