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Utpatel C, Zavaleta M, Rojas-Bolivar D, Mühlbach A, Picoy J, Portugal W, Esteve-Solé A, Alsina L, Miotto P, Bartholomeu DC, Sanchez J, Cuadros DF, Alarcon JO, Niemann S, Huaman MA. Prison as a driver of recent transmissions of multidrug-resistant tuberculosis in Callao, Peru: a cross-sectional study. LANCET REGIONAL HEALTH. AMERICAS 2024; 31:100674. [PMID: 38500964 PMCID: PMC10945431 DOI: 10.1016/j.lana.2024.100674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 03/20/2024]
Abstract
Background We sought to identify resistance patterns and key drivers of recent multidrug-resistant tuberculosis (MDR-TB) transmission in a TB-prevalent area in Peru. Methods Cross-sectional study including MDR Mycobacterium tuberculosis complex (Mtbc) strains identified in Callao-Peru between April 2017 and February 2019. Mtbc DNA was extracted for whole genome sequencing which was used for phylogenetic inference, clustering, and resistance mutation analyses. Clusters indicative of recent transmission were defined based on a strain-to-strain distance of ≤5 (D5) single nucleotide polymorphisms (SNPs). Epidemiologic factors linked to MDR-TB clustering were analyzed using Poisson regression. Findings 171 unique MDR-Mtbc strains were included; 22 (13%) had additional fluoroquinolone resistance and were classified as pre-XDR. Six strains (3.5%) harboured bedaquiline (BDQ) resistance mutations and were classified as MDR + BDQ. 158 (92%) Mtbc strains belonged to lineage 4 and 13 (8%) to lineage 2. Using a cluster threshold of ≤5 SNPs, 98 (57%) strains were grouped in one of the 17 D5 clusters indicative of recent transmission, ranging in size from 2 to the largest cluster formed by 53 4.3.3 strains (group_1). Lineage 4.3.3 strains showed the overall highest cluster rate (43%). In multivariate analyses, current or previous imprisonment was independently associated with being part of any MDR-TB transmission clusters (adjusted prevalence ratio [aPR], 1.45; 95% CI, 1.09-1.92). Interpretation Pre-XDR-TB emerged in more than 10% of the MDR-TB strains investigated. Transmission of 4.3.3 Mtbc strains especially of the dominant group_1 clone is a major driver of the MDR-TB epidemic in Callao. Current or previous imprisonment was linked to recent MDR-TB transmissions, indicating an important role of prisons in driving the MDR-TB epidemic. Funding This work was supported in part by the ERANet-LAC Network of the European Union, Latin America and the Caribbean Countries on Joint Innovation and Research Activities, and FONDECYT. Additional support was received from Leibniz Science Campus Evolutionary Medicine of the Lung, the Deutsche Forschungsgemeinschaft (German Research Foundation, under Germany's Excellence Strategy-EXC 2167 Precision Medicine in Inflammation), and the Research Training Group 2501 TransEvo.
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Affiliation(s)
- Christian Utpatel
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany
| | - Milagros Zavaleta
- Centro de Investigaciones Tecnológicas, Biomedicas y Medioambientales, Callao, Peru
| | - Daniel Rojas-Bolivar
- Centro de Investigaciones Tecnológicas, Biomedicas y Medioambientales, Callao, Peru
| | - Andreas Mühlbach
- Centro de Investigaciones Tecnológicas, Biomedicas y Medioambientales, Callao, Peru
| | - Janet Picoy
- Direccion Regional de Salud del Callao, Callao, Peru
| | | | - Ana Esteve-Solé
- Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Laia Alsina
- Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Paolo Miotto
- Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniella C. Bartholomeu
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Jorge Sanchez
- Centro de Investigaciones Tecnológicas, Biomedicas y Medioambientales, Callao, Peru
| | - Diego F. Cuadros
- Department of Geography and GIS, Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, USA
| | - Jorge O. Alarcon
- Centro de Investigaciones Tecnológicas, Biomedicas y Medioambientales, Callao, Peru
- Epidemiology Section, Instituto de Medicina Tropical, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Stefan Niemann
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany
- German Center for Infection Research, Partner Site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany
| | - Moises A. Huaman
- Centro de Investigaciones Tecnológicas, Biomedicas y Medioambientales, Callao, Peru
- Department of Internal Medicine, Division of Infectious Diseases, University of Cincinnati, Cincinnati, USA
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Campbell JR, Brode SK, Barry P, Bastos ML, Bonnet M, Guglielmetti L, Kempker R, Klimuk D, Laniado Laborín R, Milanov V, Singla R, Skrahina A, Trajman A, van der Werf TS, Viiklepp P, Menzies D. Association of indicators of extensive disease and rifampin-resistant tuberculosis treatment outcomes: an individual participant data meta-analysis. Thorax 2024; 79:169-178. [PMID: 38135489 DOI: 10.1136/thorax-2023-220249] [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: 03/15/2023] [Accepted: 10/29/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Indicators of extensive disease-acid fast bacilli (AFB) smear positivity and lung cavitation-have been inconsistently associated with clinical rifampin-resistant/multidrug-resistant tuberculosis (RR/MDR-TB) outcomes. We evaluated the association of these indicators with end-of-treatment outcomes. METHODS We did an individual participant data meta-analysis of people treated for RR/MDR-TB with longer regimens with documented AFB smear and chest radiography findings. We compared people AFB smear-negative without cavities to people: (1) smear-negative with lung cavities; (2) smear-positive without lung cavities and (3) AFB smear-positive with lung cavities. Using multivariable logistic regression accounting for demographic, treatment and clinical factors, we calculated adjusted ORs (aOR) for any unfavourable outcome (death, lost to follow-up, failure/recurrence), and mortality and treatment failure/recurrence alone. RESULTS We included 5596 participants; included participants significantly differed from excluded participants. Overall, 774 (13.8%) were AFB smear-negative without cavities, 647 (11.6%) only had cavities, 1424 (25.4%) were AFB smear-positive alone and 2751 (49.2%) were AFB smear-positive with cavities. The median age was 37 years (IQR: 28-47), 3580 (64%) were male and 686 (12.5%) had HIV. Compared with participants AFB smear-negative without cavities, aOR (95% CI) for any unfavourable outcome was 1.0 (0.8 to 1.4) for participants smear-negative with lung cavities, 1.2 (0.9 to 1.5) if smear-positive without cavities and 1.6 (1.3 to 2.0) if AFB smear-positive with lung cavities. Odds were only significantly increased for mortality (1.5, 95% CI 1.1 to 2.1) and failure/recurrence (2.2, 95% CI 1.5 to 3.3) among participants AFB smear-positive with lung cavities. CONCLUSION Only the combination of AFB smear-positivity and lung cavitation was associated with unfavourable outcomes, suggesting they may benefit from stronger regimens.
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Affiliation(s)
- Jonathon R Campbell
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Montreal Chest Institute & McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - Sarah K Brode
- West Park Healthcare Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Pennan Barry
- Tuberculosis Control Branch, California Department of Public Health, Richmond, California, USA
| | - Mayara Lisboa Bastos
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | | | | | - Russell Kempker
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dzmitry Klimuk
- Republican Scientific and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | | | - Vladimir Milanov
- Occupational Diseases, Medical University-Sofia, Sofia, Bulgaria
| | - Rupak Singla
- Tuberculosis and Respiratory Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | - Alena Skrahina
- Republican Scientific and Practical Centre for Pulmonology and Tuberculosis, Minsk, Belarus
| | - Anete Trajman
- Montreal Chest Institute & McGill International TB Centre, McGill University, Montreal, Quebec, Canada
- Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tjip S van der Werf
- Departments of Internal Medicine, Infectious Diseases, Pulmonary Diseases, and Tuberculosis, UMC Groningen, Groningen, The Netherlands
| | - Piret Viiklepp
- Department of Registries, National Institute for Health Development, Tallinn, Estonia
| | - Dick Menzies
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Montreal Chest Institute & McGill International TB Centre, McGill University, Montreal, Quebec, Canada
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3
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Du M, Liu M, Liu J. Global, regional, and national disease burden and attributable risk factors of HIV/AIDS in older adults aged 70 years and above: a trend analysis based on the Global Burden of Disease study 2019. Epidemiol Infect 2023; 152:e2. [PMID: 38097398 PMCID: PMC10789987 DOI: 10.1017/s0950268823001954] [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: 09/27/2023] [Revised: 11/10/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024] Open
Abstract
We aimed to assess the burden and trend of the HIV/AIDS epidemic among older adults over the past three decades at different geographical levels, based on the data collected from the Global Burden of Diseases (GBD) study 2019. This assessment identified the average annual percentage changes (AAPCs) using Joinpoint regression analysis. Globally, the incidence of HIV/AIDS has decreased (AAPC = -3.107); however, the overall prevalence has consistently increased (AAPC = 5.557). Additionally, both mortality (AAPC = 2.166) and disability-adjusted life years (DALYs; AAPC = 2.429) have increased. The highest increasing trends in female HIV/AIDS incidence and prevalence were observed in the Central Asia region. However, for males, these trends were observed in the Oceania region and the high-income Asia Pacific region, respectively. In recent decades, females aged 70-74 years had the highest incidence and prevalence, while males aged 70-74 years had highest mortality and DALYs in low social development index (SDI) regions. Unsafe sex resulted in 15 381.16 deaths, accounting for 90.73% of all HIV/AIDS deaths, and 331 140.56 DALYs, accounting for 91.12% of all HIV/AIDS DALYs. The HIV/AIDS disease burden differs by region, age, and sex among older adults. Sexual health education and targeted screening for older adults are recommended.
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Affiliation(s)
- Min Du
- 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
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
- Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
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Winters N, Schnitzer ME, Campbell JR, Ripley S, Winston C, Savic R, Ahmad N, Bisson G, Dheda K, Esmail A, Gegia M, Monedero I, Dalcolmo MP, Rodrigues D, Singla R, Yim JJ, Menzies D. Identifying patients with multidrug-resistant tuberculosis who may benefit from shorter durations of treatment. PLoS One 2023; 18:e0292106. [PMID: 37797071 PMCID: PMC10553332 DOI: 10.1371/journal.pone.0292106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Studying treatment duration for rifampicin-resistant and multidrug-resistant tuberculosis (MDR/RR-TB) using observational data is methodologically challenging. We aim to present a hypothesis generating approach to identify factors associated with shorter duration of treatment. STUDY DESIGN AND SETTING We conducted an individual patient data meta-analysis among MDR/RR-TB patients restricted to only those with successful treatment outcomes. Using multivariable linear regression, we estimated associations and their 95% confidence intervals (CI) between the outcome of individual deviation in treatment duration (in months) from the mean duration of their treatment site and patient characteristics, drug resistance, and treatments used. RESULTS Overall, 6702 patients with successful treatment outcomes from 84 treatment sites were included. We found that factors commonly associated with poor treatment outcomes were also associated with longer treatment durations, relative to the site mean duration. Use of bedaquiline was associated with a 0.51 (95% CI: 0.15, 0.87) month decrease in duration of treatment, which was consistent across subgroups, while MDR/RR-TB with fluoroquinolone resistance was associated with 0.78 (95% CI: 0.36, 1.21) months increase. CONCLUSION We describe a method to assess associations between clinical factors and treatment duration in observational studies of MDR/RR-TB patients, that may help identify patients who can benefit from shorter treatment.
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Affiliation(s)
- Nicholas Winters
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Mireille E. Schnitzer
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Canada
| | - Jonathon R. Campbell
- Department of Medicine & Department of Global and Public Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- McGill International TB Centre, Montreal Chest Institute, Research Institute of the McGill University Health Centre, Montreal, Canada
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Susannah Ripley
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
| | - Carla Winston
- US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Rada Savic
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco Schools of Pharmacy and Medicine, San Francisco, California, United States of America
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, California, United States of America
| | - Nafees Ahmad
- Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Gregory Bisson
- Department of Medicine and Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States of America
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, Department of Medicine & UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Ali Esmail
- Centre for Lung Infection and Immunity, Department of Medicine & UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Medea Gegia
- Global Tuberculosis Program, World Health Organization, Geneva, Switzerland
| | - Ignacio Monedero
- TB-HIV Department, International Union against Tuberculosis and Lung Diseases, Paris, France
| | | | | | - Rupak Singla
- National Institute of Tuberculosis & Respiratory Diseases, New Delhi, India
| | - Jae-Joon Yim
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Dick Menzies
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Canada
- McGill International TB Centre, Montreal Chest Institute, Research Institute of the McGill University Health Centre, Montreal, Canada
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5
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Govender T, Furin JJ, Edwards A, Pillay S, Murphy RA. What clinic closure reveals about care for drug-resistant TB: a qualitative study. BMC Infect Dis 2023; 23:474. [PMID: 37460960 DOI: 10.1186/s12879-023-08405-7] [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: 01/29/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND There have been calls for "person-centered" approaches to drug-resistant tuberculosis (DR-TB) care. In 2020, Charles James Hospital in South Africa, which incorporated person-centered care, was closed. Patients were referred mid-course to a centralized, tertiary hospital, providing an opportunity to examine person-centered DR-TB and HIV care from the perspective of patients who lost access to it. METHODS The impact of transfer was explored through qualitative interviews performed using standard methods. Analysis involved grounded theory; interviews were assessed for theme and content. RESULTS After switching to the centralized site, patients reported being unsatisfied with losing access to a single clinic and pharmacy where DR-TB, HIV and chronic disease care were integrated. Patients also reported a loss of care continuity; at the decentralized site there was a single, familiar clinician whereas the centralized site had multiple, changing clinicians and less satisfactory communication. Additionally, patients reported more disease-related stigma and less respectful treatment, noting the loss of a "special place" for DR-TB treatment. CONCLUSION By focusing on a DR-TB clinic closure, we uncovered aspects of person-centered care that were critical to people living with DR-TB and HIV. These perspectives can inform how care for DR-TB is operationalized to optimize treatment retention and effectiveness.
