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Grijota-Camino MD, Montero N, Luque MJ, Díaz-Jurado M, Sabé N, Pérez-Recio S, Couceiro C, Muñoz L, Cruzado JM, Santin M. Tuberculosis prevention in patients undergoing kidney transplantation: A nurse-led program for screening and treatment. Transpl Infect Dis 2021; 23:e13603. [PMID: 33745229 DOI: 10.1111/tid.13603] [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: 01/26/2021] [Revised: 03/02/2021] [Accepted: 03/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Systematic screening for, and treatment of, latent tuberculosis (TB) infection is recommended prior to kidney transplant. However, little is known about patient compliance with, or the safety profile of, preventive therapies used in clinical practice. METHODS This was a retrospective observational study of patients who were eligible for kidney transplant and were evaluated for TB infection between January 2013 and June 2019 at the TB clinic of a tertiary care teaching hospital. All patient data were registered prospectively as part of our nurse-led program before kidney transplant. We assessed completion rates, tolerance with therapy, development of TB, and associated workload. RESULTS In total, 1568 patients were referred to our TB clinic for evaluation. Preventive therapy was given to 385 patients and completed by 340 (88.3%). Of these, 89 (23.1%) experienced some intolerance, with 27 requiring full discontinuation. After a median follow-up of 45 months (1426 patient-years), 206 (53.5%) of the treated patients received a kidney transplant; only one patient, who failed to complete treatment, developed post-transplant TB (7.01 cases per 10 000 patient-years; 95% confidence interval, 0.35-34.59). Extra nurse or medical visits were required by 268 (69.6%) patients. CONCLUSION Despite the complexity and workload generated by patients with ESRD awaiting kidney transplant, preventive therapy for TB is effective in most cases. Our experience provides important evidence on the feasibility of preventive therapy for TB before kidney transplant when delivered as part of a comprehensive nurse-led program.
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Affiliation(s)
- Maria D Grijota-Camino
- Tuberculosis Unit, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Núria Montero
- Service of Nephrology, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Spain.,Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Maria J Luque
- Tuberculosis Unit, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Maria Díaz-Jurado
- Service of Nephrology, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Núria Sabé
- Tuberculosis Unit, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Spain.,Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Sandra Pérez-Recio
- Tuberculosis Unit, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Carlos Couceiro
- Service of Nephrology, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Spain.,Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Laura Muñoz
- Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Spain.,Service of Internal Medicine, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Josep M Cruzado
- Service of Nephrology, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Spain.,Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Miguel Santin
- Tuberculosis Unit, Service of Infectious Diseases, Bellvitge University Hospital-Bellvitge Institute of Biomedical Research (IDIBELL), L'Hospitalet de Llobregat, Spain.,Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Spain
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The Evaluation of Medication Adherence in Patients Infected With HCV Receiving Protease Inhibitors: A Pilot Study. Gastroenterol Nurs 2019; 42:259-268. [PMID: 31145250 DOI: 10.1097/sga.0000000000000386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Adherence to treatment is essential for hepatitis C cure. Studies show the complexity of the treatment due to side effects, many pills, and rigor in the schedules. The aim of this study was to evaluate the adherence to treatment with protease inhibitor in patients with hepatitis C. It is a longitudinal, observational, prospective pilot study with patients with hepatitis C genotype 1. Bimonthly consultations and biweekly calls for 20 weeks were performed. Evaluation methods for adherence were Measure of Adherence to Treatment score, patient report, count pills, and sustained virological response. Twenty-two patients were enrolled. Mean age was 54.0 ± 8.72 years; 50% were men, educational level was 7.9 ± 3.89 years for the study, and intake of pills was 2.2 ± 1.60 per day. Adverse events reported were fatigue (90.9%), muscular pain (72.7%), and nausea (68.2%). In total, 71.4% of patients took 100% of medications and were classified as having a high degree of adherence to treatment. The sustained virological response was not significant in relation to the high or low adherence degree. Measure of Adherence to Treatment score is a good instrument to measure adherence to protease inhibitor treatment. The adherence of patients undergoing long-term and complex treatments improves when the multidisciplinary team follows up every 7-15 days. The patient's access to the team through additional phone calls or medical/nursing appointment is essential to improve adherence.
