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Nagarajan K, Kumarswamy K, Begum R, Panibatla V, Singarajipura A, Adepu R, Munjattu JF, Sellapan S, Arangba S, Goswami A, Swamickan R, Basha J, Dsouza PM, Muniyandi M. Self-driven solutions and resilience adapted by people with drug-resistant tuberculosis and their caregivers in Bengaluru and Hyderabad, India: a qualitative study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 22:100372. [PMID: 38420270 PMCID: PMC10900834 DOI: 10.1016/j.lansea.2024.100372] [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: 01/05/2023] [Revised: 01/08/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
Background One-fifth of people with drug-resistance tuberculosis (DR-TB) who were initiated on newer shorter treatment regimen (with injection) had unfavourable treatment outcomes in India as on 2020. Evidence on self-driven solutions and resilience adapted by people with DR-TB (PwDR-TB) towards their multi-dimensional disease and treatment challenges are scarce globally, which we aimed to understand. Methods In this qualitative study using positive deviance framework, we conducted semi-structured in-depth interviews among consenting adult PwDR-TB (7 women, 13 men) who completed shorter treatment regimen (including injections) with maximum treatment adherence. The study was conducted in the southern districts of Bengaluru and Hyderabad, India between June 2020 and December 2022. Caregivers (14 women, 6 men) and health providers (8 men, 2 women) of PwDR-TB were also interviewed. Interviews were conducted in local language (Kannada, Tamil, Telugu, Urdu and Hindi) and inquired about practices, behaviours, experiences, perceptions and attributes which enabled maximum adherence and resilience of PwDR-TB. Interviews were audio recorded, transcribed, and translated to English and coded for thematic analysis using inductive approach. Findings Distinctive themes explanatory of the self-driven solutions and resilience exhibited by PwDR-TB and their caregivers were identified: (i) Self-adaptation towards the biological consequences of drugs, by personalised nutritional and adjuvant practices, which helped to improve drug ingestion and therapeutic effects. Also home remedies and self-plans for ameliorating injection pain. (ii) Perceptual adaptation towards drugs aversion and fatigue, by their mind diversion practices, routinisation and normalisation of drug intake process. and constant reinforcement and re-interpretation of bodily signs of disease recovery (iii) Family caregivers intense and participatory care for PwDR-TB, by aiding their essential life activities and ensuring survival, learning and fulfilling special nutritional needs and goal oriented actions to aid drug intake (iv) Health care providers care, marked by swift and timely risk mitigation of side-effects and crisis response (v) Acquired self-efficacy of PwDR-TB, by their decisive family concerns resulting in attitudinal change. Also being sensitised on the detrimental consequences of disease and being motivated through positive examples. Interpretation Synthesised findings on self-driven solutions and resilience towards the multi-dimensional DR-TB challenges provides opportunity for developing and testing new interventions for its effectiveness in DR-TB care settings globally. Designing and testing personalised cognitive interventions for PwDR-TB: to inculcate attitudinal change and self-efficacy towards medication, developing cognitive reinforcements to address the perception burden of treatment, skill building and mainstreaming the role of family caregivers as therapeutic partners of PwDR-TB, curating self-adaptive behaviours and practices of PwDR-TB to normalise their drug consumptions experiences could be the way forward in building resilience towards DR-TB. Funding United States Agency for International Development (USAID) through Karnataka Health Promotion Trust (KHPT), Bengaluru, India.
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Affiliation(s)
- Karikalan Nagarajan
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | - Karthikeyan Kumarswamy
- Karnataka Health Promotion Trust, IT Park, Rajajinagar Industrial Area, Bengaluru, Karnataka, 560044, India
| | - Rehana Begum
- Karnataka Health Promotion Trust, IT Park, Rajajinagar Industrial Area, Bengaluru, Karnataka, 560044, India
| | - Vikas Panibatla
- TB Alert India, Hyderabad, West Marredpally, Secunderabad, Telangana, 500026, India
| | - Anil Singarajipura
- State TB Office, 2nd Floor, Arogya Soudha, Magadi Road, Bengaluru, Karnataka, 560023, India
| | - Rajesham Adepu
- State TB Office, Directorate of Medical & Health Services, Hyderabad, Telangana, 500095, India
| | - Joseph Francis Munjattu
- Karnataka Health Promotion Trust, IT Park, Rajajinagar Industrial Area, Bengaluru, Karnataka, 560044, India
| | - Senthil Sellapan
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | - Stephen Arangba
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | | | | | - Javeed Basha
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | - Pearl Maria Dsouza
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | - Malaisamy Muniyandi
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
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Wagnew F, Alene KA, Kelly M, Gray D. Impacts of body weight change on treatment outcomes in patients with multidrug-resistant tuberculosis in Northwest Ethiopia. Sci Rep 2024; 14:508. [PMID: 38177234 PMCID: PMC10767082 DOI: 10.1038/s41598-023-51026-y] [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: 09/23/2023] [Accepted: 12/29/2023] [Indexed: 01/06/2024] Open
Abstract
Measuring body weight during therapy has received insufficient attention in poor resource settings like Ethiopia. We aimed to investigate the association between weight change during therapy and treatment outcomes among patients with multidrug-resistant tuberculosis (MDR-TB) in northwest Ethiopia. This retrospective cohort study analysed data from patients with MDR-TB admitted between May 2015 to February 2022 at four treatment facilities in Northwest Ethiopia. We used the joint model (JM) to determine the association between weight change during therapy and treatment outcomes for patients with MDR-TB. A total of 419 patients with MDR-TB were included in the analysis. Of these, 265 (63.3%) were male, and 255 (60.9%) were undernourished. Weight increase over time was associated with a decrease in unsuccessful treatment outcomes (adjusted hazard ratio (AHR): 0.96, 95% CI: 0.94 to 0.98). In addition, patients with undernutrition (AHR: 1.72, 95% CI: 1.10 to 2.97), HIV (AHR:1.79, 95% CI: 1.04 to 3.06), and clinical complications such as pneumothorax (AHR: 1.66, 95% CI: 1.03 to 2.67) were associated with unsuccessful treatment outcomes. The JM showed a significant inverse association between weight gain and unsuccessful MDR-TB treatment outcomes. Therefore, weight gain may be used as a surrogate marker for good TB treatment response in Ethiopia.
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Affiliation(s)
- Fasil Wagnew
- College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia.
- National Centre for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra, Australia.
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Nedlands, WA, Australia.
| | - Kefyalew Addis Alene
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Nedlands, WA, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Matthew Kelly
- National Centre for Epidemiology and Population Health (NCEPH), College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Darren Gray
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
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Kumar L, Kumar S, Vohra V, Mohan K, Khayyam KU. Risk factors of treatment interruptions among drug-sensitive and drug-resistant pulmonary tuberculosis patients - A study from South Delhi, New Delhi, India. Indian J Tuberc 2024; 71 Suppl 1:S72-S76. [PMID: 39067959 DOI: 10.1016/j.ijtb.2024.01.001] [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: 11/03/2022] [Revised: 07/09/2023] [Accepted: 01/03/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND A variety of factors influence adherence to the lengthy duration of anti-tuberculosis treatment, making it a complicated and dynamic problem. The objective of this study was to investigate the treatment interruption patterns using pre-defined criteria among a cohort of pulmonary tuberculosis patients and to elicit the associated factors. METHODS This prospective, observational study was conducted between October 2016 to May 2018. All smear and culture positive pulmonary tuberculosis patients (age ≥ 14 years) enrolled between October 1, 2016 to March 31, 2017 across 3 Designated Microscopy Centers (DMCs) were included and followed up till end of treatment for outcome in drug-sensitive, and till interim outcome at 6 months for drug-resistant TB patients. Patterns and reasons for interruptions were recorded as per the study protocol. RESULTS 171 patients were enrolled in this study, of which 135 (78.94 %) were on Category-I and Category-II treatment (drug-sensitive tuberculosis), 23 (13 %) were multidrug-resistant (MDR) and 13 (8 %) were extensively drug resistant (XDR) tuberculosis patients. Among the drug-sensitive group, 65 (48 %) patients completed their treatment without any interruption while 70 (52 %) patients interrupted with at least one missed dose. Among the 36 MDR/XDR patients, 19 (53 %) patients did not interrupt treatment, but 17 (47 %) patients interrupted with at least one missing dose. The 87 patients in both sub-groups interrupted for 232 times/episodes of which 140 were short and 84 were long interruptions. The main reasons for interruption were found to be busy schedule in 63 (29 %) patients, adverse drug reactions in 40 (18.4 %) and comorbidities in 43 (19.8 %) patients. Feeling of early improvement/no improvement in 23 (10.5 %) patients, addictions in 27 (12.4 %) patients, lack of family support in 14 (6.4 %), unawareness of dosage and duration of treatment in 7 (3.20 %) patients were other common reasons. CONCLUSION The plurality of patients studied were found to be in the younger age group i.e., 14-25 years (n = 75), constituting nearly 44 % of all the patients included and male treatment interrupters (62 %) outnumbered the females (38 %), possibly owing to work schedule or addictions. The majority of interruptions were related to patient related factors (93.5 %), followed by DOTS provided factors (6.40 %) and system related factors (3.01 %). Further studies should be conducted to classify the factors of treatment interruptions in detail and also to study the impact of these interruptions' patterns on final outcomes.
