1
|
Adejumo OA, Haffejee F, Jinabhai C, Daniel O. Association between experienced stigma, anxiety, depression and loneliness among people with drug-resistant tuberculosis in Lagos Nigeria: The moderating role of social support. Trop Med Int Health 2024. [PMID: 39233632 DOI: 10.1111/tmi.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
BACKGROUND This study assessed the moderating effect of social support on the association between experienced stigma versus anxiety, depression and loneliness among people with drug-resistant tuberculosis. METHODS A descriptive cross-sectional study was conducted among 203 adults on treatment for drug-resistant tuberculosis for at least 8 weeks. Validated scales were used to assess experienced stigma, anxiety, depression, loneliness and social support. Partial correlations and hierarchical multiple regression were used to determine the moderating effect of social support on the association between experienced stigma versus anxiety, depression and loneliness. The interaction was visualised using slope analysis. RESULTS Anxiety, loneliness and depression were reported by 148 (72.9%), 114 (56.2%) and 128 (63.1%) of the 203 participants, respectively. Experienced stigma was positively associated with depression (B = 0.428, p < 0.001), anxiety (B = 0.374, p < 0.001) and loneliness (B = 0.285, p = 0.001). Social support was negatively associated with depression (B = -0.255, p < 0.001), anxiety (B = -0.406, p < 0.001) and loneliness (B = -0.270, p = 0.001). The impact of experienced stigma on depression was different at low (B = 0.567, SE = 0.115, p < 0.001) and high (B = 0.275, SE = 0.253, p = 0.024) groups of social support. Similarly, at low social support, the effect of experienced stigma on loneliness (B = 0.491, SE = 0.250, p < 0.001) and anxiety (B = 0.254, SE = 0.060, p = 0.044) was different compared to the effect of experienced stigma on loneliness (B = 0.275, SE = 0.253, p = 0.024) and anxiety (B = 0.127, SE = 0.094, p = 0.307) at high group of social support. CONCLUSION In this study, social support reduced the effects of experienced stigma on anxiety, depression and loneliness suggesting that improving social support among people with drug-resistant tuberculosis is crucial in reducing the negative effects of stigma on anxiety, depression and loneliness.
Collapse
Affiliation(s)
- Olusola Adedeji Adejumo
- Mainland Hospital Yaba, Lagos, Nigeria
- Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Firoza Haffejee
- Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa
| | - Champaklal Jinabhai
- Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Olusoji Daniel
- Department of Community Medicine and Primary Care, Olabisi Onabanjo University, Sagamu, Nigeria
| |
Collapse
|
2
|
Zhou J, Yuan Q, Huang Q, Wang Q, Huang H, Chen W, Wang G, Liu S, Zhang T, Zhao X, Li Y. Implementation factors of tuberculosis control program in primary healthcare settings in China: a mixed-methods using the Consolidated Framework for Implementation Research framework. Infect Dis Poverty 2024; 13:52. [PMID: 38978081 PMCID: PMC11229258 DOI: 10.1186/s40249-024-01222-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/26/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major cause of death worldwide, and Chinese TB burden ranked the second globally. Chinese primary healthcare (PHC) sectors implement the TB Control Program (TCP) to improve active case finding, referral, treatment adherence, and health education. This study aimed to identify barriers and enablers of TCP implementation in high TB burden regions of West China. METHODS We conducted a representative study using mixed-methods in 28 counties or districts in Chongqing Municipality and Guizhou Province of West China from October 2021 to May 2022. Questionnaire surveys and semi-structured in-depth interviews were conducted with 2720 TB healthcare workers (HCWs) and 20 interviewees in PHC sectors. Descriptive statistical analysis was used to investigate TB HCWs' characteristics, and path analysis model was utilized to analyze the impact of associated factors on TCP implementation. Thematic framework analysis was developed with the guide of the adapted Consolidated Framework for Implementation Research (CFIR) on factors of TCP implementation. RESULTS This study found that 84.6% and 94.1% of community and village HCWs had low professional titles. Based on the results of multiple regression analysis and correlation analysis, lower TB core knowledge scores (-0.09) were identified as barriers for TCP implementation in community PHC sectors, and low working satisfaction (-0.17) and low working willingness (-0.10) are barriers for TPC implementation in village PHC sectors. The results of in-depth interviews reported barriers in all domains and enablers in four domains of CFIR. There were identified 19 CFIR constructs associated with TCP implementation, including 22 barriers such as HCWs' heavy workload, and 12 enablers such as HCWs' passion towards TCP planning. CONCLUSIONS With the guide of the CFIR framework, complex factors (barriers and enablers) of TCP implementation in PHC sectors of West China were explored, which provided important evidences to promote TB program in high TB burden regions. Further implementation studies to translate those factors into implementation strategies are urgent needed.
Collapse
Affiliation(s)
- Jiani Zhou
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Quan Yuan
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Qingning Huang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Qingya Wang
- Chongqing Tuberculosis Prevention and Control Institute, Chongqing Municipality, China
| | - Hexiang Huang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Wei Chen
- Institute of Tuberculosis Prevention and Control, Center for Disease Control and Prevention, Guiyang, Guizhou Province, China
| | - Geng Wang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Shili Liu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China
| | - Ting Zhang
- Chongqing Tuberculosis Prevention and Control Institute, Chongqing Municipality, China
| | - Xi Zhao
- Guiyang Center for Disease Control and Prevention, Guiyang, Guizhou Province, China
| | - Ying Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Shapingba District, Chongqing Municipality, China.
| |
Collapse
|
3
|
Musiimenta A, Tumuhimbise W, Atukunda E, Mugaba A, Linnemayr S, Haberer J. Digital Adherence Technologies Linked to Mobile Money Incentives for Medication Adherence Among People Living With Tuberculosis: Mixed Methods Feasibility and Acceptability Study. JMIR Hum Factors 2024; 11:e47996. [PMID: 38819905 PMCID: PMC11179015 DOI: 10.2196/47996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 10/30/2023] [Accepted: 04/07/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Complementing digital adherence technologies (DATs) with mobile money incentives may improve their utility in supporting tuberculosis medication adherence, yet the feasibility and acceptability of this integrated approach remain unclear. OBJECTIVE This study aims to describe the feasibility and acceptability of a novel DAT intervention called My Mobile Wallet composed of real-time adherence monitoring, SMS text message reminders, and mobile money incentives for tuberculosis medication adherence in a low-income setting. METHODS We purposively recruited people living with tuberculosis from the Mbarara Regional Referral Hospital in Mbarara, Uganda, who (1) were starting tuberculosis treatment at enrollment or within the past 4 weeks, (2) owned a mobile phone, (3) were able to use SMS test messaging, (4) were aged ≥18 years, and (5) were living in Mbarara district. At study exit (month 6), we used interviews and questionnaires informed by the unified theory of acceptance and use of technology (UTAUT) to collect feasibility and acceptability data, reflecting patients' experiences of using each component of My Mobile Wallet. Feasibility also included tracking the functionality of the adherence monitor (ie, an electronic pillbox) as well as SMS text message and mobile money delivery. We used a content analytical approach to inductively analyze qualitative data and Stata (version 13; StataCorp LLC) to analyze quantitative data. RESULTS All 39 participants reported that the intervention was feasible because it was easy for them to use (eg, access and read SMS text messages) and worked as expected. Almost all SMS text messages (6880/7064, 97.4%) were sent as planned. The transmission of adherence data from the monitor worked well, with 98.37% (5682/5776) of the data transmitted as planned. All participants additionally reported that the intervention was acceptable because it helped them take their tuberculosis medication as prescribed; the mobile money incentives relieved them of tuberculosis-related financial burdens; SMS text message reminders and electronic pillbox-based alarms reminded them to take their medication on time; and participants perceived real-time adherence monitoring as "being watched" while taking their medication, which encouraged them to take their medication on time to demonstrate their commitment. The intervention was perceived as a sign of care, which eventually created emotional support and a sense of connectedness to health care. Participants preferred daily SMS text message reminders (32/39, 82%) to reminders linked to missed doses (7/39, 18%), citing the fact that tuberculosis medication is taken daily. CONCLUSIONS The use of real-time adherence monitoring linked to SMS text message reminders and mobile money incentives for tuberculosis medication adherence was feasible and acceptable in a low-resource setting where poverty-based structural barriers heavily constrain tuberculosis treatment and care.