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Müller AM, Osório CS, de Figueiredo RV, Silva DR, Dalcin PDTR. Educational strategy intervention and remote supervision on the post-discharge management of tuberculosis diagnosed in the hospital: Randomized clinical trial. CLINICAL RESPIRATORY JOURNAL 2019; 13:505-512. [PMID: 31207148 DOI: 10.1111/crj.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/01/2019] [Accepted: 06/02/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION One of the most serious problems in TB control is non-adherence to treatment leading to the risk of drug resistance and subsequent treatment failure. OBJECTIVES To assess the impact of an educational strategy intervention and remote supervision on the post-discharge management of new cases of TB diagnosed in hospital on TB cure rate. Secondarily, to assess the impact of this intervention on default rate. METHODS Randomized control trial conducted at a general, tertiary care, university affiliated hospital. New cases of TB diagnosed in hospital were included. The primary outcome was cure rate and secondary outcome was default rate. Analysis was carried out by modified intention to treat. RESULTS A total of 169 new tuberculosis patients were enrolled. Among them, 80 were assigned to intervention group and 89 to control group. The cure rate was 71.3% in the intervention group and 58.4% in the control group. In the multivariate binary logistic regression model to evaluate the effect of the intervention, controlled by age, sex, current smoking status and directly observed treatment short, intervention was independently associated with cure rate (OR = 0.47; 95% CI: 0.24-0.94; P = 0.033).There was a significant difference in the default rate between the control and intervention groups (18.0% vs 5.0%, respectively, P = 0.039). CONCLUSION An educational strategy intervention and remote supervision on the post-discharge management of new cases of TB with in-hospital diagnosis had a positive effect of small magnitude on cure rate. Secondarily, the treatment default rate has been significantly decreased with the intervention.
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Affiliation(s)
- Alice Mânica Müller
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Programa de Pós-Graduação em Ciências Pneumológicas-UFRGS, Porto Alegre, Brazil
| | | | | | - Denise Rossato Silva
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Programa de Pós-Graduação em Ciências Pneumológicas-UFRGS, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Paulo de Tarso Roth Dalcin
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Programa de Pós-Graduação em Ciências Pneumológicas-UFRGS, Porto Alegre, Brazil.,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Qiu J, Wang C, Pan X, Pan L, Huang X, Xu J, Ji X, Mao M. APACHE-II score for anti-tuberculosis tolerance in critically ill patients: a retrospective study. BMC Infect Dis 2019; 19:106. [PMID: 30717702 PMCID: PMC6360662 DOI: 10.1186/s12879-019-3751-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/28/2019] [Indexed: 02/08/2023] Open
Abstract
Background To investigate the status of anti-tuberculosis treatment in critically ill patients, and to explore the value of APACHE-II score in guiding anti-tuberculosis treatment. Methods This analysis included critically ill patients with tuberculosis. The utility of APACHE-II score for predicting drug withdrawal was evaluated using receiver operating characteristic (ROC) curve analysis. Results Among 320 patients enrolled (58 ± 22 years; 256 males), 147 (45.9%) had drugs withdrawn. The drug withdrawal group had higher APACHE-II score (median [interquartile range]: 21 [3–52] vs. 17 [4–42] points), higher CD4%, lower hemoglobin level, higher rates of chronic obstructive pulmonary disease (COPD) and chronic renal failure, and lower rate of extrapulmonary tuberculosis (P < 0.05). Logistic regression identified APACHE-II score > 18 (odds ratio [95% confidence interval]: 2.099 [1.321–3.334], P < 0.01), COPD (1.913 [1.028–3.561], P < 0.05) and hemoglobin level (0.987 [0.977–0.997], P < 0.05) as independent factors associated with drug withdrawal. At an optimal cutoff of 18.5, the sensitivity, specificity, positive predictive value and negative predictive value of APACHE-II score for predicting drug withdrawal was 59.2, 61.8, 56.9 and 64.1%, respectively. Conclusions APACHE-II score > 18 points might predict patient tolerance of anti-tuberculosis treatment.