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Affiliation(s)
- Lokender Kumar
- Department of Tuberculosis and Respiratory Diseases, National Institute of TB and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, 110030, India.
| | - Santosh Kumar
- Department of Tuberculosis and Respiratory Diseases, National Institute of TB and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, 110030, India.
| | - Vikram Vohra
- Department of Tuberculosis and Respiratory Diseases, National Institute of TB and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, 110030, India.
| | - Krishna Mohan
- Division of Clinical Research, Department of Biosciences, School of Basic and Applied Sciences, Galgotias University, Greater Noida, Uttar Pradesh, 203201, India.
| | - Khalid Umer Khayyam
- Department of Epidemiology and Public Health, National Institute of TB and Respiratory Diseases, Sri Aurobindo Marg, New Delhi, 110030, India.
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Tadesse AW, Cusinato M, Weldemichael GT, Abdurhman T, Assefa D, Yazew H, Gadissa D, Shiferaw A, Belachew M, Sahile M, van Rest J, Bedru A, Foster N, Jerene D, Fielding KL. Risk factors for poor engagement with a smart pillbox adherence intervention among persons on tuberculosis treatment in Ethiopia. BMC Public Health 2023; 23:2006. [PMID: 37838677 PMCID: PMC10576388 DOI: 10.1186/s12889-023-16905-z] [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: 05/17/2023] [Accepted: 10/05/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Non-adherence to tuberculosis treatment increases the risk of poor treatment outcomes. Digital adherence technologies (DATs), including the smart pillbox (EvriMED), aim to improve treatment adherence and are being widely evaluated. As part of the Adherence Support Coalition to End TB (ASCENT) project we analysed data from a cluster-randomised trial of DATs and differentiated care in Ethiopia to examine individual-factors for poor engagement with the smart pillbox. METHODS Data were obtained from a cohort of trial participants with drug-sensitive tuberculosis (DS-TB) whose treatment started between 1 December 2020 and 1 May 2022, and who were using the smart pillbox. Poor engagement with the pillbox was defined as (i) > 20% days with no digital confirmation and (ii) the count of days with no digital confirmation, and calculated over a two evaluation periods (56-days and 168-days). Logistic random effects regression was used to model > 20% days with no digital confirmation and negative binomial random effects regression to model counts of days with no digital confirmation, both accounting for clustering of individuals at the facility-level. RESULTS Among 1262 participants, 10.8% (133/1262) over 56-days and 15.8% (200/1262) over 168-days had > 20% days with no digital confirmation. The odds of poor engagement was less among participants in the higher stratum of socio-economic position (SEP) over 56-days. Overall, 4,689/67,315 expected doses over 56-days and 18,042/199,133 expected doses over 168-days were not digitally confirmed. Compared to participants in the poorest SEP stratum, participants in the wealthiest stratum had lower rates of days not digitally confirmed over 168-days (adjusted rate ratio [RRa]:0.79; 95% confidence interval [CI]: 0.65, 0.96). In both evaluation periods (56-days and 168-days), HIV-positive status (RRa:1.29; 95%CI: 1.02, 1.63 and RRa:1.28; 95%CI: 1.07, 1.53), single/living independent (RRa:1.31; 95%CI: 1.03, 1.67 and RRa:1.38; 95%CI: 1.16, 1.64) and separated/widowed (RRa:1.40; 95%CI: 1.04, 1.90 and RRa:1.26; 95%CI: 1.00, 1.58) had higher rates of counts of days with no digital confirmation. CONCLUSION Poorest SEP stratum, HIV-positive status, single/living independent and separated/ widowed were associated with poor engagement with smart pillbox among people with DS-TB in Ethiopia. Differentiated care for these sub-groups may reduce risk of non-adherence to TB treatment.
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Affiliation(s)
- Amare Worku Tadesse
- TB Centre, Department of Infectious Disease Epidemiology, London, School of Hygiene & Tropical Medicine (LSHTM) , London, UK.
| | - Martina Cusinato
- TB Centre, Department of Infectious Disease Epidemiology, London, School of Hygiene & Tropical Medicine (LSHTM) , London, UK
- Bristol Medical School, Population Health Sciences, Bristol, UK
| | | | | | | | | | | | | | | | | | | | | | - Nicola Foster
- TB Centre, Department of Infectious Disease Epidemiology, London, School of Hygiene & Tropical Medicine (LSHTM) , London, UK
| | - Degu Jerene
- KNCV Tuberculosis Plus, The Hague, Netherlands
| | - Katherine Linda Fielding
- TB Centre, Department of Infectious Disease Epidemiology, London, School of Hygiene & Tropical Medicine (LSHTM) , London, UK
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Pedersen OS, Holmgaard FB, Mikkelsen MKD, Lange C, Sotgiu G, Lillebaek T, Andersen AB, Wejse CM, Dahl VN. Global treatment outcomes of extensively drug-resistant tuberculosis in adults: A systematic review and meta-analysis. J Infect 2023; 87:177-189. [PMID: 37356629 DOI: 10.1016/j.jinf.2023.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/21/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Historically, extensively drug-resistant tuberculosis has been notoriously difficult to treat with devasting outcomes. As we are coming to the end of an era where the 2006 extensively drug-resistant tuberculosis definitions and old treatment regimens are being replaced, we aimed to estimate the proportion of extensively drug-resistant tuberculosis patients globally who achieved successful treatment outcomes. METHODS We conducted a systematic review of PubMed/MEDLINE, Scopus, Web of Science, and Embase from January 1, 2005, through April 3, 2023. Included studies reported WHO treatment outcomes, or adaptions hereof, for pre-extensively and/or extensively drug-resistant tuberculosis patients according to the 2006 WHO definition. Eligible studies included cohorts of at least 10 adults (aged>18 years) that were not pregnant. Using a random-effects model, we calculated pooled proportions of treatment outcomes and performed sensitivity and subgroup analyses. PROSPERO registration number: CRD42022340961. RESULTS Among 5056 studies reviewed, we identified 94 studies from 26 countries, involving 10,223 extensively drug-resistant tuberculosis patients. The pooled proportion of successful treatment outcomes was 44.2% (95%CI: 38.3-50.3). Sensitivity analyses consistently produced similar estimates. A slight improvement in treatment outcomes was observed after 2013. Furthermore, 25 studies reported outcomes for 3564 individuals with pre-extensively drug-resistant tuberculosis, of which 63.3% achieved successful treatment (95%CI: 43.1-72.5). CONCLUSION Globally, the success rate of extensively drug-resistant tuberculosis treatment is 44.2%, far below the WHO's target rate of 75%. These results may serve as a reference for future studies assessing extensively drug-resistant tuberculosis treatment outcomes under the 2021 definition treated with better treatment regimens available. Comprehensive surveillance data of extensively drug-resistant tuberculosis outcomes from the whole world are desirable to monitor treatment progress.
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Affiliation(s)
- Ole Skouvig Pedersen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, 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
| | - Giovanni Sotgiu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Troels Lillebaek
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | | | - Christian Morberg Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; Center for Global Health, Aarhus University (GloHAU), Aarhus, Denmark
| | - Victor Naestholt Dahl
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark; Center for Global Health, Aarhus University (GloHAU), Aarhus, Denmark.
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Trevisi L, Hernán MA, Mitnick CD, Khan U, Seung KJ, Rich ML, Bastard M, Huerga H, Melikyan N, Atwood SA, Avaliani Z, Llanos F, Manzur-ul-Alam M, Zarli K, Binegdie AB, Adnan S, Melikyan A, Gelin A, Isani AK, Vetushko D, Daugarina Z, Nkundanyirazo P, Putri FA, Vilbrun C, Khan M, Hewison C, Khan PY, Franke MF. Effectiveness of Bedaquiline Use beyond Six Months in Patients with Multidrug-Resistant Tuberculosis. Am J Respir Crit Care Med 2023; 207:1525-1532. [PMID: 36802336 PMCID: PMC10263131 DOI: 10.1164/rccm.202211-2125oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/17/2023] [Indexed: 02/23/2023] Open
Abstract
Rationale: Current recommendations for the treatment of rifampicin- and multidrug-resistant tuberculosis include bedaquiline (BDQ) used for 6 months or longer. Evidence is needed to inform the optimal duration of BDQ. Objectives: We emulated a target trial to estimate the effect of three BDQ duration treatment strategies (6, 7-11, and ⩾12 mo) on the probability of successful treatment among patients receiving a longer individualized regimen for multidrug-resistant tuberculosis. Methods: To estimate the probability of successful treatment, we implemented a three-step approach comprising cloning, censoring, and inverse probability weighting. Measurements and Main Results: The 1,468 eligible individuals received a median of 4 (interquartile range, 4-5) likely effective drugs. In 87.1% and 77.7% of participants, this included linezolid and clofazimine, respectively. The adjusted probability of successful treatment was 0.85 (95% confidence interval [CI], 0.81-0.88) for 6 months of BDQ, 0.77 (95% CI, 0.73-0.81) for 7-11 months, and 0.86 (95% CI, 0.83-0.88) for ⩾12 months. Compared with 6 months of BDQ, the ratio of treatment success was 0.91 (95% CI, 0.85-0.96) for 7-11 months and 1.01 (95% CI, 0.96-1.06) for ⩾12 months. Naive analyses that did not account for bias revealed a higher probability of successful treatment with ⩾12 months (ratio, 1.09 [95% CI, 1.05-1.14]). Conclusions: BDQ use beyond 6 months did not increase the probability of successful treatment among patients receiving longer regimens that commonly included new and repurposed drugs. When not properly accounted for, immortal person-time bias can influence estimates of the effects of treatment duration. Future analyses should explore the effect of treatment duration of BDQ and other drugs in subgroups with advanced disease and/or receiving less potent regimens.
