1
|
Alves YM, Berra TZ, de Jezus SV, Araújo VMS, Pinheiro JDS, de Assis LBDO, Canelonez M, Sacramento DS, Perez F, Maciel ELN, Arcêncio RA. Adherence to Short-Duration Treatment (3HP) for Latent Tuberculosis among International Migrants in Manaus, Amazonas: Evaluation of the Efficacy of Different Treatment Modalities. Microorganisms 2024; 12:1629. [PMID: 39203470 PMCID: PMC11356601 DOI: 10.3390/microorganisms12081629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/31/2024] [Accepted: 08/06/2024] [Indexed: 09/03/2024] Open
Abstract
Migration, a multifaceted phenomenon, has a significant impact on health. Migrants perform similar movement patterns within their country of origin, in transit, and in the country of destination, thus making it difficult to monitor TB treatment throughout the journey. The objective was to compare the effectiveness of different treatment modalities in adherence to the short-term regimen for LTBI (3HP) among international migrants and refugees. This is a quasi-experimental study conducted in Manaus-AM. The study population was made up of international migrants. The certification and monitoring of medication intake employed three strategies: self-administration (SA), directly observed conventional therapy (DOT), and Video Telemonitoring System for Tuberculosis Treatment (VDOT). The VDOT group and SA group exhibited the lowest rate of treatment dropout or interruption at 16.1%, followed by the DOT group at 23.1%. The results suggest that the most effective strategy for ensuring adherence among migrants and refugees was VDOT (OR_adj 0.26; CI 0.7-0.94), suggesting that migrants may be more likely to adhere to and complete their treatment. The results show that relying on different treatment strategies, adapted to the individuals' needs and risk factors, is a viable and effective way of providing person-centered TB care.
Collapse
Affiliation(s)
- Yan Mathias Alves
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, Sao Paulo, Brazil; (Y.M.A.)
- Brazilian Tuberculosis Research Network (REDE-TB), Rio de Janeiro 21941-904, Rio de Janeiro, Brazil
| | - Thaís Zamboni Berra
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, Sao Paulo, Brazil; (Y.M.A.)
- Brazilian Tuberculosis Research Network (REDE-TB), Rio de Janeiro 21941-904, Rio de Janeiro, Brazil
| | - Sonia Vivian de Jezus
- Sinop Campus, Federal University of Mato Grosso (UFMT), Sinop 78550-728, Mato Grosso, Brazil
| | - Vânia Maria Silva Araújo
- Brazilian Tuberculosis Research Network (REDE-TB), Rio de Janeiro 21941-904, Rio de Janeiro, Brazil
| | - Jair dos Santos Pinheiro
- State Tuberculosis Control Program of Amazonas, Manaus 69093-018, Amazonas, Brazil; (J.d.S.P.); (L.B.d.O.d.A.)
| | | | - Marvis Canelonez
- State Tuberculosis Control Program of Amazonas, Manaus 69093-018, Amazonas, Brazil; (J.d.S.P.); (L.B.d.O.d.A.)
| | | | - Freddy Perez
- Communicable Diseases Prevention, Control, and Elimination and Environmental Determinants of Health Department, Pan American Health Organization, Washington, DC 20037, USA;
- Department of Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
| | - Ethel Leonor Noia Maciel
- Ministry of Health, Secretariat for Health Surveillance and the Environment, Brasília 70058-900, Distrito Federal, Brazil
| | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, Sao Paulo, Brazil; (Y.M.A.)
- Brazilian Tuberculosis Research Network (REDE-TB), Rio de Janeiro 21941-904, Rio de Janeiro, Brazil
| |
Collapse
|
2
|
Sodré-Alves BMC, Toledo MM, Zimmermann IR, Araújo WND, Tavares NUL. Isoniazid use, effectiveness, and safety for treatment of latent tuberculosis infection: a systematic review. Rev Soc Bras Med Trop 2024; 57:e004022024. [PMID: 38536998 PMCID: PMC10962359 DOI: 10.1590/0037-8682-0504-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/09/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND The treatment strategy for latent tuberculosis infection is to reduce the number of tuberculosis cases and consequently reduce the transmission of pathogenic bacteria. This study aimed to determine the safety, effectiveness, and adherence of isoniazid use for latent tuberculosis infection treatment. METHODS To identify studies on isoniazid use for latent tuberculosis infection, five electronic databases were searched. The methods and results are presented in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS Most studies (53) used isoniazid for 9 months. The prevalence of use and adherence to treatment varied considerably (18% to 100%), and were evaluated by participant completion of isoniazid treatment for latent tuberculosis infection. The adverse events most frequently reported were hepatotoxicity, gastric intolerance, and neuropathy; the rates of occurrence ranged from < 1% to 48%. In the studies that evaluated the effectiveness of isoniazid for latent tuberculosis infection, the rate varied from 0 to 19.7% for patients who did not have active tuberculosis after the follow-up period. CONCLUSIONS The importance of maintaining follow up for patients using isoniazid should be emphasized due to the risk of developing adverse events. Despite the treatment challenges, the rates of patients who used isoniazid and developed active tuberculosis during the follow-up period were low. We believe that isoniazid continues to contribute to tuberculosis control worldwide, and better care strategies are required.
Collapse
Affiliation(s)
- Bárbara Manuella Cardoso Sodré-Alves
- Universidade de Brasília, Laboratório de Estudos Farmacêuticos, Brasília, DF, Brasil
- Universidade de Brasília, Programa de Pós-Graduação em Ciências Farmacêuticas, Brasília, DF, Brasil
| | - Melina Mafra Toledo
- Universidade de Brasília, Programa de Pós-Graduação em Saúde Coletiva, Brasília, DF, Brasil
| | - Ivan Ricardo Zimmermann
- Universidade de Brasília, Laboratório de Estudos Farmacêuticos, Brasília, DF, Brasil
- Universidade de Brasília, Programa de Pós-Graduação em Saúde Coletiva, Brasília, DF, Brasil
| | - Wildo Navegantes de Araújo
- Universidade de Brasília, Programa de Pós-Graduação em Saúde Coletiva, Brasília, DF, Brasil
- Universidade de Brasília, Programa de Pós-Graduação em Medicina Tropical, Brasília, DF, Brasil
- Universidade de Brasília, Faculdade de Ceilândia, Brasília, DF, Brasil
- Instituto Nacional de Ciência e Tecnologia para Avaliação de Tecnologias em Saúde, Porto Alegre, RS, Brasil
| | - Noemia Urruth Leão Tavares
- Universidade de Brasília, Laboratório de Estudos Farmacêuticos, Brasília, DF, Brasil
- Universidade de Brasília, Programa de Pós-Graduação em Ciências Farmacêuticas, Brasília, DF, Brasil
- Universidade de Brasília, Programa de Pós-Graduação em Saúde Coletiva, Brasília, DF, Brasil
| |
Collapse
|
3
|
Williams AR, Rowe C, Minarik L, Gray Z, Murphy SM, Pincus HA. Use of in-network insurance benefits is critical for improving retention in telehealth-based buprenorphine treatment. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae009. [PMID: 38450044 PMCID: PMC10914333 DOI: 10.1093/haschl/qxae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 03/08/2024]
Abstract
An empiric evidence base is lacking regarding the relationship between insurance status, payment source, and outcomes among patients with opioid use disorder (OUD) on telehealth platforms. Such information gaps may lead to unintended impacts of policy changes. Following the phase-out of the COVID-19 Public Health Emergency, states were allowed to redetermine Medicaid eligibility and disenroll individuals. Yet, financial barriers remain a common and significant hurdle for patients with OUD and are associated with worse outcomes. We studied 3842 patients entering care in 2022 at Ophelia Health, one of the nation's largest OUD telehealth companies, to assess associations between insurance status and 6-month retention. In multivariable analyses, in-network patients who could use insurance benefits were more likely to be retained compared with cash-pay patients (adjusted risk ratio [aRR]: 1.50; 95% CI: 1.40-1.62; P < .001). Among a subsample of 882 patients for whom more detailed insurance data were available (due to phased-in electronic health record updates), in-network patients were also more likely to be retained at 6 months compared with insured, yet out-of-network patients (aRR: 1.86; 95% CI: 1.54-2.23; P < .001). Findings show that insurance status, and specifically the use of in-network benefits, is associated with superior retention and suggest that Medicaid disenrollment and insurance plan hesitation to engage with telehealth providers may undermine the nation's response to the opioid crisis.