Collapse
Affiliation(s)
- Angella Musiimenta
- Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara, Uganda
- Angels Compassion Research and Development Initiative, Mbarara, Uganda
| | - Wilson Tumuhimbise
- Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara, Uganda
- Angels Compassion Research and Development Initiative, Mbarara, Uganda
| | - Esther Atukunda
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Aaron Mugaba
- Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara, Uganda
- Angels Compassion Research and Development Initiative, Mbarara, Uganda
| | | | - Jessica Haberer
- Harvard Medical School, Boston, MA, United States
- Massachusetts General Hospital Center for Global Health, Boston, MA, United States
| |
Collapse
|
4
|
Ssedyabane F, Randall TC, Kajabwangu R, Namuli A, Tusubira D, Kakongi N, Galiwango M, Maling S, Turyakira E, Atukunda EC. Development of a customized m-Health-based intervention to reduce loss to follow-up among patients undergoing treatment for cervical lesions at a rural referral Hospital, South Western Uganda. Gynecol Oncol Rep 2024; 52:101338. [PMID: 38435345 PMCID: PMC10907155 DOI: 10.1016/j.gore.2024.101338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 03/05/2024] Open
Abstract
Background Loss to follow-up (LTFU) in individuals undergoing cervical cancer treatment is a major challenge in many low resource settings. We describe development of a customized and tailored mHealth intervention for reducing LTFU among patients undergoing cervical cancer treatment at Mbarara Regional Referral Hospital (MRRH). Methods We interviewed all health care providers (HCPs) at the cervical cancer clinic of MRRH, between April and May 2023. Transcripts were subsequently derived, reviewed and coded to generate themes and categories using inductive content analytic approach. Four medical experts used this data to develop relevant SMS content, which was incorporated into an app. Results HCPs had owned a phone for 13.8 ≤ years, had worked at the clinic for 5 ≤ years, and used text messages regularly. Qualitative data revealed that the main challenge to re-engagement was absence of a reminder mechanism between HCPs and patients. HCPs preferred text and or audio mode of messaging to improve health care responsiveness to LTFUs, awareness, continuity of care, and health service uptake among the majority illiterate population; though with potential constraints of costs and workload. Identified key messaging content included; the importance of attending scheduled follow-ups, follow up visit date and clinic customization and tailoring the message to the intended recipient. SMS content was uploaded onto the cc-follow-up app platform and customized according to preferred language, day, frequency and time of delivery. Conclusion Tailoring an mHealth messaging intervention could help re-engage and reduce LTFU through improved information sharing, awareness, responsiveness, care engagement and medical compliance. A pilot study is required for our intervention in South Western Uganda.
Collapse
Affiliation(s)
- Frank Ssedyabane
- Department of Medical Laboratory Science, Faculty of Medicine, Mbarara University of Science of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Thomas C. Randall
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Rogers Kajabwangu
- Department of Obstetrics & Gynecology, Faculty of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Alexcer Namuli
- Department of Obstetrics & Gynecology, Faculty of Medicine, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Deusdedit Tusubira
- Department of Biochemistry, Faculty of Medicine, Mbarara University of Science of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Nathan Kakongi
- Department of Biochemistry, Faculty of Medicine, Mbarara University of Science of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Martin Galiwango
- Department of Electrical and Electronics Engineering, Faculty of Applied Sciences and Technology, Mbarara University of Science of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Samuel Maling
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Eleanor Turyakira
- Department of Community Health, Faculty of Medicine, Mbarara University of Science of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| | - Esther Cathyln Atukunda
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science of Science and Technology, P.O. Box 1410, Mbarara, Uganda
| |
Collapse
|
5
|
Chen X, Zhou J, Yuan Q, Zhang R, Huang C, Li Y. Challenge of ending TB in China: tuberculosis control in primary healthcare sectors under integrated TB control model-a systematic review and meta-analysis. BMC Public Health 2024; 24:163. [PMID: 38212753 PMCID: PMC10785344 DOI: 10.1186/s12889-023-16292-5] [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: 12/29/2022] [Accepted: 07/11/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND China has the third-largest burden of tuberculosis (TB) cases in the world with great challenges towards ending TB. Primary health care (PHC) sectors play a critical role in TB prevention and control in communities under the Chinese integrated TB control model. However, there is a lack of comprehensive review of research evidence on TB control in PHC sectors under the integrated TB control model in China. METHODS This review was conducted following the PRISMA guidelines. Articles published from 2012 to January 2022 were searched from four international and three Chinese databases. Studies conducted inside mainland China and relevant with TB control service in PHC sectors under the integrated model were included. After study selection, data extraction, and quality assessment, the meta-analysis was performed with RevMan using a random-effect model.When I2 was more than 50%, subgroup analysis was performed to explore possible reasons for heterogeneity. We also conducted a post hoc sensitivity analysis for outcomes after meta-analysis by exclusion of studies with a high risk of bias or classified as low quality. RESULTS Forty-three studies from 16 provinces/municipalities in China were included in this review, and most studies included were of medium quality. PHC sectors in East China delivered TB control service better overall than that in West China, especially in tracing of patients and TB case management (TCM). In meta-analyses, both the pooled arrival rate of tracing and pooled TCM rate in East China were higher than those in West China. TB patients had a low degree of willingness to receive TCM provided by healthcare workers in PHC sectors nationwide, especially among migrant TB patients. There were 9 studies reporting factors related to TB control service in PHC sectors, 6 (2 in East and 4 in West China) of which indentified several characteristics of patients as associated factors. The context of PHC sectors was demonstrated to influence delivery of TB control service in PHC sectors in 5 studies (3 in East, 1 in Middle and 1 in West China). Most studies on strategies to promoting TB control services in PHC sectors were conducted in East China and some of these studies identified several online and offline interventions and strategies improving patients' treatment compliance [pooled OR (95% CI): 7.81 (3.08, 19.19] and awareness of TB [pooled OR (95% CI): 6.86 (2.16, 21.72)]. CONCLUSION It is of urgent need to improve TB control in PHC sector in China, particularly in West China. Formative and implementation research with rigorous design are necessary to develop comprehensive, context-specific, and patient-centered TB control strategies to promote ending TB in China.