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Affiliation(s)
- Letizia Trevisi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Miguel A. Hernán
- CAUSALab, Departments of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Carole D. Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
- Partners in Health, Boston, Massachusetts
| | - Uzma Khan
- Interactive Research and Development Global, Singapore, Singapore
| | - Kwonjune J. Seung
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
- Partners in Health, Boston, Massachusetts
| | - Michael L. Rich
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
- Partners in Health, Boston, Massachusetts
| | | | - Helena Huerga
- Field Epidemiology Department, Epicentre, Paris, France
| | - Nara Melikyan
- Field Epidemiology Department, Epicentre, Paris, France
| | - Sidney A. Atwood
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Zaza Avaliani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - Felix Llanos
- Unidad de Tuberculosis, Hospital Nacional Dos de Mayo, Lima, Peru
- Instituto de Investigaciones en Ciencias Biomedicas, Universidad Ricardo Palma, Lima, Peru
| | | | - Khin Zarli
- Médecins sans Frontières, Yangon, Myanmar
| | - Amsalu Bekele Binegdie
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sana Adnan
- Indus Hospital and Health Network, Karachi, Pakistan
| | | | | | - Afshan K. Isani
- National Core Research Group, Stop TB Partnership, Islamabad, Pakistan
| | - Dmitry Vetushko
- Republican Scientific and Practical Centre of Pulmonology and Tuberculosis, Minsk, Belarus
| | | | | | | | | | - Munira Khan
- Interactive Research and Development, Durban, South Africa
| | | | - Palwasha Y. Khan
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Molly F. Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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Phillips PPJ, Stout JE. To Err Is Human, to Forgive Is Pharmacodynamic. Am J Respir Crit Care Med 2023; 207:127-129. [PMID: 36165624 PMCID: PMC9893336 DOI: 10.1164/rccm.202208-1629ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
| | - Jason E. Stout
- Department of MedicineDuke UniversityDurham, North Carolina
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Sintayehu K, Zeleke ED, Temesgen B, Kifle M, Assefa DG, Zenebe K, Kassahun A, Yimer BT. Determinants of stock-outs of first line anti-tuberculosis drugs: the case of public health facilities of Addis Ababa city administration health bureau, Addis Ababa, Ethiopia. BMC Health Serv Res 2022; 22:1047. [PMID: 35978406 PMCID: PMC9381400 DOI: 10.1186/s12913-022-08430-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background The health sectors success has been determined by consistent and reasonably priced health commodities supply. Despite possible death from the disease, Tuberculosis (TB) can be prevented with early diagnosis and appropriate treatment for which enough, effective, and qualified medicines need to be available. However, studies revealed stock of anti-TB drugs in health facilities. Here we present the recent finding on determinants of stock out of Anti-TB drug at public health facilities of Addis Ababa. Objective This study aimed to identify determinants of stock outs of first line anti TB drugs at public health facilities under Addis Ababa City Administration Health Bureau. Method Mixed study design were employed. A total of 106 facilities were included in the sampling frame and data were collected from the study population such as drug store managers of health facilities providing TB treatment using semi structured questionnaire and through in-depth interview with Addis Ababa hubs of the Ethiopian Pharmaceuticals Supply Agency (EPSA), Addis Ababa City Administration Health Bureau and selected heads of pharmacy departments of health facilities from May 1–30, 2020 considering one year back retrospective data from March 20,2019 to March 20,2020. Structured record review of data from Logistics Management Information System (LMIS) tools having TB drugs was done using structured observation checklist. Data were entered, cleaned, and analyzed using SPSS Version 20. Both descriptive and multiple logistic regression analysis were performed. Result 52(62.7%) of health facilities encountered stock out for at least one of these drugs during the past 1 year. Rifampicin 75 mg + Isoniazid 50 mg (RH 75/50 mg) were most stocked out first line anti-TB drug from 33(39.8%) of facilities with 17 mean stocks out days while Rifampicin 75 mg + Isoniazid 50 mg + Pyrazinamide 150 mg (RHZ 75/50/150 mg) were the least first line anti-TB drug stocked out from facilities with mean 5 days of stock out. Delayed supply of anti TB drug from EPSA, delivery of reduced quantity of anti TB drugs by EPSA and stocked out of anti TB Drugs at EPSA were significant determinate factors of stock out of first line anti-TB drug from facilities with 95%CI of 10.34(2.167–49.329), 11.452(2.183–60.079) and 5.646(1.240–25.707) respectively. Conclusion Above median of health facilities encountered stock out of first line anti-TB drug in Addis Ababa. Delayed supply of anti TB drug from EPSA, delivery of reduced quantity of anti TB drugs by EPSA and stocked out of anti TB Drugs at EPSA were significant determinate factor of stocked out of first line anti-TB drug from facilities. EPSA and other responsible bodies shall work collaboratively to improve their service and ensure availability of adequate amount of Anti TB drug in health facilities. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08430-3.
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Affiliation(s)
- Kassech Sintayehu
- KNCV (Koninklijke Nederlandse Chemische Vereniging (Royal Dutch Chemical Association) Tuberculosis Foundation, Addis Ababa, Ethiopia.,Ethiopian food and drug Authority, Addis Ababa, Ethiopia
| | - Eden Dagnachew Zeleke
- Department of Midwifery, Institute of Health, Bule Hora University, P.O.BOX-22497/1000, Bule Hora, Ethiopia.
| | - Busha Temesgen
- Department of logistics and supply chain management, School of commerce, Addis Ababa University, Addis Ababa, Ethiopia
| | - Meron Kifle
- Ethiopian food and drug Authority, Addis Ababa, Ethiopia
| | | | | | | | - Ben Tegegn Yimer
- Addis Ababa City Administration Health Bureau, Addis Ababa, Ethiopia
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Assessment of Factors Associated with Unfavorable Outcomes among Drug-Resistant TB Patients: A 6-Year Retrospective Study from Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031574. [PMID: 35162598 PMCID: PMC8835434 DOI: 10.3390/ijerph19031574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/02/2022] [Accepted: 01/11/2022] [Indexed: 02/05/2023]
Abstract
The spread of drug-resistant tuberculosis (DR TB) poses significant challenges to the control and successful eradication of TB globally. The current retrospective study was designed to evaluate the treatment outcomes and identify the risk factors associated with unsuccessful outcomes among DR TB patients. A total of 277/308 eligible DR TB patients were enrolled for treatment at the programmatic management unit of DR TB at the Pakistan Institute of Medical Sciences, Islamabad between January 2014 and July 2019. Treatment outcomes were defined according to the WHO recommendations. Death, treatment failure, and lost to follow-up (LTFU) were collectively grouped as unsuccessful treatment outcomes, whereas cured and treatment completed were summed up together as successful treatment outcomes. Out of the total 277 patients, 265 (95.67%) were multidrug/rifampicin-resistant TB (MDR/RR-TB) cases, 8 (2.89%) were isoniazid resistant cases, and 4 (1.44%) were extensively drug-resistant ones. In the current cohort, a total of 177 (63.9%) achieved successful treatment outcomes. Among them, 153 (55.2%) were declared cured and 24 (8.7%) completed their treatment. Of the remaining 100 (36.1%) patients with unsuccessful outcomes, 60 (21.7%) died, 32 (11.5%) were LTFU, and 8 (2.9%) had failed treatment. The proportion of male patients was relatively higher (55.2%), within the age group of 21–40 years (47.3%) and lived in rural areas (66.8%). The multivariate analysis revealed that unsuccessful outcomes had a statistically significant association with being male (adjusted odds ratio, AOR: 1.92, 95% confidence interval (CI): 1.10–3.36), being in an age group above 60 years (AOR: 3.34, 95% CI: 1.09–10.1), suffering from any comorbidity (AOR: 2.69, 95% CI: 1.35–5.38), and the history of use of second-line drugs (AOR; 3.51, 95% CI 1.35–9.12). In conclusion, treatment outcomes among DR TB patients at the study site were poor and did not achieve the treatment success target (≥75%) set by the World Health Organization.