Collapse
Affiliation(s)
- Arthur Robin Williams
- Ophelia Health, Inc, New York, NY 10003, United States
- Department of Psychiatry, Columbia University Medical Center, New York, NY 10032, United States
| | | | - Lexie Minarik
- Ophelia Health, Inc, New York, NY 10003, United States
| | - Zack Gray
- Ophelia Health, Inc, New York, NY 10003, United States
| | - Sean M Murphy
- Population Health Sciences, Weill Cornell Medicine, New York, NY 10065, United States
| | - Harold A Pincus
- Department of Psychiatry, Columbia University Medical Center, New York, NY 10032, United States
| |
Collapse
|
4
|
Salamaikina S, Korchagin V, Kulabukhova E, Mironov K, Zimina V, Kravtchenko A, Akimkin V. Association of Toll-Like Receptor Gene Polymorphisms with Tuberculosis in HIV-Positive Participants. EPIGENOMES 2023; 7:15. [PMID: 37606452 PMCID: PMC10443360 DOI: 10.3390/epigenomes7030015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/23/2023] Open
Abstract
Genetic factors in the HIV-background may play a significant role in the susceptibility to secondary diseases, like tuberculosis, which is the leading cause in mortality of HIV-positive people. Toll-like receptors (TLRs) are considered to be receptors for adaptive immunity, and polymorphisms in TLR genes can influence the activity of the immune response to infection. We conducted a case-control study of the association of TLR gene polymorphisms with the risk of tuberculosis coinfection in a multi-country sample of HIV-positive participants. Our study revealed certain associations between TLR4 and TLR6 polymorphisms and HIV-tuberculosis coinfection. We also found that the analyzed TLR1 and TLR4 polymorphisms were linked with the decline in CD4+ cell count, which is a predictor of disease progression in HIV-infected individuals. Our findings confirm that TLR gene polymorphisms are factors that may contribute to development of HIV-tuberculosis coinfection. However, the essence of the observed associations remains unclear, since it can also include both environmental factors and epigenetic mechanisms of gene expression regulation.
Collapse
Affiliation(s)
- Svetlana Salamaikina
- Central Research Institute of Epidemiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing Russian Federation, Novogireevskaya Str. 3a, 111123 Moscow, Russia
| | - Vitaly Korchagin
- Central Research Institute of Epidemiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing Russian Federation, Novogireevskaya Str. 3a, 111123 Moscow, Russia
| | - Ekaterina Kulabukhova
- Central Research Institute of Epidemiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing Russian Federation, Novogireevskaya Str. 3a, 111123 Moscow, Russia
- Medical Institute, The Peoples’ Friendship University of Russia (RUDN University), Miklukho-Maklaya Str. 6, 117198 Moscow, Russia
| | - Konstantin Mironov
- Central Research Institute of Epidemiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing Russian Federation, Novogireevskaya Str. 3a, 111123 Moscow, Russia
| | - Vera Zimina
- Medical Institute, The Peoples’ Friendship University of Russia (RUDN University), Miklukho-Maklaya Str. 6, 117198 Moscow, Russia
| | - Alexey Kravtchenko
- Central Research Institute of Epidemiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing Russian Federation, Novogireevskaya Str. 3a, 111123 Moscow, Russia
| | - Vasily Akimkin
- Central Research Institute of Epidemiology Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing Russian Federation, Novogireevskaya Str. 3a, 111123 Moscow, Russia
| |
Collapse
|
5
|
Yang H, Lee JS, Kim Y. Healthcare workers' acceptance of and adherence to latent tuberculosis treatment. Occup Med (Lond) 2023; 73:186-192. [PMID: 36972514 DOI: 10.1093/occmed/kqad036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Healthcare workers (HCWs) with latent tuberculosis infection (LTBI) have a high risk of active tuberculosis and need systematic LTBI screening and treatment. However, acceptance and adherence rates of LTBI treatment are low. AIMS To examine the specific reasons for the loss at each LTBI treatment-cascade stage: acceptance, continuation and completion of LTBI treatment in HCWs. METHODS This retrospective descriptive study was conducted among 61 HCWs with an interferon-gamma release assay-confirmed LTBI diagnosis who were prescribed LTBI treatment at a tertiary hospital in the Republic of Korea. Data were analysed using Pearson's chi-square, Fisher's exact, independent t-test and Mann-Whitney U-test. A word cloud analysis was used to describe the perceived meaning of LTBI in HCWs. RESULTS HCWs who refused or discontinued LTBI treatment perceived LTBI as 'not a big deal', whereas HCWs who completed LTBI treatment had a high-risk perception of the LTBI prognosis, such as 'frightened about adverse prognosis'. Determinants of non-adherence to the recommended LTBI treatment included a busy work schedule, side effects of anti-tuberculosis agents and the inconvenience of regularly taking anti-tuberculosis agents. CONCLUSIONS To ensure LTBI treatment adherence in HCWs, effective interventions that are customized to each stage of the LTBI treatment should be developed, with due consideration of the stage-specific perceived facilitators and barriers in the LTBI treatment cascade.
Collapse
Affiliation(s)
- H Yang
- Chonnam National University, College of Nursing, Gwangju 61469, Republic of Korea
| | - J S Lee
- Chonnam National University Hwasun Hospital, Hwasun 58128, Republic of Korea
| | - Y Kim
- Chonnam National University, College of Nursing, Gwangju 61469, Republic of Korea
| |
Collapse
|
6
|
Spence BC, Bruxvoort K, Munoz-Plaza C, Shaw S, Navarro M, Chen H, Skarbinski J, Tartof S. Patient-Reported Barriers to Treatment Initiation and Completion for Latent Tuberculosis Infection Among Patients Within a Large Integrated Health Care System in Southern California. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:345-352. [PMID: 36867508 PMCID: PMC10038844 DOI: 10.1097/phh.0000000000001711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVE More than 80% of active tuberculosis in the United States is due to reactivation of latent tuberculosis infection (LTBI), which can be prevented via screening and treatment. Treatment initiation and completion rates are low for patients with LTBI in the United States, and the barriers to successful treatment are poorly understood. DESIGN We conducted semistructured qualitative interviews with 38 patients who were prescribed LTBI treatment (9 months isoniazid, 6 months rifampin, or 3 months rifamycin-isoniazid short-course combinations). We used purposeful sampling employing a maximum variation approach to obtain diverse perspectives of patients who did not initiate treatment, who did not complete treatment, and who completed treatment (n = 14, n = 16, and n = 8, respectively). Patients were asked about LTBI knowledge, experience regarding treatment, interactions with providers, and barriers they faced. Using a team coding model (2 coders/analysts), we developed deductively derived (a priori) codes based on our central research questions and inductively derived codes that emerged directly from the data. Analysis of our coding categories and relationships generated a hierarchy of key themes and subthemes. SETTING Kaiser Permanente Southern California. PARTICIPANTS Individuals 18 years or older who received a diagnosis of LTBI and prescribed treatment. MAIN OUTCOME MEASURES LTBI knowledge, attitudes toward LTBI, attitudes toward LTBI treatment, attitudes toward providers, and explanation of barriers. RESULTS Most patients reported having limited knowledge of LTBI. In addition to the duration of treatment, barriers to initiation and completion included perceived lack of support, uncomfortable side effects, and pervasive minimization of the positive impact of treatment on their health. Many patients felt there was little incentive to overcome barriers. CONCLUSIONS Overall, patient experience with LTBI treatment initiation and completion could be improved with patient-centered treatment and more frequent follow-ups.