Collapse
Affiliation(s)
- Xi Chen
- Department of Social Medicine and Health Service Management, College of Preventive Medicine, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
- Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiani Zhou
- Department of Social Medicine and Health Service Management, College of Preventive Medicine, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Quan Yuan
- Department of Social Medicine and Health Service Management, College of Preventive Medicine, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Rui Zhang
- Department of Social Medicine and Health Service Management, College of Preventive Medicine, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China
| | - Chunji Huang
- Army Medical University (Third Military Medical University), Chongqing, China.
| | - Ying Li
- Department of Social Medicine and Health Service Management, College of Preventive Medicine, Army Medical University (Third Military Medical University), No. 30 Gaotanyan Road, Shapingba District, Chongqing, 400038, China.
| |
Collapse
|
6
|
Ferreira MRL, Bonfim RO, Bossonario PA, Maurin VP, Valença ABM, Abreu PDD, Andrade RLDP, Fronteira I, Monroe AA. Social protection as a right of people affected by tuberculosis: a scoping review and conceptual framework. Infect Dis Poverty 2023; 12:103. [PMID: 37993962 PMCID: PMC10664497 DOI: 10.1186/s40249-023-01157-1] [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: 08/27/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Tuberculosis is an infectious disease strongly influenced by social determinants closely associated with cycles of poverty and social exclusion. Within this context, providing social protection for people affected by the disease constitutes a powerful instrument for reducing inequalities and enhancing inclusion and social justice. This study aimed to identify and synthesize strategies and measures aimed at ensuring social protection as a right of people affected by tuberculosis. METHODS This is a scoping review, with searches conducted in six databases in February 2023. We included publications from 2015 onwards that elucidate strategies and measures of social protection aimed at safeguarding the rights to health, nutrition, employment, income, housing, social assistance, and social security for people affected by tuberculosis. These strategies could be implemented through policies, programs, and/or governmental agreements in any given context. The data extracted from the articles underwent descriptive analysis and a narrative synthesis of findings based on the dimensions of social protection. Additionally, we developed a conceptual framework illustrating the organizational and operational aspects of measures and strategies related to each dimension of social protection identified in this review. RESULTS A total of 9317 publications were retrieved from the databases, of which sixty-three publications were included. The study's results highlighted measures and strategies concerning the social protection of people affected by tuberculosis. These measures and strategies revolved around the rights to proper nutrition and nourishment, income, housing, and health insurance, as well as expanded rights encompassing social assistance and social welfare. It was reported that ensuring these rights contributes to improving nutritional status and the quality of life for individuals with tuberculosis, along with reducing catastrophic costs, expanding access to healthcare interventions and services, and fostering TB treatment adherence, thereby leading to higher rates of TB cure. CONCLUSIONS Our findings identify social protection measures as a right for people affected by tuberculosis and have the potential to guide the development of evidence-based social and health policies through collaboration between tuberculosis control programs and governmental entities.
Collapse
Affiliation(s)
| | - Rafaele Oliveira Bonfim
- University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | | | | | | | - Paula Daniella de Abreu
- University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | | | - Inês Fronteira
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University Lisbon, Lisbon, Portugal
- National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, NOVA University Lisbon, Lisbon, Portugal
| | - Aline Aparecida Monroe
- University of Sao Paulo at Ribeirao Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| |
Collapse
|
7
|
Sahan S, Topluoglu S, Temel F, Gokler ME, Kaygusuz S. Did Financial Social Support for Tuberculosis Patients Lead to Better Treatment Outcomes in Türkiye during 2018-2019? Jpn J Infect Dis 2023; 76:365-371. [PMID: 37648486 DOI: 10.7883/yoken.jjid.2023.196] [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] [Indexed: 09/01/2023]
Abstract
This study examined which factors, including the regular financial social support program, influence tuberculosis (TB) treatment outcomes and success rates. Patients with TB registered during 2018-2019 were included in this retrospective cohort study. We classified them into 2 groups: those who received financial support for at least one month, and those who did not. Of the 22,867 sampled patients, 5,033 received financial social support and 17,834 did not. The success rate was 11.9% higher among patients who received financial social support than among those who did not (97.34% versus 85.40%). After controlling for other factors, the success rate among all patients was 1.3 times higher for female, 2.6 times higher for those under 50 years, 1.5 times higher for extra-pulmonary TB, 1.5 times higher for a new case, 5.9 times higher for drug susceptible TB, and 5.8 times higher for those who received financial support. Crucially, this is the first study from Türkiye evaluating the effect of a regular financial social support program on TB treatment outcomes since the program began in 2018. We recommend regular financial support for patients with TB in all countries.
Collapse
Affiliation(s)
- Selda Sahan
- Department of Zoonotic and Vector Borne Diseases, General Directorate of Public Health, Ministry of Health, Türkiye
| | - Seher Topluoglu
- General Directorate of Public Health, Ministry of Health, Türkiye
| | - Fehminaz Temel
- Department of Communicable Diseases and Early Warning, General Directorate of Public Health, Ministry of Health, Türkiye
| | | | - Sedat Kaygusuz
- General Directorate of Public Health, Ministry of Health, Türkiye
| |
Collapse
|
8
|
Makabayi-Mugabe R, Musaazi J, Zawedde-Muyanja S, Kizito E, Fatta K, Namwanje-Kaweesi H, Turyahabwe S, Nkolo A. Community-based directly observed therapy is effective and results in better treatment outcomes for patients with multi-drug resistant tuberculosis in Uganda. BMC Health Serv Res 2023; 23:1248. [PMID: 37957610 PMCID: PMC10644403 DOI: 10.1186/s12913-023-10120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/05/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Health facility-based directly observed therapy (HF DOT) is the main strategy for the management of patients with drug-resistant tuberculosis (DR TB) in Uganda, however, this still yields sub-optimal treatment outcomes. We set out to assess the effectiveness of community-based directly observed therapy (CB DOT) for the treatment of DR TB in Uganda. METHODS Using a previously developed patient-centered model for CB DOT, we assigned community health workers (CHWs) as primary caregivers to patients diagnosed with DR TB. CHWs administered daily DOT to patients in their homes. Once a month, patients received travel vouchers to attend clinic visits for treatment monitoring. We assessed the effectiveness of this model using a quasi-experimental pre and post-study. From December 2020 to March 2022, we enrolled adult DR-TB patients on the CB DOT model. We collected retrospective data from patients who had received care using the HF DOT model during the year before the study started. The adjusted effect of CB DOT versus HF DOT on DR TB treatment success was estimated using modified Poisson regression model with robust cluster variance estimator. RESULTS We analyzed data from 264 DR TB patients (152 HF DOT, 112 CB DOT). The majority were males (67.8%) with a median age of 36 years (IQR 29 to 44 years). Baseline characteristics were similar across the comparison groups, except for educational level, regimen type, and organizational unit with age being borderline. The treatment success rate in the CB DOT group was 12% higher than that in the HF DOT (adjusted prevalence ratio (aPR)= 1.12 [95%CI 1.01, 1.24], P-value=0.03). Males were less likely to achieve treatment success compared to their female counterparts (aPR=0.87 [95% CI 0.78, 0.98], P-value=0.02). A total of 126 (47.7%) of 264 patients reported at least one adverse event. The HF DOT group had a higher proportion of patients with at least one adverse event compared to the CB DOT group (90/152 [59.2%] versus 36/112 [32.1], P-value<0.01). The model was acceptable among patients (93.6%) and health workers (94.1%). CONCLUSIONS CB DOT for DR-TB care is effective and results in better treatment outcomes than HF DOT. The cost-effectiveness of this model of care should be further evaluated.
Collapse
Affiliation(s)
- Rita Makabayi-Mugabe
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P.0.Box 22418, Kampala, Uganda.