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10
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Ausi Y, Santoso P, Sunjaya DK, Barliana MI. Between Curing and Torturing: Burden of Adverse Reaction in Drug-Resistant Tuberculosis Therapy. Patient Prefer Adherence 2021; 15:2597-2607. [PMID: 34848950 PMCID: PMC8627322 DOI: 10.2147/ppa.s333111] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/09/2021] [Indexed: 01/07/2023] Open
Abstract
Drug-resistant tuberculosis (DR-TB) requires prolonged and complex therapy which is associated with several adverse drug reactions (ADR). The burden of ADR can affect the quality of life (QoL) of patients that consists of physical, mental, and social well-being, and influences the beliefs and behaviors of patient related to treatment. This article reviews the burden of ADR and its association with QoL and adherence. We used PubMed to retrieve the relevant original research articles written in English from 2011 to 2021. We combined the following keywords: "tuberculosis," "Drug-resistant tuberculosis," "Side Effect," "Adverse Drug Reactions," "Adverse Event," "Quality of Life," "Adherence," "Non-adherence," "Default," and "Loss to follow-up." Article selection process was unsystematic. We included 12 relevant main articles and summarized into two main topics, namely, 1) ADR and QoL (3 articles), and 2) ADR and therapy adherence (9 articles). The result showed that patients with ADR tend to have low QoL, even in the end of treatment. Although it was torturing, the presence of ADR does not always result in non-adherence. It is probably because the perception about the benefit of the treatment dominates the perceived barrier. In conclusion, burden of ADR generally tends to degrade QoL of patients and potentially influence the adherence. A comprehensive support from family, community, and healthcare provider is required to help patients in coping with the burden of ADR. Nevertheless, the regimen safety and efficacy improvement are highly needed.
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Affiliation(s)
- Yudisia Ausi
- Department of Biological Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Master Program in Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Prayudi Santoso
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Deni Kurniadi Sunjaya
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Melisa Intan Barliana
- Department of Biological Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
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11
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Thomas L, Birangal SR, Ray R, Sekhar Miraj S, Munisamy M, Varma M, S V CS, Banerjee M, Shenoy GG, Rao M. Prediction of potential drug interactions between repurposed COVID-19 and antitubercular drugs: an integrational approach of drug information software and computational techniques data. Ther Adv Drug Saf 2021; 12:20420986211041277. [PMID: 34471515 PMCID: PMC8404633 DOI: 10.1177/20420986211041277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/24/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction: Tuberculosis is a major respiratory disease globally with a higher prevalence in Asian and African countries than rest of the world. With a larger population of tuberculosis patients anticipated to be co-infected with COVID-19 infection, an ongoing pandemic, identifying, preventing and managing drug–drug interactions is inevitable for maximizing patient benefits for the current repurposed COVID-19 and antitubercular drugs. Methods: We assessed the potential drug–drug interactions between repurposed COVID-19 drugs and antitubercular drugs using the drug interaction checker of IBM Micromedex®. Extensive computational studies were performed at a molecular level to validate and understand the drug–drug interactions found from the Micromedex drug interaction checker database at a molecular level. The integrated knowledge derived from Micromedex and computational data was collated and curated for predicting potential drug–drug interactions between repurposed COVID-19 and antitubercular drugs. Results: A total of 91 potential drug–drug interactions along with their severity and level of documentation were identified from Micromedex between repurposed COVID-19 drugs and antitubercular drugs. We identified 47 pharmacodynamic, 42 pharmacokinetic and 2 unknown DDIs. The majority of our molecular modelling results were in line with drug–drug interaction data obtained from the drug information software. QT prolongation was identified as the most common type of pharmacodynamic drug–drug interaction, whereas drug–drug interactions associated with cytochrome P450 3A4 (CYP3A4) and P-glycoprotein (P-gp) inhibition and induction were identified as the frequent pharmacokinetic drug–drug interactions. The results suggest antitubercular drugs, particularly rifampin and second-line agents, warrant high alert and monitoring while prescribing with the repurposed COVID-19 drugs. Conclusion: Predicting these potential drug–drug interactions, particularly related to CYP3A4, P-gp and the human Ether-à-go-go-Related Gene proteins, could be used in clinical settings for screening and management of drug–drug interactions for delivering safer chemotherapeutic tuberculosis and COVID-19 care. The current study provides an initial propulsion for further well-designed pharmacokinetic-pharmacodynamic-based drug–drug interaction studies. Plain Language Summary
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Affiliation(s)
- Levin Thomas
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Sumit Raosaheb Birangal
- Department of Pharmaceutical Chemistry, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Rajdeep Ray
- Department of Pharmaceutical Chemistry, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Sonal Sekhar Miraj
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Murali Munisamy
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Muralidhar Varma
- Department of Infectious Diseases, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | | | - Mithu Banerjee
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Gautham G Shenoy
- Department of Pharmaceutical Chemistry, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Mahadev Rao
- Professor and Head, Department of Pharmacy Practice, Coordinator, Centre for Translational Research, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India
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12
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Tola H, Holakouie-Naieni K, Mansournia MA, Yaseri M, Gamtesa DF, Tesfaye E, Mahamed Z, Sisay MM. National treatment outcome and predictors of death and treatment failure in multidrug-resistant tuberculosis in Ethiopia: a 10-year retrospective cohort study. BMJ Open 2021; 11:e040862. [PMID: 34376436 PMCID: PMC8356165 DOI: 10.1136/bmjopen-2020-040862] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Treatment success rate in patients treated for multidrug-resistant tuberculosis (MDR-TB) is low, but predictors of treatment failure and death have been under-reported. Thus, we aimed to determine the national proportion of treatment success rate in the past 10 years and factors that predict treatment failure and death in patients with MDR-TB in Ethiopia. SETTING A retrospective cohort study with a 10-years follow-up period was conducted in 42 MDR-TB treatment-initiating centres in Ethiopia. PARTICIPANTS A total of 3395 adult patients with MDR-TB who had final treatment outcome and who were treated under national TB programme were included. Data were collected from clinical charts, registration books and laboratory reports. Competing risk survival analysis model with robust standard errors (SE) was used to determine the predictors of treatment failure and death. PRIMARY AND SECONDARY OUTCOMES Treatment outcome was a primary outcome whereas predictors of treatment failure and death were a secondary outcome. RESULTS The proportion of treatment success was 75.7%, death rate was 12.8%, treatment failure was 1.7% and lost to follow-up was 9.7%. The significant predictors of death were older age (adjusted hazard ratio (AHR)=1.03; 95% CI 1.03 to 1.05; p<0.001), HIV infection (AHR=2.0; 95% CI 1.6 to 2.4; p<0.001) and presence of any grade of anaemia (AHR=1.7; 95% CI 1.4 to 2.0; p<0.001). Unlike the predictors of death, all variables included into multivariable model were not significantly associated with treatment failure. CONCLUSION In the past 10 years, although MDR-TB treatment success in Ethiopia has been consistently favourable, the proportion of patients who died is still considerable. Death could be attributed to advanced age, HIV infection and anaemia. Prospective cohort studies are necessary to further explore the potentially modifiable predictors of treatment failure.
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Affiliation(s)
- Habteyes Tola
- Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
- TB/HIV Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - K Holakouie-Naieni
- Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Mohammad Ali Mansournia
- Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Mehdi Yaseri
- Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Dinka Fikadu Gamtesa
- TB/HIV Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Ephrem Tesfaye
- TB/HIV Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Zemedu Mahamed
- TB/HIV Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Million Molla Sisay
- Research and Evidence Generation Directorate,Saint Peter's Specialized Hospital, Addis Ababa, Ethiopia, Addis Ababa, Ethiopia
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13
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Liu J, Guo H, Lin TC, Wetmore JB, Bradbury BD, Gilbertson DT, Nieman K, Peng Y, Sprafka JM, Dluzniewski PJ. Cinacalcet and gastrointestinal bleeding risk in patients receiving hemodialysis. Pharmacoepidemiol Drug Saf 2021; 31:141-148. [PMID: 34363294 DOI: 10.1002/pds.5337] [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: 09/28/2020] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE Secondary hyperparathyroidism (SHPT) is common among dialysis patients, and calcimimetics are a mainstay of treatment. This study assessed whether cinacalcet use is associated with gastrointestinal bleeding in a large hemodialysis cohort. METHODS A linked database of clinical records and medical claims for patients receiving hemodialysis in a large dialysis organization, 2007-2010, was used. A nested case-control study was performed among patients aged ≥18 years who had received hemodialysis for ≥90 days, had Medicare Parts A, B, and D coverage for ≥1 year, and had clinical evidence of SHPT (parathyroid hormone >300 pg/mL). Cases were those who experienced death or hospitalization caused by gastrointestinal bleeding. Each case was matched to up to four controls. Exposure was measured by any cinacalcet use, current use, past use, cumulative exposure days, and cumulative dosage. Conditional logistic models were used to assess the association. RESULTS Of 48 437 patients included, 2570 experienced gastrointestinal bleeding events (2498 non-fatal, 72 fatal), and 2465 (2397 non-fatal, 68 fatal) were matched to 9500 controls; 17.2% of cases and 15.8% of controls had cinacalcet exposure and 11.1% of both cases and controls had current use. The adjusted odds ratios (95% CI) of gastrointestinal bleeding for any use, current use, and past use of cinacalcet were 1.04 (0.91-1.19), 0.97 (0.83-1.13), and 1.22 (0.99-1.50), respectively, with no use as the reference. CONCLUSION The results do not suggest an elevated risk of gastrointestinal bleeding resulting in hospitalization or death for hemodialysis patients exposed to cinacalcet.
