Initial default among diagnosed sputum smear-positive pulmonary tuberculosis patients in Andhra Pradesh, India

BACKGROUND: Under the Indian Revised National TB Control Programme (RNTCP), smear-positive pulmonary tuberculosis (PTB) patients not confirmed as starting treatment arc reported as 'initial defaulters'. SETTING: Twenty districts of Andhra Pradesh State, India. OBJECTIVE: To evaluate reasons for treatment non-initiation in smear-positive PTB patients diagnosed and reported as initial defaulters by the NTP. DESIGN: A cross-sectional survey conducted of all reported initial defaulters during the period July-September 2006. RESULTS: Of 1304 reported initial defaulters, 619 (47.5%) had been placed on treatment, having been incorrectly reported due to poor documentation of patients referred for treatment in the same district or whose treatment initiation,vas delayed until the subsequent quarter. Of the 685 (4.5% of the total diagnosed) who were confirmed initial defaulters, 350 (51%) were untraceable, 152 (22%) had died before treatment initiation, 38 (5.5%) were treated privately, 93 (13.5%) had other reasons (e.g., refusal of treatment, chronic Case, etc.) and no data were available for 52 (8%). CONCLUSIONS: Nearly 50% of smear-positive PTB patients diagnosed in the study period were confirmed as not having initiated treatment under the RNCTP. Improvements in address recording may assist efforts to retrieve these patients for treatment. Additional evaluations are needed of improved counselling of TB suspects to prevent initial default, and of reasons for death before treatment initiation.