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Affiliation(s)
| | | | - Alex Edwards
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA, USA
- University of Lincoln, Brayford Pool, Lincoln, UK
| | - Selvan Pillay
- Adrenergy Research Innovations, Durban, South Africa
| | - Richard A Murphy
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
- White River Junction Veterans Affairs Medical Center, Medicine Service 163 Veterans Drive, 05009, White River Junction, VT, USA.
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Bayowa JR, Kalyango JN, Baluku JB, Katuramu R, Ssendikwanawa E, Zalwango JF, Akunzirwe R, Nanyonga SM, Amutuhaire JS, Muganga RK, Cherop A. Mortality rate and associated factors among patients co-infected with drug resistant tuberculosis/HIV at Mulago National Referral Hospital, Uganda, a retrospective cohort study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001020. [PMID: 37410761 DOI: 10.1371/journal.pgph.0001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/06/2023] [Indexed: 07/08/2023]
Abstract
Drug resistant tuberculosis (DR-TB)/HIV co-infection remains a growing threat to public health and threatens global TB and HIV prevention and care programs. HIV is likely to worsen the outcomes of DR-TB and DR-TB is likely to worsen the outcomes of HIV despite the scale up of TB and HIV services and advances in treatment and diagnosis. This study determined the mortality rate and factors associated with mortality among persons on treatment co-infected with drug resistant TB and HIV at Mulago National Referral Hospital. We retrospectively reviewed data of 390 persons on treatment that had a DR-TB/HIV co-infection in Mulago National Referral Hospital from January 2014 to December 2019.Modified poisson regression with robust standard errors was used to determine relationships between the independent variables and the dependent variable (mortality) at bivariate and multivariate analysis. Of the 390 participants enrolled, 201(53.9%) were males with a mean age of 34.6 (±10.6) and 129 (33.2%,95% CI = 28.7-38.1%) died. Antiretroviral therapy(ART) initiation (aIRR 0.74, 95% CI = 0.69-0.79), having a body mass index (BMI)≥18.5Kg/m2 (aIRR 1.01, 95% CI = 1.03-1.17), having a documented client phone contact (aIRR 0.85, 95% CI = 0.76-0.97), having a mid-upper arm circumference,(MUAC) ≥18.5cm (aIRR 0.90, 95% CI = 0.82-0.99), being on first and second line ART regimen (aIRR 0.83, 95% CI = 0.77-0.89),having a known viral load (aIRR 1.09, 95% CI = 1.00-1.21) and having an adverse event during the course of treatment (aIRR 0.88, 95% CI = 0.83-0.93) were protective against mortality. There was a significantly high mortality rate due to DR-TB/HIV co-infection. These results suggest that initiation of all persons living with HIV/AIDS (PLWHA) with DR-TB on ART and frequent monitoring of adverse drug events highly reduces mortality.
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Affiliation(s)
- Joan Rokani Bayowa
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joan N Kalyango
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Richard Katuramu
- Ministry of Health, Tuberculosis Control Program, Kampala, Uganda
| | - Emmanuel Ssendikwanawa
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jane Frances Zalwango
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rebecca Akunzirwe
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Stella Maris Nanyonga
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Ronald Kivumbi Muganga
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Adolphus Cherop
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, Kampala, Uganda
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Graciaa DS, Schechter MC, Fetalvero KB, Cranmer LM, Kempker RR, Castro KG. Updated considerations in the diagnosis and management of tuberculosis infection and disease: integrating the latest evidence-based strategies. Expert Rev Anti Infect Ther 2023; 21:595-616. [PMID: 37128947 PMCID: PMC10227769 DOI: 10.1080/14787210.2023.2207820] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/24/2023] [Indexed: 05/03/2023]
Abstract
INTRODUCTION Tuberculosis (TB) is a leading infectious cause of global morbidity and mortality, affecting nearly a quarter of the human population and accounting for over 10 million deaths each year. Over the past several decades, TB incidence and mortality have gradually declined, but 2021 marked a threatening reversal of this trend highlighting the importance of accurate diagnosis and effective treatment of all forms of TB. AREAS COVERED This review summarizes advances in TB diagnostics, addresses the treatment of people with TB infection and TB disease including recent evidence for treatment regimens for drug-susceptible and drug-resistant TB, and draws attention to special considerations in children and during pregnancy. EXPERT OPINION Improvements in diagnosis and management of TB have expanded the available options for TB control. Molecular testing has enhanced the detection of TB disease, but better diagnostics are still needed, particularly for certain populations such as children. Novel treatment regimens have shortened treatment and improved outcomes for people with TB. However, important questions remain regarding the optimal management of TB. Work must continue to ensure the potential of the latest developments is realized for all people affected by TB.
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Affiliation(s)
- Daniel S. Graciaa
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Marcos Coutinho Schechter
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Krystle B. Fetalvero
- Angelo King Medical Research Center-De La Salle Medical and Health Science Institute, Cavite, Philippines
- Department of Family and Community Medicine, Calamba Medical Center, Laguna, Philippines
| | - Lisa Marie Cranmer
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Russell R. Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kenneth G. Castro
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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8
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Ghobadi KN, Roshanaei G, Poorolajal J, Shakiba E, KHassi K, Mahjub H. The estimation of long and short term survival time and associated factors of HIV patients using mixture cure rate models. BMC Med Res Methodol 2023; 23:123. [PMID: 37217850 DOI: 10.1186/s12874-023-01949-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/11/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND HIV is one of the deadliest epidemics and one of the most critical global public health issues. Some are susceptible to die among people living with HIV and some survive longer. The aim of the present study is to use mixture cure models to estimate factors affecting short- and long-term survival of HIV patients. METHODS The total sample size was 2170 HIV-infected people referred to the disease counseling centers in Kermanshah Province, in the west of Iran, from 1998 to 2019. A Semiparametric PH mixture cure model and a mixture cure frailty model were fitted to the data. Also, a comparison between these two models was performed. RESULTS Based on the results of the mixture cure frailty model, antiretroviral therapy, tuberculosis infection, history of imprisonment, and mode of HIV transmission influenced short-term survival time (p-value < 0.05). On the other hand, prison history, antiretroviral therapy, mode of HIV transmission, age, marital status, gender, and education were significantly associated with long-term survival (p-value < 0.05). The concordance criteria (K-index) value for the mixture cure frailty model was 0.65 whereas for the semiparametric PH mixture cure model was 0.62. CONCLUSION This study showed that the frailty mixture cure models is more suitable in the situation where the studied population consisted of two groups, susceptible and non-susceptible to the event of death. The people with a prison history, who received ART treatment, and contracted HIV through injection drug users survive longer. Health professionals should pay more attention to these findings in HIV prevention and treatment.
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Affiliation(s)
- Khadijeh Najafi Ghobadi
- Department of Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ghodratollah Roshanaei
- Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jalal Poorolajal
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ebrahim Shakiba
- Behavioral Disease Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Kaivan KHassi
- Health Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Mahjub
- Department of Biostatistics, School of Public Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
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Chen B, Chen X, Ren Y, Peng Y, Wang F, Zhou L, Xu B. Treatment cascade for patients with multidrug- or rifampicin-resistant tuberculosis and associated factors with patient attrition in southeastern China: a retrospective cohort study. J Infect Public Health 2023; 16:1073-1080. [PMID: 37209611 DOI: 10.1016/j.jiph.2023.05.012] [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: 11/21/2022] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/22/2023] Open
Abstract
OBJECTIVES To address gaps in health services for multidrug- or rifampicin-resistant tuberculosis (MDR/RR-TB), a treatment cascade model was used to evaluate patient retention and attrition at each successive step required to achieve a successful treatment outcome. METHODS From 2015-2018, a four-step treatment cascade model was established in patients with confirmed MDR/RR-TB in southeast China. Step 1: diagnosis of MDR/RR-TB, step 2: Initiation of treatment, step 3: still under treatment at 6 month and step 4: cure or completion of MDR/RR-TB treatment, with each successive step including a gap that shows attrition of patients between steps. The retention and attrition of each step were graphed. Multi-variate logistic regression was carried out to further identify potential factors associated with the attrition. RESULTS In the treatment cascade consisting of 1752 MDR/RR-TB patients, the overall patient attrition rate was 55.8% (978/1752), with 28.0% (491/1752), 19.9% (251/1261), and 23.4% (236/1010) of patients attrition in the first, second, and third gap. Factors associated with MDR/RR-TB patients not initiating treatment included age ≥60 years (OR:2.875), and time for diagnosis ≥30 days (OR: 2.653). Patients who were diagnosed with MDR/RR-TB through rapid molecular test (OR: 0.517) and non-migrant residents of Zhejiang Province (OR: 0.273) both exhibited a lower likelihood of attrition during the treatment initiation phase. Meanwhile, old age (OR: 2.190) and non-resident migrants to the province were factors associated with not completing ≥ 6 months of treatment. Old age (OR: 3.883), retreatment (OR: 1.440), and time to diagnosis ≥30 days (OR: 1.626) were factors contributing to poor treatment outcomes. CONCLUSION Several programmatic gaps were identified in the MDR/RR-TB treatment cascade. Future policies should provide more comprehensive support for vulnerable populations to improve the care quality at each step.
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Affiliation(s)
- Bin Chen
- School of Public Health, Fudan University, Shanghai 200433, People's Republic of China; Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, People's Republic of China
| | - Xinyi Chen
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, People's Republic of China
| | - Yanli Ren
- School of Public Health, Hangzhou Normal University, Hangzhou 311121, People's Republic of China
| | - Ying Peng
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, People's Republic of China
| | - Fei Wang
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, People's Republic of China
| | - Lin Zhou
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, People's Republic of China
| | - Biao Xu
- School of Public Health, Fudan University, Shanghai 200433, People's Republic of China; Key Laboratory of Health Technology Assessment, National Health Commission of the People's Republic of China, Fudan University, Shanghai 200433, People's Republic of China.
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10
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Wei W, Zhao Y, Zhang C, Yu M, Wu Z, Xu L, Peng K, Wu Z, Li Y, Wang X. Whole-genome sequencing and transcriptome-characterized in vitro evolution of aminoglycoside resistance in Mycobacterium tuberculosis. Microb Genom 2023; 9. [PMID: 37224060 DOI: 10.1099/mgen.0.001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Antibiotic resistance of Mycobacterium tuberculosis (Mtb) is a major public health concern worldwide. Therefore, it is of great significance to characterize the mutational pathways by which susceptible Mtb evolves into drug resistance. In this study, we used laboratory evolution to explore the mutational pathways of aminoglycoside resistance. The level of resistance in amikacin inducing Mtb was also associated with changes in susceptibility to other anti-tuberculosis drugs such as isoniazid, levofloxacin and capreomycin. Whole-genome sequencing (WGS) revealed that the induced resistant Mtb strains had accumulated diverse mutations. We found that rrs A1401G was the predominant mutation in aminoglycoside-resistant clinical Mtb isolates from Guangdong. In addition, this study provided global insight into the characteristics of the transcriptome in four representative induced strains and revealed that rrs mutated and unmutated aminoglycoside-resistant Mtb strains have different transcriptional profiles. WGS analysis and transcriptional profiling of Mtb strains during evolution revealed that Mtb strains harbouring rrs A1401G have an evolutionary advantage over other drug-resistant strains under the pressure of aminoglycosides because of their ultra-high resistance level and low physiological impact on the strain. The results of this study should advance our understanding of aminoglycoside resistance mechanisms.
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Affiliation(s)
- Wenjing Wei
- Center for Tuberculosis Control of Guangdong Province, Key Laboratory of Translational Medicine of Guangdong, Guangzhou 510630, PR China
| | - Yuchuan Zhao
- Center for Tuberculosis Control of Guangdong Province, Key Laboratory of Translational Medicine of Guangdong, Guangzhou 510630, PR China
| | - Chenchen Zhang
- Center for Tuberculosis Control of Guangdong Province, Key Laboratory of Translational Medicine of Guangdong, Guangzhou 510630, PR China
| | - Meiling Yu
- Center for Tuberculosis Control of Guangdong Province, Key Laboratory of Translational Medicine of Guangdong, Guangzhou 510630, PR China
| | - Zhuhua Wu
- Center for Tuberculosis Control of Guangdong Province, Key Laboratory of Translational Medicine of Guangdong, Guangzhou 510630, PR China
| | - Liuyue Xu
- Center for Tuberculosis Control of Guangdong Province, Key Laboratory of Translational Medicine of Guangdong, Guangzhou 510630, PR China
| | - Kehao Peng
- Center for Tuberculosis Control of Guangdong Province, Key Laboratory of Translational Medicine of Guangdong, Guangzhou 510630, PR China
| | - Zhilong Wu
- Foshan Fourth People's Hospital, Foshan 528000, PR China
| | - Yanxia Li
- Foshan Fourth People's Hospital, Foshan 528000, PR China
| | - Xuezhi Wang
- Foshan Fourth People's Hospital, Foshan 528000, PR China
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11
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Govender T, Jham MA, Zhang JC, Pillay S, Pak Y, Pillay P, Furin J, Malenfant J, Murphy RA. Decentralized, Integrated Treatment of RR/MDR-TB and HIV Using a Bedaquiline-Based, Short-Course Regimen Is Effective and Associated With Improved HIV Disease Control. J Acquir Immune Defic Syndr 2023; 92:385-392. [PMID: 36729541 PMCID: PMC10006315 DOI: 10.1097/qai.0000000000003150] [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: 09/07/2022] [Accepted: 12/01/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND In decentralized sites, with fewer resources and a high prevalence of advanced HIV, the effectiveness of the new short-course, bedaquiline-based regimen for rifampicin-resistant and multidrug-resistant tuberculosis (RR/MDR-TB) is not well-described. SETTING Adults with pulmonary RR/MDR-TB initiating the short-course regimen in KwaZulu-Natal, South Africa were prospectively enrolled at a decentralized program that integrated person-centered TB care. METHODS In addition to standard of care monitoring, study visits occurred at enrollment and months 1, 2, 4, 6, and 9. Favorable RR/MDR-TB outcome was defined as cure or treatment completion without loss to follow-up, death, or failure by treatment. In patients with HIV, we assessed antiretroviral therapy (ART) uptake, virologic and immunologic outcomes. RESULTS Among 57 patients, HIV was present in 73.7% (95% CI: 60.3-84.5), with a median CD4 count of 170 cells/mm 3 (intraquartile range 49-314). A favorable RR/MDR-TB outcome was achieved in 78.9% (CI: 67.1-87.9). Three deaths occurred, all in the setting of baseline advanced HIV and elevated viral load. Overall, 21.1% (95% CI: 12.1-32.9) experienced a severe or life-threatening adverse event, the most common of which was anemia. Among patients with HIV, enrollment resulted in increased ART uptake by 24% (95% CI: 12.1%-39.4%), a significant improvement from baseline ( P = 0.004); virologic suppression during concomitant treatment was observed in 71.4% (n = 30, 95% CI: 55.4-84.3). CONCLUSION Decentralized, person-centered care for RR/MDR-TB in patients with HIV using the short-course, bedaquiline-based regimen is effective and safe. In patients with HIV, enrollment led to improved ART use and reassuring virologic outcomes.