- USAID-Defeat TB Project, University Research Co. LLC., Kampala, Uganda.
| | - Joseph Musaazi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P.0.Box 22418, Kampala, Uganda
| | - Stella Zawedde-Muyanja
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P.0.Box 22418, Kampala, Uganda
- USAID-Defeat TB Project, University Research Co. LLC., Kampala, Uganda
| | - Enock Kizito
- Infectious Diseases Institute, College of Health Sciences, Makerere University, P.0.Box 22418, Kampala, Uganda
| | | | | | - Stavia Turyahabwe
- Ministry of Health, National Tuberculosis, and Leprosy Program, Kampala, Uganda
| | - Abel Nkolo
- USAID-Defeat TB Project, University Research Co. LLC., Kampala, Uganda
| |
Collapse
|
9
|
Nadon H, Dmello MK, Shetty S. Factors determining family and social support among pulmonary tuberculosis patients in East Khasi Hills, Meghalaya: a cross-sectional study. J Public Health (Oxf) 2023; 45:e542-e550. [PMID: 37183006 DOI: 10.1093/pubmed/fdad063] [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: 11/22/2022] [Revised: 04/13/2023] [Indexed: 05/16/2023] Open
Abstract
INTRODUCTION Family support plays a vital role in the outcome of individuals with tuberculosis (TB). OBJECTIVES To determine the family and social support among individuals with pulmonary TB during treatment. METHODS A cross-sectional survey was conducted among 237 pulmonary TB patients currently in the continuous phase of treatment. Bivariate and multivariate analyses were conducted to determine the association and predictors for family and social support. P-value < 0.05 was considered statistically significant. RESULTS The mean age of the respondents was 31.97 ± 12.51 years, and a majority (58.2%) of the respondents with TB disease were 18 to 38 years old, and 59.9% were males. Around 49.7% of the pulmonary TB patients received a high level of family support, whereas 73% received a high level of social support. The determinants like age, average monthly income, the educational level of the head of the family and the occupational level of both the patients and the head of the family are associated with family support. CONCLUSION This study recommends a coordinated strategy to treat TB that involves not only professional services but also the vital social support network of family and community that is required throughout therapy.
Collapse
Affiliation(s)
- Herman Nadon
- Department of Public Health, KS Hegde Medical Academy, Nitte (Deemed to be University), Deralakatte, Mangalore 575018, India
- Clinical Trial Coordinator, Department of Surgical Oncology, North Eastern Indragandhi Regional Institute of Medical Sciences, Shillong 793018, India
| | - Mackwin K Dmello
- Department of Public Health, KS Hegde Medical Academy, Nitte (Deemed to be University), Deralakatte, Mangalore 575018, India
| | - Shraddha Shetty
- Department of Biostatistics, KS Hegde Medical Academy, Nitte (Deemed to be University), Deralakatte, Mangalore 575018, India
| |
Collapse
|
10
|
Maynard C, Tariq S, Sotgiu G, Migliori GB, van den Boom M, Field N. Psychosocial support interventions to improve treatment outcomes for people living with tuberculosis: a mixed methods systematic review and meta-analysis. EClinicalMedicine 2023; 61:102057. [PMID: 37457116 PMCID: PMC10338299 DOI: 10.1016/j.eclinm.2023.102057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023] Open
Abstract
Background People with tuberculosis (TB) face multi-dimensional barriers when accessing and engaging with care. There is evidence that providing psychosocial support within people-centered models of care can improve TB outcomes, however, there is limited consensus on what works. It remains important for such interventions to be rigorously assessed, and mixed methods systematic reviews are one way of synthesising data for policy makers to be able to access such evidence. Mixed methods reviews take a complexity perspective, with qualitative data being used to contextualise the quantitative findings and giving an insight into how interventions are contingent on variations in design and context. Methods Five electronic databases were searched from January 1 2015 to 14 January 2023 for randomised controlled trials, quasi-experimental trials, cohort studies and qualitative studies of interventions providing psychosocial support (material and/or psychological-based support) to adults with any clinical form of active TB. Studies with inpatient treatment as the standard of care were excluded. Quantitative studies reporting pre-specified standard TB outcomes were eligible. In line with established mixed methods review methodology, a convergent parallel-results synthesis design was followed: quantitative and qualitative syntheses were distinct and carried out using appropriate methods. A convergent coding matrix was then used to integrate the results. The protocol was registered on PROSPERO (CRD42021235211). Findings Twenty-three studies of interventions were included (12 quantitative, 10 qualitative, and 1 mixed methods study) were included. Most studies were conducted in low-and middle-income countries with a high-burden of TB. Three explanatory and contextual middle-range theories from the integration of qualitative and quantitative data were developed: effective interventions provide multi-dimensional support; psychological-based support is transformative but there is insufficient evidence that it improves treatment outcomes on its own; intervention delivery shapes a logic of care. Interpretation This review takes a complexity perspective to provide actionable and timely insight to inform the design and implementation of locally-appropriate and people-centered psychosocial support interventions within national TB programmes. Funding There was no funding source for this study.
Collapse
Affiliation(s)
| | | | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, University of Sassari, Italy
| | | | | | - Nigel Field
- UCL Institute for Global Health, UK
- Centre for Molecular Epidemiology and Translational Research, UCL Institute for Global Health, UK
| |
Collapse
|
11
|
Wang Y, Huang Z, Chen H, Yuan Y, McNeil EB, Lu X, Zhang A. The Association Between Household Financial Burden and Patient Mobility and Their Impact on Loss to Follow-Up Among Multidrug-Resistant Tuberculosis Patients in Guizhou, China. Risk Manag Healthc Policy 2023; 16:909-919. [PMID: 37220483 PMCID: PMC10200133 DOI: 10.2147/rmhp.s400667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/04/2023] [Indexed: 05/25/2023] Open
Abstract
Purpose We aimed to assess the household financial burden due to multidrug-resistant tuberculosis (MDR-TB) treatment and its predictors, examine its association with patient mobility, and test their impact on patient loss to follow-up (LTFU). Methods A cross-sectional study combining follow-up data collection was conducted at the largest designated MDR-TB hospital in Guizhou. Data were collected from medical records and questionnaires. Household financial burden was measured by the incidence of 2 indicators: catastrophic total costs (CTC) and catastrophic health expenditure (CHE). Mobility was classified as mover or non-mover after the patient's address was verified twice. A multivariate logistic regression model was used to identify associations between variables. Model I and Model II were separated by CHE and CTC. Results Out of 180 households, the incidence of CHE and CTC was 51.7% and 80.6%, respectively. Families with low income and patients who were primary income earners were significantly associated with catastrophic costs. 42.8% of patients were movers. Patients from households with CHE (ORadj=2.2, 95% CI: 1.1-4.1) or with CTC (ORadj=2.6, 95% CI: 1.1-6.3) were more likely to move. Finding a job against financial difficulty (58.4%) was the top reason for movers. 20.0% of patients experienced LTFU. Patients from households with catastrophic payments (CHE: ORadj=4.1, 95% CI 1.6-10.5 in Model I; CTC: ORadj=4.8, 95% CI 1.0-22.9 in Model II), patients who were movers (ORadj=6.1, 95% CI 2.5-14.8 in Model I; ORadj=7.4, 95% CI 3.0-18.7 in Model II) and primary income earners (ORadj=2.5, 95% CI: 1.0-5.9 in Model I; ORadj=2.7, 95% CI 1.1-6.6 in Model II) had an increased risk of LTFU. Conclusion There is a significant association between household financial burden due to MDR-TB treatment and patient mobility in Guizhou. They impact patients' treatment adherence and cause LTFU. Being a primary breadwinner increases the risk for catastrophic household payments and LTFU.
