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Le X, Qian X, Liu L, Sun J, Song W, Qi T, Wang Z, Tang Y, Xu S, Yang J, Wang J, Chen J, Zhang R, Zhu Z, Shen Y. Trends in and Risk Factors for Drug Resistance in Mycobacterium tuberculosis in HIV-Infected Patients. Viruses 2024; 16:627. [PMID: 38675968 PMCID: PMC11054988 DOI: 10.3390/v16040627] [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] [Received: 04/06/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Trends in and risk factors for drug resistance in Mycobacterium tuberculosis (M. tuberculosis) in human immunodeficiency virus (HIV)-infected patients with active tuberculosis were analyzed. The clinical data of M. tuberculosis and HIV-coinfected patients treated at the Shanghai Public Health Clinical Center between 2010 and 2022 were collected. The diagnosis of tuberculosis was confirmed by solid or liquid culture. The phenotypic drug susceptibility test was carried out via the proportional method, and the resistance to first-line and second-line drugs was analyzed. Logistic regression analysis was performed to identify associated risk factors for drug resistance in M. tuberculosis. Of the 304 patients with a M. tuberculosis-positive culture and first-line drug susceptibility test results, 114 (37.5%) were resistant to at least one first-line anti-tuberculosis drug. Of the 93 patients with first-line and second-line drug susceptibility test results, 40 (43%) were resistant to at least one anti-tuberculosis drug, and 20 (21.5%), 27 (29.0%), 19 (20.4%), 16 (17.2%), and 14 (15.1%) were resistant to rifampicin, streptomycin, ofloxacin, levofloxacin, and moxifloxacin, respectively; 17 patients (18.3%) had multidrug-resistant tuberculosis (MDR-TB). Between 2010 and 2021, the rate of resistance to streptomycin and rifampicin ranged from 14.3% to 40.0% and from 8.0% to 26.3%, respectively, showing an increasing trend year by year. From 2016 to 2021, the rate of resistance to quinolones fluctuated between 7.7% and 27.8%, exhibiting an overall upward trend. Logistic regression analysis showed that being aged <60 years old was a risk factor for streptomycin resistance, mono-drug resistance, and any-drug resistance (RR 4.139, p = 0.023; RR 7.734, p = 0.047; RR 3.733, p = 0.009). Retreatment tuberculosis was a risk factor for resistance to rifampicin, ofloxacin, of levofloxacin (RR 2.984, p = 0.047; RR 4.517, p = 0.038; RR 6.277, p = 0.014). The drug resistance rates of M. tuberculosis to rifampicin and to quinolones in HIV/AIDS patients were high and have been increasing year by year. Age and a history of previous anti-tuberculosis treatment were the main factors associated with the development of drug resistance in HIV/AIDS patients with tuberculosis.
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Affiliation(s)
- Xiaoqin Le
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Xueqin Qian
- Department of Clinical Laboratory, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Li Liu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Jianjun Sun
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Wei Song
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Tangkai Qi
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Zhenyan Wang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Yang Tang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Shuibao Xu
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Junyang Yang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Jiangrong Wang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Jun Chen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Renfang Zhang
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Zhaoqin Zhu
- Department of Clinical Laboratory, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Yinzhong Shen
- Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
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Auganova D, Atavliyeva S, Amirgazin A, Akisheva A, Tsepke A, Tarlykov P. Genomic Characterization of Drug-Resistant Mycobacterium tuberculosis L2/Beijing Isolates from Astana, Kazakhstan. Antibiotics (Basel) 2023; 12:1523. [PMID: 37887224 PMCID: PMC10604462 DOI: 10.3390/antibiotics12101523] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023] Open
Abstract
Kazakhstan ranks among the countries with the highest number of MDR-TB patients per 100,000 population worldwide. The successful transmission of local MDR strains of Mycobacterium tuberculosis (Mtb) poses a significant threat to disease control. In this study, we employed whole-genome sequencing to examine drug resistance, compensatory mutations, population structure, and transmission patterns in a sample of 24 clinical isolates of L2/Beijing Mtb collected in Astana, Kazakhstan between 2021 and 2022. The genotypic prediction of Mtb susceptibility to anti-TB agents was consistent with the phenotypic susceptibility, except for bedaquiline. An analysis of resistance-associated genes characterized most of the isolates as pre-extensively drug-resistant tuberculosis (pre-XDR-TB) (n = 15; 62.5%). The phylogenetic analysis grouped the isolates into four transmission clusters; the dominant cluster was assigned to the "aggressive" Central Asia outbreak (CAO) clade of L2/Beijing (n = 15; 62.5%). Thirteen mutations with putative compensatory effects were observed exclusively in Mtb isolates containing the rpoB S450L mutation. The putative compensatory mutations had a stabilizing effect on RpoABC protein stability and dynamics. The high prevalence of the CAO clade in the population structure of Mtb may explain the rapid spread of MDR-TB in Kazakhstan.
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Affiliation(s)
- Dana Auganova
- National Center for Biotechnology, Astana 010000, Kazakhstan (A.A.)
| | | | | | - Akmaral Akisheva
- City Center for Phthisiopulmonology of the Akimat of Astana, Astana 010000, Kazakhstan
| | - Anna Tsepke
- City Center for Phthisiopulmonology of the Akimat of Astana, Astana 010000, Kazakhstan
| | - Pavel Tarlykov
- National Center for Biotechnology, Astana 010000, Kazakhstan (A.A.)
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Chilundo J, Muhelo A, Ahivaldino Z, Zucula H, Macuácua S, Mussagi AC, Pizzol D, Smith L, Maggioni G. Successful Management, in a Low-Resource Setting, of Disseminated Tuberculosis in a 3-Year Old Boy: A Case Report. Pathogens 2023; 12:1163. [PMID: 37764971 PMCID: PMC10537502 DOI: 10.3390/pathogens12091163] [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: 08/21/2023] [Revised: 09/11/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Disseminated or military tuberculosis (TB) is defined as the presence of at least two non-contiguous sites of Mycobacterium tuberculosis, occurring as a result of progressive primary infection, reactivation and spread of a latent focus or due to iatrogenic origin. Disseminated TB represents a life-threatening condition, especially in at-risk children and when diagnosis and treatment are delayed. We report on a case of a 3-year old boy who presented with long-lasting unrecognised disseminated TB that was successfully managed in a low-resource setting.
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Affiliation(s)
- Josina Chilundo
- Department of Pneumology, Central Hospital of Maputo, Maputo 1113, Mozambique
- Faculty of Medicine, Eduardo Mondlane University Maputo, Maputo 1113, Mozambique
| | - Arlindo Muhelo
- Department of Paediatry, Central Hospital of Maputo, Maputo 1113, Mozambique
| | - Zita Ahivaldino
- Department of Paediatry, Central Hospital of Maputo, Maputo 1113, Mozambique
| | - Helton Zucula
- Department of Paediatry, Central Hospital of Maputo, Maputo 1113, Mozambique
| | - Sheila Macuácua
- Department of Paediatry, Central Hospital of Maputo, Maputo 1113, Mozambique
| | | | - Damiano Pizzol
- Operative Research Unit, Doctors with Africa Cuamm, Beira 1100, Mozambique
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge CB1 1PT, UK
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Wang T, Zhou C, Shang L, Zhou X. Comorbidity and drug resistance of smear-positive pulmonary tuberculosis patients in the yi autonomous prefecture of China: a cross-sectional study. BMC Infect Dis 2023; 23:586. [PMID: 37674123 PMCID: PMC10483793 DOI: 10.1186/s12879-023-08568-3] [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] [Received: 06/01/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) has a high morbidity and mortality rate, and its prevention and treatment focus is on impoverished areas. The Liangshan Yi Autonomous Prefecture is a typical impoverished area in western China with insufficient medical resources and high HIV positivity. However, there have been few reports of TB and drug resistance in this area. METHODS We collected the demographic and clinical data of inpatients with sputum smear positive TB between 2015 and 2021 in an infectious disease hospital in the Liangshan Yi Autonomous Prefecture. Descriptive analyses were used for the epidemiological data. The chi-square test was used to compare categorical variables between the drug-resistant and drug-susceptible groups, and binary logistic regression was used to analyse meaningful variables. RESULTS We included 2263 patients, 79.9% of whom were Yi patients. The proportions of HIV (14.4%) and smoking (37.3%) were higher than previously reported. The incidence of extrapulmonary TB (28.5%) was high, and the infection site was different from that reported previously. When drug resistance gene detection was introduced, the proportion of drug-resistant patients became 10.9%. Patients aged 15-44 years (OR 1.817; 95% CI 1.162-2.840; P < 0.01) and 45-59 years (OR 2.175; 95% CI 1.335-3.543; P < 0.01) had significantly higher incidences of drug resistance than children and the elderly. Patients with a cough of ≥ 2 weeks had a significantly higher chance of drug resistance than those with < 2 weeks or no cough symptoms (OR 2.069; 95% CI 1.234-3.469; P < 0.01). Alcoholism (OR 1.741; 95% CI 1.107-2.736; P < 0.05) and high bacterial counts on sputum acid-fast smears (OR 1.846; 95% CI 1.115-3.058; P < 0.05) were significant in the univariate analysis. CONCLUSIONS Sputum smear-positive TB predominated in Yi men (15-44 years) with high smoking, alcoholism, and HIV rates. Extrapulmonary TB, especially abdominal TB, prevailed. Recent drug resistance testing revealed higher rates in 15-59 age group and ≥ 2 weeks cough duration. Alcohol abuse and high sputum AFB counts correlated with drug resistance. Strengthen screening and supervision to curb TB transmission and drug-resistant cases in the region.
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Affiliation(s)
- Tao Wang
- Department of Radiology, The First People's Hospital of Liangshan Yi Autonomous Prefecture, Xichang, Sichuan, China
| | - Chaoxin Zhou
- Department of Radiology, The First People's Hospital of Liangshan Yi Autonomous Prefecture, Xichang, Sichuan, China
| | - Lan Shang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology, Chengdu, China.
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
| | - Xiyuan Zhou
- Institute of Dermatology and Venereology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology, Chengdu, China.
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
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Li A, Yuan SY, Li QG, Li JX, Yin XY, Liu NN. Prevalence and risk factors of malnutrition in patients with pulmonary tuberculosis: a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1173619. [PMID: 37636566 PMCID: PMC10448260 DOI: 10.3389/fmed.2023.1173619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/30/2023] [Indexed: 08/29/2023] Open
Abstract
Background Malnutrition is prevalent in patients with pulmonary tuberculosis (PTB) and is associated with a poor prognosis. Objective This study aims to assess the prevalence and risk factors of malnutrition in patients with PTB. Methods Studies related to the prevalence and risk factors of malnutrition in patients with PTB were searched through PubMed, Embase, Web of Science, and Cochrane Library databases from January 1990 to August 2022, and two researchers screened the literature, evaluated the quality, and extracted data independently. A random-effects model was used to pool the effect sizes and 95% confidence intervals. Subgroup analysis, meta-regression analysis, and sensitivity analysis were further performed to identify sources of heterogeneity and evaluate the stability of the results. Publication bias was assessed by Doi plot, Luis Furuya-Kanamori (LFK) asymmetry index, funnel plot, and Egger's tests. Results A total of 53 studies involving 48, 598 participants were identified in this study. The prevalence of malnutrition was 48.0% (95% CI, 40.9-55.2%). Subgroup analysis revealed that malnutrition was more common among male gender (52.3%), bacterial positivity (55.9%), family size over 4 (54.5%), drug resistance (44.1%), residing in rural areas (51.2%), HIV infection (51.5%), Asian (51.5%), and African (54.5%) background. The prevalence of mild, moderate, and severe malnutrition was 21.4%, 14.0%, and 29.4%, respectively. Bacterial positivity (OR = 2.08, 95% CI 1.26-3.41), low income (OR = 1.44, 95% CI 1.11-1.86), and residing in rural areas (OR = 1.51, 95% CI 1.20-1.89) were risk factors of malnutrition in patients with PTB. However, male (OR = 1.04, 95% CI 0.85-1.26) and drinking (OR = 1.17, 95% CI 0.81-1.69) were not risk factors for malnutrition in patients with PTB. Due to the instability of sensitivity analysis, HIV infection, age, family size, smoking, and pulmonary cavity need to be reevaluated. Meta-regression suggested that sample size was a source of heterogeneity of prevalence. The Doi plot and LFK asymmetry index (LFK = 3.87) indicated the presence of publication bias for prevalence, and the funnel plot and Egger's test showed no publication bias for risk factors. Conclusion This meta-analysis indicated that malnutrition was prevalent in patients with PTB, and bacterial positivity, low income, and those residing in rural areas were risk factors for malnutrition. Therefore, clinical workers should pay attention to screening the nutritional status of patients with PTB and identifying the risk factors to reduce the incidence of malnutrition and provide nutritional interventions early to improve the prognosis in patients with PTB.
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Affiliation(s)
| | | | | | | | | | - Na-na Liu
- Department of Respiratory Critical Care Medicine, The Second People's Hospital of Weifang, Weifang, Shandong, China
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Vyawahare C, Mukhida S, Khan S, Gandham NR, Kannuri S, Bhaumik S. Assessment of risk factors associated with drug-resistant tuberculosis in pulmonary tuberculosis patients. Indian J Tuberc 2023; 71 Suppl 1:S44-S51. [PMID: 39067954 DOI: 10.1016/j.ijtb.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/10/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Tuberculosis remains a global health problem worldwide and the risk progression of Tuberculosis to Drug Resistant Tuberculosis is influenced by various factors. These include immunocompromised status, past history of tuberculosis, life style and nutritional level. Hence, identifying the population at risk of multidrug-resistant tuberculosis is essential and may help in developing appropriate case-finding strategies. Therefore, the present study was designed to study the contributing risk-factors associated with Drug resistant Tuberculosis. MATERIALS AND METHODS In this prospective observational study, we assessed 189 Pulmonary tuberculosis diagnosed patients during the period of 2 years at government recognized tertiary care centers. Data was collected from all these patients checked to investigate risk factors associated with Drug resistant tuberculosis development by multivariant analysis. RESULTS Of the 189 participants, 36 were diagnosed with drug resistant tuberculosis and 153 with drug sensitive tuberculosis. Factors associated with drug resistant tuberculosis include low-weight (OR 8.50; p = 0.0008430991), low-BMI (p = 0.0000527166), lower economic status (OR-2.1351; p = 0.048608696) and tobacco (OR-4.5192; p = 0.0023003189) were found clinically and statistically significant in development of drug resistant tuberculosis. Binary logistic regression was performed to ascertain the effects of various statistically significant factors. Drug resistant tuberculosis patients were 7.77 times more likely to be tobacco users than drug sensitive tuberculosis. CONCLUSIONS Our study suggests that, there is a compelling and urgent need for increasing public awareness, initiating better nutrition and food programs, regular screening, and better management & control of MDR-TB.