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Affiliation(s)
| | - Menal A. Jham
- UMMA Community Clinic, Community Clinic Association of Los Angeles County, CA, USA
| | | | - Selvan Pillay
- Adrenergy Research Innovations, Durban, South Africa
| | - Youngju Pak
- Lundquist Institute for Biomedical Innovation, CA, USA
| | | | | | | | - Richard A. Murphy
- Geisel School of Medicine at Dartmouth, NH, USA
- White River Junction Veterans Affairs Medical Center, VT, USA
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12
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Baluku JB, Nabwana M, Mwanahamisi SB, Kansiime G, Nuwagira E, Turyahabwe S, Kirenga B. Early culture conversion is a poor marker of treatment outcome among people with HIV and drug-resistant TB. HIV Med 2023; 24:335-343. [PMID: 36054688 DOI: 10.1111/hiv.13392] [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: 05/12/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Our objective was to determine associations between early (≤2 months) culture conversion (ECC) among people with HIV and drug-resistant tuberculosis (DRTB) in Uganda. METHODS This was a countrywide retrospective cohort of people with bacteriologically confirmed DRTB and a positive baseline culture at 16 centres in Uganda between 2013 and 2019. Data were abstracted from treatment files and unit DRTB registers. Monthly sputum cultures were performed using the Lowenstein-Jensen solid medium. RESULTS We included 664 people with DRTB and a positive baseline culture, of whom 353 (53.4%) also had HIV. Among those living with HIV, 225 (63.7%) were male and 331 (94.3%) were on antiretroviral therapy. The median month of culture conversion was 2 (interquartile range [IQR] 1-3). ECC was observed among 226 people living with HIV (64.0%; 95% confidence interval [CI] 58.9-68.9). A DRTB treatment regimen of six or more drugs was associated with ECC among people living with HIV (adjusted odds ratio [aOR] 3.82; 95% CI 1.06-13.82; p = 0.041). Cure and overall treatment success was observed among 232 (65.7%) and 269 (76.2%) people living with HIV, respectively. However, ECC was not associated with cure (crude odds ratio [OR] 0.97; 95% CI 0.61-1.54; p = 0.901), death (OR 1.12; 95% CI 0.61-2.29; p = 0.610), or overall treatment success (OR 1.29; 95% CI 0.78-2.13; p = 0.326). CONCLUSION The majority of people living with HIV and DRTB achieve ECC. However, ECC does not predict cure, death, or treatment success. Moreover, it may require six or more drugs to achieve ECC. ECC is not an excellent indicator of the effectiveness of DRTB regimens among people living with HIV.
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Affiliation(s)
- Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda
- Makerere University Lung Institute, Kampala, Uganda
| | - Martin Nabwana
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Grace Kansiime
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edwin Nuwagira
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Stavia Turyahabwe
- National TB and Leprosy Program, Ministry of Health, Kampala, Uganda
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13
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Maier C, Chesov D, Schaub D, Kalsdorf B, Andres S, Friesen I, Reimann M, Lange C. Long-term treatment outcomes in patients with multidrug-resistant tuberculosis. Clin Microbiol Infect 2023:S1198-743X(23)00083-6. [PMID: 36842637 DOI: 10.1016/j.cmi.2023.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 02/28/2023]
Abstract
OBJECTIVES To describe long-term treatment outcomes in patients with multi-drug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) and validate established outcome definitions for MDR/RR-TB treatment. METHODS Among patients with MDR/RR-TB admitted to a German MDR/RR-TB referral centre from 1 September 2002 to 29 February 2020, we compared long-term treatment outcomes derived from individual patient follow-up with treatment outcomes defined by WHO-2013, WHO-2021 and the Tuberculosis Network European Trials Group-2016. RESULTS In a total of 163 patients (mean age, 35 years; standard deviation, 13 years; 14/163 [8.6%] living with HIV; 109/163 [66.9%] men, 149/163 [91.4%] migrating to Germany within 5 years), the treatment of culture-confirmed MDR/RR-TB was initiated. Additional drug resistance to a fluoroquinolone or a second-line injectable agent was present in 15 of the 163 (9.2%) Mycobacterium tuberculosis strains; resistance against both the drug classes was present in 29 of the 163 (17.8%) strains. The median duration of MDR/RR-TB treatment was 20 months (interquartile range, 19.3-21.6 months), with a medium of five active drugs included. The median follow-up time was 4 years (47.7 months; interquartile range, 21.7-65.8 months). Among the 163 patients, cure was achieved in 25 (15.3%), 82 (50.3%) and 95 (58.3%) patients according to the outcome definitions of WHO-2013, WHO-2021, and the Tuberculosis Network European Trials Group-2016, respectively. The lost to follow-up rate was 17 of 163 (10.4%). Death was more likely in patients living with HIV (hazard ratio, 4.28; 95% confidence interval, 1.26-12.86) and older patients (hazard ratio, 1.08; 95% confidence interval, 1.05-1.12; increment of 1 year). Overall, 101/163 (62.0%) patients experienced long-term, relapse-free cure; of those, 101/122 (82.8%) patients with a known status (not lost to-follow-up or transferred out) at follow-up. CONCLUSION Under optimal management conditions leveraging individualized treatment regimens, long-term, relapse-free cure from MDR/RR-TB is substantially higher than cure rates defined by current treatment outcome definitions.
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Affiliation(s)
- Christina Maier
- Division of Clinical Infectious Diseases, Research Center Boreal, Boreal, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Hostelries-Rimes, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany
| | - Dumitru Chesov
- Division of Clinical Infectious Diseases, Research Center Boreal, Boreal, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Hostelries-Rimes, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany; Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Dagmar Schaub
- Division of Clinical Infectious Diseases, Research Center Boreal, Boreal, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Hostelries-Rimes, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany
| | - Barbara Kalsdorf
- Division of Clinical Infectious Diseases, Research Center Boreal, Boreal, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Hostelries-Rimes, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany
| | - Sönke Andres
- National Reference Centre for Mycobacteria, Borstel, Germany
| | - Inna Friesen
- National Reference Centre for Mycobacteria, Borstel, Germany
| | - Maja Reimann
- Division of Clinical Infectious Diseases, Research Center Boreal, Boreal, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Hostelries-Rimes, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Boreal, Boreal, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Hostelries-Rimes, Borstel, Germany; Respiratory Medicine and International Health, University of Lübeck, Lübeck, Germany; Baylor College of Medicine and Texas Children's Hospital, Global TB Program, Houston, TX, USA.
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14
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Nicholson TJ, Hoddinott G, Seddon JA, Claassens MM, van der Zalm MM, Lopez E, Bock P, Caldwell J, Da Costa D, de Vaal C, Dunbar R, Du Preez K, Hesseling AC, Joseph K, Kriel E, Loveday M, Marx FM, Meehan SA, Purchase S, Naidoo K, Naidoo L, Solomon-Da Costa F, Sloot R, Osman M. A systematic review of risk factors for mortality among tuberculosis patients in South Africa. Syst Rev 2023; 12:23. [PMID: 36814335 PMCID: PMC9946877 DOI: 10.1186/s13643-023-02175-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/17/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Tuberculosis (TB)-associated mortality in South Africa remains high. This review aimed to systematically assess risk factors associated with death during TB treatment in South African patients. METHODS We conducted a systematic review of TB research articles published between 2010 and 2018. We searched BioMed Central (BMC), PubMed®, EBSCOhost, Cochrane, and SCOPUS for publications between January 2010 and December 2018. Searches were conducted between August 2019 and October 2019. We included randomised control trials (RCTs), case control, cross sectional, retrospective, and prospective cohort studies where TB mortality was a primary endpoint and effect measure estimates were provided for risk factors for TB mortality during TB treatment. Due to heterogeneity in effect measures and risk factors evaluated, a formal meta-analysis of risk factors for TB mortality was not appropriate. A random effects meta-analysis was used to estimate case fatality ratios (CFRs) for all studies and for specific subgroups so that these could be compared. Quality assessments were performed using the Newcastle-Ottawa scale or the Cochrane Risk of Bias Tool. RESULTS We identified 1995 titles for screening, 24 publications met our inclusion criteria (one cross-sectional study, 2 RCTs, and 21 cohort studies). Twenty-two studies reported on adults (n = 12561) and two were restricted to children < 15 years of age (n = 696). The CFR estimated for all studies was 26.4% (CI 18.1-34.7, n = 13257 ); 37.5% (CI 24.8-50.3, n = 5149) for drug-resistant (DR) TB; 12.5% (CI 1.1-23.9, n = 1935) for drug-susceptible (DS) TB; 15.6% (CI 8.1-23.2, n = 6173) for studies in which drug susceptibility was mixed or not specified; 21.3% (CI 15.3-27.3, n = 7375) for people living with HIV/AIDS (PLHIV); 19.2% (CI 7.7-30.7, n = 1691) in HIV-negative TB patients; and 6.8% (CI 4.9-8.7, n = 696) in paediatric studies. The main risk factors associated with TB mortality were HIV infection, prior TB treatment, DR-TB, and lower body weight at TB diagnosis. CONCLUSIONS In South Africa, overall mortality during TB treatment remains high, people with DR-TB have an elevated risk of mortality during TB treatment and interventions to mitigate high mortality are needed. In addition, better prospective data on TB mortality are needed, especially amongst vulnerable sub-populations including young children, adolescents, pregnant women, and people with co-morbidities other than HIV. Limitations included a lack of prospective studies and RCTs and a high degree of heterogeneity in risk factors and comparator variables. SYSTEMATIC REVIEW REGISTRATION The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42018108622. This study was funded by the Bill and Melinda Gates Foundation (Investment ID OPP1173131) via the South African TB Think Tank.
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Affiliation(s)
- Tamaryn J Nicholson
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Infectious Diseases, Imperial College London, London, United Kingdom
| | - Mareli M Claassens
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Human, Biological and Translational Medical Sciences, School of Medicine, University of Namibia, Windhoek, Namibia
| | - Marieke M van der Zalm
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elisa Lopez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- IS Global, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universidad de Barcelona, Barcelona, Spain
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Judy Caldwell
- Community Services and Health Directorate, City of Cape Town, Cape Town, South Africa
| | - Dawood Da Costa
- Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Celeste de Vaal
- Division of Forensic Medicine and Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rory Dunbar
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karen Du Preez
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kay Joseph
- Community Services and Health Directorate, City of Cape Town, Cape Town, South Africa
| | - Ebrahim Kriel
- Metro Health Services, Southern and Western Substructure, Western Cape Government: Health, Cape Town, South Africa
| | - Marian Loveday
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa, CAPRISA-SA-MRC HIV-TB Pathogenesis and Treatment Research Unit, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Florian M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa
| | - Sue-Ann Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan Purchase
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa, CAPRISA-SA-MRC HIV-TB Pathogenesis and Treatment Research Unit, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Lenny Naidoo
- Community Services and Health Directorate, City of Cape Town, Cape Town, South Africa
| | | | - Rosa Sloot
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Muhammad Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- School of Human Sciences, Faculty of Education, Health and Human Sciences, University of Greenwich, London, United Kingdom.
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15
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Campbell JR, Chan ED, Falzon D, Trajman A, Keshavjee S, Leung CC, Miller AC, Monedero-Recuero I, Rodrigues DS, Seo H, Baghaei P, Udwadia Z, Viiklepp P, Bastos M, Menzies D. Low Body Mass Index at Treatment Initiation and Rifampicin-Resistant Tuberculosis Treatment Outcomes: An Individual Participant Data Meta-Analysis. Clin Infect Dis 2022; 75:2201-2210. [PMID: 35476134 DOI: 10.1093/cid/ciac322] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/08/2022] [Accepted: 04/18/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The impact of low body mass index (BMI) at initiation of rifampicin-resistant tuberculosis (RR-TB) treatment on outcomes is uncertain. We evaluated the association between BMI at RR-TB treatment initiation and end-of-treatment outcomes. METHODS We performed an individual participant data meta-analysis of adults aged ≥18 years with RR-TB whose BMI was documented at treatment initiation. We compared odds of any unfavorable treatment outcome, mortality, or failure/recurrence between patients who were underweight (BMI <18.5 kg/m2) and not underweight. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using logistic regression, with matching on demographic, clinical, and treatment-related factors. We evaluated effect modification by human immunodeficiency virus (HIV) status and other variables using likelihood ratio tests. We also estimated cumulative incidence of mortality during treatment stratified by HIV. RESULTS Overall, 5148 patients were included; 1702 (33%) were underweight at treatment initiation. The median (interquartile range) age was 37 years (29 to 47), and 455 (9%) had HIV. Compared with nonunderweight patients, the aOR among underweight patients was 1.7 (95% CI, 1.4-1.9) for any unfavorable outcome, 3.1 (2.4-3.9) for death, and 1.6 (1.2-2.0) for failure/recurrence. Significant effect modification was found for World Health Organization region of treatment. Among HIV-negative patients, 24-month mortality was 14.8% (95% CI, 12.7%-17.3%) for underweight and 5.6% (4.5%-7.0%) for not underweight patients. Among patients with HIV, corresponding values were 33.0% (25.6%-42.6%) and 20.9% (14.1%-27.6%). CONCLUSIONS Low BMI at treatment initiation for RR-TB is associated with increased odds of unfavorable treatment outcome, particularly mortality.
