FRONT-LINE MANAGEMENT OF PULMONARY TUBERCULOSIS - AN ANALYSIS OF TUBERCULOSIS AND TREATMENT PRACTICES IN URBAN SINDH, PAKISTAN

Setting: Karachi and Hyderabad, Pakistan. Objective: To describe the l evel and quality of tuberculosis (TB) case management by non-TB contro l program (TCP) physicians in urban Sindh, Pakistan. Design: We interv iewed 152 adults with pulmonary TB confirmed by Karachi's TB control p rogram regarding the initial management of their TB symptoms before en tering the TCP. We also surveyed 65 general practitioners (GPs) attend ing continuing education seminars with a multiple choice test to asses s their management of suspected pulmonary TB. We compared both results to guidelines from the World Health Organization (WHO) and the Intern ational Union Against Tuberculosis and Lung Disease (IUATLD). Results: Eighty percent (122/152) of patients first sought GPs. Only 14% of GP s performed any sputum test. At most, 17 (40%) of the 42 patients reca lling their GP's treatment, received the recommended 4-drug regimen. H owever, 68% (45/65) of surveyed GPs chose correct treatment from a mul tiple choice format. But their initial laboratory investigations, foll ow-up, and treatment cessation criteria (9%, 9-31%, and 11% correct, r espectively) demonstrated under-utilization of sputum tests and over-r eliance on unhelpful tests. Conclusions: GPs first saw most of these T CP patients, but their weak management likely hinders TB control. A pa rtnership between TB control programs and GPs could improve case manag ement and hasten TB control.