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Affiliation(s)
- Chanda Vyawahare
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, 411018, India
| | - Sahjid Mukhida
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, 411018, India.
| | - Sameena Khan
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, 411018, India
| | - Nageswari R Gandham
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, 411018, India
| | - Sriram Kannuri
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, 411018, India
| | - Shalini Bhaumik
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, 411018, India
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Southern J, Elliott P, Maidment I. What are patients' experiences of discontinuing clozapine and how does this impact their views on subsequent treatment? BMC Psychiatry 2023; 23:353. [PMID: 37217959 DOI: 10.1186/s12888-023-04851-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 05/07/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Discontinuing what is considered the most effective treatment for treatment-resistant schizophrenia may precipitate feelings of failure or a relapse of illness. Clozapine treatment is discontinued for a variety of reasons, including non-adherence, intolerance, or lack of efficacy. Patients' experiences of discontinuing the "best" treatment and the impact on perceptions of subsequent antipsychotic treatment are important in developing an understanding of the factors affecting people's treatment choices. This study is the first of its type, seeking to explore people's perspectives on clozapine discontinuation. METHOD Semi-structured interviews with sixteen patients who had received clozapine and discontinued treatment-thirteen males and three females, age range: thirty-two to seventy-eight years old-were audio-recorded and transcribed. A modified inductive approach to analysis, based on grounded theory, was taken to identify commonalities and differences in patients' perceptions. RESULTS The three main themes identified from participants' experiences were: (1) positive and negative effects of treatment; (2) feelings of agency, being the capacity to make decisions about treatment and act independently; (3) choice of treatment in the future. Participants exhibited agency in making choices about medication, including risking relapse, while attempting self-management of medication effects. Different participants perceived the same side effect as beneficial or intolerable. Variation in subsequent treatment choices was reported, with some participants favouring depot (long-acting) injections. A participant was frightened when not told about clozapine's side effects, which led to the participant not being engaged in future treatment decisions. Others, despite suffering serious adverse effects, retained positive perceptions of clozapine; they experienced despair at finding an effective alternative. CONCLUSIONS Experiences with clozapine discontinuation evoked powerful emotions and resulted in clozapine being the benchmark for other treatments. Knowledge, agency, and being in control were important to participants in relation to treatment. Personal perceptions of treatments or beliefs about illness could lead to non-adherence. People value the clinician listening to their experiences to better understand their perspective, enabling concerns about medication to be addressed through true shared decision making. TRIAL REGISTRATION NHS Health Research Authority and Health and Care Research Wales, IRAS Project ID 225753, Research Ethics Committee (REC) reference: 18/NW/0413, 25/06/2018.
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Affiliation(s)
- Jennifer Southern
- Aston University, Birmingham, B4 7ET, England.
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, CH2 1BQ, England.
| | - Phil Elliott
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, CH2 1BQ, England
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Ma JB, Zeng LC, Ren F, Dang LY, Luo H, Wu YQ, Yang XJ, Li R, Yang H, Xu Y. Development and validation of a prediction model for unsuccessful treatment outcomes in patients with multi-drug resistance tuberculosis. BMC Infect Dis 2023; 23:289. [PMID: 37147607 PMCID: PMC10161636 DOI: 10.1186/s12879-023-08193-0] [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: 06/07/2022] [Accepted: 03/23/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND The World Health Organization has reported that the treatment success rate of multi-drug resistance tuberculosis is approximately 57% globally. Although new drugs such as bedaquiline and linezolid is likely improve the treatment outcome, there are other factors associated with unsuccessful treatment outcome. The factors associated with unsuccessful treatment outcomes have been widely examined, but only a few studies have developed prediction models. We aimed to develop and validate a simple clinical prediction model for unsuccessful treatment outcomes in patients with multi-drug resistance pulmonary tuberculosis (MDR-PTB). METHODS This retrospective cohort study was performed between January 2017 and December 2019 at a special hospital in Xi'an, China. A total of 446 patients with MDR-PTB were included. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were used to select prognostic factors for unsuccessful treatment outcomes. A nomogram was built based on four prognostic factors. Internal validation and leave-one-out cross-validation was used to assess the model. RESULTS Of the 446 patients with MDR-PTB, 32.9% (147/446) cases had unsuccessful treatment outcomes, and 67.1% had successful outcomes. After LASSO regression and multivariate logistic analyses, no health education, advanced age, being male, and larger extent lung involvement were identified as prognostic factors. These four prognostic factors were used to build the prediction nomograms. The area under the curve of the model was 0.757 (95%CI 0.711 to 0.804), and the concordance index (C-index) was 0.75. For the bootstrap sampling validation, the corrected C-index was 0.747. In the leave-one-out cross-validation, the C-index was 0.765. The slope of the calibration curve was 0.968, which was approximately 1.0. This indicated that the model was accurate in predicting unsuccessful treatment outcomes. CONCLUSIONS We built a predictive model and established a nomogram for unsuccessful treatment outcomes of multi-drug resistance pulmonary tuberculosis based on baseline characteristics. This predictive model showed good performance and could be used as a tool by clinicians to predict who among their patients will have an unsuccessful treatment outcome.
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Affiliation(s)
- J-B Ma
- Department of Drug-resistance tuberculosis, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - L-C Zeng
- Xi'an Center for Disease Control and Prevention, Xi'an, Shaanxi Province, China
| | - F Ren
- Department of Drug-resistance tuberculosis, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China.
| | - L-Y Dang
- Department of Drug-resistance tuberculosis, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - H Luo
- Department of Drug-resistance tuberculosis, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - Y-Q Wu
- Department of Drug-resistance tuberculosis, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - X-J Yang
- Department of Drug-resistance tuberculosis, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - R Li
- Department of Drug-resistance tuberculosis, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - H Yang
- Department of Clinical Laboratory, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - Y Xu
- Department of Drug-resistance tuberculosis, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
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Ayorinde A, Ghosh I, Ali I, Zahair I, Olarewaju O, Singh M, Meehan E, Anjorin SS, Rotheram S, Barr B, McCarthy N, Oyebode O. Health inequalities in infectious diseases: a systematic overview of reviews. BMJ Open 2023; 13:e067429. [PMID: 37015800 PMCID: PMC10083762 DOI: 10.1136/bmjopen-2022-067429] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES The aim of this systematic overview of reviews was to synthesise available evidence on inequalities in infectious disease based on three dimensions of inequalities; inclusion health groups, protected characteristics and socioeconomic inequalities. METHODS We searched MEDLINE, Embase, Web of Science and OpenGrey databases in November 2021. We included reviews published from the year 2000 which examined inequalities in the incidence, prevalence or consequences of infectious diseases based on the dimensions of interest. Our search focused on tuberculosis, HIV, sexually transmitted infections, hepatitis C, vaccination and antimicrobial resistance. However, we also included eligible reviews of any other infectious diseases. We appraised the quality of reviews using the Assessment of Multiple Systematic Reviews V.2 (AMSTAR2) checklist. We conducted a narrative data synthesis. RESULTS We included 108 reviews in our synthesis covering all the dimensions of inequalities for most of the infectious disease topics of interest, however the quality and volume of review evidence and consistency of their findings varied. The existing literature reviews provide strong evidence that people in inclusion health groups and lower socioeconomic status are consistently at higher risk of infectious diseases, antimicrobial resistance and incomplete/delayed vaccination. In the protected characteristics dimension, ethnicity, and sexual orientation are important factors contributing to inequalities across the various infectious disease topics included in this overview of reviews. CONCLUSION We identified many reviews that provide evidence of various types of health inequalities in different infectious diseases, vaccination, and antimicrobial resistance. We also highlight areas where reviews may be lacking. The commonalities in the associations and their directions suggest it might be worth targeting interventions for some high risk-groups that may have benefits across multiple infectious disease outcomes rather than operating purely in infectious disease siloes.
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Affiliation(s)
| | - Iman Ghosh
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Ifra Ali
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Iram Zahair
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Olajumoke Olarewaju
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Megha Singh
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Edward Meehan
- School of Public Health and Prevention Medicine, Monash University, Clayton, Victoria, Australia
| | | | - Suzanne Rotheram
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Ben Barr
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Noel McCarthy
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Oyinlola Oyebode
- Wolfson Institute of Population Health, Queen Mary University of London, London, London, UK
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Mejía-Trujillo J, Pérez-Gómez A, de Vries H, Mercken L. Evaluating effects of IBEM-U on decreasing alcohol consumption and heavy episodic drinking among university students in Colombia: Protocol for a randomized control trial. Contemp Clin Trials Commun 2023; 32:101075. [PMID: 36949848 PMCID: PMC10025418 DOI: 10.1016/j.conctc.2023.101075] [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: 10/11/2022] [Revised: 01/05/2023] [Accepted: 01/14/2023] [Indexed: 01/24/2023] Open
Abstract
Background Alcohol misuse is a serious problem among university students in Colombia as well as in other Latin American countries. Studies show consistently that this population presents the highest rates of alcohol use. Despite such a situation, there is a lack of preventive programs for university students in this region of the world. The purpose of this paper is to present the protocol to evaluate a preventive strategy called IBEM-U, based on Motivational Interviewing and the I-Change Model. Method This protocol shows how the evaluation of the effectiveness of the IBEM-U program will be carried out. A randomized control trial with a within-subjects design with one follow-up at six months after the post-test will be implemented. The comparison group will receive an alternative program similar in length but focusing on another issue. Around 1000 participants over 18 years of age, from at least six different universities around the country, will be recruited. Results It is expected that the program will be effective in reducing past month alcohol consumption up to 15% in the experimental group as the main outcome. Secondary and tertiary outcomes include decreasing heavy episodic drinking and increasing knowledge, awareness, risk perception, attitude, self-efficacy, intention, and action planning, regarding heavy episodic drinking. Conclusion IBEM-U can be considered a highly appropriate approach for reducing alcohol misuse among university students. The main reasons for these results are the self-imposed goals based on long-term purposes, that could be seriously affected by the ingestion of high amounts of alcohol.
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Affiliation(s)
- Juliana Mejía-Trujillo
- Department of Health Promotion, Maastricht University, the Netherlands
- Corporación Nuevos Rumbos, Bogotá, Colombia
- Corresponding author. Calle 108ª No 4-15, Bogotá, Colombia.
| | | | - Hein de Vries
- Department of Health Promotion, Maastricht University, the Netherlands
| | - Liesbeth Mercken
- Department of Health Promotion, Maastricht University, the Netherlands
- Department of Health Psychology, Open University, Heerlen, the Netherlands
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Di Gennaro F, Cotugno S, Fasano M, Ricciardi A, Ronga L, Lattanzio R, Grimaldi A, Bavaro DF, Ciarallo M, Garzone S, De Iaco G, Guido G, Fiore JR, Brindicci G, Santoro CR, Sica S, Iacovazzi TL, Santantonio TA, Saracino A. High risk of unsuccessful treatment outcome in migrant population with tuberculosis: Data from three Italian hospitals. Front Public Health 2023; 10:1024474. [PMID: 36703820 PMCID: PMC9871451 DOI: 10.3389/fpubh.2022.1024474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/09/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction Tuberculosis (TB) remains an unresolved global health problem and vulnerable groups such as migrants remain the most affected with a higher risk of worse outcomes. The aim of this study was to evaluate clinical features, outcomes, and adverse events in migrant and native Italian patients admitted to three Italian hospitals in Southern Italy in order to assess differences and targeted strategies. Methods We performed a retrospective study on TB patients admitted between January 1, 2013, and December 31, 2021, in three Apulia hospitals. Two logistic regression models were used, with the dependent variables being (I) unsuccessful treatment (died, loss to follow-up, and failed treatment) and (II) adverse events. Results We enrolled 543 consecutive patients admitted at three Italian hospitals with a diagnosis of TB during the study period, of them 323 (59.5%) were migrants and 220 Italian patients. The treatment success rate in the migrant group was 44.9% (137/305), while in the non-migrant group was 97.1% (203/209). Independent factors of unsuccess treatment (death, failure or loss to follow up) were: migrant status (O.R. = 11.31; 95% CI 9.72-14.23), being male (O.R. = 4.63; 95% CI 2.16-6.10), homelessness (O.R. = 3.23; 95% CI 2.58-4.54), having a MDR (Multidrug-resistant) (O.R = 6.44; 95% CI 4.74-8.23), diagnostic delay (O.R. = 3.55; 95% CI 1.98-5.67), and length of hospitalization (O.R. = 3.43; 95% CI 1.88-5.87). While, age >65 ys (O.R. = 3.11; 95% CI 1.42-4.76), presence of extrapulmonary TB (O.R. = 1.51; 95% CI 1.31-2.18), monoresistance (O.R. = 1.45; 95% CI 1.25-3.14) and MDR pattern (O.R. = 2.44; 95% CI 1.74-5.03) resulted associated with adverse events. Conclusion Migrant population is at high risk of unsuccessful treatment (death, loss to follow-up, and treatment failure). Policies targeted specifically to this group are needed to really impact and improve their health status and also to contain the TB burden.
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Affiliation(s)
- Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Sergio Cotugno
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy,*Correspondence: Sergio Cotugno ✉
| | - Massimo Fasano
- Unità Operativa Complessa (UOC) Infectious Diseases Azienda Sanitaria Locale Bari (ASL BA), Bari, Italy
| | - Aurelia Ricciardi
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Luigi Ronga
- Microbiology and Virology Unit, University Hospital Policlinico, University of Bari, Bari, Italy
| | - Rossana Lattanzio
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Anna Grimaldi
- Chemical-Clinical and Microbiological Research Unit, ASL BA, Bari, Italy
| | - Davide Fiore Bavaro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Marianna Ciarallo
- Infectious Diseases Unit, Department of Clinical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Stefania Garzone
- Microbiology and Virology Unit, University Hospital Policlinico, University of Bari, Bari, Italy
| | - Giuseppina De Iaco
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Giacomo Guido
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Josè Ramon Fiore
- Infectious Diseases Unit, Department of Clinical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Gaetano Brindicci
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Carmen Rita Santoro
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
| | - Salvatore Sica
- Infectious Diseases Unit, Department of Clinical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Teresa Antonia Santantonio
- Infectious Diseases Unit, Department of Clinical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro,” Bari, Italy
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A Nomogram Model for Mortality Risk Prediction in Pulmonary Tuberculosis Patients Subjected to Directly Observed Treatment Shortcourse (DOTS). Can Respir J 2022; 2022:1449751. [PMID: 36567966 PMCID: PMC9788877 DOI: 10.1155/2022/1449751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/23/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
We analyzed the risk factors of mortality for patients with pulmonary tuberculosis under the Directly Observed Treatment Shortcourse (DOTS) and established a predictive nomogram for the risk of mortality. The retrospective cohort analysis was conducted on the treatment outcomes of 11207 tuberculosis patients in the tuberculosis management information system in Tianjin from 2014 to 2019. Based on the multivariable unconditional logistic regression, we analyzed the risk factors of mortality in patients with pulmonary TB and established the death risk prediction nomogram. We further applied cross-validation and the receiver operating characteristic (ROC) curve to explore the efficiency of the nomogram. There were 10,697 patients in the survival group and 510 in the mortality group who had successfully initiated DOTS, and the mortality rate was 4.55%. Multivariable logistic regression analysis showed that age, male, relapse cases, first sputum positivity, patient delay, and HIV-positive were independent risk factors for pulmonary TB death. The calibration curve shows that the average absolute error between the predicted mortality risk and the actual death risk is 0.003. The ROC curve shows that the area under the curve where the line-up model predicts the risk of death is 0.816 (95% CI: 0.799∼0.832). The nomogram model based on independent risk factors of mortality in TB patients shows good discrimination and accuracy, with potentially high clinical value in screening patients with a high risk of death, which could be useful for setting the interventional strategies in patients with tuberculosis who had successfully initiated DOTS.