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Affiliation(s)
- Jonathon R Campbell
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada
| | - Edward D Chan
- Department of Academic Affairs and Medicine, National Jewish Health, Denver, Colorado, USA.,Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.,Pulmonary Section, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Dennis Falzon
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Anete Trajman
- Departamento de Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Medicine, Division of Respiratory Diseases, McGill University, Montreal, Canada
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Chi C Leung
- Hong Kong Tuberculosis, Chest, and Heart Diseases Association, Hong Kong
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Ignacio Monedero-Recuero
- TB-HIV Department, International Union against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Denise S Rodrigues
- The Secretary of Health of The State of Sao Paulo, Instituto Clemente Ferreira, São Paulo, Brazil
| | - Haesook Seo
- Department of Tuberculosis, Seoul Metropolitan Government Seobuk Hospital, Seoul, South Korea
| | - Parvaneh Baghaei
- Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zarir Udwadia
- Pulmonary Department, Hinduja Hospital & Research Center, Mumbai, India
| | - Piret Viiklepp
- Department of Registries, National Institute for Health Development, Tallinn, Estonia
| | - Mayara Bastos
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada
| | - Dick Menzies
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada
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Anderson K, Pietersen E, Shepherd BE, Bian A, Dheda K, Warren R, Sterling TR, van der Heijden YF. High mortality among patients hospitalized for drug-resistant tuberculosis with acquired second-line drug resistance and high HIV prevalence. HIV Med 2022; 23:1085-1097. [PMID: 35608016 PMCID: PMC9588462 DOI: 10.1111/hiv.13318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/23/2022] [Accepted: 04/04/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We compared mortality between HIV-positive and HIV-negative South African adults with drug-resistant tuberculosis (DR-TB) and high incidence of acquired second-line drug resistance. METHODS We performed a retrospective review of DR-TB patients with serial second-line TB drug susceptibility tests (2008-2015) who were hospitalized at a specialized TB hospital. We used Kaplan-Meier analysis and Cox models to examine associations with mortality. RESULTS Of 245 patients, the median age was 33 years, 54% were male and 40% were HIV-positive, 96% of whom had ever received antiretroviral therapy (ART). At initial drug resistance detection, 99% of patients had resistance to at least rifampicin and isoniazid, and 18% had second-line drug resistance (fluoroquinolones and/or injectable drugs). At later testing, 88% of patients had acquired additional second-line drug resistance. Patient-initiated treatment interruptions (> 2 months) occurred in 47%. Mortality was 79%. Those with HIV had a shorter time to death (p = 0.02; log-rank): median survival time from DR-TB treatment initiation was 2.44 years [95% confidence interval (CI): 2.09-3.15] versus 3.99 years (95% CI: 3.12-4.75) for HIV-negative patients. HIV-positive patients who received ART within 6 months before DR-TB treatment had a higher mortality hazard than HIV-negative patients [adjusted hazard ratio (aHR) ratio = 1.82, 95% CI: 1.21-2.74]. By contrast, HIV-positive patients who did not receive ART within 6 months before DR-TB treatment did not have a significantly higher mortality hazard than HIV-negative patients (aHR = 1.09; 95% CI: 0.72-1.65), although those on ART had lower median CD4 counts than those not on ART (157 vs. 281 cells/μL, respectively; p = 0.02). CONCLUSIONS A very high incidence of acquired second-line drug resistance and high overall mortality were observed, reinforcing the need to reduce the risk of acquired resistance and for more effective treatment.
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Affiliation(s)
- Kim Anderson
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung InstituteUniversity of Cape TownCape TownSouth Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | - Elize Pietersen
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung InstituteUniversity of Cape TownCape TownSouth Africa
| | - Bryan E. Shepherd
- Department of BiostatisticsVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Aihua Bian
- Department of BiostatisticsVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung InstituteUniversity of Cape TownCape TownSouth Africa
- South African MRC Centre for the Study of Antimicrobial ResistanceUniversity of Cape TownCape TownSouth Africa
- Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical MedicineLondonUK
| | - Robin Warren
- DST‐NRF Centre of Excellence for Biomedical Tuberculosis Research/SAMRC Centre for TB Research/Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health SciencesStellenbosch UniversityTygerbergSouth Africa
| | - Timothy R. Sterling
- Vanderbilt Tuberculosis CenterVanderbilt University School of MedicineNashvilleTennesseeUSA
- Division of Infectious Diseases, Department of MedicineVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Yuri F. van der Heijden
- Vanderbilt Tuberculosis CenterVanderbilt University School of MedicineNashvilleTennesseeUSA
- Division of Infectious Diseases, Department of MedicineVanderbilt University School of MedicineNashvilleTennesseeUSA
- The Aurum InstituteJohannesburgSouth Africa
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17
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Li Z, Lai K, Li T, Lin Z, Liang Z, Du Y, Zhang J. Factors associated with treatment outcomes of patients with drug-resistant tuberculosis in China: A retrospective study using competing risk model. Front Public Health 2022; 10:906798. [PMID: 36159235 PMCID: PMC9490188 DOI: 10.3389/fpubh.2022.906798] [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: 03/29/2022] [Accepted: 08/15/2022] [Indexed: 01/22/2023] Open
Abstract
Objectives Drug-resistant tuberculosis remains a serious public health problem worldwide, particularly in developing countries, including China. This study determined treatment outcomes among a cohort in Guangzhou, China, and identified factors associated with them. Methods We initiated a retrospective study using drug-resistant TB data in Guangzhou from 2016 to 2020, managed by Guangzhou Chest Hospital. A competing risk model was used to identify the factors associated with treatment failure and death, as well as loss to follow-up (LTFU). Results A total of 809 patients were included in the study, of which 281 were under treatment. Of the remaining 528 who had clear treatment outcomes, the number and proportion of treatment success, treatment failure, death, and LTFU were 314 (59.5%), 14 (2.7%), 32 (6.0%), and 168 (31.8%), respectively. Being older and having cavities involving the upper lungs were risk factors for treatment failure and death, while non-Guangzhou household registration and interprovincial mobility were risk factors associated with LTFU. Conclusion Treatment failure and death were significantly associated with cavitation in the lungs, and LTFU was significantly associated with household registration and geographical mobility. Early identification of factors associated with different treatment outcomes is extremely important for policymakers, health experts, and researchers to implement appropriate strategies and measures to treat and manage the TB-infected population in China.
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Affiliation(s)
- Zhiwei Li
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Keng Lai
- Department of Tuberculosis Control and Prevention, Guangzhou Chest Hospital, Guangzhou, China
| | - Tiegang Li
- Department of Administration of Disease Prevention and Control, Guangzhou Health Committee, Guangzhou, China
| | - Zhuochen Lin
- Department of Medical Records, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zichao Liang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuhua Du
- Department of Tuberculosis Control and Prevention, Guangzhou Chest Hospital, Guangzhou, China,Yuhua Du
| | - Jinxin Zhang
- Department of Tuberculosis Control and Prevention, Guangzhou Chest Hospital, Guangzhou, China,*Correspondence: Jinxin Zhang
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18
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Abstract
Mycobacterium tuberculosis, the causative agent of tuberculosis (TB), continues to pose a major public health problem and is the leading cause of mortality in people infected with human immunodeficiency virus (HIV). HIV infection greatly increases the risk of developing TB even before CD4+ T-cell counts decrease. Co-infection provides reciprocal advantages to both pathogens and leads to acceleration of both diseases. In HIV-coinfected persons, the diagnosis and treatment of tuberculosis are particularly challenging. Intensifying integration of HIV and tuberculosis control programmes has an impact on reducing diagnostic delays, increasing early case detection, providing prompt treatment onset, and ultimately reducing transmission. In this Review, we describe our current understanding of how these two pathogens interact with each other, new sensitive rapid assays for TB, several new prevention methods, new drugs and regimens.
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Affiliation(s)
- Qiaoli Yang
- Department of Infectious Diseases, Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Jinjin Han
- Department of Infectious Diseases, Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Jingjing Shen
- Department of Infectious Diseases, Changzhi people’s Hospital, Changzhi, Shanxi Province, China
| | - Xinsen Peng
- Department of Cardiology, Changzhi Medical College, Changzhi, Shanxi Province, China
| | - Lurong Zhou
- Department of Infectious Diseases, Changzhi Medical College, Changzhi, Shanxi Province, China
- *Correspondence: Lurong Zhou, Vice President, Chief Physician, Professor, Department of Infectious Diseases, Changzhi People’s Hospital, No.502 Changzhi Middle Road, Changzhi 046000, Shanxi Province, China. (e-mail: )
| | - Xuejing Yin
- Department of Neurology, Changzhi Medical College, Changzhi, Shanxi Province, China
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Deshkar AT, Shirure PA. Bedaquiline: A Novel Diarylquinoline for Multidrug-Resistant Pulmonary Tuberculosis. Cureus 2022; 14:e28519. [PMID: 36185922 PMCID: PMC9516320 DOI: 10.7759/cureus.28519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022] Open
Abstract
A new drug Bedaquiline, a diarylquinoline agent has been approved by the Food and Drug Administration for the treatment of pulmonary multidrug-resistant tuberculosis. It has been given approval for use along with the basic regimen with only conditional access through the National Program for tuberculosis in India. The major problem with existing antitubercular drugs used for the treatment of multi-drug resistant tuberculosis is antimicrobial resistance, less efficacy, and poor side effect profile. Bedaquiline might be a solution to these issues. Bedaquiline is a first of its class drug with a unique and specific mechanism of action. It inhibits mycobacterial adenosine triphosphate (ATP) synthase's proton pump. There are many randomized clinical trials and cohort studies that reported a higher culture conversion rate with bedaquiline treatment as compared to the control group. Many meta-analyses and systematic reviews have reported higher culture conversion rate, higher cure rate, and lower mortality rate in patients with drug-resistant tuberculosis treated with a bedaquiline-containing regimen. Here is a detailed drug profile of bedaquiline to help health care workers treat tuberculosis patients. Keywords:
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20
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So C, Ling L, Wong WT, Zhang JZ, Ho CM, Ng PY, Shum HP, Yeung AWT, Sin KC, Chan J, Au KF, Liong T, Ho E, Chow FL, Ho L, Chan KM, Joynt GM. Population study on diagnosis, treatment and outcomes of critically ill patients with tuberculosis in Hong Kong (2008-2018). Thorax 2022:thorax-2022-218868. [PMID: 35981883 DOI: 10.1136/thorax-2022-218868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/17/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Tuberculosis (TB) is a preventable and curable disease, but mortality remains high among those who develop sepsis and critical illness from TB. METHODS This was a population-based, multicentre retrospective cohort study of patients admitted to all 15 publicly funded Hong Kong adult intensive care units (ICUs) between 1 April 2008 and 31 March 2019. 940 adult critically ill patients with at least one positive Mycobacterium tuberculosis (MTB) culture were identified out of 133 858 ICU admissions. Generalised linear modelling was used to determine the impact of delay in TB treatment on hospital mortality. Trend of annual Acute Physiology and Chronic Health Evaluation (APACHE) IV-adjusted standardised mortality ratio (SMR) over the 11-year period was analysed by Mann-Kendall's trend test. RESULTS ICU and hospital mortality were 24.7% (232/940) and 41.1% (386/940), respectively. Of those who died in the ICU, 22.8% (53/232) never received antituberculosis drugs. SMR for ICU patients with TB remained unchanged over the study period (Kendall's τb=0.37, p=0.876). After adjustment for age, Charlson comorbidity index, APACHE IV, albumin, vasopressors, mechanical ventilation and renal replacement therapy, delayed TB treatment was directly associated with hospital mortality. In 302/940 (32.1%) of patients, TB could only be established from MTB cultures alone as Ziehl-Neelsen staining or PCR was either not performed or negative. Among this group, only 31.1% (94/302) had concurrent MTB PCR performed. CONCLUSIONS Survival of ICU patients with TB has not improved over the last decade and mortality remains high. Delay in TB treatment was associated with higher hospital mortality. Use of MTB PCR may improve diagnostic yield and facilitate early treatment.