Collapse
Affiliation(s)
- Brigitte C Spence
- Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, California (Mss Spence, Munoz-Plaza, and Navarro, Drs Shaw and Tartof, and Mr Chen); and University of Alabama Birmingham, Birmingham, Alabama (Dr Bruxvoort)
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Otero L, Zetola N, Campos M, Zunt J, Bayer A, Curisinche M, Ochoa T, Reyes M, Vega V, Van der Stuyft P, Sterling TR. Isoniazid preventive therapy completion in children under 5 years old who are contacts of tuberculosis cases in Lima, Peru: study protocol for an open-label, cluster-randomized superiority trial. Trials 2023; 24:54. [PMID: 36694242 PMCID: PMC9871424 DOI: 10.1186/s13063-022-07062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/30/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Children < 5 years old in contact with TB cases are at high risk for developing severe and fatal forms of TB. Contact investigation, BCG vaccination, and isoniazid preventive therapy (IPT) are the most effective strategies to prevent TB among children. However, the implementation of IPT faces challenges at several stages of the cascade of care of TB infection among children, particularly those less than 5 years old. In Peru, a large proportion of children do not complete IPT, which highlights the need to design effective interventions that enhance preventive therapy adherence and completion. Although the body of evidence for such interventions has grown, interventions in medium TB incidence settings are lacking. This study aims to test the effectiveness, acceptability, and feasibility of an intervention package to increase information and motivation to complete IPT among children < 5 who have been prescribed IPT. METHODS An open-label, cluster-randomized superiority trial will be conducted in two districts in South Lima, Peru. Thirty health facilities will be randomized as clusters, 10 to the intervention and 20 to control (standard of care). We aim to recruit 10 children from different households in each cluster. Participants will be caretakers of children aged < 5 years old who initiated IPT. The intervention consists of educational material, and short message services (SMS) reminders and motivators. The primary outcomes will be the proportion of children who picked up > 90% of the 24 weeks of IPT (22 pick-ups) and the proportion of children who picked up the 24 weeks of IPT. The standard of care is a weekly pick-up with monthly check-ups in a health facility. Feasibility and acceptability of the intervention will be assessed through an interview with the caretaker. DISCUSSION Unfavorable outcomes of TB in young children, high effectiveness of IPT, and low rates of IPT completion highlight the need to enhance adherence and completion of IPT among children < 5 years old. Testing of a context-adapted intervention is needed to improve IPT completion rates and therefore TB prevention in young children. TRIAL REGISTRATION ClinicalTrials.gov NCT03881228. Registered on March 19, 2019.
Collapse
Affiliation(s)
- L Otero
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru.
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
- Unit of General Epidemiology and Disease Control, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | - N Zetola
- Division of Pulmonary and Critical Care, Augusta University, Augusta, GA, USA
| | - M Campos
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Ciencias, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J Zunt
- Department of Neurology, University of Washington School of Medicine, WA, Seattle, USA
| | - A Bayer
- Facultad de Salud Pública, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - M Curisinche
- Dirección de Prevención Y Control de Tuberculosis, Ministerio de Salud, Lima, Peru
- Centro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Peru
| | - T Ochoa
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - M Reyes
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - V Vega
- Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - P Van der Stuyft
- Department of Public Health, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - T R Sterling
- Vanderbilt University School of Medicine, Nashville, TN, USA
| |
Collapse
|
8
|
Stærke NB, Fløe A, Nielsen MF, Holm M, Holm E, Hilberg O, Wejse C, Hvass AMF. The cascade of care in tuberculosis infection screening and management in newly arrived refugees in Aarhus, Denmark. Travel Med Infect Dis 2022; 49:102388. [PMID: 35753660 DOI: 10.1016/j.tmaid.2022.102388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/25/2022] [Accepted: 06/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Screening for tuberculosis (TB) disease and infection is often a part of health screening programs offered to refugees, but the yield of screening varies and losses along the steps from screening to treatment completion was reported. METHODS A retrospective cohort study was performed investigating a newly arrived refugee population offered a systematic refugee health assessment in Aarhus, Denmark. Data was collected on screening, referral, diagnosis and treatment for TB disease and infection. RESULTS Among both adults and children IGRA positivity was associated with origin in a high TB incidence country and increasing age. The number needed to screen (NNS) to find one case of TB infection was 7 among adult refugees and 19 among children, while NNS for TB disease was 266 and 164 respectively. The proportion of the eligible population with a valid result was 78.1% for adults and 71.3% for children, while 43.1% and 50% of adults and children with presumed TB infection completed preventive treatment. DISCUSSION Screening for TB disease and infection among refugees in Aarhus had a high yield in terms of diagnosis, however significant losses were seen during screening, follow-up and preventive treatment completion.
Collapse
Affiliation(s)
- Nina Breinholt Stærke
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Andreas Fløe
- Department of Respiratory Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Mie Fryd Nielsen
- Department of Respiratory Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Mette Holm
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Emma Holm
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Sygehus Lillebælt, Beriderbakken 4, 7100, Vejle, Denmark; Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark; Center for Global Health (GloHAU), Aarhus University, Bartholins allé 2, 8000, Aarhus C, Denmark
| | - Anne Mette Fløe Hvass
- Center for Global Health (GloHAU), Aarhus University, Bartholins allé 2, 8000, Aarhus C, Denmark; Department of Social Medicine, Aarhus Municipality, Fredens torv 6, 8000, Aarhus N, Denmark
| |
Collapse
|
9
|
Wong YJ, Ng KY, Lee SWH. Digital health use in latent tuberculosis infection care: A systematic review. Int J Med Inform 2022; 159:104687. [PMID: 35007924 DOI: 10.1016/j.ijmedinf.2022.104687] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/12/2021] [Accepted: 01/02/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE With one-quarter of the world's population estimated to have latent tuberculosis infection (LTBI), it is important that the drop-outs from the LTBI cascade of care are minimized. Digital health technology could play an important role in case detection and treatment adherence. This study aims to evaluate the use and impact of digital health technology in LTBI care. METHODS A systematic literature search was conducted on six electronic databases from database inception until May 31st 2021. Studies that reported on the clinical use or economic analysis of digital health technology for LTBI care were included. Two investigators independently evaluated, extracted relevant studies, and assessed the risk of bias of using the Cochrane tools. The studies were synthesized qualitatively. RESULTS Fifteen articles describing 14 studies were included. Voice and/or textual reminders and synchronous video call to improve LTBI treatment adherence were the most commonly examined digital health interventions. Other interventions examined the use of mobile phones to improve the number of patients who returned for tuberculin skin test follow-up measurement (screening retention) and eLearning videos to enhance health literacy in LTBI care. The economic analysis supported the use of textual reminders in LTBI treatment as a cost-effective option for widescale implantation. CONCLUSIONS Despite limited evidence on the effects of digital health technologies in LTBI, available studies suggest they are at least equivalent to current practice. This means digital health can potentially supplement current practice, to constantly monitor and engage with people undergoing LTBI screening or treatment, as an initiative to ensure the provision of continuous and optimal care to all LTBI-affected individuals.
Collapse
Affiliation(s)
- Yen Jun Wong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia
| | - Khuen Yen Ng
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia; Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia; Gerontechnology Laboratory, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia; School of Pharmacy, Taylor's University Lakeside Campus, Jalan Taylors, 47500 Selangor, Malaysia; Center for Global Health, University of Pennsylvania, PA, USA.
| |
Collapse
|
10
|
Verma S, Pacheco C, Carter EJ, Szkwarko D. Latent Tuberculosis Infection Treatment Outcomes in an At-Risk Underserved Population in Rhode Island. J Prim Care Community Health 2022; 13:21501319221111106. [PMID: 35850568 PMCID: PMC9310062 DOI: 10.1177/21501319221111106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: Within the United States (US), significant racial and ethnic disparities
exist in the rates of latent TB infection (LTBI) and active TB disease. A
disproportionate number of TB disease cases result from untreated LTBI among
individuals born outside the US. This study evaluates LTBI treatment
outcomes among an underserved, at-risk population in Rhode Island. Methods: A quantitative retrospective chart review of adult patients with a positive
screening test assessed LTBI care cascade outcomes including referral,
treatment initiation, and completion. Results: Seventy-four percent of patients found to have positive screening TB tests
were born outside of the US; 80% identified as Hispanic or Black and 45%
spoke a preferred language other than English. Twenty-one percent of
potential candidates for LTBI treatment initiated treatment. Conclusions: Major gaps were identified in referral success and treatment initiation.