Collapse
Affiliation(s)
- Yun Wang
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
| | - Zhongfeng Huang
- Department of Tuberculosis, Guiyang Public Health Clinical Center, Guiyang, Guizhou, People’s Republic of China
| | - Huijuan Chen
- Department of Tuberculosis Prevention and Control, Guizhou Center for Disease Prevention and Control, Guiyang, Guizhou, People’s Republic of China
| | - Ye Yuan
- Department of Tuberculosis, Guiyang Public Health Clinical Center, Guiyang, Guizhou, People’s Republic of China
| | - Edward B McNeil
- Department of Infectious Diseases, School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Xiaolong Lu
- School of Medicine and Health Management, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
| | - Aihua Zhang
- Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, School of Public Health, Guizhou Medical University, Guiyang, Guizhou, People’s Republic of China
| |
Collapse
|
12
|
Jiang Y, Chen J, Ying M, Liu L, Li M, Lu S, Li Z, Zhang P, Xie Q, Liu X, Lu H. Factors associated with loss to follow-up before and after treatment initiation among patients with tuberculosis: A 5-year observation in China. Front Med (Lausanne) 2023; 10:1136094. [PMID: 37181365 PMCID: PMC10167013 DOI: 10.3389/fmed.2023.1136094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/28/2023] [Indexed: 05/16/2023] Open
Abstract
Background Loss to follow-up (LTFU) is a significant barrier to the completion of anti-tuberculosis (TB) treatment and a major predictor of TB-associated deaths. Currently, research on LTFU-related factors in China is both scarce and inconsistent. Methods We collected information from the TB observation database of the National Clinical Research Center for Infectious Diseases. The data of all patients who were documented as LTFU were assessed retrospectively and compared with those of patients who were not LTFU. Descriptive epidemiology and multivariable logistic regression analyses were conducted to identify the factors associated with LTFU. Results A total of 24,265 TB patients were included in the analysis. Of them, 3,046 were categorized as LTFU, including 678 who were lost before treatment initiation and 2,368 who were lost afterwards. The previous history of TB was independently associated with LTFU before treatment initiation. Having medical insurance, chronic hepatitis or cirrhosis, and providing an alternative contact were independent predictive factors for LTFU after treatment initiation. Conclusion Loss to follow-up is frequent in the management of patients with TB and can be predicted using patients' treatment history, clinical characteristics, and socioeconomic factors. Our research illustrates the importance of early assessment and intervention after diagnosis. Targeted measures can improve patient engagement and ultimately treatment adherence, leading to better health outcomes and disease control.
Collapse
Affiliation(s)
- Youli Jiang
- Hengyang Medical School, School of Nursing, University of South China, Hengyang, China
| | | | - Meng Ying
- Shenzhen Third People’s Hospital, Shenzhen, China
| | - Linlin Liu
- Shenzhen Third People’s Hospital, Shenzhen, China
| | - Min Li
- Hengyang Medical School, School of Nursing, University of South China, Hengyang, China
| | - Shuihua Lu
- Hengyang Medical School, School of Nursing, University of South China, Hengyang, China
| | - Zhihuan Li
- Department of Intelligent Security Laboratory, Shenzhen Tsinghua University Research Institute, Shenzhen, China
| | - Peize Zhang
- Hengyang Medical School, School of Nursing, University of South China, Hengyang, China
| | - Qingyao Xie
- Hengyang Medical School, School of Nursing, University of South China, Hengyang, China
| | - Xuhui Liu
- Shenzhen Third People’s Hospital, Shenzhen, China
| | - Hongzhou Lu
- Shenzhen Third People’s Hospital, Shenzhen, China
| |
Collapse
|
13
|
Yoshino CA, Sidney-Annerstedt K, Wingfield T, Kirubi B, Viney K, Boccia D, Atkins S. Experiences of conditional and unconditional cash transfers intended for improving health outcomes and health service use: a qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 3:CD013635. [PMID: 36999604 PMCID: PMC10064639 DOI: 10.1002/14651858.cd013635.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
BACKGROUND It is well known that poverty is associated with ill health and that ill health can result in direct and indirect costs that can perpetuate poverty. Social protection, which includes policies and programmes intended to prevent and reduce poverty in times of ill health, could be one way to break this vicious cycle. Social protection, particularly cash transfers, also has the potential to promote healthier behaviours, including healthcare seeking. Although social protection, particularly conditional and unconditional cash transfers, has been widely studied, it is not well known how recipients experience social protection interventions, and what unintended effects such interventions can cause. OBJECTIVES: The aim of this review was to explore how conditional and unconditional cash transfer social protection interventions with a health outcome are experienced and perceived by their recipients. SEARCH METHODS: We searched Epistemonikos, MEDLINE, CINAHL, Social Services Abstracts, Global Index Medicus, Scopus, AnthroSource and EconLit from the start of the database to 5 June 2020. We combined this with reference checking, citation searching, grey literature and contact with authors to identify additional studies. We reran all strategies in July 2022, and the new studies are awaiting classification. SELECTION CRITERIA We included primary studies, using qualitative methods or mixed-methods studies with qualitative research reporting on recipients' experiences of cash transfer interventions where health outcomes were evaluated. Recipients could be adult patients of healthcare services, the general adult population as recipients of cash targeted at themselves or directed at children. Studies could be evaluated on any mental or physical health condition or cash transfer mechanism. Studies could come from any country and be in any language. Two authors independently selected studies. DATA COLLECTION AND ANALYSIS: We used a multi-step purposive sampling framework for selecting studies, starting with geographical representation, followed by health condition, and richness of data. Key data were extracted by the authors into Excel. Methodological limitations were assessed independently using the Critical Appraisal Skills Programme (CASP) criteria by two authors. Data were synthesised using meta-ethnography, and confidence in findings was assessed using the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. MAIN RESULTS: We included 127 studies in the review and sampled 41 of these studies for our analysis. Thirty-two further studies were found after the updated search on 5 July 2022 and are awaiting classification. The sampled studies were from 24 different countries: 17 studies were from the African region, seven were from the region of the Americas, seven were from the European region, six were from the South-East Asian region, three from the Western Pacific region and one study was multiregional, covering both the African and the Eastern Mediterranean regions. These studies primarily explored the views and experiences of cash transfer recipients with different health conditions, such as infectious diseases, disabilities and long-term illnesses, sexual and reproductive health, and maternal and child health. Our GRADE-CERQual assessment indicated we had mainly moderate- and high-confidence findings. We found that recipients perceived the cash transfers as necessary and helpful for immediate needs and, in some cases, helpful for longer-term benefits. However, across conditional and unconditional programmes, recipients often felt that the amount given was too little in relation to their total needs. They also felt that the cash alone was not enough to change their behaviour and, to change behaviour, additional types of support would be required. The cash transfer was reported to have important effects on empowerment, autonomy and agency, but also in some settings, recipients experienced pressure from family or programme staff on cash usage. The cash transfer was reported to improve social cohesion and reduce intrahousehold tension. However, in settings where some received the cash and others did not, the lack of an equal approach caused tension, suspicion and conflict. Recipients also reported stigma in terms of cash transfer programme assessment processes and eligibility, as well as inappropriate eligibility processes. Across settings, recipients experienced barriers in accessing the cash transfer programme, and some refused or were hesitant to receive the cash. Some recipients found cash transfer programmes more acceptable when they agreed with the programme's goals and processes. AUTHORS' CONCLUSIONS: Our findings highlight the impact of the sociocultural context on the functioning and interaction between the individual, family and cash transfer programmes. Even where the goals of a cash transfer programme are explicitly health-related, the outcomes may be far broader than health alone and may include, for example, reduced stigma, empowerment and increased agency of the individual. When measuring programme outcomes, therefore, these broader impacts could be considered for understanding the health and well-being benefits of cash transfers.