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Affiliation(s)
- Christina So
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Lowell Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai Tat Wong
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Jack Zhenhe Zhang
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Chun Ming Ho
- Department of Intensive Care, Tuen Mun Hospital, Hong Kong, China.,Department of Intensive Care, Pok Oi Hospital, New Territories, Hong Kong SAR, China
| | - Pauline Yeung Ng
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, China
| | - Hoi Ping Shum
- Department of Intensive Care, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Alwin Wai Tak Yeung
- Department of Medicine and Geriatrics, Ruttonjee & Tang Shiu Kin Hospitals, Hong Kong SAR, China
| | - Kai Cheuk Sin
- Department of Intensive Care, Queen Elizabeth Hospital, Hong Kong, China
| | - Jacky Chan
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China
| | - Ka Fai Au
- Department of Intensive Care, Kwong Wah Hospital, Hong Kong, China
| | - Ting Liong
- Department of Intensive Care, United Christian Hospital, Hong Kong, China
| | - Eunise Ho
- Department of Intensive Care, Princess Margaret Hospital, Hong Kong, China.,Department of Intensive Care, Yan Chai Hospital, Hong Kong, Hong Kong, China
| | - Fu Loi Chow
- Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong, China
| | - Laptin Ho
- Department of Intensive Care, North District Hospital, Hong Kong, China
| | - Kai Man Chan
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Gavin Matthew Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, China
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Kokebu DM, Ahmed S, Moodliar R, Chiang CY, Torrea G, Van Deun A, Goodall RL, Rusen ID, Meredith SK, Nunn AJ. Failure or relapse predictors for the STREAM Stage 1 short regimen for RR-TB. Int J Tuberc Lung Dis 2022; 26:753-759. [PMID: 35898125 PMCID: PMC9341498 DOI: 10.5588/ijtld.22.0073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: STREAM (Standardised Treatment Regimens of Anti-tuberculosis drugs for Multidrug-Resistant Tuberculosis) Stage 1 demonstrated non-inferior efficacy of a short regimen for rifampicin-resistant TB (RR-TB) compared to a long regimen as recommended by the WHO. The present paper analyses factors associated with a definite or probable failure or relapse (FoR) event in participants receiving the Short regimen.METHODS: This analysis is restricted to 253 participants allocated to the Short regimen and is based on the protocol-defined modified intention to treat (mITT) population. Multivariable Cox regression models were built using backwards elimination with an exit probability of P = 0.157, equivalent to the Akaike Information Criterion, to identify factors independently associated with a definite or probable FoR event.RESULTS: Four baseline factors were identified as being significantly associated with the risk of definite or probable FoR (male sex, a heavily positive baseline smear grade, HIV co-infection and the presence of costophrenic obliteration). There was evidence of association of culture positivity at Week 8 and FoR in a second model and Week 16 smear positivity, presence of diabetes and of smoking in a third model.CONCLUSION: The factors associated with FoR outcomes identified in this analysis should be considered when determining the optimal shortened treatment regimen.
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Affiliation(s)
- D. M. Kokebu
- St Peter’s Tuberculosis Specialised Hospital/Global Health Committee, Addis Ababa, Ethiopia
| | - S. Ahmed
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - R. Moodliar
- Tuberculosis & HIV Investigative Network (THINK), Doris Goodwin Hospital, Pietermaritzburg, South Africa
| | - C-Y. Chiang
- Division of Pulmonary Medicine, Department of Internal Medicine, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan
, Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
, International Union Against Tuberculosis and Lung Disease, Paris, France
| | - G. Torrea
- Institute of Tropical Medicine, Antwerp, Belgium
| | - A. Van Deun
- Institute of Tropical Medicine, Antwerp, Belgium
| | - R. L. Goodall
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - I. D. Rusen
- Research Division, Vital Strategies, New York, USA
| | - S. K. Meredith
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - A. J. Nunn
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
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22
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Xue Y, Zhou J, Wang P, Lan JH, Lian WQ, Fan YY, Xu BN, Yin JP, Feng ZH, Zhou J, Jia CY. Burden of tuberculosis and its association with socio-economic development status in 204 countries and territories, 1990–2019. Front Med (Lausanne) 2022; 9:905245. [PMID: 35935764 PMCID: PMC9355511 DOI: 10.3389/fmed.2022.905245] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/24/2022] [Indexed: 12/04/2022] Open
Abstract
Background Tuberculosis (TB) always runs in the forefront of the global burden when it comes to infectious diseases. Tuberculosis, which can lead to impairment of quality of life, financial hardship, discrimination, marginalization, and social barriers, is a major public health problem. The assessment of TB burden and trend can provide crucial information for policy decision and planning, and help countries in the world to achieve the goal of sustainable development of ending the epidemic of TB in 2030. Methods All data are from the Global Burden of Disease 2019 (GBD 2019) database, which analyzed the burden trend of age-standardized incidence, DALYs, and deaths rate in TB and HIV/AIDS-infected TB over the past 30 years. Also, GBD 2019 not only analyzed the burden distribution of TB in 204 countries and main regions of the world but also analyzed the relationship between the burden of global TB and the socio–demographic Index (SDI). Results The age-standardized incidence, age-standardized disability-adjusted life years (DALYs), and age-standardized deaths rate for HIV-negative TB were 10,671.45 (9,395.60–12,194.10), 59,042.45 (53,684.78–64,641.53), and 1,463.62 (1,339.24–1,602.71) (95% CI, per 100,000 person-years) in 2019, respectively. Age-standardized incidence, age-standardized DALYs, and age-standardized deaths rate of HIV/AIDS-XDR-TB (95% CI, per 1,000 person-years) were 2.10 (1.51–2.90), 64.23 (28.64–117.74), and 1.01 (0.42–1.86), respectively. We found that TB is inversely proportional to SDI, the age-standardized incidence, DALYs, and deaths rate low burden countries were in high SDI areas, while high burden countries were in low SDI areas. The global TB showed a slow decline trend, but the age-standardized incidence of HIV-positive TB was increasing, and mainly distributed in sub-Saharan Africa. Conclusion Age-standardized incidence, age-standardized DALYs, and age-standardized deaths rate of TB is related to SDI, and the burden of low SDI countries is lighter than that of high SDI countries. Without effective measures, it will be difficult for countries around the world to achieve the goal of ending the TB epidemic by 2030. Effective control of the spread of TB requires concerted efforts from all countries in the world, especially in the countries with low SDI, which need to improve the diagnosis and preventive measures of TB and improve the control of HIV/AIDS-TB.
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Affiliation(s)
- Yi Xue
- Department of Burns and Plastic and Wound Repair Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jie Zhou
- School of Medicine, Xiamen University, Xiamen, China
| | - Peng Wang
- Department of Burns and Plastic and Wound Repair Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jun-hong Lan
- Department of Burns and Plastic and Wound Repair Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Wen-qin Lian
- Department of Burns and Plastic and Wound Repair Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Yue-Ying Fan
- Department of Burns and Plastic and Wound Repair Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Bei-Ni Xu
- Department of Clinical Laboratory, Shanghai Ninth people's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jia-Peng Yin
- Division of Plastic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zi-hao Feng
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Chi-Yu Jia
| | - Jian Zhou
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
- Jian Zhou
| | - Chi-Yu Jia
- Department of Burns and Plastic and Wound Repair Surgery, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- Zi-hao Feng
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23
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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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24
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Ndjeka N, Campbell JR, Meintjes G, Maartens G, Schaaf HS, Hughes J, Padanilam X, Reuter A, Romero R, Ismail F, Enwerem M, Ferreira H, Conradie F, Naidoo K, Menzies D. Treatment outcomes 24 months after initiating short, all-oral bedaquiline-containing or injectable-containing rifampicin-resistant tuberculosis treatment regimens in South Africa: a retrospective cohort study. THE LANCET INFECTIOUS DISEASES 2022; 22:1042-1051. [PMID: 35512718 PMCID: PMC9217754 DOI: 10.1016/s1473-3099(21)00811-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/05/2021] [Accepted: 12/16/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Norbert Ndjeka
- National Department of Health, Tuberculosis Control and Management Cluster, Pretoria, South Africa; Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa.
| | - Jonathon R Campbell
- Department of Epidemiology, Biostatistics, and Occupational Health and the McGill International TB Centre, McGill University, and The Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada
| | - Graeme Meintjes
- Department of Medicine and Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
| | - Gary Maartens
- Department of Medicine and Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jennifer Hughes
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Xavier Padanilam
- Sizwe Tropical Disease Hospital, Department of Health, Johannesburg, South Africa
| | - Anja Reuter
- Medicines Sans Frontieres, Khayelitsha, South Africa
| | - Rodolfo Romero
- Clinical head, District Clinical Specialist Team, Namakwa, South Africa
| | - Farzana Ismail
- Centre for Tuberculosis, National Institute for Communicable Diseases, Johannesburg, South Africa; Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | | | - Hannetjie Ferreira
- Klerksdorp and Tshepong Hospital Complex MDR/XDR TB Unit, Northwest Provincial Department of Health, Mahikeng, South Africa
| | - Francesca Conradie
- Department of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Kogieleum Naidoo
- Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa; Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa; South African Medical Research Council (SAMRC)-CAPRISA TB-HIV Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Dick Menzies
- Department of Epidemiology, Biostatistics, and Occupational Health and the McGill International TB Centre, McGill University, and The Montreal Chest Institute, McGill University Health Centre, Montreal, QC, Canada
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25
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Effectiveness of the Novel Anti-TB Bedaquiline against Drug-Resistant TB in Africa: A Systematic Review of the Literature. Pathogens 2022; 11:pathogens11060636. [PMID: 35745490 PMCID: PMC9229213 DOI: 10.3390/pathogens11060636] [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] [Received: 04/29/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background: In 2018, an estimated 10.0 million people contracted tuberculosis (TB), and 1.5 million died from it, including 1.25 million HIV-negative persons and 251,000 HIV-associated TB fatalities. Drug-resistant tuberculosis (DR-TB) is an important contributor to global TB mortality. Multi-drug-resistant TB (MDR-TB) is defined as TB resistant to at least isoniazid (INH) and rifampin (RMP), which are recommended by the WHO as essential drugs for treatment. Objective: To investigate the effectiveness of bedaquiline addition to the treatment of drug-resistant TB infections on the African continent. Methodology: The search engine databases Medline, PubMed, Google Scholar, and Embase were used to obtain published data pertaining to DR-TB between 2012 and 2021 in Africa. Included studies had to document clinical characteristics at treatment initiation and outcomes at the end of treatment (i.e., success, failure, recurrence, loss to follow-up, and death). The included studies were used to conduct a meta-analysis. All data analysis and visualization were performed using the R programming environment. The log risk ratios and sample variances were calculated for DR-TB patients treated with BBQ monotherapy vs. BDQ and other drug therapy. To quantify heterogeneity among the included studies, random effect sizes were calculated. Results: A total of 16 studies in Africa from Mozambique (N = 1 study), Eswatini (N = 1 study), Democratic Republic of the Congo (N = 1 study), South Africa (N = 12 studies), and a multicenter study undertaken across Africa (N = 1 study) were included. In total, 22,368 individuals participated in the research studies. Among the patients, (55.2%; 12,350/22,368) were male while 9723/22,368 (44%) were female. Overall, (9%; 2033/22,368) of patients received BDQ monotherapy, while (88%; 19,630/22,368) patients received bedaquiline combined with other antibiotics. In total, (42%; 9465/22,368) of the patients were successfully treated. About (39%; 8653/22,368) of participants finished their therapy, meanwhile (5%; 1166/22,368) did not finish their therapy, while people (0.4%; 99/22,368) were lost to follow up. A total of (42%; 9265/22,368) patients died. Conclusion: Very few studies on bedaquiline usage in DR-TB in Africa have been published to date. Bedaquiline has been shown to enhance DR-TB results in clinical studies and programmatic settings. Hence, the World Health Organization (WHO) has recommended that it be included in DR-TB regimens. However, in the current study limited improvement to DR-TB treatment results were observed using BDQ on the continent. Better in-country monitoring and reporting, as well as multi-country collaborative cohort studies of DR-TB, can expand the knowledge of bedaquiline usage and clinical impact, as well as the risks and benefits throughout the continent.
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Du M, Yuan J, Jing W, Liu M, Liu J. The Effect of International Travel Arrivals on the New HIV Infections in 15–49 Years Aged Group Among 109 Countries or Territories From 2000 to 2018. Front Public Health 2022; 10:833551. [PMID: 35252102 PMCID: PMC8888525 DOI: 10.3389/fpubh.2022.833551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The prevalent international travel may have an impact on new HIV infections, but related studies were lacking. We aimed to explore the association between international travel arrivals and new HIV infections in 15–49 years aged group from 2000 to 2018, to make tailored implications for HIV prevention. Methods We obtained the data of new HIV infections from the Joint United Nations Programme on HIV/AIDS and international travel arrivals from the World Bank. Correlation analysis was used to explore the relation briefly. Log-linear models were built to analyze the association between international travel arrivals and new HIV infections. Results International travel arrivals were positively correlated with new HIV infections (correlation coefficients: 0.916, p < 0.001). After controlling population density, the median age of the total population (years), socio-demographic index (SDI), travel-related mandatory HIV testing, HIV-related restrictions, and antiretroviral therapy coverage, there were 6.61% (95% CI: 5.73, 7.50; p < 0.001) percentage changes in new HIV infections of 15–49 years aged group associated with a 1 million increase in international travel arrivals. Conclusions Higher international travel arrivals were correlated with new HIV infections in 15–49 years aged group. Therefore, multipronged structural and effective strategies and management should be implemented and strengthened.