Expanding LTBI treatment access into primary care settings could be a
solution to improve outcomes and decrease health inequities among at-risk
communities.
Collapse
Affiliation(s)
- Shelly Verma
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Blackstone Valley Community Health Care, Pawtucket, RI, USA
| | - Cristina Pacheco
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Blackstone Valley Community Health Care, Pawtucket, RI, USA
| | - E Jane Carter
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Daria Szkwarko
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,UMass Chan Medical School, Worcester, MA, USA
| |
Collapse
|
11
|
Souza AB, Arriaga MB, Amorim G, Araújo-Pereira M, Nogueira BMF, Queiroz ATL, Figueiredo MC, Rocha MS, Benjamin A, Moreira ASR, Oliveira JG, Rolla V, Durovni B, Lapa E Silva JR, Kritski AL, Cavalcante S, Sterling T, Andrade BB, Cordeiro-Santos M. Determinants of losses in the latent tuberculosis infection cascade of care in Brazil. BMJ Glob Health 2021; 6:bmjgh-2021-005969. [PMID: 34518204 PMCID: PMC8438757 DOI: 10.1136/bmjgh-2021-005969] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/21/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Factors associated with losses in the latent tuberculosis infection (LTBI) cascade of care in contacts of patients with tuberculosis (TB) were investigated in a multicentre prospective cohort from highly endemic regions in Brazil. METHODS Close contacts of 1187 patients with culture-confirmed pulmonary TB were prospectively studied between 2015 and 2019, with follow-up of 6-24 months. Data on TB screening by clinical investigation, radiographic examination and interferon-gamma release assay (IGRA) were collected. Multivariable regressions were used to identify determinants of losses in the LTBI cascade. RESULTS Among 4145 TB contacts initially identified, 1901 were examined (54% loss). Among those examined, 933 were people living with HIV, ≤5 years old and/or had positive IGRA results, and therefore had a recommendation to start TB preventive treatment (TPT). Of those, 454 (23%) initiated treatment, and 247 (54% of those initiating; 26% of those in whom treatment was recommended) completed TPT. Multivariable regression analysis revealed that living with HIV, illiteracy and black/pardo (brown) race were independently associated with losses in the cascade. CONCLUSION There were losses at all LTBI cascade stages, but particularly at the initial screening and examination steps. Close contacts of low socioeconomic status and living with HIV were at heightened risk of not completing the LTBI cascade of care in Brazil.
Collapse
Affiliation(s)
- Alexandra Brito Souza
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Manaus, AM, Brazil
| | - María B Arriaga
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Gustavo Amorim
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mariana Araújo-Pereira
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil
| | - Betânia M F Nogueira
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil.,Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, BA, Brazil
| | - Artur T L Queiroz
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.,Center of Data and Knowledge Integration for Health (CIDACS),Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil
| | - Marina C Figueiredo
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Michael S Rocha
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.,Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, BA, Brazil
| | - Aline Benjamin
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Adriana S R Moreira
- Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Jamile G Oliveira
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Valeria Rolla
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Betina Durovni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José R Lapa E Silva
- Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Afrânio L Kritski
- Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Solange Cavalcante
- Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, RJ, Brazil.,Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Timothy Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Bruno B Andrade
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, BA, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, BA, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil.,Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Marcelo Cordeiro-Santos
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil .,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Manaus, AM, Brazil.,Faculdade de Medicina, Universidade Nilton Lins, Manaus, AM, Brazil
| | | |
Collapse
|
12
|
Alvarez GG, Van Dyk D, Mallick R, Lesperance S, Demaio P, Finn S, Potvin SE, Patterson M, Pease C, Amaratunga K, Hui C, Cameron DW, Mulpuru S, Aaron SD, Momoli F, Zwerling A. The implementation of rifapentine and isoniazid (3HP) in two remote Arctic communities with a predominantly Inuit population, the Taima TB 3HP study. Int J Circumpolar Health 2021; 79:1758501. [PMID: 32379538 PMCID: PMC7241515 DOI: 10.1080/22423982.2020.1758501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background: The incidence of TB among Inuit is the highest in Canada. A significantly shorter latent TB infection (LTBI) treatment with rifapentine and isoniazid once weekly for 12 weeks (3HP) is now available in limited settings in Canada.Methods: A prospective open-label 2-year observational postmarketing study was conducted introducing 3HP for the first time in Canada in Iqaluit followed by a program rollout in Qikiqtarjuaq, Nunavut.Results: A total of 247 people were offered 3HP, 102 in the Iqaluit postmarketing study and 145 in the Qikiqtarjuaq program roll out. Although statistical significance was not reached, more people who started treatment completed treatment in the 3HP group (Iqaluit, 60/73 (82.2%) and Qikiqtarjuaq, 89/115 (77.4%)) than in the historical control 9INHgroup (306/420 = 72.9%) (p = 0.2). Most of the adverse events in 3HP treated patients were associated with mild discomfort but no disruption of normal daily activity. Not drinking alcohol was associated with increased 3HP completion (OR 13.33, 95% CI, 2.27-78.20) as was not taking concomitant medications (OR 7.19, 95% CI, 1.47-35.30).Conclusions: The present study supports the feasibility and safety profile of 3HP for the treatment of LTBI in Nunavut.
Collapse
Affiliation(s)
- G G Alvarez
- Ottawa Hospital Research Institute, Ottawa, Canada.,University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada.,The Ottawa Hospital Department of Medicine, Ottawa, Canada
| | - D Van Dyk
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - R Mallick
- Ottawa Hospital Research Institute, Ottawa, Canada.,University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada
| | | | - P Demaio
- Nunavut Department of Health, Iqaluit, Canada
| | - S Finn
- Nunavut Department of Health, Iqaluit, Canada
| | | | - M Patterson
- Nunavut Department of Health, Iqaluit, Canada
| | - C Pease
- University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada
| | - K Amaratunga
- The Ottawa Hospital Department of Medicine, Ottawa, Canada
| | - C Hui
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - D W Cameron
- Ottawa Hospital Research Institute, Ottawa, Canada.,University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada.,The Ottawa Hospital Department of Medicine, Ottawa, Canada
| | - S Mulpuru
- Ottawa Hospital Research Institute, Ottawa, Canada.,The Ottawa Hospital Department of Medicine, Ottawa, Canada
| | - S D Aaron
- Ottawa Hospital Research Institute, Ottawa, Canada.,University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada.,The Ottawa Hospital Department of Medicine, Ottawa, Canada
| | - F Momoli
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - A Zwerling
- University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada
| |
Collapse
|
13
|
Wong YJ, Noordin NM, Keshavjee S, Lee SWH. Impact of latent tuberculosis infection on health and wellbeing: a systematic review and meta-analysis. Eur Respir Rev 2021; 30:30/159/200260. [PMID: 33408089 DOI: 10.1183/16000617.0260-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/25/2020] [Indexed: 12/29/2022] Open
Abstract
The impact of latent tuberculosis infection (LTBI) on health and wellbeing is not well understood. This review aims to evaluate the health and wellbeing of individuals with LTBI. A systematic literature search was performed to assess studies reporting patient-reported outcomes in LTBI management including health-related quality of life (HRQoL), health utilities, disease burden and experience of individuals with LTBI. A pooled analysis was performed to estimate the effect of LTBI on HRQoL.A total of 4464 studies were screened, of which 13 eligible articles describing nine unique studies were included for review. The HRQoL of individuals with LTBI and without tuberculosis (TB) infection were comparable, and better than patients with active TB disease. However, individuals with LTBI reported poorer mental health compared with individuals without TB infection (mean difference -4.16, 95% CI -7.45- -0.87; p=0.01). Qualitative studies suggest the presence of fear, anxiety and stigma in individuals with LTBI.This review highlights potential psychosocial challenges in individuals with LTBI despite the absence of clinical symptoms. While their quality of life was marginally affected, this could be evidence to support LTBI management in preventing TB re-activation and the severe consequences of active TB disease that affect all domains of HRQoL.
Collapse
Affiliation(s)
- Yen Jun Wong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia
| | | | - Salmaan Keshavjee
- Dept of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Malaysia .,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Subang Jaya, Malaysia.,Gerontechnology Laboratory, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Subang Jaya, Malaysia.,School of Pharmacy, Taylor's University Lakeside Campus, Subang Jaya, Malaysia
| |
Collapse
|
14
|
Heyd A, Heffernan C, Storey K, Wild TC, Long R. Treating latent tuberculosis infection (LTBI) with isoniazid and rifapentine (3HP) in an inner-city population with psychosocial barriers to treatment adherence: A qualitative descriptive study. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000017. [PMID: 36962068 PMCID: PMC10021900 DOI: 10.1371/journal.pgph.0000017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022]
Abstract
In Canada, preventive therapy for latent tuberculosis infection (LTBI) has required multiple doses of medication over an extended period of time. Such regimens are associated with poor adherence and completion rates. A shortened treatment regimen of once weekly isoniazid plus rifapentine for 3 months (3HP), is now available, and holds promise in populations facing challenges to treatment adherence. Although many factors impact treatment adherence, a knowledge gap exists in describing these factors in the context of this regimen. We present findings from a qualitative descriptive study, involving semi-structured interviews with unstably housed or homeless individuals in Edmonton and Fort McMurray, Alberta, Canada who were offered directly-observed preventive therapy (DOPT) with 3HP, and their health care providers. Latent content analysis revealed incomplete understandings of LTBI and about the need for preventive therapy. Clients' motivation to be healthy, alongside education, health care outreach, relationships developed in the context of DOPT, ease of treatment regimen, incentives, and collaboration were all described as supporting treatment completion. Competing priorities, difficulty in reaching clients, undesirable aspects of the regimen and difficulties obtaining and initiating 3HP were identified as barriers. Perceptions of stigma related to LTBI and TB were described by clients in addition to feelings of shame related to their diagnosis. Our study provides insight into LTBI and indicates that multiple interacting psychosocial factors influence preventive therapy access, uptake, and adherence. Findings from this study of both client and provider perspectives can be used to inform and address inequities among individuals experiencing homelessness, and ultimately contribute to a diminished reservoir of LTBI.
Collapse
Affiliation(s)
- Amber Heyd
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Courtney Heffernan
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kate Storey
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - T Cameron Wild
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Richard Long
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
15
|
Stagg HR, Flook M, Martinecz A, Kielmann K, Abel Zur Wiesch P, Karat AS, Lipman MCI, Sloan DJ, Walker EF, Fielding KL. All nonadherence is equal but is some more equal than others? Tuberculosis in the digital era. ERJ Open Res 2020; 6:00315-2020. [PMID: 33263043 PMCID: PMC7682676 DOI: 10.1183/23120541.00315-2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/16/2020] [Indexed: 12/20/2022] Open
Abstract
Adherence to treatment for tuberculosis (TB) has been a concern for many decades, resulting in the World Health Organization's recommendation of the direct observation of treatment in the 1990s. Recent advances in digital adherence technologies (DATs) have renewed discussion on how to best address nonadherence, as well as offering important information on dose-by-dose adherence patterns and their variability between countries and settings. Previous studies have largely focussed on percentage thresholds to delineate sufficient adherence, but this is misleading and limited, given the complex and dynamic nature of adherence over the treatment course. Instead, we apply a standardised taxonomy - as adopted by the international adherence community - to dose-by-dose medication-taking data, which divides missed doses into 1) late/noninitiation (starting treatment later than expected/not starting), 2) discontinuation (ending treatment early), and 3) suboptimal implementation (intermittent missed doses). Using this taxonomy, we can consider the implications of different forms of nonadherence for intervention and regimen design. For example, can treatment regimens be adapted to increase the "forgiveness" of common patterns of suboptimal implementation to protect against treatment failure and the development of drug resistance? Is it reasonable to treat all missed doses of treatment as equally problematic and equally common when deploying DATs? Can DAT data be used to indicate the patients that need enhanced levels of support during their treatment course? Critically, we pinpoint key areas where knowledge regarding treatment adherence is sparse and impeding scientific progress.
Collapse
Affiliation(s)
- Helen R Stagg
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mary Flook
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Antal Martinecz
- Department of Biology, Pennsylvania State University, University Park, PA, USA.,Center for Infectious Disease Dynamics, Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA.,Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Karina Kielmann
- The Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Pia Abel Zur Wiesch
- Department of Biology, Pennsylvania State University, University Park, PA, USA.,Center for Infectious Disease Dynamics, Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA.,These authors contributed equally
| | - Aaron S Karat
- The Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK.,TB Centre, London School of Hygiene & Tropical Medicine, London, UK.,These authors contributed equally
| | - Marc C I Lipman
- UCL Respiratory, Division of Medicine, University College London, London, UK.,Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK.,These authors contributed equally
| | - Derek J Sloan
- School of Medicine, University of St Andrews, St Andrews, UK.,These authors contributed equally
| | | | - Katherine L Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
16
|
Nguyen Truax F, Morisky D, Low J, Carson M, Girma H, Nyamathi A. Non-completion of latent tuberculosis infection treatment among Vietnamese immigrants in Southern California: A retrospective study. Public Health Nurs 2020; 37:846-853. [PMID: 32896018 DOI: 10.1111/phn.12798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine socio-demographic and health-related factors associated with latent tuberculosis infection (LTBI) treatment refusal, non-initiation, and non-completion among a cohort of Vietnamese immigrants. DESIGN This is a retrospective cohort study in which LTBI charts were reviewed at a public health clinic in Orange County, California between January 2010 and August 2011. SAMPLE Altogether, 474 patient charts with documented LTBI treatment were reviewed for patients who met the inclusion criteria. MEASUREMENTS Univariate and multivariate analyses were used to identify socio-demographic and health-related factors associated with LTBI treatment refusal, non-initiation, and non-completion. RESULTS Of the 474 charts reviewed, 171(36.1%) patients refused LTBI treatment and 21(6.9%) accepted but did not initiate. Of the 282 that started treatment, 62 (22.0%) did not complete the regimen prescribed. The primary barrier documented for treatment refusal and non-completion was concern about medication side effects. Other barriers to treatment non-completion include transportation issues and conflicts with travel plans or work schedules. CONCLUSIONS Community and public health nurses working with the Vietnamese immigrant population can play a vital role in improving patients' LTBI treatment acceptance, initiation, and completion. A proactive approach to addressing barriers and potential medication side effects can improve overall treatment success.