Collapse
Affiliation(s)
- Clara A Yoshino
- World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Kristi Sidney-Annerstedt
- World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Tom Wingfield
- World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Clinical Infection, Microbiology, and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Department of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical and Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Beatrice Kirubi
- World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Public Health Research (CPHR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Kerri Viney
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Research School of Population Health, Australian National University, Canberra, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Delia Boccia
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Salla Atkins
- World Health Organization Collaborating Centre on Tuberculosis and Social Medicine, Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Global Health and Development, Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| |
Collapse
|
14
|
Dilas D, Flores R, Morales-García WC, Calizaya-Milla YE, Morales-García M, Sairitupa-Sanchez L, Saintila J. Social Support, Quality of Care, and Patient Adherence to Tuberculosis Treatment in Peru: The Mediating Role of Nurse Health Education. Patient Prefer Adherence 2023; 17:175-186. [PMID: 36704124 PMCID: PMC9871033 DOI: 10.2147/ppa.s391930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/07/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Peru is one of the countries with the highest burden of tuberculosis (TB) and multidrug-resistant tuberculosis (MDR-TB) in the Latin American region and globally. Health education provided by nurses reinforces social support and the quality of patient care allows a greater impact on adherence to TB treatment. PURPOSE This study evaluated the mediating effect of treatment education between social support, quality of care, and treatment adherence in TB patients. METHODS A cross-sectional study was carried out considering 162 adult TB patients from four health centers of the public sector located in the center of the city of Lima, Peru. Data were collected on variables, such as social support, quality of care, health education, and adherence to TB treatment. SmartPLS was used for data analysis. RESULTS The results showed that social support and quality of care significantly influence health education. Likewise, health education mediates social support and quality of care for better adherence to treatment. CONCLUSION It is recommended that hospitals take initiatives to provide better health education on TB treatment to ensure better adherence to treatment.
Collapse
Affiliation(s)
- Delker Dilas
- Unit of Public Health, Postgraduate School, Peruvian Union University, Lima, Perú
| | - Rosarias Flores
- Unit of Public Health, Postgraduate School, Peruvian Union University, Lima, Perú
| | - Wilter C Morales-García
- Unit of Public Health, Postgraduate School, Peruvian Union University, Lima, Perú
- Correspondence: Wilter C Morales-García, Unit of Public Health, Postgraduate School, Peruvian Union University, Km 19, Carretera Central, Lima, 15033, Perú, Email
| | | | | | | | - Jacksaint Saintila
- School of Medicine, Señor de Sipán University, Chiclayo, Perú
- Jacksaint Saintila, School of Medicine, Señor de Sipán University, Km 5, Carretera a Pimentel, Chiclayo, 14001, Lambayeque, Perú, Email
| |
Collapse
|
15
|
Taylor HA, Dowdy DW, Searle AR, Stennett AL, Dukhanin V, Zwerling AA, Merritt MW. Disadvantage and the Experience of Treatment for Multidrug-Resistant Tuberculosis (MDR-TB). SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100042. [PMID: 35252955 PMCID: PMC8896740 DOI: 10.1016/j.ssmqr.2022.100042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Holly A Taylor
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205 USA
| | - David W Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - Alexandra R Searle
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - Andrea L Stennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| | - Vadim Dukhanin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205 USA
| | - Alice A Zwerling
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand, Ottawa ON K1G 5Z3 Canada
| | - Maria W Merritt
- Johns Hopkins Berman Institute of Bioethics; and Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland 21205 USA
| |
Collapse
|
16
|
Anley DT, Akalu TY, Merid MW, Tsegaye T. Development and Validation of a Nomogram for the Prediction of Unfavorable Treatment Outcome Among Multi-Drug Resistant Tuberculosis Patients in North West Ethiopia: An Application of Prediction Modelling. Infect Drug Resist 2022; 15:3887-3904. [PMID: 35903578 PMCID: PMC9317379 DOI: 10.2147/idr.s372351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Multidrug-resistant tuberculosis (MDR-TB) is a global problem and a health security threat, which makes “Ending the global TB epidemic in 2035” unachievable. Globally, the unfavourable treatment outcome remains unacceptably high. Therefore, this study aimed to develop a risk prediction model for unfavorable treatment outcomes in MDR-TB patients, which can be used by clinicians as a simple clinical tool in their decision-making. Objective The objective of this study was to develop and validate a risk prediction model for the prediction of unfavorable treatment outcomes among MDR-TB patients in North-West Ethiopia. Methods We used MDR-TB data collected from the University of Gondar and Debre Markos referral hospitals. A retrospective follow-up study was conducted and a total of 517 patients were included in the study. STATA version 16 statistical software and R version 4.0.5 were used for the analysis. Descriptive statistics were carried out. A multivariable model was fitted using all potent predictors selected by the lasso regression method. A simplified risk prediction model (nomogram) was developed based on the binomial logit-based model, and its performance was described by assessing its discriminatory power and calibration. Finally, decision curve analysis (DCA) was done to evaluate the clinical and public health impact of the developed model. Results The developed nomogram comprised six predictors: baseline anemia, major adverse event, comorbidity, age, marital status, and treatment supporter. The model has a discriminatory power of 0.753 (95% CI: 0.708, 0.798) and calibration test of (P-value = 0.695). It was internally validated by bootstrapping method, and it has a relatively corrected discrimination performance (AUC = 0.744, 95CI: 0.699, 0.788). The optimism coefficient was found to be 0.009. The decision curve analysis showed the net benefit of the model as threshold probabilities varied. Conclusion The developed nomogram can be used for individualized prediction of unfavorable treatment outcomes in MDR-TB patients for it has a satisfactory level of accuracy and good calibration. The model is clinically interpretable and was found to have added benefits in clinical practice.
Collapse
Affiliation(s)
- Denekew Tenaw Anley
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, Institute of Public Health, 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
| |
Collapse
|
17
|
Agbeko CK, Mallah MA, He B, Liu Q, Song H, Wang J. Mental Health Status and Its Impact on TB Treatment and Its Outcomes: A Scoping Literature Review. Front Public Health 2022; 10:855515. [PMID: 35712316 PMCID: PMC9194388 DOI: 10.3389/fpubh.2022.855515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/25/2022] [Indexed: 12/04/2022] Open
Abstract
Background Tuberculosis (TB) infection interferes with the health-related quality of life (HRQOL), including physical, social, mental, emotional and financial domains of individuals. The goal of this scoping review is to outline the most frequent mental issues encountered by TB patients and evaluate the effects of mental health on TB treatment outcomes. Our findings identify research gaps that could help bridge the overall treatment outcomes in the near future. Method A systematic stepwise approach was adopted to search online resource databases like PubMed, Web of science, and gray literature to retrieve published scientific articles for the review. Titles and abstracts of selected studies were examined for their possible eligibility. The studies matching our eligibility criteria were taken into account for this scoping review. Results One hundred and ninety three articles were retrieved out of which 26 met the final inclusion criteria. We found that studies adopting interventional approaches reported good mental wellbeing outcomes and better medical compliance as compared with studies that just investigated the subjects. The data represented 15 countries including three low-income countries (LICs), four low-middle-income-countries (LMICs), seven upper-middle-income countries (UMICs), and one high-income country (HIC). Conclusion Depression, anxiety, and poor social support, and stigma affect the wellbeing of individuals across the globe irrespective of age, race, demographic characteristics, geographical location, and social status.