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Mohr-Holland E, Daniels J, Reuter A, Rodriguez CA, Mitnick C, Kock Y, Cox V, Furin J, Cox H. Early mortality during rifampicin-resistant TB treatment. Int J Tuberc Lung Dis 2022; 26:150-157. [PMID: 35086627 PMCID: PMC8802559 DOI: 10.5588/ijtld.21.0494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/30/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND: Data suggest that treatment with newer TB drugs (linezolid [LZD], bedaquiline [BDQ] and delamanid [DLM]), used in Khayelitsha, South Africa, since 2012, reduces mortality due to rifampicin-resistant TB (RR-TB).METHODS: This was a retrospective cohort study to assess 6-month mortality among RR-TB patients diagnosed between 2008 and 2019.RESULTS: By 6 months, 236/2,008 (12%) patients died; 12% (78/651) among those diagnosed in 2008-2011, and respectively 8% (49/619) and 15% (109/738) with and without LZD/BDQ/DLM in 2012-2019. Multivariable analysis showed a small, non-significant mortality reduction with LZD/BDQ/DLM use compared to the 2008-2011 period (aOR 0.79, 95% CI 0.5-1.2). Inpatient treatment initiation (aOR 3.2, 95% CI 2.4-4.4), fluoroquinolone (FQ) resistance (aOR 2.7, 95% CI 1.8-4.2) and female sex (aOR 1.5, 95% CI 1.1-2.0) were also associated with mortality. When restricted to 2012-2019, use of LZD/BDQ/DLM was associated with lower mortality (aOR 0.58, 95% CI 0.39-0.87).CONCLUSIONS: While LZD/BDQ/DLM reduced 6-month mortality between 2012 and 2019, there was no significant effect overall. These findings may be due to initially restricted LZD/BDQ/DLM use for those with high-level resistance or treatment failure. Additional contributors include increased treatment initiation among individuals who would have otherwise died before treatment due to universal drug susceptibility testing from 2012, an effect that also likely contributed to higher mortality among females (survival through to care-seeking).
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Affiliation(s)
- E Mohr-Holland
- Khayelitsha Project, Médecins Sans Frontières (MSF), Cape Town, South Africa, Southern Africa Medical Unit, MSF, Cape Town, South Africa
| | - J Daniels
- Khayelitsha Project, Médecins Sans Frontières (MSF), Cape Town, South Africa
| | - A Reuter
- Khayelitsha Project, Médecins Sans Frontières (MSF), Cape Town, South Africa
| | - C A Rodriguez
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - C Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Y Kock
- National Department of Health, Pretoria, South Africa
| | - V Cox
- Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - H Cox
- Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape Town, South Africa, Institute for Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Disease Research in Africa, University of Cape Town, Cape Town, South Africa
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Dutt R, Singh R, Majhi J, Basu G. Status of drug resistant tuberculosis among patients attending a tuberculosis unit of West Bengal: A record based cross-sectional study. J Family Med Prim Care 2022; 11:84-89. [PMID: 35309659 PMCID: PMC8930159 DOI: 10.4103/jfmpc.jfmpc_576_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/02/2022] Open
Abstract
Context: Tuberculosis (TB) is one of the main causes of death due to infectious diseases worldwide. Multidrug resistance/rifampicin resistance (MDR/RR) TB remains a public health crisis. India has the highest burden of tuberculosis and multidrug resistant TB (MDR TB) in the world. There is wide geographical variation in the epidemic and its trends that can be updated by regular reporting and sound surveillance systems. The current study tries to fill this gap by analyzing the data of TB patients from a Tuberculosis Unit, studying socio-demographic and clinical profile from December 2017 to November 2019 in Nadia district of West Bengal. Aims: The aims of this work were to study socio-demographic and clinical profile of TB patients attending Tuberculosis Unit of West Bengal, and to find out factors associated with drug-resistant TB. Settings and Design: Record-based study from Tuberculosis Unit. Methods: Records of all patients who undergo CBNAAT in TU are stored as monthly unit. We randomly selected 10 months from a period of December 2017 to November 2019 by using lot method. Data of all patients undergoing CBNAAT at Kalyani – Gayeshpur Tuberculosis Unit during randomly selected 10 months were accessed. Statistical Analysis Used: Monthly data was entered in Microsoft Excel and descriptive tests of significance, proportions and Chi-square were applied. Results: There was male preponderance for testing of tuberculosis. Seven percent of the TB suspects were HIV positive. The positivity rate of MTB by CBNAAT was 23%. Four percent of the samples were Rifampicin resistance. Tobacco consumption, contact with TB case and Diabetes were common risk factors of TB. Most of the information was missing in the records. Conclusions: Most of Rifampicin Resistant cases showed very low Ct value in CBNAAT. Previous history of TB treatment and positive HIV status was significantly associated with RR TB. There is a need to capture complete information on the records of presumptive TB cases.
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Riccardi N, Canetti D, Rodari P, Besozzi G, Saderi L, Dettori M, Codecasa LR, Sotgiu G. Tuberculosis and pharmacological interactions: A narrative review. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2021; 2:100007. [PMID: 34909643 PMCID: PMC8663953 DOI: 10.1016/j.crphar.2020.100007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 02/04/2023] Open
Abstract
Even if major improvements in therapeutic regimens and treatment outcomes have been progressively achieved, tuberculosis (TB) remains the leading cause of death from a single infectious microorganism. To improve TB treatment success as well as patients' quality of life, drug-drug-interactions (DDIs) need to be wisely managed. Comprehensive knowledge of anti-TB drugs, pharmacokinetics and pharmacodynamic (PK/PD) parameters, potential patients’ changes in absorption and distribution, possible side effects and interactions, is mandatory to built effective anti-TB regimens. Optimization of treatments and adherence to international guidelines can help bend the curve of TB-related mortality and, ultimately, decrease the likelihood of treatment failure and drop-out during anti-TB treatment. Aim of this paper is to describe the most relevant DDIs between anti-TB and other drugs used in daily clinical practice, providing an updated and “easy-to-use” guide to minimize adverse effects, drop-outs and, in the long run, increase treatment success. Tuberculosis (TB) remains the leading cause of death from a single infectious microorganism. Comprehensive knowledge of anti-TB drugs and PK/PD parameters is mandatory to built effective anti-TB regimens. Drug-drug-interactions (DDIs) need to be avoided and/or wisely managed to ensure treatment success. Optimization of anti-TB treatment to avoid DDIs can help to bend the curve of TB related mortality.
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Affiliation(s)
- Niccolò Riccardi
- StopTB Italia Onlus, Milan, Italy
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Diana Canetti
- StopTB Italia Onlus, Milan, Italy
- Clinic of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Rodari
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | | | - Laura Saderi
- StopTB Italia Onlus, Milan, Italy
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Marco Dettori
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Luigi R. Codecasa
- StopTB Italia Onlus, Milan, Italy
- Regional TB Reference Centre, Villa Marelli Inst., Niguarda Hospital, Milan, Italy
| | - Giovanni Sotgiu
- StopTB Italia Onlus, Milan, Italy
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
- Corresponding author. Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
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Edessa D, Adem F, Hagos B, Sisay M. Incidence and predictors of mortality among persons receiving second-line tuberculosis treatment in sub-Saharan Africa: A meta-analysis of 43 cohort studies. PLoS One 2021; 16:e0261149. [PMID: 34890421 PMCID: PMC8664218 DOI: 10.1371/journal.pone.0261149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/27/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Drug resistance remains from among the most feared public health threats that commonly challenges tuberculosis treatment success. Since 2010, there have been rapid evolution and advances to second-line anti-tuberculosis treatments (SLD). However, evidence on impacts of these advances on incidence of mortality are scarce and conflicting. Estimating the number of people died from any cause during the follow-up period of SLD as the incidence proportion of all-cause mortality is the most informative way of appraising the drug-resistant tuberculosis treatment outcome. We thus aimed to estimate the pooled incidence of mortality and its predictors among persons receiving the SLD in sub-Saharan Africa. METHODS We systematically identified relevant studies published between January, 2010 and March, 2020, by searching PubMed/MEDLINE, EMBASE, SCOPUS, Cochrane library, Google scholar, and Health Technology Assessment. Eligible English-language publications reported on death and/or its predictors among persons receiving SLD, but those publications that reported death among persons treated for extensively drug-resistant tuberculosis were excluded. Study features, patients' clinical characteristics, and incidence and/or predictors of mortality were extracted and pooled for effect sizes employing a random-effects model. The pooled incidence of mortality was estimated as percentage rate while risks of the individual predictors were appraised based on their independent associations with the mortality outcome. RESULTS A total of 43 studies were reviewed that revealed 31,525 patients and 4,976 deaths. The pooled incidence of mortality was 17% (95% CI: 15%-18%; I2 = 91.40; P = 0.00). The studies used varied models in identifying predictors of mortality. They found diagnoses of clinical conditions (RR: 2.36; 95% CI: 1.82-3.05); excessive substance use (RR: 2.56; 95% CI: 1.78-3.67); HIV and other comorbidities (RR: 1.96; 95% CI: 1.65-2.32); resistance to SLD (RR: 1.75; 95% CI: 1.37-2.23); and male sex (RR: 1.82; 95% CI: 1.35-2.44) as consistent predictors of the mortality. Few individual studies also reported an increased incidence of mortality among persons initiated with the SLD after a month delay (RR: 1.59; 95% CI: 0.98-2.60) and those persons with history of tuberculosis (RR: 1.21; 95% CI: 1.12-1.32). CONCLUSIONS We found about one in six persons who received SLD in sub-Saharan Africa had died in the last decade. This incidence of mortality among the drug-resistant tuberculosis patients in the sub-Saharan Africa mirrors the global average. Nevertheless, it was considerably high among the patients who had comorbidities; who were diagnosed with other clinical conditions; who had resistance to SLD; who were males and substance users. Therefore, modified measures involving shorter SLD regimens fortified with newer or repurposed drugs, differentiated care approaches, and support of substance use rehabilitation programs can help improve the treatment outcome of persons with the drug-resistant tuberculosis. TRIAL REGISTRATION NUMBER CRD42020160473; PROSPERO.
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Affiliation(s)
- Dumessa Edessa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fuad Adem
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bisrat Hagos
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Efficacy of integrating short-course chemotherapy with Chinese herbs to treat multi-drug resistant pulmonary tuberculosis in China: a study protocol. Infect Dis Poverty 2021; 10:131. [PMID: 34742353 PMCID: PMC8572065 DOI: 10.1186/s40249-021-00913-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/20/2021] [Indexed: 02/03/2023] Open
Abstract
Background Tuberculosis (TB) caused Mycobacterium tuberculosis (M.tb) is one of infectious disease that lead a large number of morbidity and mortality all over the world. Although no reliable evidence has been found, it is considered that combining chemotherapeutic drugs with Chinese herbs can significantly improves the cure rate and the clinical therapeutic effect. Methods Multi-drug resistant pulmonary tuberculosis (MDR-PTB, n = 258) patients with Qi-yin deficiency syndrome will be randomly assigned into a treatment group (n = 172) or control/placebo group (n = 86). The treatment group will receive the chemotherapeutic drugs combined with Chinese herbs granules (1 + 3 granules), while the control group will receive the chemotherapeutic drugs combined with Chinese herbs placebo (1 + 3 placebo granules). In addition, MDR-PTB (n = 312) patients with Yin deficiency lung heat syndrome will be randomly assigned to a treatment (n = 208) or control/placebo (n = 104) group. The treatment group will receive the chemotherapeutic regimen combined with Chinese herbs granules (2 + 4 granules), while the control group will receive the chemotherapeutic drugs and Chinese herbs placebo (2 + 4 placebo granules). The primary outcome is cure rate, the secondary outcomes included time to sputum culture conversion, lesion absorption rate and cavity closure rate. BACTEC™ MGIT™ automated mycobacterial detection system will be used to evaluate the M.tb infection and drug resistance. Chi-square test and Cox regression will be conducted with SAS 9.4 Statistical software to analyze the data. Discussion The treatment cycle for MDR-PTB using standardized modern medicine could cause lengthy substantial side effects. Chinese herbs have been used for many years to treat MDR-PTB, but are without high-quality evidence. Hence, it is unknown whether Chinese herbs enhances the clinical therapeutic effect of synthetic drugs for treating MDR-PTB. Therefore, this study will be conducted to evaluate the clinical therapeutic effect of combining Chinese herbs and chemotherapeutic drugs to treat MDR-PTB cases. It will assist in screening new therapeutic drugs and establishing treatment plan that aims to improve the clinical therapeutic effect for MDR-PTB patients. Trial registration This trial was registered at ClinicalTrials.gov (ChiCTR1900027720) on 24 November 2019 (prospective registered). Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-021-00913-5.
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Ismail N, Rivière E, Limberis J, Huo S, Metcalfe JZ, Warren RM, Van Rie A. Genetic variants and their association with phenotypic resistance to bedaquiline in Mycobacterium tuberculosis: a systematic review and individual isolate data analysis. THE LANCET MICROBE 2021; 2:e604-e616. [PMID: 34796339 PMCID: PMC8597953 DOI: 10.1016/s2666-5247(21)00175-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Background Methods Findings Interpretation Funding
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Charlie L, Saidi B, Getachew E, Wanjiru CL, Abebe M, Tesfahunei HA, Atim MG, Manyazewal T, Mlera RN. Programmatic challenges in managing multidrug-resistant tuberculosis in Malawi. Int J Mycobacteriol 2021; 10:255-259. [PMID: 34494563 PMCID: PMC8542254 DOI: 10.4103/ijmy.ijmy_47_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Multidrug-resistant tuberculosis (MDR-TB) is one of the most urgent challenges that Malawi tends to take a firm public health action. A recent increase in multidrug MDR-TB cases, a decrease in treatment success rate, and a double increase of lost-to-follow-up call into question the country's programmatic management of MDR-TB (PMDT). As such, the study aimed at exploring programmatic challenges in managing MDR-TB in Malawi. Methods A comprehensive and nonsystematic search was made in PubMed and Google Scholar using mainly the keywords "MDR-TB" "extensively drug-resistant TB," Malawi. The study reviewed existing guidelines and gray literature and reviewed data obtained from the national TB program (NTP) as well. Results The study found the following challenges affecting PMDT: decrease in funding, partial access to GeneXpert, delay in diagnosis, long treatment duration, lack of adequate personal protective equipment, the long turnaround time of culture results, failure to initiate all diagnosed patients on treatment, absence of alternative second-line medicines, and lack of transport from health facilities to patient homes. Conclusion If the Malawi NTP is to achieve a vision of a "TB-free Malawi," rigorous efforts at all levels must be made, including mobilizing domestic resources for improved MDR-TB program performance. Developing partners should continue providing the much-needed funding to the Malawi government to stand in the wake of the MDR-TB crisis.
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Affiliation(s)
- Loveness Charlie
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University; KNCV TB Foundation, Challenge TB Project, Blantyre, Malawi
| | - Bibie Saidi
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Blantyre, Malawi; Kibong'oto National Tuberculosis Hospital, Kilimanjaro, Tanzania
| | - Emnet Getachew
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Blantyre, Malawi; Department of Public Health, College of Health Science, Arsi University, Asella, Ethiopia
| | - Cathreen Lydiah Wanjiru
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Blantyre, Malawi
| | - Mekdelawit Abebe
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Blantyre, Malawi; Department of Nursing, Saint Peter Tuberculosis Specialized Hospital, Addis Ababa, Ethiopia
| | - Hanna Amanuel Tesfahunei
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Blantyre, Malawi; Hager Biomedical Research Institute, Asmara, Eritrea
| | - Mary Gorret Atim
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Blantyre, Malawi; Department of Clinical Pharmacy, Soroti Regional Referral Hospital, Soroti, Uganda
| | - Tsegahun Manyazewal
- Center for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Blantyre, Malawi
| | - Ronald Nachipo Mlera
- Department of Professional Practice and Conduct, Nurses and Midwives Council of Malawi, Lilongwe, Malawi
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Alemu A, Bitew ZW, Worku T, Gamtesa DF, Alebel A. Predictors of mortality in patients with drug-resistant tuberculosis: A systematic review and meta-analysis. PLoS One 2021; 16:e0253848. [PMID: 34181701 PMCID: PMC8238236 DOI: 10.1371/journal.pone.0253848] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Even though the lives of millions have been saved in the past decades, the mortality rate in patients with drug-resistant tuberculosis is still high. Different factors are associated with this mortality. However, there is no comprehensive global report addressing these risk factors. This study aimed to determine the predictors of mortality using data generated at the global level. METHODS We systematically searched five electronic major databases (PubMed/Medline, CINAHL, EMBASE, Scopus, Web of Science), and other sources (Google Scholar, Google). We used the Joanna Briggs Institute Critical Appraisal tools to assess the quality of included articles. Heterogeneity assessment was conducted using the forest plot and I2 heterogeneity test. Data were analyzed using STATA Version 15. The pooled hazard ratio, risk ratio, and odd's ratio were estimated along with their 95% CIs. RESULT After reviewing 640 articles, 49 studies met the inclusion criteria and were included in the final analysis. The predictors of mortality were; being male (HR = 1.25,95%CI;1.08,1.41,I2;30.5%), older age (HR = 2.13, 95%CI;1.64,2.62,I2;59.0%,RR = 1.40,95%CI; 1.26, 1.53, I2; 48.4%) including a 1 year increase in age (HR = 1.01, 95%CI;1.00,1.03,I2;73.0%), undernutrition (HR = 1.62,95%CI;1.28,1.97,I2;87.2%, RR = 3.13, 95% CI; 2.17,4.09, I2;0.0%), presence of any type of co-morbidity (HR = 1.92,95%CI;1.50-2.33,I2;61.4%, RR = 1.61, 95%CI;1.29, 1.93,I2;0.0%), having diabetes (HR = 1.74, 95%CI; 1.24,2.24, I2;37.3%, RR = 1.60, 95%CI;1.13,2.07, I2;0.0%), HIV co-infection (HR = 2.15, 95%CI;1.69,2.61, I2; 48.2%, RR = 1.49, 95%CI;1.27,1.72, I2;19.5%), TB history (HR = 1.30,95%CI;1.06,1.54, I2;64.6%), previous second-line anti-TB treatment (HR = 2.52, 95% CI;2.15,2.88, I2;0.0%), being smear positive at the baseline (HR = 1.45, 95%CI;1.14,1.76, I2;49.2%, RR = 1.58,95%CI;1.46,1.69, I2;48.7%), having XDR-TB (HR = 2.01, 95%CI;1.50,2.52, I2;60.8%, RR = 2.44, 95%CI;2.16,2.73,I2;46.1%), and any type of clinical complication (HR = 2.98, 95%CI; 2.32, 3.64, I2; 69.9%). There are differences and overlaps of predictors of mortality across different drug-resistance categories. The common predictors of mortality among different drug-resistance categories include; older age, presence of any type of co-morbidity, and undernutrition. CONCLUSION Different patient-related demographic (male sex, older age), and clinical factors (undernutrition, HIV co-infection, co-morbidity, diabetes, clinical complications, TB history, previous second-line anti-TB treatment, smear-positive TB, and XDR-TB) were the predictors of mortality in patients with drug-resistant tuberculosis. The findings would be an important input to the global community to take important measures.
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Affiliation(s)
- Ayinalem Alemu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | | | | | - Animut Alebel
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Roelens M, Battista Migliori G, Rozanova L, Estill J, Campbell JR, Cegielski JP, Tiberi S, Palmero D, Fox GJ, Guglielmetti L, Sotgiu G, Brust JCM, Bang D, Lienhardt C, Lange C, Menzies D, Keiser O, Raviglione M. Evidence-based Definition for Extensively Drug-resistant Tuberculosis. Am J Respir Crit Care Med 2021; 204:713-722. [PMID: 34107231 DOI: 10.1164/rccm.202009-3527oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Until 2020, extensively drug-resistant tuberculosis (XDR-TB) was defined as resistance to rifampicin and isoniazid (multidrug-resistant tuberculosis, MDR-TB), any fluoroquinolone (FQ) and any second-line injectable drug (SLID). In 2019 the World Health Organization issued new recommendations for managing patients with drug-resistant tuberculosis, substantially limiting the role of SLID in MDR-TB treatment and thus putting that XDR-TB definition into question. OBJECTIVE To propose an up-to-date definition for XDR-TB. METHODS We used a large dataset to assess treatment outcomes for MDR-TB patients exposed to any type of longer regimen. We included patients with bacteriologically confirmed MDR-TB and known FQ and SLID resistance results. We did logistic regression to estimate adjusted odds ratios (aORs) for unfavourable treatment outcome (failure, relapse, death, loss-to-follow-up) by resistance pattern (FQ, SLID) and Group A drug use (moxifloxacin/levofloxacin, linezolid, bedaquiline). MEASUREMENTS AND MAIN RESULTS We included 11,666 patients with MDR-TB; 4653 (39.9%) had an unfavourable treatment outcome. Resistance to FQs increased the odds of an unfavourable treatment outcome (aOR 1.91; 95% confidence interval [95%CI] 1.63-2.23). Administration of bedaquiline and/or linezolid improved treatment outcomes regardless of resistance to FQ and/or SLID. Among XDR-TB patients, compared to persons receiving no Group A drug, aORs for unfavourable outcome were 0.37 (95%CI 0.20-0.69) with linezolid only, 0.40 (95%CI 0.21-0.77) with bedaquiline only, and 0.21 (95%CI 0.12-0.38) with both. CONCLUSIONS Our study supports a new definition of XDR-TB as MDR plus additional resistance to FQ plus bedaquiline and/or linezolid, and helps assess the adequacy of this definition for surveillance and treatment choice.NOTE: This article has been updated on July 16, 2021. When it was initially posted on June 9, 2021, the name of one of the coauthors, Dr. Christian Lienhardt, was inadvertently omitted. This version includes Dr. Lienhardt's affilations and contributions; the affiliations have therefore been renumbered.
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Affiliation(s)
- Maroussia Roelens
- University of Geneva Institute of Global Health, 30492, Geneve, Switzerland
| | | | - Liudmila Rozanova
- University of Geneva Institute of Global Health, 30492, Geneve, Switzerland
| | - Janne Estill
- University of Geneva Institute of Global Health, 30492, Geneve, Switzerland.,University of Bern, 27210, Institute of Mathematical Statistics and Actuarial Science, Bern, Switzerland
| | | | - J Peter Cegielski
- Rollins School of Public Health, 25798, Department of Epidemiology, Atlanta, Georgia, United States
| | - Simon Tiberi
- Queen Mary University of London Barts and The London School of Medicine and Dentistry, 4952, Blizard Institute, London, United Kingdom of Great Britain and Northern Ireland.,Barts Health NHS Trust, 9744, Division of Infection, Royal London Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | | | - Gregory J Fox
- University of Sydney, Sydney, New South Wales, Australia
| | - Lorenzo Guglielmetti
- Sorbonne Universite, 27063, Centre d'Immunologie et des Maladies Infectieuses, Paris, France.,APHP, 26930, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Paris, France
| | - Giovanni Sotgiu
- University of Sassari, 9312, Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, Sassari, Italy
| | - James C M Brust
- Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, New York, United States
| | - Didi Bang
- Statens Serum Institut, 4326, Kobenhavn, Denmark.,Copenhagen University Hospital, 53146, Department of Clinical Microbiology, Kobenhavn, Denmark
| | - Christian Lienhardt
- Unité Mixte Internationale TransVIHMI , (Université de Montpellier, UMI 233 IRD, U1175 INSERM), Institut de Recherche pour le Développement (IRD), Montpellier, France.,London School of Hygiene and Tropical Medicine, Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London, United Kingdom of Great Britain and Northern Ireland
| | - Christoph Lange
- Research Center Borstel, German Center for Infection Research (DZIF) Clinical Tuberculosis Center, Borstel, Germany.,University of Lübeck, Respiratory Medicine & International Health, Lübeck, Germany.,Baylor College of Medicine, 3989, Global TB Program, Houston, Texas, United States
| | - Dick Menzies
- McGill University, 5620, McGill International TB Centre, Montreal, Quebec, Canada
| | - Olivia Keiser
- University of Geneva Institute of Global Health, 30492, Geneve, Switzerland
| | - Mario Raviglione
- University of Milan, 9304, Centre for Multidisciplinary Research in Health Science, Milano, Italy.,University of Geneva Global Studies Institute, 87659, Geneve, Switzerland;
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Habimana DS, Ngabonziza JCS, Migambi P, Mucyo-Habimana Y, Mutembayire G, Byukusenge F, Habiyambere I, Remera E, Mugwaneza P, Mwikarago IE, Mazarati JB, Turate I, Nsanzimana S, Decroo T, de Jong CB. Predictors of Rifampicin-Resistant Tuberculosis Mortality among HIV-Coinfected Patients in Rwanda. Am J Trop Med Hyg 2021; 105:47-53. [PMID: 33999845 PMCID: PMC8274780 DOI: 10.4269/ajtmh.20-1361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/26/2021] [Indexed: 11/22/2022] Open
Abstract
Tuberculosis (TB), including multidrug-resistant (MDR; i.e., resistant to at least rifampicin and isoniazid)/rifampicin-resistant (MDR/RR) TB, is the most important opportunistic infection among people living with HIV (PLHIV). In 2005, Rwanda launched the programmatic management of MDR/RR-TB. The shorter MDR/RR-TB treatment regimen (STR) has been implemented since 2014. We analyzed predictors of MDR/RR-TB mortality, including the effect of using the STR overall and among PLHIV. This retrospective study included data from patients diagnosed with RR-TB in Rwanda between July 2005 and December 2018. Multivariable logistic regression was used to assess predictors of mortality. Of 898 registered MDR/RR-TB patients, 861 (95.9%) were included in this analysis, of whom 360 (41.8%) were HIV coinfected. Overall, 86 (10%) patients died during MDR/RR-TB treatment. Mortality was higher among HIV-coinfected compared with HIV-negative TB patients (13.3% versus 7.6%). Among HIV-coinfected patients, patients aged ≥ 55 years (adjusted odds ratio = 5.89) and those with CD4 count ≤ 100 cells/mm3 (adjusted odds ratio = 3.77) had a higher likelihood of dying. Using either the standardized longer MDR/RR-TB treatment regimen or the STR was not correlated with mortality overall or among PLHIV. The STR was as effective as the long MDR/RR-TB regimen. In conclusion, older age and advanced HIV disease were strong predictors of MDR/RR-TB mortality. Therefore, special care for elderly and HIV-coinfected patients with ≤ 100 CD4 cells/mL might further reduce MDR/RR-TB mortality.