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Affiliation(s)
- Junke Qiu
- Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China
| | - Caihong Wang
- Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China
| | - Xiaohong Pan
- Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China
| | - Lei Pan
- Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China
| | - Xiaoqing Huang
- Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China
| | - Jiekun Xu
- Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China
| | - Xiaobo Ji
- Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China
| | - Minjie Mao
- Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China.
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García P, Sanchez J, Mora J, Ronda E. Assessment of 16-year retrospective cohort study of factors associated with non-compliance with a tuberculosis contact tracing programme at a Spanish hospital. J Eval Clin Pract 2018; 24:758-766. [PMID: 29987867 DOI: 10.1111/jep.12973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/02/2018] [Accepted: 06/04/2018] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVE Contact tracing and screening is an essential strategy in tuberculosis (TB) control. Our aim is to assess factors associated with the degree of compliance with the main recommendations made to contacts of TB cases as part of the contact tracing programme, and to identify factors associated with non-compliance. METHODS We conducted a retrospective cohort study to assess the TB contact tracing programme at a Spanish hospital over the period 1998-2013. RESULTS A total 2269 contacts were identified corresponding to 644 active TB index cases, and initial screening indicated that 3.2% had active TB and 41.3% had latent TB infection (LTBI). Compliance with the recommendation for primary chemoprophylaxis increased significantly over the study period, rising from 76.5% in the period 1998 to 2002 to 82.7% in the period 2010 to 2013. A similar significant increase was also observed for latent tuberculosis infection treatment (46.1% in the first period to 68.0% in the latter period). Factors that were significantly associated with non-compliance with the recommendations were: being of foreign origin, alcoholism, being recommended latent tuberculosis infection treatment, repeating the tuberculin skin test at 3 months, a smear-positive index case, and an index case aged under 35 years old. CONCLUSIONS Although compliance levels have improved over the years, it remains necessary to adopt strategies that target contacts in groups identified as being at risk of non-compliance.
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Affiliation(s)
- Patricia García
- Preventive Medicine Service, University General Hospital of Alicante, Pintor Baeza 11, 03010, Alicante, Spain
| | - José Sanchez
- Preventive Medicine Service, University General Hospital of Alicante, Pintor Baeza 11, 03010, Alicante, Spain
| | - Juan Mora
- Preventive Medicine Service, University General Hospital of Alicante, Pintor Baeza 11, 03010, Alicante, Spain
| | - Elena Ronda
- Public Health Research Group, University of Alicante, Carretera San Vicente del Raspeig, s/n 03690, Alicante, Spain
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Alsdurf H, Hill PC, Matteelli A, Getahun H, Menzies D. The cascade of care in diagnosis and treatment of latent tuberculosis infection: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2016; 16:1269-1278. [PMID: 27522233 DOI: 10.1016/s1473-3099(16)30216-x] [Citation(s) in RCA: 299] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/22/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND WHO estimates that a third of the world's population has latent tuberculosis infection and that less than 5% of those infected are diagnosed and treated to prevent tuberculosis. We aimed to systematically review studies that report the steps from initial tuberculosis screening through to treatment for latent tuberculosis infection, which we call the latent tuberculosis cascade of care. We specifically aimed to assess the number of people lost at each stage of the cascade. METHODS We did a systematic review and meta-analysis of study-level observational data. We searched MEDLINE (via OVID), Embase, and Health Star for observational studies, published between 1946 and April 12, 2015, that reported primary data for diagnosis and treatment of latent tuberculosis infection. We did meta-analyses using random and fixed effects analyses to identify percentages of patients with latent tuberculosis infection completing each step in the cascade. We also estimated pooled proportions in subgroups stratified by different characteristics of interest to assess risk factors for losses. RESULTS We identified 58 studies, describing 70 distinct cohorts and 748 572 people. Steps in the cascade associated with greater losses included completion of testing (71·9% [95% CI 71·8-72·0] of people intended for screening), completion of medical evaluation (43·7% [42·5-44·9]), recommendation for treatment (35·0% [33·8-36·4]), and completion of treatment if started (18·8% [16·3-19·7]). Steps with fewer losses included receiving test results, referral for evaluation if test positive, and accepting to start therapy if recommended. Factors associated with fewer losses were immune-compromising medical indications, being part of contact investigations, and use of rifamycin-based regimens. INTERPRETATION We identify major losses at several steps in the cascade of care for latent tuberculosis infection. Improvements in management of latent tuberculosis will need programmatic approaches to address the losses at each step in the cascade. FUNDERS Canadian Institutes of Health Research.