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Affiliation(s)
- Jiannong Liu
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Haifeng Guo
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Tzu-Chieh Lin
- Center for Observational Research, Amgen, Inc., California, USA
| | - James B Wetmore
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.,Division of Nephrology, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | | | - David T Gilbertson
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Kimberly Nieman
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Yi Peng
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
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14
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Isralls S, Baisley K, Ngam E, Grant AD, Millard J. QT Interval Prolongation in People Treated With Bedaquiline for Drug-Resistant Tuberculosis Under Programmatic Conditions: A Retrospective Cohort Study. Open Forum Infect Dis 2021; 8:ofab413. [PMID: 34466629 PMCID: PMC8403230 DOI: 10.1093/ofid/ofab413] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/30/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Bedaquiline has a black-box warning of the risk of arrhythmias and sudden death. This study aimed to determine the incidence of QTc prolongation and cardiac events in patients receiving bedaquiline for drug-resistant tuberculosis (DR-TB) under programmatic conditions. METHODS Retrospective cohort study of patients receiving bedaquiline at a DR-TB hospital in KwaZulu Natal, South Africa from September 2017 to February 2019. The primary outcome, a prolonged QT interval corrected using the Fridericia formula (QTcF), was defined as QTcF >500 ms, QTcF change >60 ms from baseline, or both. RESULTS Among 420 patients (66.2% male, median age 36 years), the median QTcF was 406.4 (interquartile range [IQR], 389.1-421.3) ms at baseline, increasing to 430.5 (IQR, 414.4-445.1) ms by 3 months and 434.0 (IQR, 419.0-447.9) ms at 6 months. Eighteen of 420 patients (4.3%) had a QTcF >500 ms and 110 of 420 patients (26.2%) had a QTcF change >60 ms. There were no recorded arrhythmias or cardiac deaths. Odds of prolonged QTcF were increased with concomitant azoles (adjusted odds ratio [aOR], 5.61 [95% confidence interval (CI), 2.26-13.91]; P < .001) and an inverse association with HIV-positive status (aOR, 0.34 [95% CI, .15-.75]; P = .008) and hypertension (aOR, 0.13 [95% CI, .02-.86]; P = .02). After prolongation, the QTcF declined to <500 ms, whether drugs were interrupted or not. CONCLUSIONS We observed a modest prolongation of QTcF, maximal at week 15; there were no recorded arrhythmias or related deaths.
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Affiliation(s)
- Sharon Isralls
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kathy Baisley
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Africa Health Research Institute, Durban, South Africa
| | - Eric Ngam
- University of KwaZulu-Natal, Durban, South Africa
| | - Alison D Grant
- Africa Health Research Institute, Durban, South Africa
- Tuberculosis Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - James Millard
- Africa Health Research Institute, Durban, South Africa
- Wellcome Trust Liverpool Glasgow Centre for Global Health Research, Liverpool, United Kingdom
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
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15
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Bogale L, Tsegaye T, Abdulkadir M, Akalu TY. Unfavorable Treatment Outcome and Its Predictors Among Patients with Multidrug-Resistance Tuberculosis in Southern Ethiopia in 2014 to 2019: A Multi-Center Retrospective Follow-Up Study. Infect Drug Resist 2021; 14:1343-1355. [PMID: 33854347 PMCID: PMC8041603 DOI: 10.2147/idr.s300814] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/16/2021] [Indexed: 12/16/2022] Open
Abstract
Background According to the 2017 global report, Ethiopia is among the top 30 high tuberculosis (TB) and multidrug-resistant tuberculosis (MDR-TB) burden countries. However, studies on MDR-TB treatment outcomes in Southern Ethiopia was very limited. Therefore, the study was aimed at determining the unfavorable treatment outcome and its predictors among patients with multidrug-resistant tuberculosis in Southern Ethiopia MDR-TB treatment centers. Subjects and Methods A retrospective follow-up study was conducted in Southern Ethiopia MDR-TB treatment initiating centers. Three hundred sixty-three patients were included in the study. Kaplan–Meier failure curve, median time, and Log rank test were used to present the descriptive findings. Then, a Cox regression analysis was used to identify predictors of unfavorable treatment outcome. The strength of the association was reported using an adjusted hazard ratio (AHR) and a 95% confidence interval (CI). Finally, the Cox Snell residual test was used to check the goodness of fit. Results For the entire cohort, the unfavorable treatment outcome was 23.68% (19.29, 28.09). Hospitalization for care (AHR = 2.07; 95% CI = 1.21, 3.63), male sex (AHR = 1.85; 95% CI = 1.002, 3.42), attending tertiary education (AHR = 0.31; 95% CI = 0.11, 0.91), and those with low hemoglobin (AHR = 2.89; 95% CI = 1.55, 5.38) were predictors for unfavorable treatment outcome. Conclusion The unfavorable treatment outcome was higher compared with the national goal of END-TB by 2020. Hospitalizations for care, male sex, and low hemoglobin level increased the hazard of the unfavorable treatment outcome. On the other hand, attending territory education decreased the hazard of the unfavorable treatment outcome.
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Affiliation(s)
- Lemlem Bogale
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Tsegaye
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohamed Abdulkadir
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Temporal Factors and Missed Doses of Tuberculosis Treatment. A Causal Associations Approach to Analyses of Digital Adherence Data. Ann Am Thorac Soc 2021; 17:438-449. [PMID: 31860328 PMCID: PMC7175980 DOI: 10.1513/annalsats.201905-394oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Rationale: Tuberculosis treatment lasts for 6 months or more. Treatment adherence is critical; regimen length, among other factors, makes this challenging. Globally, analyses mapping common types of nonadherence are lacking. For example, is there a greater challenge resulting from early treatment cessation (discontinuation) or intermittent missed doses (suboptimal dosing implementation)? This is essential knowledge for the development of effective interventions and more “forgiving” regimens, as well as to direct national tuberculosis programs. Objectives: To granularly describe how patients take their tuberculosis medication and the temporal factors associated with missed doses. Methods: The present study included patients with pulmonary tuberculosis enrolled in the control arm of a pragmatic, cluster-randomized trial in China of electronic reminders to improve treatment adherence. Treatment was the standard 6-month course (180 d), dosed every other day (90 doses). Medication monitor boxes recorded adherence (box opening) without prompting reminders. Patterns of adherence were visualized and described. Mixed-effects logistic regression models examined the temporal factors associated with per-dose suboptimal dosing implementation, adjusting for clustering within a participant. Cox regression models were used to examine the association between early suboptimal dosing implementation and permanent discontinuation. Results: Across 780 patients, 16,794 (23.9%) of 70,200 doses were missed, 9,487 of which were from suboptimal dosing implementation (56.5%). By 60 days, 5.1% of participants had discontinued, and 14.4% had discontinued by 120 days. Most participants (95.9%) missed at least one dose. The majority of gaps were of a single dose (71.4%), although 22.6% of participants had at least one gap of 2 weeks or more. In adjusted models, the initiation–continuation phase transition (odds ratio, 3.07 [95% confidence interval, 2.68–3.51]) and national holidays (1.52 [1.39–1.65]) were associated with increased odds of suboptimal dosing implementation. Early-stage suboptimal dosing implementation was associated with increased discontinuation rates. Conclusions: Digital tools provide an unprecedented step change in describing and addressing nonadherence. In our setting, nonadherence was common; patients displayed a complex range of patterns. Dividing nonadherence into suboptimal dosing implementation and discontinuation, we found that both increased over time. Discontinuation was associated with early suboptimal dosing implementation. These apparent causal associations between temporal factors and nonadherence present opportunities for targeted interventions. Clinical trial registered with the ISRCTN Registry (ISRCTN46846388).
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Stagg HR, Flook M, Martinecz A, Kielmann K, Abel Zur Wiesch P, Karat AS, Lipman MCI, Sloan DJ, Walker EF, Fielding KL. All nonadherence is equal but is some more equal than others? Tuberculosis in the digital era. ERJ Open Res 2020; 6:00315-2020. [PMID: 33263043 PMCID: PMC7682676 DOI: 10.1183/23120541.00315-2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/16/2020] [Indexed: 12/20/2022] Open
Abstract
Adherence to treatment for tuberculosis (TB) has been a concern for many decades, resulting in the World Health Organization's recommendation of the direct observation of treatment in the 1990s. Recent advances in digital adherence technologies (DATs) have renewed discussion on how to best address nonadherence, as well as offering important information on dose-by-dose adherence patterns and their variability between countries and settings. Previous studies have largely focussed on percentage thresholds to delineate sufficient adherence, but this is misleading and limited, given the complex and dynamic nature of adherence over the treatment course. Instead, we apply a standardised taxonomy - as adopted by the international adherence community - to dose-by-dose medication-taking data, which divides missed doses into 1) late/noninitiation (starting treatment later than expected/not starting), 2) discontinuation (ending treatment early), and 3) suboptimal implementation (intermittent missed doses). Using this taxonomy, we can consider the implications of different forms of nonadherence for intervention and regimen design. For example, can treatment regimens be adapted to increase the "forgiveness" of common patterns of suboptimal implementation to protect against treatment failure and the development of drug resistance? Is it reasonable to treat all missed doses of treatment as equally problematic and equally common when deploying DATs? Can DAT data be used to indicate the patients that need enhanced levels of support during their treatment course? Critically, we pinpoint key areas where knowledge regarding treatment adherence is sparse and impeding scientific progress.
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Affiliation(s)
- Helen R Stagg
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Mary Flook
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Antal Martinecz
- Department of Biology, Pennsylvania State University, University Park, PA, USA.,Center for Infectious Disease Dynamics, Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA.,Department of Pharmacy, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Karina Kielmann
- The Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Pia Abel Zur Wiesch
- Department of Biology, Pennsylvania State University, University Park, PA, USA.,Center for Infectious Disease Dynamics, Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, PA, USA.,These authors contributed equally
| | - Aaron S Karat
- The Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK.,TB Centre, London School of Hygiene & Tropical Medicine, London, UK.,These authors contributed equally
| | - Marc C I Lipman
- UCL Respiratory, Division of Medicine, University College London, London, UK.,Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK.,These authors contributed equally
| | - Derek J Sloan
- School of Medicine, University of St Andrews, St Andrews, UK.,These authors contributed equally
| | | | - Katherine L Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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18
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Treatment interruption patterns and adverse events among patients on bedaquiline containing regimen under programmatic conditions in India. Pulmonology 2020; 28:203-209. [PMID: 33121945 DOI: 10.1016/j.pulmoe.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The study aimed to analyze frequency and severity of adverse events (AEs) and other reasons for interruption of treatment and loss to follow up (LTFU) during first six months of treatment among tuberculosis patients on bedaquiline containing regimens. METHODS This pilot exploratory observational study included 275 patients enrolled consecutively over two years who received bedaquiline containing regimen under programmatic conditions in India. RESULTS Among 275 patients with median age of 25 years, 86 (31.3%) patients had at least one interruption with 122 total episodes of interruption. Among these 70 were temporary, 35 were permanent interruptions and 17 were LTFU. The AEs due to drugs were the commonest reason for interruption observed in 81.4% of temporary interruption group and 97.1% of permanent interruption group. Among a total 192 adverse event episodes, (49.5%) were minor (grade 1-2) and (50.5%) were serious (grade 3-5). Personal factors were the commonest reason for interruption observed in LTFU (94.1%) group. The most common temporarily interrupted drug was bedaquiline in 8.7% and permanently stopped drug was linezolid in 5% of patients. CONCLUSIONS Our study observed that drug related AEs are important risk factors associated with treatment interruptions in bedaquiline containing regimens. Bedaquiline is the most common temporarily interrupted drug due to AEs.
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Merid MW, Muluneh AG, Yenit MK, Kassa GM. Treatment interruption and associated factors among patients registered on drug-resistant tuberculosis treatment in Amhara regional state, Ethiopia: 2010-2017. PLoS One 2020; 15:e0240564. [PMID: 33052983 PMCID: PMC7556470 DOI: 10.1371/journal.pone.0240564] [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: 06/16/2020] [Accepted: 09/28/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Drug-Resistant Tuberculosis (DR-TB) is a rising threat of the TB control program caused mainly by treatment interruption in Ethiopia. The success of the current treatment regimen for DR-TB is poor partly due to a high treatment interruption rate. Thus, this study assessed treatment interruption and associated factors among DR-TB patients. METHODS An institution-based cross-sectional study was conducted among 550 DR-TB patients who have initiated treatment from September 2010 to December 2017. Data were entered using Epi Data version 4.200 and exported to STATA version 14 for analysis. A bi-variable logistic regression model was first fitted, and variables having a p-value < 0.2 in the bi-variable analysis were entered into the multivariable logistic regression model. Crude and Adjusted Odds Ratios (COR and AOR) with 95% confidence interval (CI) were used to determine the strength of association between the treatment interruption and independent variables. Variables with p-value <0.05 in the multi-variable model were considered as statistically significant predictors of treatment interruption. RESULTS In this study, the prevalence of treatment interruption among patients registered on DR-TB treatment was 14.55% (95% CI: 11.83, 17.76). Of the interrupters, the treatment interruption during the intensive and continuation phase of treatment was reported as 45% and 71.25%, respectively. Similarly, about 15% of patients had treatment interruption both during the intensive and continuation phase of treatment. The average duration of treatment interruption was 12 (±2.03 SD) and 6 (±1.2 SD) days during the intensive and continuation phase of treatment, respectively. Patients who had no treatment supporter [AOR = 1.45; 95% CI: 1.23-3.66] and developed adverse drug events [AOR = 1.60; 95% CI: 1.22-2.85] were statistically significant predictors of treatment interruption. CONCLUSIONS Treatment interruption was low in the study setting. The presence of treatment supporter and absence of drug side effects was significantly associated with decreased occurrence of treatment interruption. Thus, patient linkage to treatment supporter and excellent pharmacovigilance are highly recommended in the study setting.
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Affiliation(s)
- Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Atalay Goshu Muluneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Kindie Yenit
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getahun Molla Kassa
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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20
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Tibble H, Flook M, Sheikh A, Tsanas A, Horne R, Vrijens B, De Geest S, Stagg HR. Measuring and reporting treatment adherence: What can we learn by comparing two respiratory conditions? Br J Clin Pharmacol 2020; 87:825-836. [PMID: 32639589 DOI: 10.1111/bcp.14458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/02/2020] [Accepted: 06/24/2020] [Indexed: 01/03/2023] Open
Abstract
Medication non-adherence, defined as any deviation from the regimen recommended by their healthcare provider, can increase morbidity, mortality and side effects, while reducing effectiveness. Through studying two respiratory conditions, asthma and tuberculosis (TB), we thoroughly review the current understanding of the measurement and reporting of medication adherence. In this paper, we identify major methodological issues in the standard ways that adherence has been conceptualised, defined and studied in asthma and TB. Between and within the two diseases there are substantial variations in adherence reporting, linked to differences in dosing intervals and treatment duration. Critically, the communicable nature of TB has resulted in dose-by-dose monitoring becoming a recommended treatment standard. Through the lens of these similarities and contrasts, we highlight contemporary shortcomings in the generalised conceptualisation of medication adherence. Furthermore, we outline elements in which knowledge could be directly transferred from one condition to the other, such as the application of large-scale cost-effective monitoring methods in TB to resource-poor settings in asthma. To develop a more robust evidence-based approach, we recommend the use of standard taxonomies detailed in the ABC taxonomy when measuring and discussing adherence. Regimen and intervention development and use should be based on sufficient evidence of the commonality and type of adherence behaviours displayed by patients with the relevant condition. A systematic approach to the measurement and reporting of adherence could improve the value and generalisability of research across all health conditions.
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Affiliation(s)
- Holly Tibble
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.,Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - Mary Flook
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.,Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK.,Health Data Research UK, London, UK
| | - Athanasios Tsanas
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.,Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
| | - Rob Horne
- Asthma UK Centre for Applied Research, Usher Institute, Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK.,Centre for Behavioural Medicine, Department for Practice and Policy, UCL School of Pharmacy, University College London, London, UK
| | - Bernard Vrijens
- AARDEX Group, Seraing, Belgium.,Liège University, Liège, Belgium
| | - Sabina De Geest
- Institute of Nursing Science, University of Basel, Basel, Switzerland.,Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Helen R Stagg
- Usher Institute, Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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21
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Intermittent treatment interruption and its effect on multidrug resistant tuberculosis treatment outcome in Ethiopia. Sci Rep 2019; 9:20030. [PMID: 31882784 PMCID: PMC6934462 DOI: 10.1038/s41598-019-56553-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/12/2019] [Indexed: 11/21/2022] Open
Abstract
Treatment interruption is one of the main risk factors of poor treatment outcome and occurrence of additional drug resistant tuberculosis. This study is a national retrospective cohort study with 10 years follow up period in MDR-TB patients in Ethiopia. We included 204 patients who had missed the treatment at least for one day over the course of the treatment (exposed group) and 203 patients who had never interrupted the treatment (unexposed group). We categorized treatment outcome into successful (cured or completed) and unsuccessful (lost to follow up, failed or died). We described treatment interruption by the length of time between interruptions, time to first interruption, total number of interruption episodes and percent of missed doses. We used Poisson regression model with robust standard error to determine the association between treatment interruption and outcome. 82% of the patients interrupted the treatment in the first six month of treatment period, and considerable proportion of patients demonstrated long intervals between two consecutive interruptions. Treatment interruption was significantly associated with unsuccessful treatment outcome (Adjusted Risk Ratio (ARR) = 1.9; 95% CI (1.4–2.6)). Early identification of patients at high risk of interruption is vital in improving successful treatment outcome.