Collapse
Affiliation(s)
- Charles Kwaku Agbeko
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | | | - Biyu He
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Qiao Liu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Huan Song
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jianming Wang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Key Laboratory of Infectious Diseases, School of Public Health, Nanjing Medical University, Nanjing, China
| |
Collapse
|
18
|
Redwood L, Fox GJ, Nguyen TA, Bernarys S, Mason P, Vu VA, Nguyen VN, Mitchell EMH. Good citizens, perfect patients, and family reputation: Stigma and prolonged isolation in people with drug-resistant tuberculosis in Vietnam. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000681. [PMID: 36962771 PMCID: PMC10021913 DOI: 10.1371/journal.pgph.0000681] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 06/01/2022] [Indexed: 11/19/2022]
Abstract
Stigma and isolation are common in people with tuberculosis (TB). Social isolation contributes to reduced health outcomes and TB treatment adherence. Stigma and the drivers of isolation in people with Drug-Resistant (DR)-TB may include modifiable advice and practices of family and Health Care Workers (HCW). This study aimed to understand the drivers of isolation and stigma from the perspective of people with DR-TB in Vietnam. A greater understanding of stigma and isolation is important to identify and balance patients' needs and disease transmission risk. In-depth interviews were conducted with 12 people with DR-TB and seven HCWs who care for people with DR-TB in two provinces in Vietnam. Interviews were audio-recorded, transcribed verbatim and translated to English. Data collection and analysis were conducted simultaneously. The data were then analysed using a thematic framework approach. Stigma and extended isolation were common experiences among people with DR-TB. To mitigate stigma, people with DR-TB used the local term 'lao lực' to describe their condition to others which is believed to be a less infectious and less stigmatising type of TB. This study identified that although HCW informed people with DR-TB of when they were no longer infectious and isolation was no longer required, their infection control advice was not always consistent. Despite knowing they were no longer infectious, most people with DR-TB continued to self-isolate to minimise the perceived repercussions of societal stigma, to protect their 'thể diện' (honour, prestige, reputation), and eliminate all risk of transmitting DR-TB to their family. This study identified three interconnected drivers of self-isolation in Vietnam, including fear of infecting others, fear of stigmatization, and to protect family reputation. TB control programmes need to better understand the social aspects of DR-TB to enable them to better support patients. Educating HCW to provide evidence-based infection control advice is vital.
Collapse
Affiliation(s)
- Lisa Redwood
- The Faculty of Medicine and Health, The University of Sydney, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
- The Woolcock Institute of Medical Research, Ba Dinh District, Hanoi, Vietnam
| | - Greg J Fox
- The Faculty of Medicine and Health, The University of Sydney, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
- The Woolcock Institute of Medical Research, Ba Dinh District, Hanoi, Vietnam
| | - Thu Anh Nguyen
- The Faculty of Medicine and Health, The University of Sydney, Central Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
- The Woolcock Institute of Medical Research, Ba Dinh District, Hanoi, Vietnam
| | - Sarah Bernarys
- The University of Sydney, School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Paul Mason
- Taronga Conservation Society Australia, Sydney, Australia
- The University of Sydney, School of Education and Social Work, The University of Sydney, Camperdown New South Wales, Australia
| | - Van Anh Vu
- The Woolcock Institute of Medical Research, Ba Dinh District, Hanoi, Vietnam
| | | | - Ellen M H Mitchell
- Department of Public Health, Tropical Infectious Disease Group, Institute for Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
19
|
Yani DI, Juniarti N, Lukman M. Factors Related to Complying with Anti-TB Medications Among Drug-Resistant Tuberculosis Patients in Indonesia. Patient Prefer Adherence 2022; 16:3319-3327. [PMID: 36568917 PMCID: PMC9769133 DOI: 10.2147/ppa.s388989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A variety of factors influenced the decision of tuberculosis (TB) drug-resistant patients to continue treatment. The study aimed to analyze factors that influence complying with anti-TB medications in patients with TB drug resistance in Indonesia. PATIENTS AND METHODS The study employed a cross-sectional approach and was conducted in various community health centers and polyclinics offering TB drug-resistant services in Bandung city, Indonesia. Participants were 79 patients with TB drug resistance who met the criteria during their treatment for TB drug resistance, were willing to be involved in the research, and accessed TB services in Bandung. Complying with anti-TB medications scale, TB Health Behaviors questionnaire, the family support questionnaire, the TB-Related Stigma Scale, and TB knowledge were used in this study. Data were analyzed using Spearman's Rho. RESULTS Health behavior (r = 0.36) was positively associated with complying with anti-TB medications, while family support, TB stigma, and knowledge were not related to treatment compliance. CONCLUSION Information on these factors will inform the development of models and modules for the prevention and control of TB drug resistance in Indonesia, which can later be used widely in Indonesia.
Collapse
Affiliation(s)
- Desy Indra Yani
- Lecturer, Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Jatinangor, West Java, Indonesia
- Correspondence: Desy Indra Yani, Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Jatinangor, 45363, West Java Province, Indonesia, Tel +6222-7796647, Fax +6222-7796647, Email
| | - Neti Juniarti
- Lecturer, Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Jatinangor, West Java, Indonesia
| | - Mamat Lukman
- Lecturer, Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Jatinangor, West Java, Indonesia
| |
Collapse
|
20
|
Haldane V, Zhang Z, Ma Q, Yin T, Zhang B, Li Y, Pan Q, Dainty KN, Rea E, Pasang P, Wei X, Hu J. A qualitative study of perspectives on access to tuberculosis health services in Xigaze, China. Infect Dis Poverty 2021; 10:120. [PMID: 34544492 PMCID: PMC8451167 DOI: 10.1186/s40249-021-00906-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Tuberculosis (TB) is a major global health threat and the leading infectious disease cause of death worldwide. Access to and retention in TB care remains a challenge for patients, particularly those living in rural and remote settings. This qualitative study explored barriers and facilitators to accessing and maintaining contact with TB care services in communities in Xigaze (Shigatse) prefecture, Xizang Autonomous Region (Tibet Autonomous Region), China from the perspective of persons impacted by TB. Methods We conduced in-depth interviews with 23 participants impacted by TB in four rural districts in Xigaze prefecture, Xizang Autonomous Region, China between April 2019 and November 2020. Interviews were conducted in Tibetan and Mandarin, transcribed in Mandarin and translated into English. Transcripts were checked against recordings by native Tibetan and Mandarin speakers. QSR NVivo12 software was used for framework analysis guided by an access to care conceptual framework by Levesque et al. Results Overall patients reported low awareness of and an indifferent attitude towards TB, although all reported understanding the need to adhere to treatment. Participants reported complex pathways to care, often requiring visits to multiple healthcare facilities. Some participants reported visiting traditional Tibetan medicine (TTM) providers. Participants reported various barriers to accessing care including challenges physically reaching care, out-of-pocket payments for tests, diagnostics and transport. Barriers to maintaining care included medication side effects and worry about treatment effectiveness. Enablers to accessing care identified included knowledge or past experience with TB, integrated models of TTM and western care, supportive village doctors who conducted home visits, free TB treatment and other subsidies, as well as having family support with care and social support as barriers and facilitators to maintaining treatment. Conclusions We identified barriers and facilitators to accessing services in rural communities in Xigaze from the perspective of persons impacted by TB. Challenges include complex pathways to care, travel distances, wait times and low awareness. Tuberculosis care in the region could be strengthened by ongoing culturally tailored educational campaigns to increase awareness, partnerships with TTM providers, providing comprehensive treatment subsidies and strengthening the role of family members in comprehensive TB care. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40249-021-00906-4.