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Korri R, Bakuli A, Owolabi OA, Lalashowi J, Azize C, Rassool M, Sathar F, Rachow A, Ivanova O. Tuberculosis and Sexual and Reproductive Health of Women in Four African Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15103. [PMID: 36429820 PMCID: PMC9690042 DOI: 10.3390/ijerph192215103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 06/16/2023]
Abstract
Tuberculosis (TB) is a major reason of maternal mortality in low-income countries, and it increases the probability of adverse sexual and reproductive health (SRH) outcomes, including ectopic pregnancy and perinatal mortality. The data presented here is from the TB Sequel observational cohort conducted in four African countries. For this sub-study, we selected only female participants, who were diagnosed with drug susceptible TB and followed-up until the end of anti-TB treatment. The data collection included questionnaires, clinical examination and laboratory tests at TB diagnosis, day 14, month 2, 4 and 6. A total of 486 women, with 88.3% being 18-49 years old, were included in the analysis. Around 54.7% were HIV positive. Most of the participants (416/486; 85.6%) in our cohort were considered cured at month 6. Only 40.4% of non-pregnant women of reproductive age used contraception at TB diagnosis. A total of 31 out of 486 women experienced pregnancy during TB treatment. Pregnancy outcomes varied between live birth (16/31; 51.6%), induced abortion (6/31; 19.4%), miscarriage (4/31; 12.9%) and stillbirth (3/31; 9.6%). Integration and linking of SRH services with TB programmes are vital to increase contraception use and protect women from obstetric risks associated with pregnancy during TB treatment.
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Affiliation(s)
- Rayan Korri
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany
| | - Abhishek Bakuli
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany
| | - Olumuyiwa A. Owolabi
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Banjul P.O. Box 273, The Gambia
| | - Julieth Lalashowi
- National Institute for Medical Research (NIMR), Mbeya Medical Research Centre, Mbeya P.O. Box 2410, Tanzania
| | - Cândido Azize
- Instituto Nacional de Saúde (INS), Marracuene 3943, Mozambique
| | - Mohammed Rassool
- Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg 2092, South Africa
| | | | - Andrea Rachow
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany
| | - Olena Ivanova
- Division of Infectious Diseases and Tropical Medicine, Medical Centre of the University of Munich (LMU), 80802 Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, 80802 Munich, Germany
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14
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dos Santos MS, Pieri FM, Berra TZ, Scholze AR, Ramos ACV, de Almeida Crispim J, Giacomet CL, Alves YM, da Costa FBP, Moura HSD, Teibo TKA, Alonso JB, de Freitas GL, Arcêncio RA. Acquired and Transmitted Multidrug-Resistant Tuberculosis among the Incarcerated Population and Its Determinants in the State of Paraná-Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14895. [PMID: 36429614 PMCID: PMC9691214 DOI: 10.3390/ijerph192214895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/31/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Tuberculosis remains a public health problem in the world. The study analyzed the factors associated with drug-resistant tuberculosis in the prison population of the state of Paraná. (2) Methods: Ecological study of drug-resistant tuberculosis cases registered in the Paraná Information System, Brazil (2008 to 2018). We performed descriptive statistics of quantitative parameters calculated with absolute frequencies. Additionally, we used binary regression logistics, where the odds ratio with its respective confidence interval was calculated. (3) Results: Of the 653 cases registered as cases of tuberculosis in the incarcerated population, 98 were drug-resistant tuberculosis. We observed that educational level of up to 8 to 11 years of schooling, negative bacterial culture (test outcome) and no tobacco use were factors associated with the non-development of drug-resistant tuberculosis, while clinically confirmed pulmonary TB and positive sputum smear microscopy in the fourth month of follow-up showed an association for the development of drug resistance. (4) Conclusions: The study showed that clinically confirmed pulmonary TB and a positive sputum smear microscopy in the fourth month of follow-up were associated with drug-resistant tuberculosis.
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Affiliation(s)
- Márcio Souza dos Santos
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 05403-000, SP, Brazil
| | | | - Thaís Zamboni Berra
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 05403-000, SP, Brazil
| | - Alessandro Rolim Scholze
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 05403-000, SP, Brazil
| | - Antônio Carlos Vieira Ramos
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 05403-000, SP, Brazil
| | - Juliane de Almeida Crispim
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 05403-000, SP, Brazil
| | - Clóvis Luciano Giacomet
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 05403-000, SP, Brazil
| | - Yan Mathias Alves
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 05403-000, SP, Brazil
| | - Fernanda Bruzadelli Paulino da Costa
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 05403-000, SP, Brazil
| | - Heriederson Sávio Dias Moura
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 05403-000, SP, Brazil
| | - Titilade Kehinde Ayandeyi Teibo
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 05403-000, SP, Brazil
| | - Jonas Bodini Alonso
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 05403-000, SP, Brazil
| | - Giselle Lima de Freitas
- Department of Nursing, Federal University of Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Ricardo Alexandre Arcêncio
- Department of Maternal-Infant and Public Health Nursing, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 05403-000, SP, Brazil
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15
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Plata-Casas L, Gutierrez-Lesmes O, Cala-Vitery F. Tuberculosis Disability Adjusted Life Years, Colombia 2010-2018. Trop Med Infect Dis 2022; 7:250. [PMID: 36136661 PMCID: PMC9505559 DOI: 10.3390/tropicalmed7090250] [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] [Received: 08/27/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Estimating the burden of tuberculosis disease is relevant for assessing and identifying population health status and progress in policies and programs aimed at epidemic control. The objective of this study was to estimate disability-adjusted life years attributable to Tuberculosis in Colombia 2010-2018. A longitudinal descriptive study was conducted. The variables, sex, age groups and origin were studied. This study included 110,475 cases of morbidity and 8514 cases of mortality. Indicators of years of life lost, years of life with disability and disability-adjusted life years at the subnational level were determined using the methodology of the World Health Organization. With the results of this last indicator, an epidemiological risk stratification was carried out. The DALY rate of the study period was 684 (95% CI 581.2-809.1) per 100,000 inhabitants. According to sex, 68.4% occurred in men; for every DALY in women, 2.21 occur in men. People of productive age (15 to 69 years) account for 56% of DALYs. Amazonas (1857.1 CI 95% 1177.1-2389.6) was the territorial entity with the highest rate. A total of 51.5% of the territorial entities of departmental order of the country are of high burden for Tuberculosis. For the first time in Colombia, a comprehensive assessment of the status of the disease burden at a subnational (departmental) territorial level attributable to Tuberculosis is being carried out using the updated World Health Organization methodology. The results obtained allow us to specify that there is a knowledge gap in terms of the realization and clear understanding of the burden of the disease in Colombia. There are territorial gaps that are necessary to know in order to plan, develop, implement and redirect policies to improve health and eliminate disparities according to the territorial context.
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Affiliation(s)
- Laura Plata-Casas
- Faculty of Natural Sciences and Engineering, University Jorge Tadeo Lozano, Bogota 111711, Colombia
| | - Oscar Gutierrez-Lesmes
- School of Public Health, Faculty of Health Sciences, University of the Llanos, Villavicencio 500003, Colombia
| | - Favio Cala-Vitery
- Faculty of Natural Sciences and Engineering, University Jorge Tadeo Lozano, Bogota 111711, Colombia
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16
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Wang Y, Jing W, Liu J, Liu M. Global trends, regional differences and age distribution for the incidence of HIV and tuberculosis co-infection from 1990 to 2019: results from the global burden of disease study 2019. Infect Dis (Lond) 2022; 54:773-783. [PMID: 35801264 DOI: 10.1080/23744235.2022.2092647] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND People living with human immunodeficiency virus (HIV) are more likely to develop tuberculosis (TB), and their co-infection (HIV-TB) increases the risk of death. We aimed to describe the global trends, regional differences and age distribution of HIV-TB. METHODS Annual new cases, age-standardized incidence rates (ASRs) and age-specific incidence rates with 95% uncertainty intervals (UIs) of HIV-infected drug-susceptible tuberculosis (HIV-DS-TB), HIV-infected multidrug-resistant tuberculosis without extensive drug resistance (HIV-MDR-TB) and HIV-infected extensively drug-resistant tuberculosis (HIV-XDR-TB) during 1990-2019 were collected from the Global Burden of Disease Study 2019. To reveal the trends of HIV-TB by region and age, the percentage change of new cases and estimated annual percentage change (EAPC) of ASRs were calculated. RESULTS The ASR of HIV-XDR-TB increased significantly by an average of 14.77% (95% CI: 11.05%-18.62%) per year during 1990-2019 worldwide, while the ASRs of HIV-DS-TB and HIV-MDR-TB decreased after 2005. HIV-XDR-TB was a great threat to Eastern Europe for the largest number of new cases (792, 95% UI: 487-1167) and the highest ASR (0.34 per 100,000 population, 95% UI: 0.21-0.50). In addition, Oceania had the largest rise in ASRs of HIV-MDR-TB (EAPC = 22.56, 95% CI: 18.62-26.64) and HIV-XDR-TB (EAPC = 32.95, 95% CI: 27.90-38.20) during 1990-2019. Recently, age-specific incidence rates of HIV-XDR-TB increased in all age groups, especially in the 50-69 age groups among high, low-middle and low Socio-Demographic Index regions. Additionally, the proportion of patients aged <15 years was nearly 10% of new cases in sub-Saharan Africa in 2019, which was higher than in other regions. CONCLUSIONS HIV-infected drug-resistant TB is common in Oceania and Eastern Europe. Moreover, HIV-XDR-TB among elderly people became increasingly prevalent. In the future, the collaboration of management for HIV and TB should be intensified in Oceania and Eastern Europe, and more concerns need to be paid in elderly people.
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Affiliation(s)
- Yaping Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Wenzhan Jing
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Predictors for Pulmonary Tuberculosis Outcome and Adverse Events in an Italian Referral Hospital: A Nine-Year Retrospective Study (2013–2021). Ann Glob Health 2022; 88:26. [PMID: 35582409 PMCID: PMC9053535 DOI: 10.5334/aogh.3677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: The COVID-19 pandemic has undone years of progress in providing essential TB services and controlling the TB burden. Italy, a low TB burden country, has an incidence of 7.1 cases per 100,000 people. To control the TB spreading in Italy is critical to investigate the characteristics of patients with the worst outcomes and the highest risk of adverse events related to antituberculosis therapy. Therefore, we conducted a large retrospective study in TB patients admitted to the Clinic of Infectious Diseases University of Bari, Italy, in order to describe the clinical presentation and the factors associated with adverse events and outcomes. Methods: We retrospectively evaluated the patients admitted to the Clinic of Infectious Diseases from January 2013 to 15 December 2021. We stratified our cohort into two groups: <65 years of age and ≥65 years in order to assess any differences between the two groups. Two logistic regression models were implemented considering the dependent variables as: (I) the adverse events; and (II) the unsuccessful treatments. Results: In total, 206 consecutive patients [60% (n = 124) M, median age 39 years, range 16–92] were diagnosed and admitted with TB at Clinic of Infectious Diseases. Of the whole sample, 151 (74%) were <65 years and 55 (26%) were ≥65. Statistically significant differences between the two groups were detected (p-value < 0.05) for nationality (p-value = 0.01), previous contact with TB patient (p-value = 0.00), type of TB (p-value = 0.00), unsuccessful treatment (p-value = 0.00), length of hospitalization (p-value = 0.02) and diagnostic delay (p-value = 0.01). Adverse events related to TB drug regimen were reported in 24% (n = 49). Age < 65 years (O.R. = 3.91; 95% CI 1.72–4.21), non-Italian nationality (O.R. = 4.45; 95% CI 2.22–4.98.), homeless (O.R. = 3.23; 95% CI 2.58–4.54), presence of respiratory symptoms (O.R. = 1.23; 95% CI 1.10–1.90), diagnostic delay (O.R = 2.55; 95% CI 1.98–3.77) resulted associated with unsuccessful treatment outcome (death, failure or lost to follow up). Finally, age < 65 years (O.R. = 1.73; 95% CI 1.31–2.49), presence of pulmonary TB (O.R. = 1.15; 95% CI 1.02–1.35), length of hospitalization (O.R. = 1.82; 95% CI 1.35–2.57) and TB culture positive (O.R. = 1.35; 95% CI 1.12–1.82) were associated with adverse events in our populations. Conclusions: The pharmacological approach alone seems insufficient to treat and cure a disease whose ethiopathogenesis is not only due to the Mycobacterium tuberculosis, but also to the poverty or the social fragility. Our data suggest that young foreigners, the homeless, and the people with low social and economic status are at higher risk of an unfavorable outcome in low incidence TB countries. Targeted actions to support this highly vulnerable population both in terms of outcome and occurrence of adverse events are needed.
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Carranza C, Carreto-Binaghi LE, Guzmán-Beltrán S, Muñoz-Torrico M, Torres M, González Y, Juárez E. Sex-Dependent Differential Expression of Lipidic Mediators Associated with Inflammation Resolution in Patients with Pulmonary Tuberculosis. Biomolecules 2022; 12:biom12040490. [PMID: 35454079 PMCID: PMC9025322 DOI: 10.3390/biom12040490] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/14/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
There is a sex bias in tuberculosis’s severity, prevalence, and pathogenesis, and the rates are higher in men. Immunological and physiological factors are fundamental contributors to the development of the disease, and sex-related factors could play an essential role in making women more resistant to severe forms of the disease. In this study, we evaluated sex-dependent differences in inflammatory markers. Serum samples were collected from 34 patients diagnosed with pulmonary TB (19 male and 15 female) and 27 healthy controls (18 male and 9 female). Cytokines IL2, IL4, IL6, IL8, IL10, IFNγ, TNFα, and GM-CSF, and eicosanoids PGE2, LTB4, RvD1, and Mar1 were measured using commercially available immunoassays. The MDA, a product of lipidic peroxidation, was measured by detecting thiobarbituric-acid-reactive substances (TBARS). Differential inflammation patterns between men and women were observed. Men had higher levels of IL6, IL8, and TNFα than women. PGE2 and LTB4 levels were higher in patients than healthy controls, but there were no differences for RvD1 and Mar1. Women had higher RvD1/PGE2 and RvD1/LTB4 ratios among patients. RvD1 plays a vital role in resolving the inflammatory process of TB in women. Men are the major contributors to the typical pro-inflammatory profile observed in the serum of tuberculosis patients.