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22
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Stagg HR, Abubakar I, Campbell CN, Copas A, Darvell M, Horne R, Kielmann K, Kunst H, Mandelbaum M, Pickett E, Story A, Vidal N, Wurie FB, Lipman M. IMPACT study on intervening with a manualised package to achieve treatment adherence in people with tuberculosis: protocol paper for a mixed-methods study, including a pilot randomised controlled trial. BMJ Open 2019; 9:e032760. [PMID: 31852704 PMCID: PMC6937100 DOI: 10.1136/bmjopen-2019-032760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Compared with the rest of the UK and Western Europe, England has high rates of the infectious disease tuberculosis (TB). TB is curable, although treatment is for at least 6 months and longer when disease is drug resistant. If patients miss too many doses (non-adherence), they may transmit infection for longer and the infecting bacteria may develop resistance to the standard drugs used for treatment. Non-adherence may therefore risk both their health and that of others. Within England, certain population groups are thought to be at higher risk of non-adherence, but the factors contributing to this have been insufficiently determined, as have the best interventions to promote adherence. The objective of this study was to develop a manualised package of interventions for use as part of routine care within National Health Services to address the social and cultural factors that lead to poor adherence to treatment for TB disease. METHODS AND ANALYSIS This study uses a mixed-methods approach, with six study components. These are (1) scoping reviews of the literature; (2) qualitative research with patients, carers and healthcare professionals; (3) development of the intervention; (4) a pilot randomised controlled trial of the manualised intervention; (5) a process evaluation to examine clinical utility; and (6) a cost analysis. ETHICS AND DISSEMINATION This study received ethics approval on 24 December 2018 from Camberwell St. Giles Ethics Committee, UK (REC reference 18/LO/1818). Findings will be published and disseminated through peer-reviewed publications and conference presentations, published in an end of study report to our funder (the National Institute for Health Research, UK) and presented to key stakeholders. TRIAL REGISTRATION NUMBER ISRCTN95243114 SECONDARY IDENTIFYING NUMBERS: University College London/University College London Hospitals Joint Research Office 17/0726.National Institute for Health Research, UK 16/88/06.
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Affiliation(s)
- Helen R Stagg
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
| | | | - Andrew Copas
- Centre for Pragmatic Global Health Trials, Institute of Global Health, University College London, London, UK
| | | | - Robert Horne
- UCL School of Pharmacy, University College London, London, UK
| | - Karina Kielmann
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Edinburgh, UK
| | - Heinke Kunst
- Department of Respiratory Medicine, Queen Mary University of London, London, UK
| | | | - Elisha Pickett
- Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - Alistair Story
- Find&Treat, University College Hospitals NHS Foundation Trust, London, UK
| | - Nicole Vidal
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Edinburgh, UK
| | - Fatima B Wurie
- Institute for Global Health, University College London, London, UK
| | - Marc Lipman
- UCL Respiratory, University College London, London, UK
- Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
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23
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Wang Y, Chen H, Huang Z, McNeil EB, Lu X, Chongsuvivatwong V. Drug Non-Adherence And Reasons Among Multidrug-Resistant Tuberculosis Patients In Guizhou, China: A Cross-Sectional Study. Patient Prefer Adherence 2019; 13:1641-1653. [PMID: 31686790 PMCID: PMC6777430 DOI: 10.2147/ppa.s219920] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/12/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Treatment interruption and incorrect dosage for measuring drug non-adherence have seldom been studied in multidrug-resistant tuberculosis (MDR-TB) treatment. This study aimed to 1) estimate the overall and drug-specific incidence of short (≤14 days) and serious (>14 days) treatment interruption among MDR-TB patients, 2) identify main reasons and predictors for serious interruption, and 3) document the level of agreement of classification for incorrect drug dosage between self-report and pill count. PATIENTS AND METHODS A cross-sectional study combining hospital-based interviews and home-based pill count was conducted from January to June 2018. Treatment interruption was determined from patient's medical records and interviews using a structured questionnaire among 202 patients treated at one designated hospital for MDR-TB treatment. Concordance of pills counted with self-reports for each drug use within one month was assessed for a subgroup of patients at their homes using kappa statistics. RESULTS Of 202 patients, the incidence of short and serious treatment interruption was 37.6% and 28.7%, respectively. Adverse drug reactions (ADRs) and financial hardship were the top two reasons for serious interruption. Amikacin and cycloserine had the highest rate of specific drug interruption (18.3% and 10.2%, respectively). ADRs (ORadj: 2.82, 95% CI: 1.41-5.61), monthly out-of-pocket expenses exceeding 250 US dollars (ORadj: 2.27, 95% CI: 1.14-4.50), and baseline co-morbidities (ORadj: 2.53, 95% CI: 1.19-5.38) were significantly associated with serious treatment interruption. Of 111 patients assessed for pill count at home, 5.4% had perfect drug adherence, 54.1% had drug under-use, 6.3% had drug over-use, and 34.2% had both problems. The respective number from self-reports was 7.2%, 56.8%, 5.4% and 30.6%. The two methods gave an acceptable level of agreement for most of the drugs (kappa: 0.52-0.95). CONCLUSION Close monitoring of ADRs, revision of drug regimens, and financial support for MDR-TB in this study population are needed. Self-report on drug under-use and over-use should be monitored monthly in clinical settings.
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Affiliation(s)
- Yun Wang
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Huijuan Chen
- Department of Tuberculosis Prevention and Control, Guizhou Center for Disease Prevention and Control, Guiyang, Guizhou, People’s Republic of China
| | - Zhongfeng Huang
- Department of Tuberculosis, Guiyang Public Health Clinical Center, Guiyang, Guizhou, People’s Republic of China
| | - Edward B McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Xiaolong Lu
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
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24
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Hwang B, Shroufi A, Gils T, Steele SJ, Grimsrud A, Boulle A, Yawa A, Stevenson S, Jankelowitz L, Versteeg-Mojanaga M, Govender I, Stephens J, Hill J, Duncan K, van Cutsem G. Stock-outs of antiretroviral and tuberculosis medicines in South Africa: A national cross-sectional survey. PLoS One 2019; 14:e0212405. [PMID: 30861000 PMCID: PMC6413937 DOI: 10.1371/journal.pone.0212405] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 02/02/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV and TB programs have rapidly scaled-up over the past decade in Sub-Saharan Africa and uninterrupted supplies of those medicines are critical to their success. However, estimates of stock-outs are largely unknown. This survey aimed to estimate the extent of stock-outs of antiretroviral and TB medicines in public health facilities across South Africa, which has the world's largest antiretroviral treatment (ART) program and a rising multidrug-resistant TB epidemic. METHODS We conducted a cross-sectional telephonic survey (October-December 2015) of public health facilities. Facilities were asked about the prevalence of stock-outs on the day of the survey and in the preceding three months, their duration and impact. RESULTS Nationwide, of 3547 eligible health facilities, 79% (2804) could be reached telephonically. 88% (2463) participated and 4% (93) were excluded as they did not provide ART or TB treatment. Of the 2370 included facilities, 20% (485) reported a stock-out of at least 1 ARV and/or TB-related medicine on the day of contact and 36% (864) during the three months prior to contact, ranging from 74% (163/220) of health facilities in Mpumalanga to 12% (32/261) in the Western Cape province. These 864 facilities reported 1475 individual stock-outs, with one to fourteen different medicines out of stock per facility. Information on impact was provided in 98% (1449/1475) of stock-outs: 25% (366) resulted in a high impact outcome, where patients left the facility without medicine or were provided with an incomplete regimen. Of the 757 stock-outs that were resolved 70% (527) lasted longer than one month. INTERPRETATION There was a high prevalence of stock-outs nationwide. Large interprovincial differences in stock-out occurrence, duration, and impact suggest differences in provincial ability to prevent, mitigate and cope within the same framework. End-user monitoring of the supply chain by patients and civil society has the potential to increase transparency and complement public sector monitoring systems.
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Affiliation(s)
- Bella Hwang
- Médecins Sans Frontières South Africa, Operational Control Centre Brussels, Cape Town, South Africa
- * E-mail:
| | - Amir Shroufi
- Médecins Sans Frontières South Africa, Operational Control Centre Brussels, Cape Town, South Africa
| | - Tinne Gils
- Médecins Sans Frontières South Africa, Operational Control Centre Brussels, Cape Town, South Africa
| | - Sarah Jane Steele
- Médecins Sans Frontières South Africa, Operational Control Centre Brussels, Cape Town, South Africa
| | | | - Andrew Boulle
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Anele Yawa
- Treatment Action Campaign, Johannesburg, South Africa
| | | | | | | | - Indira Govender
- Rural Doctors Association of Southern Africa, Johannesburg, South Africa
| | | | - Julia Hill
- Médecins Sans Frontières South Africa, Operational Control Centre Brussels, Cape Town, South Africa
| | - Kristal Duncan
- Médecins Sans Frontières South Africa, Operational Control Centre Brussels, Cape Town, South Africa
| | - Gilles van Cutsem
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
- Médecins Sans Frontières, Southern African Medical Unit, Cape Town, South Africa
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25
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Law S, Daftary A, O'Donnell M, Padayatchi N, Calzavara L, Menzies D. Interventions to improve retention-in-care and treatment adherence among patients with drug-resistant tuberculosis: a systematic review. Eur Respir J 2019; 53:13993003.01030-2018. [PMID: 30309972 DOI: 10.1183/13993003.01030-2018] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/20/2018] [Indexed: 11/05/2022]
Abstract
The global loss to follow-up (LTFU) rate among drug-resistant tuberculosis (DR-TB) patients remains high at 15%. We conducted a systematic review to explore interventions to reduce LTFU during DR-TB treatment.We searched for studies published between January 2000 and December 2017 that provided any form of psychosocial or material support for patients with DR-TB. We estimated point estimates and 95% confidence intervals of the proportion LTFU. We performed subgroup analyses and pooled estimates using an exact binomial likelihood approach.We included 35 DR-TB cohorts from 25 studies, with a pooled proportion LTFU of 17 (12-23)%. Cohorts that received any form of psychosocial or material support had lower LTFU rates than those that received standard care. Psychosocial support throughout treatment, via counselling sessions or home visits, was associated with lower LTFU rates compared to when support was provided through a limited number of visits or not at all.Our review suggests that psychosocial support should be provided throughout DR-TB treatment in order to reduce treatment LTFU. Future studies should explore the potential of providing self-administered therapy complemented with psychosocial support during the continuation phase.