Collapse
Affiliation(s)
| | - Donald Morisky
- School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Julie Low
- County of Orange Health Care Agency, Santa Ana, CA, USA
| | | | | | - Adeline Nyamathi
- Sue and Bill Gross School of Nursing, University of California, Irvine, Irvine, CA, USA
| |
Collapse
|
17
|
Chiang LY, Baumann B, Romanowski K, Kumar D, Campbell JR, Djurdjev O, Morshed M, Sekirov I, Cook VJ, Levin A, Johnston JC. Latent Tuberculosis Therapy Outcomes in Dialysis Patients: A Retrospective Cohort. Am J Kidney Dis 2020; 77:696-703. [PMID: 32818551 DOI: 10.1053/j.ajkd.2020.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 06/20/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVES Maintenance dialysis patients are at an increased risk for active tuberculosis (TB). In 2012, British Columbia, Canada, began systematically screening maintenance dialysis patients for latent TB infection (LTBI) and treating people with evidence of LTBI when appropriate. We examined LTBI treatment outcomes and compared treatment outcomes before and after rollout of the systematic screening program. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS The study comprised 365 people in British Columbia, Canada, initiating at least 90 days of dialysis from January 1, 2001, to May 31, 2017, and starting LTBI therapy: 290 (79.5%) people in the recent cohort and 75 (20.5%) in the historical cohort. People starting LTBI therapy from January 1, 2012, onward were classified as the recent cohort, whereas people starting LTBI therapy before January 1, 2012, were classified as the historical cohort. EXPOSURE Systematic LTBI screening and therapy. OUTCOMES Proportion of people who experience grade 3 to 5 adverse events (AEs) or any grade rash and end-of-treatment outcomes. ANALYTICAL APPROACH Outcomes were reported using descriptive statistics. 2-sample test of proportions using χ2 distribution was used to test for statistical significance between the recent and historical cohorts. RESULTS 298 (81.6%) people successfully completed LTBI therapy. The proportion of people experiencing a grade 3 to 4 AE or any grade rash was 21.1%. Most AEs were related to gastrointestinal events, general malaise, or pruritus that resulted in regimen changes. 2 (0.5%) people were hospitalized for AEs related to LTBI therapy. No significant difference was found between the recent and historical cohorts in all outcomes of interest. No grade 5 AEs (deaths) were attributed to LTBI therapy. LIMITATIONS Retrospective data and generalizability outside low-TB-burden settings. CONCLUSIONS Our findings suggest that a high proportion of people receiving maintenance dialysis can complete LTBI therapy. The rate of grade 3 to 4 AEs was high and associated with frequent medication changes during therapy. LTBI therapy in maintenance dialysis may be safe but requires close monitoring.
Collapse
Affiliation(s)
- Leslie Y Chiang
- British Columbia Centre for Disease Control, Vancouver, Canada; Provincial Health Services Authority, Vancouver, Canada
| | | | - Kamila Romanowski
- British Columbia Centre for Disease Control, Vancouver, Canada; Provincial Health Services Authority, Vancouver, Canada; University of British Columbia, Vancouver, Canada
| | - Divjot Kumar
- University of British Columbia, Vancouver, Canada
| | | | - Ognjenka Djurdjev
- Provincial Health Services Authority, Vancouver, Canada; British Columbia Renal, Vancouver, Canada
| | - Muhammad Morshed
- Provincial Health Services Authority, Vancouver, Canada; University of British Columbia, Vancouver, Canada; British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, Canada
| | - Inna Sekirov
- Provincial Health Services Authority, Vancouver, Canada; University of British Columbia, Vancouver, Canada; British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, Canada
| | - Victoria J Cook
- British Columbia Centre for Disease Control, Vancouver, Canada; Provincial Health Services Authority, Vancouver, Canada; University of British Columbia, Vancouver, Canada
| | - Adeera Levin
- Provincial Health Services Authority, Vancouver, Canada; University of British Columbia, Vancouver, Canada; British Columbia Renal, Vancouver, Canada
| | - James C Johnston
- British Columbia Centre for Disease Control, Vancouver, Canada; Provincial Health Services Authority, Vancouver, Canada; University of British Columbia, Vancouver, Canada.
| |
Collapse
|
18
|
Bastos ML, Campbell JR, Oxlade O, Adjobimey M, Trajman A, Ruslami R, Kim HJ, Baah JO, Toelle BG, Long R, Hoeppner V, Elwood K, Al-Jahdali H, Apriani L, Benedetti A, Schwartzman K, Menzies D. Health System Costs of Treating Latent Tuberculosis Infection With Four Months of Rifampin Versus Nine Months of Isoniazid in Different Settings. Ann Intern Med 2020; 173:169-178. [PMID: 32539440 DOI: 10.7326/m19-3741] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Four months of rifampin treatment for latent tuberculosis infection is safer, has superior treatment completion rates, and is as effective as 9 months of isoniazid. However, daily medication costs are higher for a 4-month rifampin regimen than a 9-month isoniazid regimen. OBJECTIVE To compare health care use and associated costs of 4 months of rifampin and 9 months of isoniazid. DESIGN Health system cost comparison using all health care activities recorded during 2 randomized clinical trials. (ClinicalTrials.gov: NCT00931736 and NCT00170209). SETTING High-income countries (Australia, Canada, Saudi Arabia, and South Korea), middle-income countries (Brazil and Indonesia), and African countries (Benin, Ghana, and Guinea). PARTICIPANTS Adults and children with clinical or epidemiologic factors associated with increased risk for developing tuberculosis that warranted treatment for latent tuberculosis infection. MEASUREMENTS Health system costs per participant. RESULTS A total of 6012 adults and 829 children were included. In both adults and children, greater health system use and higher costs were observed with 9 months of isoniazid than with 4 months of rifampin. In adults, the ratios of costs of 4 months of rifampin versus 9 months of isoniazid were 0.76 (95% CI, 0.70 to 0.82) in high-income countries, 0.90 (CI, 0.85 to 0.96) in middle-income countries, and 0.80 (CI, 0.78 to 0.81) in African countries. Similar findings were observed in the pediatric population. LIMITATION Costs may have been overestimated because the trial protocol required a minimum number of follow-up visits, although fewer than recommended by many authoritative guidelines. CONCLUSION A 4-month rifampin regimen was safer and less expensive than 9 months of isoniazid in all settings. This regimen could be adopted by tuberculosis programs in many countries as first-line therapy for latent tuberculosis infection. PRIMARY FUNDING SOURCE Canadian Institutes of Health Research.
Collapse
Affiliation(s)
- Mayara Lisboa Bastos
- State University of Rio de Janeiro, Rio de Janeiro, Brazil, and McGill University, Montreal, Quebec, Canada (M.L.B.)
| | | | - Olivia Oxlade
- McGill International TB Center, Montreal, Quebec, Canada (O.O.)
| | - Menonli Adjobimey
- Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A.)
| | - Anete Trajman
- McGill University, Montreal, Quebec, Canada, and Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (A.T.)
| | | | - Hee Jin Kim
- Korean National Tuberculosis Association, Seoul, South Korea (H.J.K.)
| | | | - Brett G Toelle
- The University of Sydney, Woolcock Institute of Medical Research, and Sydney Local Health District, Sydney, Australia (B.G.T.)
| | - Richard Long
- University of Alberta, Edmonton, Alberta, Canada (R.L.)
| | - Vernon Hoeppner
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada (V.H.)
| | - Kevin Elwood
- BC Centre for Disease Control and University of British Columbia, Vancouver, British Columbia, Canada (K.E.)
| | - Hamdan Al-Jahdali
- King Saud University, King Abdulaziz Medical City, Riyadh, Saudi Arabia (H.A.)
| | - Lika Apriani
- Universitas Padjadjaran, Bandung, Indonesia (L.A.)
| | - Andrea Benedetti
- McGill University, Montreal, Quebec, Canada (J.R.C., A.B., K.S., D.M.)
| | - Kevin Schwartzman
- McGill University, Montreal, Quebec, Canada (J.R.C., A.B., K.S., D.M.)
| | - Dick Menzies
- McGill University, Montreal, Quebec, Canada (J.R.C., A.B., K.S., D.M.)
| |
Collapse
|
19
|
Abstract
Despite considerable efforts to control tuberculosis (TB) among Ethiopian immigrants in Israel, an outbreak of TB among second-generation Ethiopian immigrants that involved native Israelis occurred between January 2011 and December 2019. The aim of this article is to report on this outbreak and discuss the patient and health system barriers that led to its propagation. Overall, 13 culture-positive TB patients were diagnosed in this outbreak. An additional 36 cases with identical mycobacterium tuberculosis genotypes were identified through cross-checking with the National TB Laboratory Registry. Among the 32 close contacts of the index case, 18 (56.3%) reported for screening and treatment of latent TB infection (LTBI) was recommended for 11 (61.1%) of them. However, none completed treatment and eight eventually developed TB. Of the 385 close contacts identified in this outbreak, 286 (74.3%) underwent contact investigation, 154 (53.8%) were recommended LTBI treatment, but only 26 (16.9%) completed the treatment. Routine contact investigation and treatment practice measures failed to contain the cascade of infection and disease, leading to the spread of the infecting strain of TB. This report highlights the challenges to identify the high-risk group and address barriers to care among such a vulnerable population.