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Affiliation(s)
- Claudia Carranza
- Laboratorio de Inmunobiología de la Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (C.C.); (L.E.C.-B.); (M.T.)
| | - Laura Elena Carreto-Binaghi
- Laboratorio de Inmunobiología de la Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (C.C.); (L.E.C.-B.); (M.T.)
| | - Silvia Guzmán-Beltrán
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (S.G.-B.); (Y.G.)
| | - Marcela Muñoz-Torrico
- Servicio Clínico de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico;
| | - Martha Torres
- Laboratorio de Inmunobiología de la Tuberculosis, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (C.C.); (L.E.C.-B.); (M.T.)
| | - Yolanda González
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (S.G.-B.); (Y.G.)
| | - Esmeralda Juárez
- Departamento de Investigación en Microbiología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Sección XVI, Mexico City 14080, Mexico; (S.G.-B.); (Y.G.)
- Correspondence:
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Nidoi J, Muttamba W, Walusimbi S, Imoko JF, Lochoro P, Ictho J, Mugenyi L, Sekibira R, Turyahabwe S, Byaruhanga R, Putoto G, Villa S, Raviglione MC, Kirenga B. Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study. BMC Public Health 2021; 21:2167. [PMID: 34836521 PMCID: PMC8620143 DOI: 10.1186/s12889-021-12056-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major public health problem and at 48%, Karamoja in North-Eastern Uganda has the lowest treatment success rate nationally. Addressing the social determinants of TB is crucial to ending TB. This study sought to understand the extent and ways in which socio-economic factors affect TB treatment outcomes in Karamoja. METHODS We conducted a convergent parallel mixed methods study in 10 TB Diagnostic and Treatment Units. The study enrolled former TB patients diagnosed with drug-susceptible TB between April 2018 and March 2019. Unit TB and laboratory registers were reviewed to identify pre-treatment losses to follow-up. Four focus group discussions with former TB patients and 18 key informant interviews with healthcare workers were conducted. Principle component analysis was used to generate wealth quintiles that were compared to treatment outcomes using the proportion test. The association between sociodemographic characteristics and TB treatment outcomes was evaluated using the chi-square test and multiple logistic regression. RESULTS A total of 313 participants were randomly selected from 1184 former TB patients recorded in the unit TB registers. Of these, 264 were contacted in the community and consented to join the study: 57% were male and 156 (59.1%) participants had unsuccessful treatment outcomes. The wealthiest quintile had a 58% reduction in the risk of having an unsuccessful treatment outcome (adj OR = 0.42, 95% CI 0.18-0.99, p = 0.047). People who were employed in the informal sector (adj OR = 4.71, 95% CI 1.18-18.89, p = 0.029) and children under the age of 15 years who were not in school or employed (adj OR = 2.71, 95% CI 1.11-6.62, p = 0.029) had significantly higher odds of unsuccessful treatment outcome. Analysis of the pre-treatment loss to follow-up showed that 17.2% of patients with pulmonary bacteriologically confirmed TB did not initiate treatment with a higher proportion among females (21.7%) than males (13.5%). Inadequate food, belonging to migratory communities, stigma, lack of social protection, drug stock-outs and transport challenges affected TB treatment outcomes. CONCLUSIONS This study confirmed that low socio-economic status is associated with poor TB treatment outcomes emphasizing the need for multi- and cross-sectoral approaches and socio-economic enablers to optimise TB care.
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Affiliation(s)
- Jasper Nidoi
- Makerere University Lung Institute (MLI), Kampala, Uganda.
| | | | | | - Joseph F Imoko
- Makerere University Lung Institute (MLI), Kampala, Uganda
| | | | | | | | | | - Stavia Turyahabwe
- National Tuberculosis and Leprosy Control Program (NTLP), Kampala, Uganda
| | - Raymond Byaruhanga
- National Tuberculosis and Leprosy Control Program (NTLP), Kampala, Uganda
| | | | - Simone Villa
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Mario C Raviglione
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Bruce Kirenga
- Makerere University Lung Institute (MLI), Kampala, Uganda
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Low-Wage Agricultural Migrant Workers in Apulian Ghettos, Italy: General Health Conditions Assessment and HIV Screening. Trop Med Infect Dis 2021; 6:tropicalmed6040184. [PMID: 34698299 PMCID: PMC8544678 DOI: 10.3390/tropicalmed6040184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/07/2021] [Accepted: 10/12/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Approximately 500,000 migrants work in the agricultural sector in Italy. Many of them live in shantytowns, wrongly called “ghettos”, far away from city centers, with no water, proper hygienic conditions or health services. The aim of this study is to assess general health conditions and HIV prevalence by giving hygienic and sanitary sustenance. Methods: Between June 2019 and February 2020, we performed a screening campaign for HIV–diabetes–hypertension, involving migrants living in three Apulian establishments: ghetto Pista, “Sankara House” and “Arena House”. Results: Overall, 321 migrants were enrolled in the study. In the medical screening, one HIV test resulted positive. Hypertension was found in 12% of the migrants visited, diabetes in 2% and TB symptoms in 17%. Among others symptoms explored, muscle and joint pain/fatigue resulted in being the most frequent, and was reported by 34% of the migrants, followed by cough (10%). Significant predictors of muscle and joint pain/fatigue were: low BMI values (OR = 1.32; 95% CI 1.19–1.99), the absence of education (OR = 1.85; 95% CI 1.02–2.95), being employed with a regular contract (OR = 2.64; 95% CI 2.39–2.83) and living in the ghettos since >12 months (OR = 1.74; 95% CI 1.24–2.21). Conclusions: Our experience suggests that, in this population, the health condition is mainly linked to the specific working activities in the agricultural fields, as well as to the hygienic and living conditions, and that all of this is due to the lack of social protection in their life and job.
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Degefa MG, Bezabih AM, Kahsay ZH, Belachew AB. Barriers and facilitators of nutrition assessment, counseling, and support for tuberculosis patients: a qualitative study. BMC Nutr 2021; 7:58. [PMID: 34641977 PMCID: PMC8513346 DOI: 10.1186/s40795-021-00463-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 08/20/2021] [Indexed: 11/29/2022] Open
Abstract
Background Nutrition has a substantial role in the prevention, treatment, and cure of tuberculosis. Thus, nutrition assessment, counseling, and support (NACS) have been implemented as part of tuberculosis treatment. However, evidence on the barriers and facilitators (enablers) of its implementation is lacking. Objective To explore barriers and facilitators of implementation of NACS for tuberculosis patients. Methods An exploratory qualitative study was conducted in public health facilities and health offices of Mekelle City, Northern Ethiopia. We conducted 17 interviews using purposively selected key informants comprising health professionals (n = 12) and tuberculosis patients (n = 5). Interviews were tape-recorded, transcribed verbatim, and coded and analyzed using a thematic approach in ATLAS.ti 7 software. Results Barriers were identified at three levels -organization, care provider, and patient levels. Suboptimal nutritional supply, lack of supportive supervision, lack of adequate workforce, staff turn-over, the sudden withdrawal of partners, and weak link with social service were the barriers at the organization level. Lack of commitment was reported as the only barrier at the care provider level, and socioeconomic status of patients, sharing and selling of supplies, perceived improved status, and perceived stigma were identified as the major barriers for the implementation of nutrition assessment, counseling, and support service. While training, availability of measurement and educational tools, the inclusion of nutrition indicators in the tuberculosis register, and the presence of collaborating partners were identified as facilitators at the organizational level. Patients’ motivation to know their health status was reported to be a facilitator at the patient level. Conclusions Organization, care provider, and patient-level barriers and facilitators were found to influence the implementation of NACS. Hence, multilevel factors should be considered to successfully implement the program and to gain its potential impact. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-021-00463-x.
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Affiliation(s)
- Meaza Girma Degefa
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia.
| | - Afework Mulugeta Bezabih
- Department of Nutrition and Dietetics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Znabu Hadush Kahsay
- Department of Environmental Health and Behavioral Sciences, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Abate Bekele Belachew
- School of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.,Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland.,Biocenter Oulu, University of Oulu, Oulu, Finland
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Kerkhoff AD, Kagujje M, Nyangu S, Mateyo K, Sanjase N, Chilukutu L, Eshun-Wilson I, Geng EH, Havlir DV, Muyoyeta M. Pathways to care and preferences for improving tuberculosis services among tuberculosis patients in Zambia: A discrete choice experiment. PLoS One 2021; 16:e0252095. [PMID: 34464392 PMCID: PMC8407587 DOI: 10.1371/journal.pone.0252095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/21/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Delays in the diagnosis of tuberculosis (TB) contribute to a substantial proportion of TB-related mortality, especially among people living with HIV (PLHIV). We sought to characterize the diagnostic journey for HIV-positive and HIV-negative patients with a new TB diagnosis in Zambia, to understand drivers of delay, and characterize their preferences for service characteristics to inform improvements in TB services. METHODS We assessed consecutive adults with newly microbiologically-confirmed TB at two public health treatment facilities in Lusaka, Zambia. We administered a survey to document critical intervals in the TB care pathway (time to initial care-seeking, diagnosis and treatment initiation), identify bottlenecks and their reasons. We quantified patient preferences for a range of characteristics of health services using a discrete choice experiment (DCE) that assessed 7 attributes (distance, wait times, hours of operation, confidentiality, sex of provider, testing incentive, TB test speed and notification method). RESULTS Among 401 patients enrolled (median age of 34 years, 68.7% male, 46.6% HIV-positive), 60.9% and 39.1% were from a first-level and tertiary hospital, respectively. The median time from symptom onset to receipt of TB treatment was 5.0 weeks (IQR: 3.6-8.0) and was longer among HIV-positive patients seeking care at a tertiary hospital than HIV-negative patients (6.4 vs. 4.9 weeks, p = 0.002). The time from symptom onset to initial presentation for evaluation accounted for the majority of time until treatment initiation (median 3.0 weeks, IQR: 1.0-5.0)-an important minority of 11.0% of patients delayed care-seeking ≥8 weeks. The DCE found that patients strongly preferred same-day TB test results (relative importance, 37.2%), facilities close to home (18.0%), and facilities with short wait times (16.9%). Patients were willing to travel to a facility up to 7.6 kilometers further away in order to access same-day TB test results. Preferences for improving current TB services did not differ according to HIV status. CONCLUSIONS Prolonged intervals from TB symptom onset to treatment initiation were common, especially among PLHIV, and were driven by delayed health-seeking. Addressing known barriers to timely diagnosis and incorporating patients' preferences into TB services, including same-day TB test results, may facilitate earlier TB care engagement in high burden settings.
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Affiliation(s)
- Andrew D. Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center University of California, San Francisco, California, United States of America
| | - Mary Kagujje
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sarah Nyangu
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Kondwelani Mateyo
- University Teaching Hospital, Department of Internal Medicine, Lusaka, Zambia
| | - Nsala Sanjase
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Ingrid Eshun-Wilson
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Elvin H. Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Diane V. Havlir
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center University of California, San Francisco, California, United States of America
| | - Monde Muyoyeta
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
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Prats-Uribe A, Xie J, Prieto-Alhambra D, Petersen I. Smoking and COVID-19 Infection and Related Mortality: A Prospective Cohort Analysis of UK Biobank Data. Clin Epidemiol 2021; 13:357-365. [PMID: 34079378 PMCID: PMC8164669 DOI: 10.2147/clep.s300597] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/17/2021] [Indexed: 11/23/2022] Open
Abstract
Background Several papers have shown contradictory evidence about the relationship between smoking and COVID-19-related deaths. There is little evidence about smoking and risk of infection. We aim to examine association between smoking and COVID-19 infection and subsequent mortality. Methods This was a prospective study with participants from the UK Biobank cohort. Participants who lived in England were followed up from 01/02/2020 to 28/06/2020 with data linked to hospital episode statistics, Office for National Statistics and Public Health England PCR tests. We compared current-smokers, previous-smokers with never-smokers and estimated risk ratio (RR) of COVID-19 infection and subsequent mortality using Poisson regression adjusting for age, sex, ethnicity, body mass index and socio-economic status. Interactions between smoking status and age and sex were tested for using multiplicative interactions, and analyses were stratified by median age (49–68 years, 69–86 years) and sex. Results In total, 402,978 participants were included in the analyses. The majority were never smokers, 226,294 (56.2%), 140,090 (34.8%) were previous smokers, and 39,974 (9.9%) current smokers. COVID-19 infection was identified in 1591 (0.39%) people, and 372/1591 (23.4%) died. Amongst the younger participants, smokers were nearly twice as likely to become infected with COVID-19 than never smokers (RR 1.88 [1.49–2.38]) whereas there was no difference for those aged 69+ (RR 1.05 [0.82–1.34]). In contrast, amongst the older participants, smokers were twice as likely to die from COVID-19 compared to non-smokers (RR 2.15 [1.11–4.16]) whereas there was no difference for those under the age of 69 (RR 1.22[0.83–1.79]). Similar patterns were observed for previous smokers. The impact of smoking was similar in men and women. Conclusion The association between smoking and COVID-19 infection and subsequent death is modified by age. Smokers and previous smokers aged under 69 were at higher risk of COVID-19 infection, suggesting the risk is associated with increased exposure to SARS-COV-2 virus. Once infected, older smokers were twice as likely to die from COVID-19 than never smokers, possibly mediated by increased risk of chronic conditions/illnesses.
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Affiliation(s)
- Albert Prats-Uribe
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine - Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Junqing Xie
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine - Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Daniel Prieto-Alhambra
- Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine - Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, UCL, London, NW3 2PF, UK.,Department of Clinical Epidemiology, Aarhus University, Aarhus N, 8200, Denmark
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Woldeyohannes D, Tekalegn Y, Sahiledengle B, Assefa T, Aman R, Hailemariam Z, Mwanri L, Girma A. Predictors of mortality and loss to follow-up among drug resistant tuberculosis patients in Oromia Hospitals, Ethiopia: A retrospective follow-up study. PLoS One 2021; 16:e0250804. [PMID: 33956812 PMCID: PMC8101723 DOI: 10.1371/journal.pone.0250804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Drug resistance tuberculosis (DR-TB) patients' mortality and loss to follow-up (LTF) from treatment and care is a growing worry in Ethiopia. However, little is known about predictors of mortality and LTF among drug-resistant tuberculosis patients in Oromia region, Ethiopia. The current study aimed to identify predictors of mortality and loss to follow-up among drug resistance tuberculosis patients in Oromia Hospitals, Ethiopia. METHODS A retrospective follow up study was carried out from 01 November 2012 to 31 December 2017 among DR-TB patients after calculating sample size using single proportion population formula. Mean, median, Frequency tables and bar charts were used to describe patients' characteristics in the cohort. The Kaplan-Meier curve was used to estimate the probability of death and LTF after the treatment was initiated. The log-rank test was used to compare time to death and time to LTF. The Cox proportional hazard model was used to determine predictors of mortality and LTF after DR-TB diagnosis. The Crude and adjusted Cox proportional hazard ratio was used to measure the strength of association whereas p-value less than 0.05 were used to declare statistically significant predictors. RESULT A total of 406 DR-TB patients were followed for 7084 person-months observations. Among the patients, 71 (17.5%) died and 32 (7.9%) were lost to follow up (LTF). The incidence density of death and LTF in the cohort was 9.8 and 4.5 per 1000 person-months, respectively. The median age of the study participants was 28 years (IQR: 27.1, 29.1). The overall cumulative survival probability of patients at the end of 24 months was 77.5% and 84.5% for the mortality and LTF, respectively. The independent predictors of death was chest radiographic findings (AHR = 0.37, 95% CI: 0.17-0.79) and HIV serostatus 2.98 (95% CI: 1.72-5.19). Drug adverse effect (AHR = 6.1; 95% CI: 2.5, 14.34) and culture test result (AHR = 0.1; 95% CI: 0.1, 0.3) were independent predictors of LTF. CONCLUSION This study concluded that drug-resistant tuberculosis mortality and LTF remains high in the study area. Continual support of the integration of TB/HIV service with emphasis and work to identified predictors may help in reducing drug-resistant tuberculosis mortality and LTF.