Collapse
Affiliation(s)
- Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, ON, M5T 3M6, Canada
| | - Zhitong Zhang
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada
| | - Qi Ma
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, ON, M5T 3M6, Canada
| | - Tingting Yin
- Weifang Medical College, Weifang, Shandong, China
| | - Bei Zhang
- Weifang Medical College, Weifang, Shandong, China
| | - Yinlong Li
- Jining Medical University, Jining, Shandong, China
| | - Qiuyu Pan
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Katie N Dainty
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, ON, M5T 3M6, Canada
| | - Elizabeth Rea
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada
| | - Pande Pasang
- Xigaze Centre for Disease Control and Prevention, 7 Keji Road, Sangzhuzi District, Xigaze, Xizang, China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M7, Canada.
| | - Jun Hu
- Shandong University of Traditional Chinese Medicine, Jinan, 250355, China.
| |
Collapse
|
21
|
Bustos M, Luu K, Lau LL, Dodd W. Addressing tuberculosis through complex community-based socioeconomic interventions in low- and middle-income countries: A systematic realist review. Glob Public Health 2021; 17:1924-1944. [PMID: 34403306 DOI: 10.1080/17441692.2021.1966487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The established relationship between poverty and tuberculosis has led to the implementation of complex socioeconomic interventions to address poverty as both a risk factor for and consequence of tuberculosis. However, limited research to date has examined the conditions that facilitate the successful implementation of these interventions. We conducted a systematic realist review to examine how complex socioeconomic interventions for tuberculosis treatment and care were defined, implemented, and evaluated in low- and middle-income countries. We used a systematic search to identify published work that implemented complex socioeconomic interventions for tuberculosis, followed by a realist analysis informed by existing programme theories. From a total of 2825 collected records, 36 peer-reviewed articles and 17 grey literature reports were included in this review. The realist analysis identified three main contexts (sociopolitical and cultural; relational and interpersonal; operational and administrative) and ten mechanisms that facilitated successful implementation of interventions. Overall, this review highlights the importance of political commitment in shaping sustainable programme delivery, the role of healthcare and community-based provider training in creating patient-centred treatment environments, and the opportunity to leverage operational research for evidence-based decision making to address the socioeconomic needs of tuberculosis patients experiencing poverty.
Collapse
Affiliation(s)
- Monica Bustos
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Kathy Luu
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Lincoln L Lau
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.,International Care Ministries, Manila, Philippines.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Warren Dodd
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
22
|
Swaminathan K, Ramakrishnan L. Lived Experiences of Drug-Resistant Tuberculosis survivors - An Interpretative Phenomenological Analysis. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2021. [DOI: 10.1080/10720537.2021.1953419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Karthick Swaminathan
- Department of Management Studies, Pondicherry University, Karaikal Campus, Karaikal, Puducherry, India
| | - Lalitha Ramakrishnan
- Department of Management Studies, Pondicherry University, Karaikal Campus, Karaikal, Puducherry, India
| |
Collapse
|
23
|
Ndambuki J, Nzomo J, Muregi L, Mutuku C, Makokha F, Nthusi J, Ambale C, Lynen L, Decroo T. Comparison of first-line tuberculosis treatment outcomes between previously treated and new patients: a retrospective study in Machakos subcounty, Kenya. Int Health 2021; 13:272-280. [PMID: 32860045 PMCID: PMC8079320 DOI: 10.1093/inthealth/ihaa051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/24/2020] [Accepted: 08/10/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Since 2016, patients with rifampicin-susceptible tuberculosis (TB) have been treated with the 6-month first-line regimen, regardless of treatment history. We assessed treatment outcomes of previously treated and new patients in Machakos subcounty, Kenya. METHODS We performed a retrospective cohort study in patients started on first-line treatment between 2016 and 2017. Firth's logistic regression was used to estimate the effect of previous treatment on having a programmatic adverse outcome (either lost to follow-up, death, failure) and treatment failure vs treatment success (either cure or completion). RESULTS Of 1024 new and 79 previously treated patients, 88.1% and 74.7% were treated successfully, 6.5% and 7.6% died, 4.2% and 10.1% were lost to follow-up and 1.2% and 7.6% had treatment failure, respectively. Previous treatment predicted having a programmatic adverse outcome (adjusted odds ratio [aOR] 2.4 [95% confidence interval {CI} 1.4 to 4.2]) and treatment failure (aOR 7.3 [95% CI 2.6 to 20.4]) but not mortality. Similar correlations were found in 334 new and previously treated patients with confirmed baseline rifampicin susceptibility. CONCLUSION Previously treated patients were more at risk of experiencing a poor treatment outcome, mainly lost to follow-up and treatment failure. Adherence support may reduce lost to follow-up. Rifampicin drug susceptibility testing coverage should increase. More robust retreatment regimens may reduce treatment failure.
Collapse
Affiliation(s)
| | - Joseph Nzomo
- Department of Health and Emergency Services, Machakos County, Kenya
| | - Lucy Muregi
- Department of Health and Emergency Services, Machakos County, Kenya
| | - Chris Mutuku
- Department of Health and Emergency Services, Machakos County, Kenya
| | - Francis Makokha
- Directorate of Research and Innovation, Mount Kenya University, Box 342-01000, Thika, Kenya
| | - Jonathan Nthusi
- Department of Health and Emergency Services, Machakos County, Kenya
| | - Clarice Ambale
- Department of Health and Emergency Services, Machakos County, Kenya
| | - Lutgarde Lynen
- Institute of Tropical Medicine-Antwerp, Nationalestraat 155-B-2000, Belgium
| | - Tom Decroo
- Institute of Tropical Medicine-Antwerp, Nationalestraat 155-B-2000, Belgium
- Research Foundation Flanders, Brussels, 1000 Brussels, Belgium
| |
Collapse
|
24
|
du Cros P, Khamraev A, Tigay Z, Abdrasuliev T, Greig J, Cooke G, Herboczek K, Pylypenko T, Berry C, Ronnachit A, Lister D, Dietrich S, Ariti C, Safaev K, Nyang'wa BT, Parpieva N, Tillashaikhov M, Achar J. Outcomes with a shorter multidrug-resistant tuberculosis regimen from Karakalpakstan, Uzbekistan. ERJ Open Res 2021; 7:00537-2020. [PMID: 33585652 PMCID: PMC7869592 DOI: 10.1183/23120541.00537-2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/12/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND In 2016, World Health Organization guidelines conditionally recommended standardised shorter 9-12-month regimens for multidrug-resistant (MDR) tuberculosis (TB) treatment. We conducted a prospective study of a shorter standardised MDR-TB regimen in Karakalpakstan, Uzbekistan. METHODS Consecutive adults and children with confirmed rifampicin-resistant pulmonary TB were enrolled between September 1, 2013 and March 31, 2015; exclusions included prior treatment with second-line anti-TB drugs, and documented resistance to ofloxacin or to two second-line injectable agents. The primary outcome was recurrence-free cure at 1 year following treatment completion. RESULTS Of 146 enrolled patients, 128 were included: 67 female (52.3%), median age 30.1 (interquartile range 23.8-44.4) years. At the end of treatment, 71.9% (92 out of 128) of patients achieved treatment success, with 68% (87 out of 128) achieving recurrence-free cure at 1 year following completion. Unsuccessful outcomes during treatment included 22 (17.2%) treatment failures with fluoroquinolone-resistance amplification in 8 patients (8 out of 22, 36.4%); 12 (9.4%) lost to follow-up; and 2 (1.5%) deaths. Recurrence occurred in one patient. Fourteen patients (10.9%) experienced serious adverse events. Baseline resistance to both pyrazinamide and ethambutol (adjusted OR 6.13, 95% CI 2.01; 18.63) and adherence <95% (adjusted OR 5.33, 95% CI 1.73; 16.36) were associated with unsuccessful outcome in multivariable logistic regression. CONCLUSIONS Overall success with a standardised shorter MDR-TB regimen was moderate with considerable treatment failure and amplification of fluoroquinolone resistance. When introducing standardised shorter regimens, baseline drug susceptibility testing and minimising missed doses are critical. High rates globally of pyrazinamide, ethambutol and ethionamide resistance raise questions of continued inclusion of these drugs in shorter regimens in the absence of drug susceptibility testing-confirmed susceptibility.
Collapse
Affiliation(s)
- Philipp du Cros
- Manson Unit, Médecins Sans Frontières, London, UK,Burnet Institute, Melbourne, Australia,Philipp du Cros, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3000, Australia. E-mail:
| | | | | | | | - Jane Greig
- Manson Unit, Médecins Sans Frontières, London, UK,Burnet Institute, