D22-12 Real World Evaluation of Gaps in Diagnosis and Treatment of Extrapulmonary Tuberculosis Based on Guidelines Under National Tuberculosis Elimination Program

Abstract Background Extrapulmonary tuberculosis (EPTB) constituting approximately one-fifth of the overall burden of tuberculosis (TB), is challenge both in terms of diagnosis due to lower rates of microbiological positivity and for treatment in terms of drug penetration, duration of therapy and possibly poorer response rates. Although national guidelines have tried to optimise diagnostic algorithms and standardise treatment regimens, compliance to variousrecommendations vary. Methodology This multicentric study recruited and followed up patients with various forms of EPTB at two, six, nine and 12 months across three centres. The primary outcome was to study gaps in diagnosis and treatment of EPTB and the study evaluated for any impact ontreatment outcomes. Results 433 patients with EPTB were recruited. The most common sites were lymph node (20%), central nervous system (14%), pleural (14%) and abdomen (14%). 10% of patients were diabetic while 15% had previous tuberculosis. The median patient delay from symptom onset to presentation was 4.2 weeks (with highest delay being 21 weeks) while median health system diagnostic delay was 4 weeks (with highest delay being 14 weeks). The median total diagnostic delay from symptom onset to diagnosis was 10.1 weeks with musculoskeletal TB experiencing the greatest delay (28 weeks). 76% of patients were clinic radiologically diagnosed without microbiological confirmation, of which approximately 61.3% beingdiagnosed without imaging confirmation. 88% of patients were reported on Nikshay, the integrated digital system for reporting and tracking TB cases. The duration of therapy varied with the site, mean (± S.D.) duration being higher in musculoskeletal TB 13.4 ± 5.4 months and CNS TB 11.4 ± 7.9 months. Overall mortality did not differ with delay in diagnosis but was higher in patients with DM Odds ratio: 7.57(95% CI: 2.64-21.72) and previous TBOdds ratio: 4.82 (95% CI: 1.69,13.7). Conclusion Despite national guidelines, real world challenges in diagnostics and treatmentexist in EPTB, owing to patient related and health system diagnostic delays. Further, challenges in obtaining a microbiological diagnosis and optimising diagnostic confirmation inthose without a microbiological diagnosis remains a challenge. Significant variability in response to treatment in EPTB impacts the duration of therapy. This abstract is funded by: AIIMS