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Affiliation(s)
- Demelash Woldeyohannes
- Department of Public Health, Collage of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Yohannes Tekalegn
- Department of Public Health, School of Health Science, Madda Walabu University, Bale Goba, Ethiopia
| | - Biniyam Sahiledengle
- Department of Public Health, School of Health Science, Madda Walabu University, Bale Goba, Ethiopia
| | - Tesfaye Assefa
- Department of Nursing, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
| | - Rameto Aman
- Department of Public Health, School of Health Science, Madda Walabu University, Bale Goba, Ethiopia
| | - Zeleke Hailemariam
- Department of Public Health, Collage of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Alemu Girma
- Department of Surgery, School of Health Science, Goba Referral Hospital, Madda Walabu University, Bale Goba, Ethiopia
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Patients' perceptions regarding multidrug-resistant tuberculosis and barriers to seeking care in a priority city in Brazil during COVID-19 pandemic: A qualitative study. PLoS One 2021; 16:e0249822. [PMID: 33836024 PMCID: PMC8034748 DOI: 10.1371/journal.pone.0249822] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/26/2021] [Indexed: 12/29/2022] Open
Abstract
This study aimed to analyze the discourses of patients who were diagnosed with multidrug-resistant tuberculosis, the perception of why they acquired this health condition and barriers to seeking care in a priority city in Brazil during the COVID-19 pandemic. This was an exploratory qualitative study, which used the theoretical-methodological framework of the Discourse Analysis of French matrix, guided by the Consolidated Criteria for Reporting Qualitative Research. The study was conducted in Ribeirão Preto, São Paulo, Brazil. Seven participants were interviewed who were undergoing treatment at the time of the interview. The analysis of the participants' discourses allowed the emergence of four discursive blocks: (1) impact of the social determinants in the development of multidrug-resistant tuberculosis, (2) barriers to seeking care and difficulties accessing health services, (3) perceptions of the side effects and their impact on multidrug-resistant tuberculosis treatment, and (4) tuberculosis and COVID-19: a necessary dialogue. Through discursive formations, these revealed the determinants of multidrug-resistant tuberculosis. Considering the complexity involved in the dynamics of multidrug-resistant tuberculosis, advancing in terms of equity in health, that is, in reducing unjust differences, is a challenge for public policies, especially at the current moment in Brazil, which is of accentuated economic, political and social crisis. The importance of psychosocial stressors and the lack of social support should also be highlighted as intermediary determinants of health. The study has also shown the situation of COVID-19, which consists of an important barrier for patients seeking care. Many patients reported fear, insecurity and worry with regard to returning to medical appointments, which might contribute to the worsening of tuberculosis in the scenario under study.
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Cannon LAL, Oladimeji KE, Goon DT. Socio-economic drivers of drug-resistant tuberculosis in Africa: a scoping review. BMC Public Health 2021; 21:488. [PMID: 33706723 PMCID: PMC7953648 DOI: 10.1186/s12889-021-10267-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 01/19/2021] [Indexed: 12/13/2022] Open
Abstract
Background Drug-resistant TB (DR-TB) remains a public health concern due to the high morbidity and mortality rates from the disease. The DR-TB is a multifaceted illness with expensive treatment regimens, toxic medications and most often the long duration of treatment constitutes a substantial financial burden on both infected patients and the health system. Despite significant research advances in the diagnosis and treatment, there is a paucity of synthesized evidence on how socio-economic factors are associated with DR-TB. This review aims to address this gap by synthesizing available evidence and data on the common socio-economic drivers of DR-TB infection in Africa. Methods A systematic search was conducted on PUBMED and Google Scholar databases from January 2011 to January 2020 using Joanna Briggs Institute’s scoping review approach. An updated search was conducted on 21 September 2020. The eligibility criteria only included systematic reviews and studies with quantitative research methods (cross-sectional, case-control, cohort, and randomized-control trials). Studies conducted in Africa and focusing on socio-economic factors influencing DR-TB burden in African countries were also considered. Data was extracted from all the studies that met the eligibility criteria based on the study’s objectives. Results Out of the 154 articles that were retrieved for review, 20 abstracts of these articles met all the eligibility criteria. Of the 20 articles, 17 quantitative and 3 reviews. Two additional articles were found eligible, following the updated search. The following themes were identified as major findings: Social and economic drivers associated with DR-TB. Substance abuse of which, stigma and discrimination were the prominent social drivers. Economic drivers included poverty, financial constraints because of job loss, loss of productive time during hospital admission and treatment costs. Conclusion This review has highlighted which socio-economic factors contribute to DR- TB This is relevant to assist DR-TB management program and TB stakeholders in different settings to address identified socio-economic gaps and to reduce its negative impact on the programmatic management of DR TB. Therefore, redirecting strategies with more focus on socio-economic empowerment of DR-TB patients could be one of the innovative solutions to reduce the spread and eliminate DR-TB in Africa. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10267-0.
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Affiliation(s)
- Lesley-Ann Lynnath Cannon
- Department of Public Health, Faculty of Health Sciences, University of Fort Hare, East London, 5200, Eastern Cape, South Africa.
| | - Kelechi Elizabeth Oladimeji
- Department of Public Health, Faculty of Health Sciences, University of Fort Hare, East London, 5200, Eastern Cape, South Africa
| | - Daniel Ter Goon
- Department of Public Health, Faculty of Health Sciences, University of Fort Hare, East London, 5200, Eastern Cape, South Africa
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Increase in Tuberculosis Diagnostic Delay during First Wave of the COVID-19 Pandemic: Data from an Italian Infectious Disease Referral Hospital. Antibiotics (Basel) 2021; 10:antibiotics10030272. [PMID: 33800406 PMCID: PMC7998965 DOI: 10.3390/antibiotics10030272] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background: The WHO advised that the impact of COVID-19 pandemic on TB services was estimated to be dramatic due to the disruption of TB services. Methods: A retrospective data collection and evaluation was conducted to include all the patients hospitalized for TB at INMI from 9 March to 31 August 2020 (lockdown period and three months thereafter). For the purpose of the study, data from patients hospitalized in the same period of 2019 were also collected. Results: In the period of March–August 2019, 201 patients were hospitalized with a diagnosis of TB, while in the same period of 2020, only 115 patients, with a case reduction of 43%. Patients with weight loss, acute respiratory failure, concurrent extrapulmonary TB, and higher Timika radiographic scores were significantly more frequently hospitalized during 2020 vs. 2019. The median patient delay was 75 days (IQR: 40–100) in 2020 compared to 30 days (IQR: 10–60) in 2019 (p < 0.01). Diagnostic delays in 2020 remain significant in the multiple logistic model (AOR = 6.93, 95%CI: 3.9–12.3). Conclusions: Our experience suggests that COVID-19 pandemic had an impact on TB patient care in terms of higher diagnostic delay, reduction in hospitalization, and a greater severity of clinical presentations.
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Factors affecting outcome of longer regimen multidrug-resistant tuberculosis treatment in West Java Indonesia: A retrospective cohort study. PLoS One 2021; 16:e0246284. [PMID: 33556094 PMCID: PMC7870080 DOI: 10.1371/journal.pone.0246284] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Multidrug-resistant tuberculosis had high treatment failure and mortality. Success rate of treatment currently 56% at global level, 48% in Indonesia and 36% in West Java province, the most populated province and surround Jakarta, the capitol of Indonesia. Objective This study aimed to evaluate factors affecting success of multidrug-resistant tuberculosis treatment in patients using longer treatment regimen in West Java Indonesia. Methods This was a retrospective cohort study of multidrug-resistant tuberculosis patients treated with longer regimen at Hasan Sadikin General Hospital from January 2015 to December 2017. Potential risk factors associated with the treatment outcome were analyzed using multiple logistic regression. Results A total of 492 patients were enrolled during the study period. Fifty percents multidrug-resistant tuberculosis patients had successful treatment outcome. Age ≤45 years, male, normal body mass index, no previous tuberculosis treatment, culture conversion ≤2 months, acid fast bacilli sputum smear ≤+1 were independent factors associated with increased treatment success. Sputum culture conversion ≤2 months was the major factor affecting successful outcome (RR 2.79; 95% CI: 1.61–4.84; p-value<0.001). Human Immunodeficiency Virus infection, chronic kidney disease, and cavitary lesion were independent risk factors for unfavourable outcome. Conclusion Age, gender, body mass index, tuberculosis treatment history, time of sputum conversion, acid fast bacilli sputum smear, HIV infection, chronic kidney disease, and cavitary lesion can be used as predictors for longer multidrug-resistant tuberculosis treatment regimen outcome.
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Rifampicin and Isoniazid Maximal Concentrations are Below Efficacy-associated Thresholds in the Majority of Patients: Time to Increase the Doses? Int J Antimicrob Agents 2021; 57:106297. [PMID: 33539932 DOI: 10.1016/j.ijantimicag.2021.106297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 01/15/2021] [Accepted: 01/24/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND The treatment of drug-sensitive tuberculosis (TB) is highly effective; however, many patients have suboptimal drug exposure, which possibly explains treatment failures and selection of resistance. This study aimed to describe the prevalence and determinants of suboptimal maximal concentrations (Cmax) for anti-TB drugs. METHODS An observational study was conducted in patients receiving first-line anti-TB treatment. At two early time points (T1 and T2), blood samples were withdrawn 2 hours post-dose (Cmax) and drug concentrations were measured. Data were expressed as medians (interquartile ranges). RESULTS The study included 199 participants: 72.9% were male and the median age was 39.8 years (27.5-51.4). The median Cmax at T1 and T2 were 7950 ng/mL and 7122 ng/mL (rifampicin), 3260 ng/mL and 3185 ng/mL (isoniazid), 4210 ng/mL and 5742 ng/mL (ethambutol), and 31 008 ng/mL and 30 352 ng/mL (pyrazinamide), respectively. Higher doses/kg and other variables (being born in Italy and female gender for rifampicin, older age and proton pump inhibitor use for isoniazid, female gender and older age for pyrazinamide) were identified by multivariate linear regression analysis. Participants with a higher body mass index received lower doses/kg of all anti-TB drugs. Suboptimal Cmax at T1 and T2 were observed in 60% and 66% (rifampicin), 54% and 55% (isoniazid), 33% and 39% (ethambutol), 20% and 11% (pyrazinamide) of patients. Despite 21% of patients at T1 and 24% at T2 showing two or more drugs with suboptimal exposure, no effect on treatment outcome was observed. DISCUSSION The majority of patients receiving first-line anti-TB drugs had low isoniazid and rifampin Cmax. Increased doses or the use of therapeutic drug monitoring in selected patients may be advised.
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Zhang P, Xiong J, Zeng J, Zhan S, Chen T, Wang Y, Deng G. Clinical Evaluation of Active Tuberculosis-Related Deaths in Shenzhen, China: A Descriptive Study. Int J Gen Med 2021; 14:237-242. [PMID: 33519230 PMCID: PMC7837593 DOI: 10.2147/ijgm.s291146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/07/2021] [Indexed: 12/27/2022] Open
Abstract
Objective The aim of this study was to assess active tuberculosis-related deaths in Shenzhen city of China to identify major causes of mortality in different age groups. Patients and Methods Medical records of mortality cases of patients with active TB diagnosed during 2013-2018 were reviewed. All TB deaths were classified into two broad age groups (the young group: 18-65 years old and the elderly group: >65 years old). Causes of death were analyzed based on medical records. Results A total of 279 mortality cases of active TB were reviewed during the study period. Among them, mean age was 54.0±20.5 years old; 80.6% (225/279) were male. There were 5.7% and 4.6% MDR/XDRTB patients in the young and elderly group. Newly treated TB accounted for 89.6% in the young group and 85.1% in the elderly group. Pulmonary TB was a major infection type in both groups (65.1% vs 77.0%). Advanced TB (23.4%) and HIV co-infection (20.8%) were the leading causes of deaths in the young group, but deaths in the elderly group were mostly associated with underlying diseases, including cardiovascular disease (52.9%), diabetes (33.3%), COPD (16.1%) and cancer (11.5%). Malnutrition was a significant condition in both groups (43.2% vs 35.6%). In terms of respiratory complications, bacterial infection was the leading comorbidity in both groups (27.1% vs 18.4%), followed by septic shock (18.2% vs 12.6%) and respiratory failure (12.0% vs 11.5%). There were no significant statistical differences between the two groups. Conclusion Our findings suggest that screening for HIV co-infection and early diagnosis of TB is vital in lowering TB-related deaths in young patients. Most deaths in elderly TB patients were caused by underlying health conditions or complications other than TB.