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Affiliation(s)
- Stephanie Law
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Amrita Daftary
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,McGill International TB Centre, McGill University, Montreal, QC, Canada.,CAPRISA-MRC TB-HIV Pathogenesis and Treatment Unit, Durban, South Africa
| | - Max O'Donnell
- CAPRISA-MRC TB-HIV Pathogenesis and Treatment Unit, Durban, South Africa.,Division of Pulmonary, Allergy and Critical Care Medicine, and Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
| | - Nesri Padayatchi
- CAPRISA-MRC TB-HIV Pathogenesis and Treatment Unit, Durban, South Africa
| | - Liviana Calzavara
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Dick Menzies
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,McGill International TB Centre, McGill University, Montreal, QC, Canada
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26
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Bastard M, Sanchez-Padilla E, du Cros P, Khamraev AK, Parpieva N, Tillyashaykov M, Hayrapetyan A, Kimenye K, Khurkhumal S, Dlamini T, Perez SF, Telnov A, Hewison C, Varaine F, Bonnet M. Outcomes of HIV-infected versus HIV-non-infected patients treated for drug-resistance tuberculosis: Multicenter cohort study. PLoS One 2018. [PMID: 29518098 PMCID: PMC5843270 DOI: 10.1371/journal.pone.0193491] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background The emergence of resistance to anti-tuberculosis (DR-TB) drugs and the HIV epidemic represent a serious threat for reducing the global burden of TB. Although data on HIV-negative DR-TB treatment outcomes are well published, few data on DR-TB outcomes among HIV co-infected people is available despite the great public health importance. Methods We retrospectively reported and compared the DR-TB treatment outcomes of HIV-positive and HIV-negative patients treated with an individualized regimen based on WHO guidelines in seven countries: Abkhazia, Armenia, Colombia, Kenya, Kyrgyzstan, Swaziland and Uzbekistan. Results Of the 1,369 patients started DRTB treatment, 809 (59.1%) were multi-drug resistant (MDR-TB) and 418 (30.5%) were HIV-positive. HIV-positive patients were mainly from African countries (90.1%) while HIV-negative originated from Former Soviet Union (FSU) countries. Despite a higher case fatality rate (19.0% vs 9.4%), HIV-positive MDR-TB patients had a 10% higher success rate than HIV-negative patients (64.0% vs 53.2%, p = 0.007). No difference in treatment success was found among polydrug-resistant (PDR-TB) patients. Overall, lost to follow-up rate was much higher among HIV-negative (22.0% vs. 8.4%). Older age and not receiving ART were the only factors associated with unfavorable treatment outcome among HIV-positive patients. Conclusions As already known for HIV-negative patients, success rate of DR-TB HIV-positive patients remains low and requires more effective DR-TB regimen using new drugs also suitable to HIV-infected patients on ART. The study also confirms the need of ART introduction in HIV co-infected patients.
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Affiliation(s)
| | | | | | - Atadjan Karimovich Khamraev
- Teaching Assistant of the Department of Public Health Administration, Nukus branch of Tashkent Pediatric Medical Institute, Nukus, Uzbekistan
| | | | | | | | - Kamene Kimenye
- Programmatic Management of Drug resistant Tuberculosis, Nairobi, Kenya
| | | | - Themba Dlamini
- MoH-TB National Control Program National Manager, Mbanane, Swaziland
| | - Santiago Fadul Perez
- National Public Health Institute, Respiratory disease department, Bogota, Colombia
| | - Alex Telnov
- Médecins Sans Frontières, Geneva, Switzerland
| | | | | | - Maryline Bonnet
- Epicentre, Paris, France
- Unité Mixte Internationale UMI233-U1175, Institute of Research for Development, Montpelier, France
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27
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Jimma W, Ghazisaeedi M, Shahmoradi L, Abdurahman AA, Kalhori SRN, Nasehi M, Yazdi S, Safdari R. Prevalence of and risk factors for multidrug-resistant tuberculosis in Iran and its neighboring countries: systematic review and meta-analysis. Rev Soc Bras Med Trop 2017; 50:287-295. [PMID: 28700044 DOI: 10.1590/0037-8682-0002-2017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/18/2017] [Indexed: 11/21/2022] Open
Abstract
Tuberculosis, in particular drug-resistant tuberculosis, is of global concern due to the high mortality and morbidity associated with it annually. The aim of this study was to determine the prevalence of and the risk factors for multidrug-resistant tuberculosis in Iran and its neighboring countries. Four databases (PubMed, BioMed Central, EMBASE, and Web of Science) were searched using key terms. Nineteen eligible articles were identified, of which 12 and seven were used for quantitative and qualitative analysis, respectively. The overall pooled estimate of the prevalence of multidrug-resistant tuberculosis, including both new and previously treated tuberculosis cases, in Iran, Iraq, Turkey and Pakistan was 16% (95% confidence interval [CI] 11-20). The patients with a previous tuberculosis treatment history (odds ratio [OR] = 6.45; 95% CI 5.12-7.79), those aged <45 years (OR = 1.57; 95% CI 1.12-2.03), and those who were males (OR = 1.83; 95% CI 1.19-2.48) had an increased pool risk of developing multidrug-resistant tuberculosis. The forest plot revealed that the pooled odds for the development of multidrug- resistant tuberculosis were 2.01 (95% CI 1.65-2.36). Poor adherence to treatment was one of the predictors of unsuccessful treatment outcomes. Multidrug-resistant tuberculosis is a great concern for public health programs in many countries globally, including those included in this review. The risk factors for the development of multidrug-resistant tuberculosis, specifically a previous tuberculosis treatment history, should be targeted through the implementation of specialized interventions.
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Affiliation(s)
- Worku Jimma
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, International Campus, Tehran, Iran.,Department of Information Science, College of Natural Sciences, Jimma University, Ethiopia.,Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeedi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Shahmoradi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmed Abdulahi Abdurahman
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, International Campus, Tehran, Iran
| | - Sharareh Rostam Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahshid Nasehi
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sharifi Yazdi
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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28
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Yin J, Yuan J, Hu Y, Wei X. Association between Directly Observed Therapy and Treatment Outcomes in Multidrug-Resistant Tuberculosis: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0150511. [PMID: 26930287 PMCID: PMC4773051 DOI: 10.1371/journal.pone.0150511] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 02/14/2016] [Indexed: 11/30/2022] Open
Abstract
Background Multidrug-resistant tuberculosis (MDR-TB) represents a major obstacle towards successful TB control. Directly observed therapy (DOT) was recommended by WHO to improve adherence and treatment outcomes of MDR-TB patients, however, the effectiveness of DOT on treatment outcomes of MDR-TB patients was mixed in previous studies. We conducted this systematic review and meta-analysis to assess the association between DOT and treatment outcomes and to examine the impact of different DOT providers and DOT locations on successful treatment outcomes in MDR-TB patients. Methods We searched studies published in English between January 1970 and December 2015 in major electronic databases. Two reviewers independently screened articles and extracted information of DOT, treatment success rate and other characteristics of studies. Random effects model was used to calculate the pooled treatment success rate and 95% confidence interval (CI). Sub-group analyses were conducted to access factors associated with successful treatment outcomes. Results A total of 31 articles 7,466 participants were included. Studies reporting full DOT (67.4%, 95% CI: 61.4–72.8%) had significantly higher pooled treatment success rates than those reporting self-administration therapy (46.9%, 95% CI: 41.4–52.4%). No statistically difference was found among DOT provided by healthcare providers (65.8%, 95% CI: 55.7–74.7%), family members (72.0%, 95% CI: 31.5–93.5%) and private DOT providers (69.5%, 95% CI: 57.0–79.7%); and neither did we find significantly difference on pooled treatment success rates between patients having health facility based DOT (70.5%, 95% CI: 61.5–78.1%) and home-based DOT (68.4%, 95% CI: 51.5–81.5%). Conclusion Providing DOT for a full course of treatment associated with a higher treatment success rate in MDR-TB patients.
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Affiliation(s)
- Jia Yin
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jinqiu Yuan
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yanhong Hu
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Xiaolin Wei
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Pasipanodya J, Srivastava S, Gumbo T. Fatal Lure of Look-Back Studies in Explaining Pharmacological Events Such as Acquired Drug Resistance in Patients With Multidrug-Resistant Tuberculosis. J Infect Dis 2015; 212:166-7. [DOI: 10.1093/infdis/jiv068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 01/27/2015] [Indexed: 11/15/2022] Open
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