Collapse
|
20
|
Zhu J, Shi Y, Li J, Zhang Z. Role of risk attitude and time preference in preventive aspirin use adherence. J Eval Clin Pract 2020; 26:819-825. [PMID: 31478307 DOI: 10.1111/jep.13274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Poor adherence to medication that is taken chronically for the prevention of cardiovascular disease (CVD) continues to occur. Poor adherence is a primary barrier to treatment success and affects not only the patient but also the health care system. OBJECTIVE We aim to explore the impacts of risk attitudes and time preferences on the decisions of patients to begin and comply with aspirin therapy for CVD prevention. METHODS Three hundred fifty-seven patients who used low-dose aspirin for CVD prevention under the guidance of their doctors completed the survey. The risk attitudes and time preferences of the patients were elicited using a multiple price list experiment. Logistic regression models were used to examine the predictors of adherence to aspirin use. RESULTS Risk-seeking behaviours were significantly associated with both nonparticipation (P < .01) and lower compliance (P < .05) in patients. The coefficient for time preference was only significant at the 0.05 level for the decision to initiate aspirin use, which indicated that more impatient patients were less likely to begin with the use of aspirin. Forgetfulness in using aspirin on time and a lack of knowledge (as well as a lack of belief in the use of aspirin) could largely explain the poor adherence to aspirin therapy. CONCLUSIONS The identification of risk seekers and of those individuals who discount the future to a lesser degree may help providers to formulate tailored strategies to their patients, thus effectively enhancing their adherence to treatment.
Collapse
Affiliation(s)
- Jingrong Zhu
- School of Management and Economics, Beijing Institute of Technology, Beijing, China.,College of Health and Human Development, Pennsylvania State University, State College, Pennsylvania
| | - Yunfeng Shi
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Jinlin Li
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Zengbo Zhang
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| |
Collapse
|
21
|
Yasri S, Wiwanitkit V. Newly registered tuberculosis: A comparison of rate and success of management in two island districts with different in accessibility of transportation in Thailand. Int J Mycobacteriol 2020; 8:371-373. [PMID: 31793508 DOI: 10.4103/ijmy.ijmy_140_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Tuberculosis is an important infection that can be seen in several countries. The occurrence of disease in the remoted setting is an interesting issue that is an actual challenge for management. Here, the authors present and discuss on the newly registered tuberculosis cases in two island districts of Thailand, a tropical endemic country in Southeast Asia. Methods The authors hereby retrospectively analyzed registered data of newly registered tuberculosis cases in two island districts with different in accessibility of transportation in Thailand. A comparison of rate and success of management was made. Results According to the statistical analysis, there is a significant difference of incidence rates of newly registered tuberculosis cases between the two island districts (0.13% vs. 0.04%). There is also a significant difference of successful antituberculosis drug management rates between the two island districts (72.7% vs. 100%). Conclusion The island district with easier accessibility by transportation has a more number of newly registered tuberculosis case and a less success rate of antituberculosis drug treatment.
Collapse
Affiliation(s)
- Sora Yasri
- KMT Primary Care Center, Bangkok, Thailand
| | - Viroj Wiwanitkit
- Department of Community Medicine, Dr. DY Patil University, Pune, Maharashtra, India; Department of Biological Science, Joseph Ayobabalola University, Ikeji-Arakeji, Nigeria
| |
Collapse
|
22
|
Martin-Sanchez M, Brugueras S, de Andrés A, Simon P, Gorrindo P, Ros M, Masdeu E, Millet JP, Caylà JA, Orcau À. Tuberculosis incidence among infected contacts detected through contact tracing of smear-positive patients. PLoS One 2019; 14:e0215322. [PMID: 30986227 PMCID: PMC6464217 DOI: 10.1371/journal.pone.0215322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/29/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The contacts of people with pulmonary tuberculosis (PTB) have a high risk of becoming infected and developing tuberculosis (TB). Our aim was to determine the incidence of TB and its risk factors in a cohort of contacts with latent TB infection (LTBI) detected through contact tracing of smear-positive PTB cases. METHODS AND FINDINGS We performed a population-based retrospective cohort study including contacts that had LTBI, and were contacts of people with PTB who started treatment between 2008 and 2014. We followed up contacts until they developed TB or until the end date for follow-up (31st December 2016). We used Kaplan-Meier curves to compute incidence at 2 and 5 years, and Cox regression to compute hazard ratios (HR) and their 95% confidence intervals (CI). We analyzed 3097 close contacts of 565 PTB cases. After exclusion of 81 co-prevalent TB cases, 953 contacts had LTBI, of which 14 developed TB. Their risk of developing TB after two and five years was 0.7% (CI: 0.3-1.6) and 1.8% (CI: 1.1-3.1) respectively. Contacts who had not been referred for LTBI treatment had a 1.0% (CI: 0.2-4.0) risk at 5 years. Risk of developing TB at 5 years was 1.2% (CI: 0.5-3.0) among people who completed treatment, and 11.1% (CI: 5.1-23.3) for those who did not. Risk factors for TB were not completing LTBI treatment (HR 9.4, CI: 2.9-30.8) and being female (HR 3.5, CI: 1.1-11-3). CONCLUSIONS LTBI treatment plays a fundamental role in decreasing the risk of developing TB. It is necessary to achieve a maximum contact tracing coverage and the highest possible compliance with LTBI treatment.
Collapse
Affiliation(s)
- Mario Martin-Sanchez
- Epidemiology Service, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Preventive Medicine and Public Health Training Unit Parc de Salut Mar–Pompeu Fabra University—Agència de Salut Pública de Barcelona (PSMar-UPF-ASPB), Barcelona, Spain
| | - Silvia Brugueras
- Epidemiology Service, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- The Biomedical Research Center Network of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna de Andrés
- Epidemiology Service, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Pere Simon
- Epidemiology Service, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Pilar Gorrindo
- Epidemiology Service, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Miriam Ros
- Epidemiology Service, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Eva Masdeu
- Epidemiology Service, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
| | - Joan-Pau Millet
- Epidemiology Service, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- The Biomedical Research Center Network of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Foundation of the Tuberculosis Research Unit of Barcelona (fuiTB), Barcelona, Spain
| | - Joan A. Caylà
- Foundation of the Tuberculosis Research Unit of Barcelona (fuiTB), Barcelona, Spain
| | - Àngels Orcau
- Epidemiology Service, Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- The Biomedical Research Center Network of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Foundation of the Tuberculosis Research Unit of Barcelona (fuiTB), Barcelona, Spain
| | | |
Collapse
|
23
|
Activity of a Long-Acting Injectable Bedaquiline Formulation in a Paucibacillary Mouse Model of Latent Tuberculosis Infection. Antimicrob Agents Chemother 2019; 63:AAC.00007-19. [PMID: 30745396 PMCID: PMC6437534 DOI: 10.1128/aac.00007-19] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/05/2019] [Indexed: 11/20/2022] Open
Abstract
The potent antituberculosis activity and long half-life of bedaquiline make it an attractive candidate for use in long-acting/extended-release formulations for the treatment of latent tuberculosis infection (LTBI). Our objective was to evaluate a long-acting injectable (LAI) bedaquiline formulation in a validated paucibacillary mouse model of LTBI. The potent antituberculosis activity and long half-life of bedaquiline make it an attractive candidate for use in long-acting/extended-release formulations for the treatment of latent tuberculosis infection (LTBI). Our objective was to evaluate a long-acting injectable (LAI) bedaquiline formulation in a validated paucibacillary mouse model of LTBI. Following immunization with Mycobacterium bovis rBCG30, BALB/c mice were challenged by aerosol infection with M. tuberculosis H37Rv. Treatment began 13 weeks after challenge infection with one of the following regimens: an untreated negative-control regimen; positive-control regimens of daily rifampin (10 mg/kg of body weight), once-weekly rifapentine (15 mg/kg) and isoniazid (50 mg/kg), or daily bedaquiline (25 mg/kg); test regimens of one, two, or three monthly doses of LAI bedaquiline at 160 mg/dose (BLAI-160); and test regimens of daily bedaquiline at 2.67 mg/kg (B2.67), 5.33 mg/kg (B5.33), or 8 mg/kg (B8) to deliver the same total amount of bedaquiline as one, two, or three doses of BLAI-160, respectively. All drugs were administered orally, except for BLAI-160 (intramuscular injection). The primary outcome was the decline in M. tuberculosis lung CFU counts during 12 weeks of treatment. The negative- and positive-control regimens performed as expected. One, two, and three doses of BLAI-160 resulted in decreases of 2.9, 3.2, and 3.5 log10 CFU/lung, respectively, by week 12. Daily oral dosing with B2.67, B5.33, and B8 decreased lung CFU counts by 1.6, 2.8, and 4.1 log10, respectively. One dose of BLAI-160 exhibited activity for at least 12 weeks. The sustained activity of BLAI-160 indicates that it shows promise as a short-course LTBI treatment requiring few patient encounters to ensure treatment completion.