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Affiliation(s)
- Peize Zhang
- Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, People's Republic of China
| | - Juan Xiong
- School of Public Health, Health Science Center, Shenzhen University, Shenzhen, Guangdong, People's Republic of China
| | - Jianfeng Zeng
- Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, People's Republic of China
| | - Senlin Zhan
- Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, People's Republic of China
| | - Tao Chen
- Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, People's Republic of China
| | - Yuxiang Wang
- Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, People's Republic of China
| | - Guofang Deng
- Department of Pulmonary Medicine and Tuberculosis, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong, People's Republic of China
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Oladimeji O, Adepoju V, Anyiam FE, San JE, Odugbemi BA, Hyera FLM, Sibiya MN, Yaya S, Zoakah AI, Lawson L. Treatment outcomes of drug susceptible Tuberculosis in private health facilities in Lagos, South-West Nigeria. PLoS One 2021; 16:e0244581. [PMID: 33471851 PMCID: PMC7816975 DOI: 10.1371/journal.pone.0244581] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 12/13/2020] [Indexed: 11/19/2022] Open
Abstract
Background The Lagos State Tuberculosis, Buruli Ulcer, and Leprosy Control Program (LSTBLCP) started engaging private hospitals under the Public-Private Mix (PPM) Program in 2008. The study aimed to evaluate the trend and predictors of successful Tuberculosis (TB) treatment outcomes of patients managed across these private health facilities between 2010–2016 in Lagos, Nigeria. Methods Retrospective review of TB treatment register and treatment cards of patients commenced on TB treatment between January 2010 and December 2016 in 36 private health facilities engaged by the LSTBLCP. Between December 2016 and February 2017, data were collected and entered into Microsoft Excel by trained data entry clerks. The analysis was done using SPSS software. Independent predictors of successful treatment outcomes were determined using multivariate analysis at the statistical significance of p<0.05 and 95% confidence interval. Results A total of 1660 records of TB patients were reviewed. 1535 (92.47%) commenced treatment, while 1337 (87.10%) of all records had documented treatment outcomes. Of the 1337 patients with outcomes, 1044 (78.09%) had a successful treatment outcome, and 293 (21.91%) had an unsuccessful outcome. Majority were male, 980 (59.04%), Human Immunodeficiency Virus (HIV) negative status, 1295 (80.24%), diagnosed with smear, 1141 (73.14%), treated in private not-for-profit (PNFP) hospital, 1097 (66.08%), treated for TB between 2014–2016 (18.96%-19.52%). In multivariate analysis, age>20years (aOR = 0.26, p = 0.001), receiving TB treatment in 2013 (aOR = 0.39, p = 0.001), having genexpert for TB diagnosis (aOR = 0.26, p = 0.031) and being HIV positive (aOR = 0.37, p = 0.001) significantly reduced likelihood of successful treatment outcome. The site of TB, being on ART or CPT, were confounding determinants of successful treatment outcomes as they became non-significant at the multivariate analysis level. Conclusion Treatment outcome among Lagos private hospitals was low compared with NTBLCP and World Health Organization (WHO) target. We urge the government and TB stakeholders to strengthen the PPM interventions to improve adherence, particularly among People Living with HIV (PLHIV) and older TB patients. Hence, promotion of early care-seeking, improving diagnostic and case holding efficiencies of health facilities, and TB/HIV collaborative interventions can reduce the risk of an unsuccessful outcome.
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Affiliation(s)
- Olanrewaju Oladimeji
- Department of Public Health, Walter Sisulu University, Eastern Cape, South Africa
- Faculty of Health Sciences, Durban University of Technology, Eastern Cape, South Africa
- Faculty of Medicine, Department of Family Medicine and Public Health, University of Botswana, Gaborone, Botswana
- * E-mail:
| | - Victor Adepoju
- Adolescent Friendly Research Initiative and Care (ADOLFRIC), Ekiti State, Nigeria
| | - Felix Emeka Anyiam
- Center for Health and Development, University of Port Harcourt, Port Harcourt, Nigeria
| | - James Emmanuel San
- Kwazulu-Natal Research and Innovation Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Babatunde A. Odugbemi
- Department of Community Health and Primary Health Care, Lagos State University, College of Medicine, Ikeja, Lagos, Nigeria
| | | | | | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, The University of Oxford, Oxford, United Kingdom
| | - Ayuba Ibrahim Zoakah
- Department of Community Medicine, Jos University Teaching Hospital, University of Jos, Plateau State, Nigeria
| | - Lovett Lawson
- Zankli Medical Services Ltd, Utako District, Abuja, Nigeria
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Calligaro GL, de Wit Z, Cirota J, Orrell C, Myers B, Decker S, Stein DJ, Sorsdahl K, Dawson R. Brief psychotherapy administered by non-specialised health workers to address risky substance use in patients with multidrug-resistant tuberculosis: a feasibility and acceptability study. Pilot Feasibility Stud 2021; 7:28. [PMID: 33468251 PMCID: PMC7814702 DOI: 10.1186/s40814-020-00764-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 12/21/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Only 55% of multidrug-resistant tuberculosis (MDR-TB) cases worldwide complete treatment, with problem substance use a risk for default and treatment failure. Nevertheless, there is little research on psychotherapeutic interventions for reducing substance use amongst MDR-TB patients, in general, and on their delivery by non-specialist health workers in particular. OBJECTIVES To explore the feasibility and acceptability of a non-specialist health worker-delivered 4-session brief motivational interviewing and relapse prevention (MI-RP) intervention for problem substance use and to obtain preliminary data on the effects of this intervention on substance use severity, depressive symptoms, psychological distress and functional impairment at 3 months after hospital discharge. METHODS Between December 2015 and October 2016, consenting MDR-TB patients admitted to Brewelskloof Hospital who screened at moderate to severe risk for substance-related problems on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were enrolled, and a baseline questionnaire administered. In the 4 weeks prior to planned discharge, trained counsellors delivered the MI-RP intervention. The baseline questionnaire was re-administered 3 months post-discharge and qualitative interviews were conducted with a randomly selected sample of participants (n = 10). RESULTS Sixty patients were screened: 40 (66%) met inclusion criteria of which 39 (98%) were enrolled. Of the enrolled patients, 26 (67%) completed the counselling sessions and the final assessment. Qualitative interviews revealed participants' perceptions of the value of the intervention. From baseline to follow-up, patients reported reductions in substance use severity, symptoms of depression, distress and functional impairment. CONCLUSION In this feasibility study, participant retention in the study was moderate. We found preliminary evidence supporting the benefits of the intervention for reducing substance use and symptoms of psychological distress, supported by qualitative reports of patient experiences. Randomised studies are needed to demonstrate efficacy of this intervention before considering potential for wider implementation. TRIAL REGISTRATION South African National Clinical Trials Register ( DOH-27-0315-5007 ) on 01/04/2015 ( http://www.sanctr.gov.za ).
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Affiliation(s)
- Gregory L Calligaro
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Zani de Wit
- Centre for TB Research Innovation, University of Cape Town Lung Institute, George Road, Mowbray, Cape Town, 7925, South Africa
| | - Jacqui Cirota
- Centre for TB Research Innovation, University of Cape Town Lung Institute, George Road, Mowbray, Cape Town, 7925, South Africa
| | - Catherine Orrell
- The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Addiction Psychiatry Division, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Dan J Stein
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Katherine Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Rodney Dawson
- Centre for TB Research Innovation, University of Cape Town Lung Institute, George Road, Mowbray, Cape Town, 7925, South Africa.
- Division of Pulmonology, Department of Medicine, University of Cape Town Lung Institute, Cape Town, South Africa.
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Cheng Q, Xie L, Wang L, Lu M, Li Q, Wu Y, Huang Y, Jia Q, Zhao G. Impact of different tuberculosis history at the onset of future multidrug-resistant tuberculosis: A large, retrospective, population-based cohort study. J Glob Antimicrob Resist 2020; 24:158-168. [PMID: 33359935 DOI: 10.1016/j.jgar.2020.12.001] [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: 05/05/2020] [Revised: 09/22/2020] [Accepted: 12/03/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The impact of tuberculosis (TB) history on the risk of multidrug-resistant tuberculosis (MDR-TB) is not yet fully understood. We aimed to identify the impact of different TB history at the onset of future MDR-TB. METHODS A large, retrospective, population-based cohort study was performed between 2005 and 2019. A multivariable Cox model was used to evaluate independent risk factors for MDR-TB for individuals with different previous TB history (PTBH), such as newly diagnosed TB history (NDTH) and re-treated TB history (RTH). RESULTS Overall, 12 172 individuals with PTBH were included in this study. The main impacts of different PTBH at the onset of future MDR-TB were as follows: (a) low family income, high-risk occupation, TB patients with severe infection, extended or shortened treatment course, 2H3R3Z3E3/4H3R3 and frequency of sputum culture were significantly linked to incident MDR-TB only in individuals with NDTH (P < 0.05); (b) passive mode of TB case finding, individualised treatment regimens, 3HRZES/6HRE, duration of pulmonary cavities, excellent frequency of chest X-ray examination and duration of negative sputum smear were significantly associated with incident MDR-TB only in individuals with RTH (P < 0.05); (c) age <60 years, history of direct contact, human immunodeficiency virus (HIV) infection, unsuccessful treatment and duration of positive sputum culture were related to incident MDR-TB in both categories of PTBH individuals (P < 0.05). CONCLUSION Early and differential surveillances, assessments and interventions for reducing the risk of MDR-TB among individuals with different PTBH play a key role.
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Affiliation(s)
- Qinglin Cheng
- Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, China; School of Medicine, Hangzhou Normal University, Hangzhou 310021, China
| | - Li Xie
- Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, China
| | - Le Wang
- Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, China
| | - Min Lu
- Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, China
| | - Qingchun Li
- Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, China
| | - Yifei Wu
- Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, China
| | - Yinyan Huang
- Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, China
| | - Qingjun Jia
- Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, China
| | - Gang Zhao
- Hangzhou Center for Disease Control and Prevention, Hangzhou 310021, China.
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Plymoth M, Sanders EJ, Van Der Elst EM, Medstrand P, Tesfaye F, Winqvist N, Balcha T, Björkman P. Socio-economic condition and lack of virological suppression among adults and adolescents receiving antiretroviral therapy in Ethiopia. PLoS One 2020; 15:e0244066. [PMID: 33320900 PMCID: PMC7737988 DOI: 10.1371/journal.pone.0244066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 12/02/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction The potential impact of socio-economic condition on virological suppression during antiretroviral treatment (ART) in sub-Saharan Africa is largely unknown. In this case-control study, we compared socio-economic factors among Ethiopian ART recipients with lack of virological suppression to those with undetectable viral load (VL). Methods Cases (VL>1000 copies/ml) and controls (VL<150 copies/ml) aged ≥15years, with ART for >6 months and with available VL results within the last 3 months, were identified from registries at public ART clinics in Central Ethiopia. Questionnaire-based interviews on socio-economic characteristics, health condition and transmission risk behavior were conducted. Univariate variables associated with VL>1000 copies/ml (p<0.25) were added to a multivariable logistic regression model. Results Among 307 participants (155 cases, 152 controls), 61.2% were female, and the median age was 38 years (IQR 32–46). Median HIV-RNA load among cases was 6,904 copies/ml (IQR 2,843–26,789). Compared to controls, cases were younger (median 36 vs. 39 years; p = 0.004), more likely to be male (46.5% vs. 30.9%; p = 0.005) and had lower pre-ART CD4 cell counts (170 vs. 220 cells/μl; p = 0.009). In multivariable analysis of urban residents (94.8%), VL>1000 copies/ml was associated with lower relative wealth (adjusted odds ratio [aOR] 2.98; 95% CI 1.49–5.94; p = 0.016), geographic work mobility (aOR 6.27, 95% CI 1.82–21.6; p = 0.016), younger age (aOR 0.94 [year], 95% CI 0.91–0.98; p = 0.011), longer duration of ART (aOR 1.19 [year], 95% CI 1.07–1.33; p = 0.020), and suboptimal (aOR 3.83, 95% CI 1.33–10.2; p = 0.048) or poor self-perceived wellbeing (aOR 9.75, 95% CI 2.85–33.4; p = 0.012), after correction for multiple comparisons. High-risk sexual behavior and substance use was not associated with lack of virological suppression. Conclusion Geographic work mobility and lower relative wealth were associated with lack of virological suppression among Ethiopian ART recipients in this predominantly urban population. These characteristics indicate increased risk of treatment failure and the need for targeted interventions for persons with these risk factors.
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Affiliation(s)
- Martin Plymoth
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- * E-mail: ,
| | - Eduard J. Sanders
- Centre for Geographic Medicine Research, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Nuffield Department of Clinical Medicine, University of Oxford, Headington, United Kingdom
| | - Elise M. Van Der Elst
- Centre for Geographic Medicine Research, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Patrik Medstrand
- Clinical Virology, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Fregenet Tesfaye
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Niclas Winqvist
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Taye Balcha
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Per Björkman
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden
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Mbuthia GW, Nyamogoba HDN, Chiang SS, McGarvey ST. Burden of stigma among tuberculosis patients in a pastoralist community in Kenya: A mixed methods study. PLoS One 2020; 15:e0240457. [PMID: 33057420 PMCID: PMC7561176 DOI: 10.1371/journal.pone.0240457] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) stigma remains a barrier to early diagnosis and treatment completion. Increased understanding of stigma is necessary for improved interventions to minimise TB stigma and its effects. The purpose of this study is to quantitatively measure TB stigma and to explore qualitatively its manifestation among TB patients in a rural Kenyan community. METHODS This hospital based study using explanatory sequential mixed methods approach was conducted in 2016. In the quantitative part of the study, a questionnaire containing socio-demographic characteristics and scales measuring perceived TB stigma and experienced TB stigma, was administered to 208 adult pulmonary TB patients receiving treatment in West Pokot County. Respondents with high stigma were purposively selected to take part in in-depth interviews and focus group discussions. The qualitative data were collected through 15 in-depth interviews and 6 focus group discussions with TB patients. Descriptive and bivariate analysis was done for the quantitative data while the thematic analysis was done for qualitative data. RESULTS The internal consistency reliability coefficients were satisfactory with Cronbach alphas of 0.87 and 0.86 for the 11-item and 12-item stigma measurement scale. The investigation revealed that TB stigma was high. The key drivers of TB stigma were the association of TB with HIV/AIDS and the fear of TB transmission. TB stigma was exemplified through patients being isolated by others, self-isolation, fear to disclose TB diagnosis, association of TB with human immunodeficiency virus (HIV) and lack of social support. Being a woman was significantly associated with high levels of both experienced stigma (p = 0.007) and perceived stigma (p = 0.005) while age, marital status, occupation and the patient's religion were not. CONCLUSION There is a need to implement stigma reduction interventions in order to improve TB program outcomes.
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Affiliation(s)
- Grace Wambura Mbuthia
- College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | | | - Silvia S. Chiang
- Department of Pediatrics, Alpert Medical School, Brown University, Providence, RI, United States of America
- Center for International Health Research, Rhode Island Hospital, Providence, RI, United States of America
| | - Stephen T. McGarvey
- International Health Institute, and Department of Epidemiology, School of Public Health, Brown University, Providence, RI, United States of America
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Soto Cabezas MG, Munayco Escate CV, Escalante Maldonado O, Valencia Torres E, Arica Gutiérrez J, Yagui Moscoso MJA. [Epidemiological profile of extensively drug-resistant tuberculosis in Peru, 2013-2015Perfil epidemiológico da tuberculose extremamente resistente no Peru, 2013-2015]. Rev Panam Salud Publica 2020; 44:e29. [PMID: 32973891 PMCID: PMC7498293 DOI: 10.26633/rpsp.2020.29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/07/2020] [Indexed: 12/21/2022] Open
Abstract
Objetivo. Describir las características clínico-epidemiológicas y el perfil de resistencia de los casos de tuberculosis extensivamente resistente (TB-XDR) diagnosticados en Perú entre los años 2013 y 2015. Métodos. Estudio descriptivo que incluyó a los pacientes que cumplían con la definición de TB-XDR y que fueron notificados al sistema nacional de vigilancia epidemiológica del Ministerio de Salud del Perú. Se realizó un análisis descriptivo y se elaboró un mapa de calor basado en la estimación de densidad Kernel para identificar la distribución espacial. Resultados. Se estimó que los casos de TB-XDR diagnosticados como nuevos representaron 7,3% del total de casos de tuberculosis multidrogorresistente (TB-MDR) reportados para el período de estudio, 74% de los casos tenían entre 15 y 44 años y la relación hombre/mujer fue de 1,7. La mitad de los departamentos reportó al menos un caso de TB-XDR, con 42% de casos nuevos sin ningún antecedente de resistencia ni tratamiento previo. En la otra mitad de los departamentos, la mayoría tenían resistencia previa tipo MDR y de tipo pre-XDR. El 57,7% de los casos presentaron resistencia a 5 y 7 drogas y 41,6% presentaba resistencia a 8 y 10 drogas de primera y segunda línea. Conclusiones. Este estudio ofrece detalles importantes del perfil epidemiológico de la TB-XDR en el Perú, donde se muestra un incremento de los casos de TB-XDR primario; es decir, casos sin antecedentes de enfermedad previa. Además, esta forma de tuberculosis se ha extendido a un mayor número de departamentos del país.