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Affiliation(s)
- Dominique Savio Habimana
- HIV, AIDS, STIs and Other Blood Borne Infections Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Jean Claude Semuto Ngabonziza
- National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Center, Kigali, Rwanda
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Patrick Migambi
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Yves Mucyo-Habimana
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Grace Mutembayire
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Francine Byukusenge
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Innocent Habiyambere
- Tuberculosis and Other Respiratory Diseases Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Center, Kigali, Rwanda
| | - Eric Remera
- HIV, AIDS, STIs and Other Blood Borne Infections Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Placidie Mugwaneza
- HIV, AIDS, STIs and Other Blood Borne Infections Division, Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | - Ivan Emil Mwikarago
- National Reference Laboratory Division, Department of Biomedical Services, Rwanda Biomedical Center, Kigali, Rwanda
| | | | - Innocent Turate
- Department of Institute of HIV/AIDS Disease Prevention and Control, Rwanda Biomedical Centre, Kigali, Rwanda
| | | | - Tom Decroo
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - Catherine Bouke de Jong
- Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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37
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Baluku JB, Nakazibwe B, Naloka J, Nabwana M, Mwanja S, Mulwana R, Sempiira M, Nassozi S, Babirye F, Namugenyi C, Ntambi S, Namiiro S, Bongomin F, Katuramu R, Andia-Biraro I, Worodria W. Treatment outcomes of drug resistant tuberculosis patients with multiple poor prognostic indicators in Uganda: A countrywide 5-year retrospective study. J Clin Tuberc Other Mycobact Dis 2021; 23:100221. [PMID: 33553682 PMCID: PMC7856462 DOI: 10.1016/j.jctube.2021.100221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Comorbid conditions and adverse drug events are associated with poor treatment outcomes among patients with drug resistant tuberculosis (DR - TB). This study aimed at determining the treatment outcomes of DR - TB patients with poor prognostic indicators in Uganda. METHODS We reviewed treatment records of DR - TB patients from 16 treatment sites in Uganda. Eligible patients had confirmed DR - TB, a treatment outcome in 2014-2019 and at least one of 15 pre-defined poor prognostic indicators at treatment initiation or during therapy. The pre-defined poor prognostic indicators were HIV co-infection, diabetes, heart failure, malignancy, psychiatric illness/symptoms, severe anaemia, alcohol use, cigarette smoking, low body mass index, elevated creatinine, hepatic dysfunction, hearing loss, resistance to fluoroquinolones and/or second-line aminoglycosides, previous exposure to second-line drugs (SLDs), and pregnancy. Tuberculosis treatment outcomes were treatment success, mortality, loss to follow up, and treatment failure as defined by the World Health Organisation. We used logistic and cox proportional hazards regression analysis to determine predictors of treatment success and mortality, respectively. RESULTS Of 1122 DR - TB patients, 709 (63.2%) were male and the median (interquartile range, IQR) age was 36.0 (28.0-45.0) years. A total of 925 (82.4%) had ≥2 poor prognostic indicators. Treatment success and mortality occurred among 806 (71.8%) and 207 (18.4%) patients whereas treatment loss-to-follow-up and failure were observed among 96 (8.6%) and 13 (1.2%) patients, respectively. Mild (OR: 0.57, 95% CI 0.39-0.84, p = 0.004), moderate (OR: 0.18, 95% CI 0.12-0.26, p < 0.001) and severe anaemia (OR: 0.09, 95% CI 0.05-0.17, p < 0.001) and previous exposure to SLDs (OR: 0.19, 95% CI 0.08-0.48, p < 0.001) predicted lower odds of treatment success while the number of poor prognostic indicators (HR: 1.62, 95% CI 1.30-2.01, p < 0.001), for every additional poor prognostic indicator) predicted mortality. CONCLUSION Among DR - TB patients with multiple poor prognostic indicators, mortality was the most frequent unsuccessful outcomes. Every additional poor prognostic indicator increased the risk of mortality while anaemia and previous exposure to SLDs were associated with lower odds of treatment success. The management of anaemia among DR - TB patients needs to be evaluated by prospective studies. DR - TB programs should also optimise DR - TB treatment the first time it is initiated.
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Affiliation(s)
- Joseph Baruch Baluku
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
- Mildmay Uganda, Wakiso, Uganda
- Makerere University Lung Institute, Kampala, Uganda
| | - Bridget Nakazibwe
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | - Joshua Naloka
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | - Martin Nabwana
- Makerere University – Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Sarah Mwanja
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | - Rose Mulwana
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | - Mike Sempiira
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | | | - Febronius Babirye
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | - Carol Namugenyi
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | - Samuel Ntambi
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | | | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Richard Katuramu
- National Tuberculosis and Leprosy Control Program, Ministry of Health, Kampala, Uganda
| | - Irene Andia-Biraro
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- MRC/UVRI & LSHTM Uganda Research Unit, Uganda
| | - William Worodria
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
- Makerere University Lung Institute, Kampala, Uganda
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38
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Safaev K, Parpieva N, Liverko I, Yuldashev S, Dumchev K, Gadoev J, Korotych O, Harries AD. Trends, Characteristics and Treatment Outcomes of Patients with Drug-Resistant Tuberculosis in Uzbekistan: 2013-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094663. [PMID: 33925705 PMCID: PMC8124452 DOI: 10.3390/ijerph18094663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 01/02/2023]
Abstract
Uzbekistan has a high burden of drug-resistant tuberculosis (TB). Although conventional treatment for multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) has been available since 2013, there has been no systematic documentation about its use and effectiveness. We therefore documented at national level the trends, characteristics, and outcomes of patients with drug-resistant TB enrolled for treatment from 2013–2018 and assessed risk factors for unfavorable treatment outcomes (death, failure, loss to follow-up, treatment continuation, change to XDR-TB regimen) in patients treated in Tashkent city from 2016–2017. This was a cohort study using secondary aggregate and individual patient data. Between 2013 and 2018, MDR-TB numbers were stable between 2347 and 2653 per annum, while XDR-TB numbers increased from 33 to 433 per annum. At national level, treatment success (cured and treatment completed) for MDR-TB decreased annually from 63% to 57%, while treatment success for XDR-TB increased annually from 24% to 57%. On multivariable analysis, risk factors for unfavorable outcomes, death, and loss to follow-up in drug-resistant TB patients treated in Tashkent city included XDR-TB, male sex, increasing age, previous TB treatment, alcohol abuse, and associated comorbidities (cardiovascular and liver disease, diabetes, and HIV/AIDS). Reasons for these findings and programmatic implications are discussed.
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Affiliation(s)
- Khasan Safaev
- Republican Specialized Scientific Practical Medical Centre of Phthisiology and Pulmonology under Ministry of Health of the Republic of Uzbekistan, 1 Majlisiy Str., Tashkent 100086, Uzbekistan; (N.P.); (I.L.); (S.Y.)
- Correspondence: ; Tel.: +998-931-844-282
| | - Nargiza Parpieva
- Republican Specialized Scientific Practical Medical Centre of Phthisiology and Pulmonology under Ministry of Health of the Republic of Uzbekistan, 1 Majlisiy Str., Tashkent 100086, Uzbekistan; (N.P.); (I.L.); (S.Y.)
| | - Irina Liverko
- Republican Specialized Scientific Practical Medical Centre of Phthisiology and Pulmonology under Ministry of Health of the Republic of Uzbekistan, 1 Majlisiy Str., Tashkent 100086, Uzbekistan; (N.P.); (I.L.); (S.Y.)
| | - Sharofiddin Yuldashev
- Republican Specialized Scientific Practical Medical Centre of Phthisiology and Pulmonology under Ministry of Health of the Republic of Uzbekistan, 1 Majlisiy Str., Tashkent 100086, Uzbekistan; (N.P.); (I.L.); (S.Y.)
| | - Kostyantyn Dumchev
- The Charitable Organization “Ukrainian Institute on Public Health Policy”, 02000 Kyiv, Ukraine;
| | - Jamshid Gadoev
- World Health Organization Country Office Uzbekistan, 16, M.Tarobiy Str., Tashkent 100100, Uzbekistan
| | - Oleksandr Korotych
- World Health Organization Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen, Denmark
| | - Anthony D. Harries
- International Union against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France;
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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39
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Osman M, Karat AS, Khan M, Meehan SA, von Delft A, Brey Z, Charalambous S, Hesseling AC, Naidoo P, Loveday M. Health system determinants of tuberculosis mortality in South Africa: a causal loop model. BMC Health Serv Res 2021; 21:388. [PMID: 33902565 PMCID: PMC8074279 DOI: 10.1186/s12913-021-06398-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/09/2021] [Indexed: 12/14/2022] Open
Abstract
Background Tuberculosis (TB) is a major public health concern in South Africa and TB-related mortality remains unacceptably high. Numerous clinical studies have examined the direct causes of TB-related mortality, but its wider, systemic drivers are less well understood. Applying systems thinking, we aimed to identify factors underlying TB mortality in South Africa and describe their relationships. At a meeting organised by the ‘Optimising TB Treatment Outcomes’ task team of the National TB Think Tank, we drew on the wide expertise of attendees to identify factors underlying TB mortality in South Africa. We generated a causal loop diagram to illustrate how these factors relate to each other. Results Meeting attendees identified nine key variables: three ‘drivers’ (adequacy & availability of tools, implementation of guidelines, and the burden of bureaucracy); three ‘links’ (integration of health services, integration of data systems, and utilisation of prevention strategies); and three ‘outcomes’ (accessibility of services, patient empowerment, and socio-economic status). Through the development and refinement of the causal loop diagram, additional explanatory and linking variables were added and three important reinforcing loops identified. Loop 1, ‘Leadership and management for outcomes’ illustrated that poor leadership led to increased bureaucracy and reduced the accessibility of TB services, which increased TB-related mortality and reinforced poor leadership through patient empowerment. Loop 2, ‘Prevention and structural determinants’ describes the complex reinforcing loop between socio-economic status, patient empowerment, the poor uptake of TB and HIV prevention strategies and increasing TB mortality. Loop 3, ‘System capacity’ describes how fragmented leadership and limited resources compromise the workforce and the performance and accessibility of TB services, and how this negatively affects the demand for higher levels of stewardship. Conclusions Strengthening leadership, reducing bureaucracy, improving integration across all levels of the system, increasing health care worker support, and using windows of opportunity to target points of leverage within the South African health system are needed to both strengthen the system and reduce TB mortality. Further refinement of this model may allow for the identification of additional areas of intervention.
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Affiliation(s)
- Muhammad Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Aaron S Karat
- TB Centre, London School of Hygiene & Tropical Medicine, London, UK.,The Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Munira Khan
- Tuberculosis and HIV Investigative Network (THINK), Durban, South Africa
| | - Sue-Ann Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Arne von Delft
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,TB Proof, Cape Town, South Africa
| | - Zameer Brey
- Bill and Melinda Gates Foundation, Johannesburg, South Africa
| | - Salome Charalambous
- The Aurum Institute, Parktown, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Pren Naidoo
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marian Loveday
- HIV Prevention Research Unit, South African Medical Research Council, KwaZulu-Natal, Pietermaritzburg, South Africa.,South African Medical Research Council-CAPRISA-HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
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40
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Brust JCM, Gandhi NR, Wasserman S, Maartens G, Omar SV, Ismail NA, Campbell A, Joseph L, Hahn A, Allana S, Hernandez-Romieu AC, Zhang C, Mlisana K, Viljoen CA, Zalta B, Ebrahim I, Franczek M, Master I, Ramangoaela L, Te Riele J, Meintjes G. Effectiveness and cardiac safety of bedaquiline-based therapy for drug-resistant tuberculosis: a prospective cohort study. Clin Infect Dis 2021; 73:2083-2092. [PMID: 33882121 PMCID: PMC8664482 DOI: 10.1093/cid/ciab335] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Indexed: 11/12/2022] Open
Abstract
Background Bedaquiline improves treatment outcomes in patients with rifampin-resistant (RR) tuberculosis but prolongs the QT interval and carries a black-box warning from the US Food and Drug Administration. The World Health Organization recommends that all patients with RR tuberculosis receive a regimen containing bedaquiline, yet a phase 3 clinical trial demonstrating its cardiac safety has not been published. Methods We conducted an observational cohort study of patients with RR tuberculosis from 3 provinces in South Africa who received regimens containing bedaquiline. We performed rigorous cardiac monitoring, which included obtaining electrocardiograms in triplicate at 4 time points during bedaquiline therapy. Participants were followed up until the end of therapy or 24 months. Outcomes included final tuberculosis treatment outcome and QT interval prolongation (QT prolongation), defined as any QT interval corrected by the Fridericia method (QTcF) >500 ms or an absolute change from baseline (ΔQTcF) >60 ms. Results We enrolled 195 eligible participants, of whom 40% had extensively drug-resistant tuberculosis. Most participants (97%) received concurrent clofazimine. Of the participants, 74% were cured or successfully completed treatment, and outcomes did not differ by human immunodeficiency virus status. QTcF continued to increase throughout bedaquiline therapy, with a mean increase (standard deviation) of 23.7 (22.7) ms from baseline to month 6. Four participants experienced a QTcF >500 ms and 19 experienced a ΔQTcF >60 ms. Older age was independently associated with QT prolongation. QT prolongation was neither more common nor more severe in participants receiving concurrent lopinavir-ritonavir. Conclusions Severe QT prolongation was uncommon and did not require permanent discontinuation of either bedaquiline or clofazimine. Close monitoring of the QT interval may be advisable in older patients.
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Affiliation(s)
- James C M Brust
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA
| | - Neel R Gandhi
- Departments of Epidemiology & Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Division of Infectious Diseases, Department of Medicine, Emory School of Medicine, Emory University, Atlanta, GA, USA
| | - Sean Wasserman
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Cape Town, South Africa.,Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Shaheed V Omar
- Centre for Tuberculosis, National Institute for Communicable Diseases, Johannesburg, South Africa.,Department of Molecular Medicine & Haematology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand
| | - Nazir A Ismail
- Centre for Tuberculosis, National Institute for Communicable Diseases, Johannesburg, South Africa.,Department of Molecular Medicine & Haematology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand
| | - Angela Campbell
- Departments of Epidemiology & Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lindsay Joseph
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA
| | - Alexandria Hahn
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA
| | - Salim Allana
- Departments of Epidemiology & Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alfonso C Hernandez-Romieu
- Division of Infectious Diseases, Department of Medicine, Emory School of Medicine, Emory University, Atlanta, GA, USA
| | - Chenshu Zhang
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA
| | - Koleka Mlisana
- National Health Laboratory Services, Johannesburg, South Africa
| | - Charle A Viljoen
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Benjamin Zalta
- Department of Radiology, Albert Einstein College of Medicine & Montefiore Medical Center, Bronx, NY, USA
| | - Ismaeel Ebrahim
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Meghan Franczek
- Departments of Epidemiology & Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Iqbal Master
- King Dinuzulu Hospital Complex, Durban, South Africa
| | | | | | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Cape Town, South Africa
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41
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Wie kann kann die Mortalität bei HIV-Patienten mit multiresistenter Tuberkulose gesenkt werden? Dtsch Med Wochenschr 2021. [DOI: 10.1055/a-1251-7421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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42
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Mayanja-Kizza H, Sekaggya-Wiltshire C, Kassa D. Optimal therapy for multidrug-resistant tuberculosis and HIV. Lancet 2020; 396:363-365. [PMID: 32771093 DOI: 10.1016/s0140-6736(20)31688-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - Desta Kassa
- HIV/AIDS and TB Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
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