Collapse
|
24
|
Mohidem NA, Hashim Z, Osman M, Shaharudin R, Muharam FM, Makeswaran P. Demographic, socio-economic and behavior as risk factors of tuberculosis in Malaysia: a systematic review of the literature. REVIEWS ON ENVIRONMENTAL HEALTH 2018; 33:407-421. [PMID: 30325736 DOI: 10.1515/reveh-2018-0026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/16/2018] [Indexed: 06/08/2023]
Abstract
Background Tuberculosis (TB) is making a comeback and has remained one of the main causes of mortality among the list of infectious diseases in Malaysia. Objective To evaluate the burden and demographic, socio-economic and behavior as risk factors of TB among communities in Malaysia. Method A comprehensive search of Scopus, Sciencedirect, PubMed, DOAJ, CINAHL Plus, MyJournal, BIREME, BMC Public Health, Medline, CAB, EMBASE (Excerpta Medica dataBASE), and Web of Science (WoS) was undertaken from the articles published from 1st January 2008 to 31st December 2017 using medical subject heading (MeSH) key terms. Results Of 717 papers screened, 31 eligible studies met our inclusion criteria. Gender, age, marriage status, ethnicity, area of living, being in prison and immigrant were evaluated as demographic factors, while educational level, occupation and household income were evaluated as socio-economic factors. For behavioral factors, smoking, drug abuse, alcohol consumption and other lifestyle practices were evaluated. However, not all the studies were statistically significantly associated with these risk factors. Studies on household income were few and too small to permit a conclusion. We also did not find any study that investigated TB infection among sex workers. Conclusion Immigrant in high density settings may increase the progression of disease infection in Malaysia. The risk factors for the development of TB, specifically in a high-risk population, should be targeted through the implementation of specialized interventions. Further research into the role of indoor and outdoor physical environments is required to better understand the association between the physical environment and the social environment with TB infection.
Collapse
Affiliation(s)
- Nur Adibah Mohidem
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor, Malaysia
| | - Zailina Hashim
- Department of Environmental and Occupational Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia, Phone: +603-89472406
| | - Malina Osman
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Malaysia
| | - Rafiza Shaharudin
- Institute for Medical Research, Environmental Health Research Centre, Jalan Pahang, Kuala Lumpur, Malaysia
| | - Farrah Melissa Muharam
- Department of Agriculture Technology, Faculty of Agriculture, Universiti Putra Malaysia, UPM Serdang, Malaysia
| | - Punitha Makeswaran
- Public Health Division, Selangor State Health Department, Shah Alam, Selangor, Malaysia
| |
Collapse
|
25
|
Milinkovic DA, Birch S, Scott F, Newbold KB, Hopkins J, Saffie M, Essue BM. Low prioritization of latent tuberculosis infection-A systemic barrier to tuberculosis control: A qualitative study in Ontario, Canada. Int J Health Plann Manage 2018; 34:384-395. [PMID: 30402949 DOI: 10.1002/hpm.2670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Eliminating tuberculosis (TB) in low-incidence countries is an important global health priority, and Canada has committed to achieve this goal. The elimination of TB in low-incidence countries requires effective management and treatment of latent tuberculosis infection (LTBI). This study aimed to understand and describe the system-level barriers to LTBI treatment for immigrant populations in the Greater Toronto and Hamilton Area, Ontario, Canada. METHODS A qualitative study that used purposive sampling to recruit and interview health system advisors and planners (n = 10), providers (n = 13), and clients of LTBI health services (n = 9). Data were recorded, transcribed verbatim, and analyzed using content analysis. RESULTS Low prioritization of LTBI was an overarching theme that impacted four dimensions of LTBI care: management, service delivery, health literacy, and health care access. These factors explained, in part, inequities in the system that were linked to variations in health care quality and health care access. While some planners and providers at the local level were attempting to prioritize LTBI care, there was no clear pathway for information sharing. CONCLUSIONS This multiperspective study identified barriers beyond the typical socioeconomic determinants and highlighted important upstream factors that hinder treatment initiation and adherence. Addressing these factors is critical if Canada is to meet the WHO's global call to eradicate TB in all low incidence settings.
Collapse
Affiliation(s)
- Deborah A Milinkovic
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada
| | - Stephen Birch
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Centre for the Business and Economics of Health, University of Queensland, Brisbane, Australia.,Centre for Health Economics, University of Manchester, Manchester, UK
| | - Fran Scott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada
| | - K Bruce Newbold
- School of Geography and Earth Sciences (SGES), McMaster University, Hamilton, Canada
| | - Jessica Hopkins
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Region of Peel Public Health, Mississauga, Canada
| | - Muntasir Saffie
- Division of Respirology, McMaster University, Hamilton, Canada
| | - Beverley M Essue
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada.,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
| |
Collapse
|
26
|
Essue BM, Milinkovic D, Birch S. Better data to drive more effective care for people with latent tuberculosis infection in Canada. CMAJ 2018; 190:E700-E701. [PMID: 29891473 PMCID: PMC5995594 DOI: 10.1503/cmaj.180488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Beverley M Essue
- Department of Health Research Methods, Evidence, and Impact (Essue, Milinkovic, Birch), and Centre for Health Economics and Policy Analysis (Essue, Milinkovic), McMaster University, Hamilton, Ont.; School of Public Health (Essue), The University of Sydney, Sydney, Australia; Centre for the Business and Economics of Health (Birch), The University of Queensland, Brisbane, Australia; University of Manchester (Birch), Manchester, UK
| | - Deborah Milinkovic
- Department of Health Research Methods, Evidence, and Impact (Essue, Milinkovic, Birch), and Centre for Health Economics and Policy Analysis (Essue, Milinkovic), McMaster University, Hamilton, Ont.; School of Public Health (Essue), The University of Sydney, Sydney, Australia; Centre for the Business and Economics of Health (Birch), The University of Queensland, Brisbane, Australia; University of Manchester (Birch), Manchester, UK
| | - Stephen Birch
- Department of Health Research Methods, Evidence, and Impact (Essue, Milinkovic, Birch), and Centre for Health Economics and Policy Analysis (Essue, Milinkovic), McMaster University, Hamilton, Ont.; School of Public Health (Essue), The University of Sydney, Sydney, Australia; Centre for the Business and Economics of Health (Birch), The University of Queensland, Brisbane, Australia; University of Manchester (Birch), Manchester, UK
| |
Collapse
|