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Affiliation(s)
- Mirtha Gabriela Soto Cabezas
- Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud Lima Perú Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud, Lima, Perú
| | - César Vladimir Munayco Escate
- Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud Lima Perú Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, Ministerio de Salud, Lima, Perú
| | | | | | - Johans Arica Gutiérrez
- Universidad Nacional Mayor de San Marcos Lima Perú Universidad Nacional Mayor de San Marcos, Lima, Perú
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Di Gennaro F, Vittozzi P, Gualano G, Musso M, Mosti S, Mencarini P, Pareo C, Di Caro A, Schininà V, Girardi E, Palmieri F. Active Pulmonary Tuberculosis in Elderly Patients: A 2016-2019 Retrospective Analysis from an Italian Referral Hospital. Antibiotics (Basel) 2020; 9:antibiotics9080489. [PMID: 32784552 PMCID: PMC7459440 DOI: 10.3390/antibiotics9080489] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023] Open
Abstract
Tuberculosis (TB) in the elderly (>65 years old) has increasingly become a global health problem. It has long been recognized that older people are vulnerable to developing tuberculosis. We retrospectively evaluated data from patients older than 65 years diagnosed with pulmonary TB admitted to the National Institute for Infectious Diseases L. Spallanzani, Rome, Italy, from 1 January 2016 to 31 December 2019. One hundred and six consecutive patients were diagnosed with pulmonary TB and 68% reported at least one comorbidity and 44% at least one of the TB risk-factors. Out of the 26 elderly patients who reported an adverse event, having risk factors for TB (O.R. (Odds Ratios) = 1.45; 95% CI 1.12-3.65) and the presence of cavities on Chest X-rays (O.R. = 1.42; 95% CI 1.08-2.73) resulted in being more likely to be associated with adverse events in elderly patients. Having weight loss (O.R. = 1.31; 95% CI 1.08-1.55) and dyspnea (O.R. = 1.23; 95% CI 1.13-1.41) resulted in being significant predictors of unsuccessful treatment outcome in elderly patients. Older people with TB represent a vulnerable group, with high mortality rate, with a challenging diagnosis. Hospitalizations in tertiary referral hospital with clinical expertise in TB management can be useful to improve the outcome of these fragile patients.
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Affiliation(s)
- Francesco Di Gennaro
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
- Correspondence: ; Tel.: +39-3924-804-707
| | - Pietro Vittozzi
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Gina Gualano
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Maria Musso
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Silvia Mosti
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Paola Mencarini
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Carlo Pareo
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
| | - Antonino Di Caro
- Microbiology and Bio-Repository Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy;
| | - Vincenzo Schininà
- Diagnostic Imaging Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy;
| | - Enrico Girardi
- Clinical Epidemiology Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy;
| | - Fabrizio Palmieri
- Respiratory Infectious Diseases Unit, National Institute for Infectious Diseases “L. Spallanzani” IRCCS, 00149 Rome, Italy; (P.V.); (G.G.); (M.M.); (S.M.); (P.M.); (C.P.); (F.P.)
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Darisheva M, Tracy M, Terlikbayeva A, Zhussupov B, Schluger N, McCrimmon T. Knowledge and attitudes towards ambulatory treatment of tuberculоsis in Kazakhstan. BMC Health Serv Res 2020; 20:563. [PMID: 32571356 PMCID: PMC7310255 DOI: 10.1186/s12913-020-05413-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/09/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Ambulatory based treatment of tuberculosis has been recently introduced in Kazakhstan. We sought to assess the attitudes of the general population, TB patients and their household members towards ambulatory TB treatment and identify how knowledge of TB is associated with these attitudes. METHODS New pulmonary TB cases and their household and community controls were recruited from three regions of Kazakhstan in 2012-2014. 1083 participants completed audio computer-assisted self interviews to assess their knowledge of TB and attitudes towards ambulatory care. Mixed effects logistic regression models were used to identify factors associated with attitudes toward ambulatory TB treatment. RESULTS The proportion of people who considered ambulatory TB treatment as appropriate was very low (24.9%). Positive attitudes towards ambulatory TB treatment were significantly associated with region of residence, higher level of education, family support and experience with TB. The association between sufficient tuberculosis knowledge and favorable attitude toward ambulatory treatment was stronger among community controls compared to TB patients and their family members. CONCLUSIONS This study provides insight into attitudes toward ambulatory TB treatment among different groups and the specific influence of TB knowledge on these attitudes. Our findings can inform the process of integration of new TB treatment strategies and the development of appropriate education and advocacy programs in the general population.
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Affiliation(s)
- Meruyert Darisheva
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan.
| | - Melissa Tracy
- School of Public Health, Department of Epidemiology and Biostatistics, University at Albany, Albany, NY, USA
| | - Assel Terlikbayeva
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | - Neil Schluger
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Tara McCrimmon
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, USA
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Arroyo LH, Yamamura M, Ramos ACV, Campoy LT, Crispim JDA, Berra TZ, Alves LS, Alves YM, Dos Santos FL, Souza LLL, Bruce ATI, de Andrade HLP, Bollela VR, Krainski ET, Nunes C, Arcêncio RA. Determinants of multidrug-resistant tuberculosis in São Paulo-Brazil: a multilevel Bayesian analysis of factors associated with individual, community and access to health services. Trop Med Int Health 2020; 25:839-849. [PMID: 32358845 PMCID: PMC7383622 DOI: 10.1111/tmi.13409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective Multidrug‐resistant tuberculosis (MDR‐TB) remains a serious public health problem worldwide. Accordingly, this study sought to identify individual, community and access to health services risk factors for MDR‐TB. Methods Retrospective cohort of all TB cases diagnosed between 2006 and 2016 in the state of São Paulo. A Bayesian spatial hierarchical analysis with a multilevel design was carried out. Results It was identified that the history of previous TB treatment (Odds Ratios [OR]:13.86, 95% credibility interval [95% CI]:12.06–15.93), positive sputum culture test (OR: 5.26, 95% CI: 4.44–6.23), diabetes mellitus (OR: 2.34, 95% CI: 1.87–2.91), residing at a standard address (OR: 2.62, 95% CI: 1.91–3.60), positive sputum smear microscopy (OR: 1.74, 95% CI: 1.44–2.12), cavitary pulmonary TB (OR: 1.35, 95% CI: 1.14–1.60) and diagnosis performed due to spontaneous request (OR: 1.26; 95% CI: 1.10–1.46) were associated with MDR‐TB. Furthermore, municipalities that performed HIV tests in less than 42.65% of patients with TB (OR: 1.50, 95% CI: 1.25–1.79), that diagnosed TB cases only after death (OR: 1.50, 95% CI: 1.17–1.93) and that had more than 20.16% of their population with income between ¼ and ½ of one minimum wage (OR: 1.56, 95% CI: 1.30–1.87) were also related to the MDR‐TB. Conclusions Knowledge of these predictive factors may help to develop more comprehensive disease prevention strategies for MDR‐TB, avoiding the risks expressed regarding drug resistance expansion.
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Affiliation(s)
- Luiz Henrique Arroyo
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Brazil
| | - Mellina Yamamura
- Department of Nursing, Federal University of São Carlos, São Carlos, Brazil
| | | | | | | | - Thais Zamboni Berra
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Brazil
| | - Luana Seles Alves
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Brazil
| | - Yan Mathias Alves
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | | | | | | | | | - Carla Nunes
- National School of Public Health, Nova University of Lisbon, Lisbon, Portugal
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Davletshin R, Khayarov K, Zykova K, Galkina I, Davletshina N, Ivshin K, Kataeva O. Synthesis and crystal structure of new ligand - N-didodecylphosphinoxido-4-nitrobenzyledenetetradecylammonium-4-methylbenzenesulfonate. J Organomet Chem 2020. [DOI: 10.1016/j.jorganchem.2020.121189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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De Palma A, Maruccia M, Di Gennaro F. Right thoracotomy approach for treatment of left bronchopleural fistula after pneumonectomy for tubercolosis. Gen Thorac Cardiovasc Surg 2020; 68:1539-1542. [PMID: 32036566 DOI: 10.1007/s11748-020-01307-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/29/2020] [Indexed: 11/27/2022]
Abstract
Pneumonectomy for pulmonary tuberculosis is a rare option but can sometimes be necessary in cases of destroyed lung, resulting from a previous or persistent chronic infection. Bronchopleural fistula on the bronchial stump may develop as a postoperative complication, favoured by the long-lasting infectious disease and the poor nutritional status. Right-sided approach can be used for treatment of left bronchopleural fistula after pneumonectomy. We report a rare case of left bronchopleural fistula after pneumonectomy for pulmonary tuberculosis in a 38-year-old woman, treated by re-closure and re-stapling of the left main bronchial stump through a right thoracotomy approach. The patient is in excellent general condition and without evidence of bronchopleural fistula and tuberculosis at 3 years from re-closure of the left bronchial stump through right thoracotomy. This approach allowed a successful and safe management of our case of left bronchopleural fistula after pneumonectomy for tuberculosis, without short and long-term complications.
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Affiliation(s)
- Angela De Palma
- Section of Thoracic Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Piazza Giulio Cesare, 11, 70124, Bari, Italy.
| | - Michele Maruccia
- Section of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
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Jiamsakul A, Lee MP, Nguyen KV, Merati TP, Cuong DD, Ditangco R, Yunihastuti E, Ponnampalavanar S, Zhang F, Kiertiburanakul S, Avihingasanon A, Ng OT, Sim BLH, Wong WW, Ross J, Law M. Socio-economic status and risk of tuberculosis: a case-control study of HIV-infected patients in Asia. Int J Tuberc Lung Dis 2019; 22:179-186. [PMID: 29506614 DOI: 10.5588/ijtld.17.0348] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Tuberculosis (TB) is the most common human immunodeficiency virus (HIV) related opportunistic infection and cause of acquired immune-deficiency syndrome related death. TB often affects those from a low socio-economic background. OBJECTIVE To assess the socio-economic determinants of TB in HIV-infected patients in Asia. DESIGN This was a matched case-control study. HIV-positive, TB-positive cases were matched to HIV-positive, TB-negative controls according to age, sex and CD4 cell count. A socio-economic questionnaire comprising 23 questions, including education level, employment, housing and substance use, was distributed. Socio-economic risk factors for TB were analysed using conditional logistic regression analysis. RESULTS A total of 340 patients (170 matched pairs) were recruited, with 262 (77.1%) matched for all three criteria. Pulmonary TB was the predominant type (n = 115, 67.6%). The main risk factor for TB was not having a university level education (OR 4.45, 95%CI 1.50-13.17, P = 0.007). Burning wood or coal regularly inside the house and living in the same place of origin were weakly associated with TB diagnosis. CONCLUSIONS These data suggest that lower socio-economic status is associated with an increased risk of TB in Asia. Integrating clinical and socio-economic factors into HIV treatment may help in the prevention of opportunistic infections and disease progression.
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Affiliation(s)
- A Jiamsakul
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - M-P Lee
- Queen Elizabeth Hospital, Hong Kong, SAR China
| | - K V Nguyen
- National Hospital for Tropical Diseases, Hanoi, Viet Nam
| | - T P Merati
- Faculty of Medicine Udayana University & Sanglah Hospital, Bali, Indonesia
| | | | - R Ditangco
- Research Institute for Tropical Medicine, Manila, The Philippines
| | - E Yunihastuti
- Working Group on AIDS, Faculty of Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - S Ponnampalavanar
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - F Zhang
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - S Kiertiburanakul
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok
| | - A Avihingasanon
- HIV-Netherlands Australia Thailand Research Collaboration, The Thai Red Cross AIDS Research Centre and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - O T Ng
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - B L H Sim
- Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - W-W Wong
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - J Ross
- Therapeutics Research, Education, and AIDS Training in Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - M Law
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
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Muñoz del Carpio-Toia A, Sánchez H, Vergès de López C, Sotomayor MA, López Dávila L, Sorokin P. Tuberculosis en América Latina y el Caribe: reflexiones desde la bioética. PERSONA Y BIOÉTICA 2018. [DOI: 10.5294/pebi.2018.22.2.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
El objetivo de este artículo es analizar las condiciones de acceso a servicios de salud de las personas con tuberculosis en América Latina y el Caribe (ALC), reflexionando desde la bioética sobre los aspectos de salud pública implicados. Se realizó una revisión documental del contexto de la tuberculosis en ALC con base en datos epidemiológicos. Los resultados se analizaron a partir de su relación con los determinantes sociales de la salud, los principios éticos que pautan la práctica médica y la responsabilidad social de los actores de salud. La tuberculosis es un problema de salud pública acuciante en la región, debido a su impacto familiar, comunitario, social, económico y sanitario, que afecta principalmente a personas y poblaciones vulneradas. En ALC la tuberculosis constituye un serio problema ético y de salud pública que causa un significativo número de muertes, discapacidad e incremento de la pobreza. La comprensión de su responsabilidad social por parte de los actores de salud es imperativa para cumplir con el derecho a servicios de salud de calidad, que aseguren un diagnóstico oportuno y un tratamiento completo de la enfermedad, y que guarden los principios de justicia, no discriminación y dignidad de los/las enfermos/as, para lo cual es importante que las estrategias nacionales de control de la tuberculosis incluyan cambios en los determinantes sociales de la enfermedad, así como el respeto de la etnia, cultura, lengua e identidad de los pacientes.
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Noppert GA, Malosh RE, Moran EB, Ahuja SD, Zelner J. Contemporary Social Disparities in TB Infection and Disease in the USA: a Review. CURR EPIDEMIOL REP 2018; 5:442-449. [PMID: 31588406 PMCID: PMC6777735 DOI: 10.1007/s40471-018-0171-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Socioeconomic status (SES) has long been understood to be a key determinant of the distribution of tuberculosis (TB), and the role of social factors has long been a truism of TB epidemiology. We review studies that have examined the social determinants of TB in the USA in the past 20 years. We pay particular attention to how the findings of these studies fit within the framework of fundamental cause theory and argue that a more explicit linkage with fundamental cause theory is critical for understanding the current state of TB health disparities in the USA and for charting a way towards TB elimination in the USA. RECENT FINDINGS AND SUMMARY Our review finds that while in the past 20 years there have been studies that have documented the ongoing association between social factors and TB disease in the USA, few studies explore the precise mechanisms through which social factors continue to influence TB patterns. We advocate for a move towards a system-based approach both in theory development and analyses, allowing for the incorporation of more complex social dynamics to address long-standing disparities in TB disease.