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Affiliation(s)
- Hannah Alsdurf
- Montreal Chest Institute, McGill University, Montreal, QC, Canada
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Alberto Matteelli
- Global TB Programme, WHO, Geneva, Switzerland; Clinic of Infectious and Tropical Diseases, WHO Collaborating Center for TB/HIV and TB Elimination, University of Brescia, Brescia, Italy
| | | | - Dick Menzies
- Montreal Chest Institute, McGill University, Montreal, QC, Canada; Global TB Programme, WHO, Geneva, Switzerland.
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Vega-Cubillo EM, Andrés-Carreira JM, Cirillo-Ibargüen S, Manzanares-Arnaiz C, Moreno-Moreno G, Redondo-Figuero CG. [Non-compliance with the systemic antibiotic treatment prescribed in Primary Health Care emergency departments (Study INCUMAT')]. Semergen 2016; 43:4-12. [PMID: 27165297 DOI: 10.1016/j.semerg.2016.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 02/11/2016] [Accepted: 03/02/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Non-compliance with antibiotics treatment has severe consequences. Although antibiotics are commonly prescribed drugs, there are few studies that evaluate therapeutic compliance in acute diseases. The main objective of this study is to determine the percentage of non-compliance with the systemic antibiotics treatment prescribed in emergency departments. MATERIAL AND METHODS A prospective observational study was performed in the Emergency Department of 2 health centres of the Cantabria Health Service between the months of June and September 2014. The study included patients of any age, and those could be monitored, who were prescribed a systemic antibiotic for any infectious disease. Sociodemographic variables, diseases, and compliance were the variables studied. The Morinsky-Green test was used, plus 3 questions added by the authors. RESULTS Of the 303 patients included, non-compliance, evaluated using the Morinsky-Green test, was 32.7% (95% CI 27.6-38.1), with this rising to the 44.9% (95% CI 39.4-50.5) when the 3 mentioned questions were added to the test. A downward trend is observed in non-compliance as the age increases. The risk of non-compliance is twice in men than in women: OR=2.02 (95% CI 1.27-3.24). CONCLUSIONS Almost half (45%) of the patients who are prescribed antibiotics do not comply with the indications. Most of them attribute this fact to forgetfulness in compliance with the prescribed treatment. The elderly and women follow the treatment better, which should be taken into account when designing strategies to improve therapeutic compliance.
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Affiliation(s)
- E M Vega-Cubillo
- Servicio de Urgencias de Atención Primaria (SUAP) de Colindres, Servicio Cántabro de Salud (SCS), Colindres, Cantabria, España.
| | - J M Andrés-Carreira
- Servicio de Urgencias de Atención Primaria (SUAP) de Colindres, Servicio Cántabro de Salud (SCS), Colindres, Cantabria, España
| | - S Cirillo-Ibargüen
- Servicio de Urgencias de Atención Primaria (SUAP) de Santoña, Servicio Cántabro de Salud (SCS), Santoña, Cantabria, España
| | - C Manzanares-Arnaiz
- Servicio de Urgencias de Atención Primaria (SUAP) de Santoña, Servicio Cántabro de Salud (SCS), Santoña, Cantabria, España
| | - G Moreno-Moreno
- Servicio de Urgencias de Atención Primaria (SUAP) de Colindres, Servicio Cántabro de Salud (SCS), Colindres, Cantabria, España
| | - C G Redondo-Figuero
- Centro de Salud Vargas, Servicio Cántabro de Salud (SCS), Santander, Cantabria, España
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