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Affiliation(s)
- Grace A. Noppert
- Carolina Population Center, University of North Carolina, Chapel Hill, Office #2205B, 123 West Franklin St., Chapel Hill, NC 27516, USA
| | - Ryan E. Malosh
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Elizabeth B. Moran
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Shama D. Ahuja
- New York City Department of Health and Mental Hygiene, Bureau of Tuberculosis Control, New York City, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Jon Zelner
- Center for Social Epidemiology & Population Health, University of Michigan School of Public Health, Ann Arbor, MI, USA
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Di Gennaro F, Marotta C, Pizzol D, Chhaganlal K, Monno L, Putoto G, Saracino A, Casuccio A, Mazzucco W. Prevalence and Predictors of Malaria in Human Immunodeficiency Virus Infected Patients in Beira, Mozambique. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15092032. [PMID: 30227677 PMCID: PMC6163722 DOI: 10.3390/ijerph15092032] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 12/31/2022]
Abstract
Co-infection between malaria and HIV has major public health implications. The aims of this study were to assess the malaria prevalence and to identify predictors of positivity to malaria Test in HIV positive patients admitted to the health center São Lucas of Beira, Mozambique. A retrospective cross-sectional study was performed from January 2016 to December 2016. Overall, 701 adult HIV patients were enrolled, positivity to malaria test was found in 232 (33.0%). These patients were found to be more frequently unemployed (76.3%), aged under 40 (72.0%), with a HIV positive partner (22.4%) and with a CD4 cell count <200 (59.9%). The following variables were predictors of malaria: age under 40 (O.R. = 1.56; 95%CI: 1.22–2.08), being unemployed (O.R. = 1.74; 95%CI: 1.24–2.21), irregularity of cotrimoxazole prophylaxis’s (O.R. = 1.42; 95%CI: 1.10–1.78), CD4 cell count <200 (O.R. = 2.01; 95%CI: 1.42–2.32) and tuberculosis comorbidity (O.R. = 1.58; 95%CI: 1.17–2.79). In conclusion, high malaria prevalence was found in HIV patients accessing the out-patients centre of São Lucas of Beira. Our findings allowed us to identify the profile of HIV patients needing more medical attention: young adults, unemployed, with a low CD4 cell count and irregularly accessing to ART and cotrimoxazole prophylaxis.
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Affiliation(s)
- Francesco Di Gennaro
- Department of Infectious Diseases, University of Bari "Aldo Moro", 35128 Bari, Italy.
| | - Claudia Marotta
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", via del Vespro, University of Palermo, 90217 Palermo, Italy.
| | - Damiano Pizzol
- Doctors with Africa-CUAMM, Research Unit, Beira 1363, Mozambique.
| | - Kajal Chhaganlal
- Center for Research in Infectious Diseases, Faculty of Health Sciences, Catholic University of Mozambique, Beira 1363, Mozambique.
| | - Laura Monno
- Department of Infectious Diseases, University of Bari "Aldo Moro", 35128 Bari, Italy.
| | - Giovanni Putoto
- Research Section, Doctors with Africa CUAMM, 35128 Padova, Italy.
| | - Annalisa Saracino
- Department of Infectious Diseases, University of Bari "Aldo Moro", 35128 Bari, Italy.
| | - Alessandra Casuccio
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", via del Vespro, University of Palermo, 90217 Palermo, Italy.
| | - Walter Mazzucco
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", via del Vespro, University of Palermo, 90217 Palermo, Italy.
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Marotta C, Di Gennaro F, Pizzol D, Madeira G, Monno L, Saracino A, Putoto G, Casuccio A, Mazzucco W. The At Risk Child Clinic (ARCC): 3 Years of Health Activities in Support of the Most Vulnerable Children in Beira, Mozambique. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071350. [PMID: 29954117 PMCID: PMC6069480 DOI: 10.3390/ijerph15071350] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 01/08/2023]
Abstract
The concept of “children at risk” changes worldwide according to each specific context. Africa has a large burden of overall risk factors related to childhood health and development, most of which are of an infective or social origin. The aim of this study was to report and analyze the volumes of activities of fifteen At Risk Child Clinics (ARCCs) within the Beira District (Mozambique) over a 3 year-period in order to define the health profile of children accessing such health services. We retrospectively analyzed the data from all of the children accessing one of the 15 Beira ARCCs from January 2015 to December 2017. From this, 17,657 first consultations were registered. The motivations for accessing the services were in order of relevance: HIV exposure (n. 12,300; 69.7%), other risk conditions (n. 2542; 14.4%), Moderate Acute Malnutrition (MAM) (n. 1664; 9.4%), Severe Acute Malnutrition (SAM) (n. 772; 4.4%), and TB exposure (n. 542; 3.1%). During the first consultations, 16,865 children were screened for HIV (95.5%), and 7.89% tested HIV-positive. In our three years of experience, HIV exposure was the main indication for children to access the ARCCs in Mozambique. ARCCs could represent a strategic point to better understand health demands and to monitor the quality of care provided to this vulnerable population group, however significant effort is needed to improve the quality of the data collection.
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Affiliation(s)
- Claudia Marotta
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Via del Vespro, Palermo 90217, Italy.
| | - Francesco Di Gennaro
- Department of Infectious Diseases, University of Bari "Aldo Moro", Bari 70124, Italy.
- Research Unit, Doctors with Africa CUAMM, Beira 1363, Mozambique.
| | - Damiano Pizzol
- Research Unit, Doctors with Africa CUAMM, Beira 1363, Mozambique.
| | | | - Laura Monno
- Department of Infectious Diseases, University of Bari "Aldo Moro", Bari 70124, Italy.
| | - Annalisa Saracino
- Department of Infectious Diseases, University of Bari "Aldo Moro", Bari 70124, Italy.
| | - Giovanni Putoto
- Research Section, Doctors with Africa CUAMM, Padova 35128, Italy.
| | - Alessandra Casuccio
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Via del Vespro, Palermo 90217, Italy.
| | - Walter Mazzucco
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Via del Vespro, Palermo 90217, Italy.
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Wang MG, Huang WW, Wang Y, Zhang YX, Zhang MM, Wu SQ, Sandford AJ, He JQ. Association between tobacco smoking and drug-resistant tuberculosis. Infect Drug Resist 2018; 11:873-887. [PMID: 29928135 PMCID: PMC6003534 DOI: 10.2147/idr.s164596] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Tobacco smoking is a risk factor for tuberculosis but little is known about the relationship between tobacco smoking and drug-resistant tuberculosis (DR-TB). We undertook a systematic review and meta-analysis to quantitatively assess the association between DR-TB and tobacco smoking. Methods We searched for relevant studies in the Ovid MEDLINE, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WANFANG, and WEIPU data-bases from inception to September 1, 2017. Results were expressed as odds ratios (ORs) with accompanying 95% CIs, and subgroup analyses were performed by study design, smoking type, DR-TB type, and multivariate analysis. Results Thirty-three studies related to tobacco smoking and DR-TB were included. We found substantial evidence that tobacco smoking is associated with an increased risk of DR-TB (OR 1.57, 95% CI 1.33–1.86). Associations were also found in subgroup analyses: for multidrug-resistant tuberculosis (OR 1.49, 95% CI 1.19–1.86) and for any DR-TB (OR 1.70, 95% CI 1.3–2.23); the pooled OR was 1.45 (95% CI 1.11–1.90) for current smoking, 2.25 (95% CI 1.46–3.47) for past smoking, and 1.56 (95% CI 1.22–1.98) for smoking history; and similar ORs were also observed in study design and multivariate analysis subgroup analysis. Conclusion This study demonstrated that tobacco smoking is an independent risk factor for DR-TB.
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Affiliation(s)
- Ming-Gui Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Wei-Wei Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Yu Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Yun-Xia Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Miao-Miao Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Shou-Quan Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Andrew J Sandford
- Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada
| | - Jian-Qing He
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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Guix-Comellas EM, Rozas-Quesada L, Velasco-Arnaiz E, Ferrés-Canals A, Estrada-Masllorens JM, Force-Sanmartín E, Noguera-Julian A. Impact of nursing interventions on adherence to treatment with antituberculosis drugs in children and young people: A nonrandomized controlled trial. J Adv Nurs 2018; 74:1819-1830. [PMID: 29726024 DOI: 10.1111/jan.13692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the association of a new nursing intervention on the adherence to antituberculosis treatment in a paediatric cohort (<18 years). BACKGROUND Tuberculosis remains a public health problem worldwide. The risk of developing tuberculosis after primary infection and its severity are higher in children. Proper adherence to antituberculosis treatment is critical for disease control. DESIGN Nonrandomized controlled trial; Phase 1, retrospective (2011-2013), compared with Phase 2, prospective with intervention (2015-2016), in a referral centre for paediatric tuberculosis in Spain (NCT03230409). METHODS A total of 359 patients who received antituberculosis drugs after close contact with a smear-positive patient (primary chemoprophylaxis) or were treated for latent tuberculosis infection or tuberculosis disease were included, 261 in Phase 1 and 98 in Phase 2. In Phase 2, a new nurse-led intervention was implemented in all patients and included two educational steps (written information in the child's native language and follow-up telephone calls) and two monitoring steps (Eidus-Hamilton test and follow-up questionnaire) that were exclusively carried out by nurses. RESULTS Adherence to antituberculosis treatment increased from 74.7% in Phase 1% to 87.8% in Phase 2 (p = 0.014; Chi-square test), after the implementation of the nurse-led intervention. In Phase 2, nonadherence was only associated with being born abroad (28.6% vs. 7.8%; p = 0.019; Chi-square test) and with foreign origin families (27.3% vs. 0%; p < 0.0001; Chi-square test). CONCLUSION The nurse-led intervention was associated to an increase in adherence to antituberculosis treatment. Immigrant-related variables remained major risk factors for sub-optimal adherence in a low-endemic setting.
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Affiliation(s)
- Eva Maria Guix-Comellas
- School of Nursing, Faculty of Medicine and Health Sciences, Department of Medical and Surgical Nursing, University of Barcelona, Barcelona, Spain
| | - Librada Rozas-Quesada
- Childhood Tuberculosis Specialist Unit, Nursing Department, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Eneritz Velasco-Arnaiz
- Malalties infeccioses i resposta inflamatòria sistèmica en pediatria, Unitat d'Infeccions, Servei de Pediatria. Institut de Recerca, Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain
- Traslational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Ariadna Ferrés-Canals
- Childhood Tuberculosis Specialist Unit, Nursing Department, Sant Joan de Déu Hospital, Barcelona, Spain
| | - Joan Maria Estrada-Masllorens
- School of Nursing, Faculty of Medicine and Health Sciences, Department of Medical and Surgical Nursing, University of Barcelona, Barcelona, Spain
| | - Enriqueta Force-Sanmartín
- School of Nursing, Faculty of Medicine and Health Sciences, Department of Medical and Surgical Nursing, University of Barcelona, Barcelona, Spain
| | - Antoni Noguera-Julian
- Traslational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
- Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública, Ciberesp, Madrid, Spain
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Pizzol D, Veronese N, Marotta C, Di Gennaro F, Moiane J, Chhaganlal K, Monno L, Putoto G, Mazzucco W, Saracino A. Predictors of therapy failure in newly diagnosed pulmonary tuberculosis cases in Beira, Mozambique. BMC Res Notes 2018; 11:99. [PMID: 29402317 PMCID: PMC5800087 DOI: 10.1186/s13104-018-3209-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 01/31/2018] [Indexed: 02/08/2023] Open
Abstract
Objective Tuberculosis (TB) remains a major global health issue, ranking in the top ten causes of death worldwide. A deep understanding of factors influencing poor treatment outcomes may allow the development of additional treatment strategies, focused on the most vulnerable groups. Aims of the study were: (i) to evaluate the treatment outcome among TB subjects followed in an outpatient setting and (ii) to analyze factors associated with treatment failure in newly diagnosed patients with pulmonary TB in Beira, the second largest city of Mozambique. Results A total of 301 TB adult patients (32.6% females) were enrolled. Among them, 62 (20.6%) experienced a treatment failure over a 6 months follow-up. On multivariate model, being males (O.R. = 1.73; 95% CI 1.28–2.15), absence of education (O.R. = 1.85; 95% CI 1.02–2.95), monthly income under 50 dollars (O.R. = 1.74; 95% CI 1.24–2.21) and being employed (O.R. = 1.57; 95% CI 1.21–1.70), low body mass index values (O.R. = 1.42; 95% CI 1.18–1.72) and HIV status (O.R. = 1.42; 95% CI 1.10–1.78) increased the likelihood of therapy failure over 6 months of follow-up. In this study, patients who need more medical attention were young males, malnourished, with low income and low educational degree and HIV positive. These subjects were more likely to fail therapy.
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Affiliation(s)
- Damiano Pizzol
- Research Unit, Doctors with Africa-CUAMM, Beira, Mozambique
| | - Nicola Veronese
- Department of Medicine (DIMED)-Geriatrics Section, University of Padova, Padua, Italy
| | - Claudia Marotta
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, via del Vespro, 133, Palermo, Italy
| | - Francesco Di Gennaro
- Department of Infectious Diseases, University of Bari "Aldo Moro", P.zza G Cesare 3, Bari, Italy. .,Doctors with Africa-CUAMM, Padua, Italy.
| | - Jorge Moiane
- Faculty of Health Sciences, Catholic University of Mozambique, Center for Research in Infectious Diseases, Beira, Mozambique
| | - Kajal Chhaganlal
- Faculty of Health Sciences, Catholic University of Mozambique, Center for Research in Infectious Diseases, Beira, Mozambique
| | - Laura Monno
- Department of Infectious Diseases, University of Bari "Aldo Moro", P.zza G Cesare 3, Bari, Italy
| | | | - Walter Mazzucco
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, via del Vespro, 133, Palermo, Italy
| | - Annalisa Saracino
- Department of Infectious Diseases, University of Bari "Aldo Moro", P.zza G Cesare 3, Bari, Italy
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50
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Pizzol D, Di Gennaro F, Chhaganlal KD, Fabrizio C, Monno L, Putoto G, Saracino A. Prevalence of diabetes mellitus in newly diagnosed pulmonary tuberculosis in Beira, Mozambique. Afr Health Sci 2017; 17:773-779. [PMID: 29085405 PMCID: PMC5656213 DOI: 10.4314/ahs.v17i3.20] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction Data regarding the association between diabetes mellitus (DM) and tuberculosis (TB) in Africa are scarce. DM screening among TB patients in Mozambique was carried out. Methods The study was implemented from January to August 2016 in three Urban Health Centers in Beira, Mozambique and recruited adult (>18 years) patients newly diagnosed with pulmonary TB. Results Three hundred and one patients were enrolled (67.4%, males mean age 31.7(SD 11 years). Diabetes was diagnosed in only 3 patients (1%) and impaired glucose tolerance (IGT) in an additional 6 subjects (2%). Conclusion A lower than expected prevalence of DM was observed, which could be explained by the lack of traditional risk factors for DM (overweight, age over 45 years, hypertension and smoking) in Mozambique.
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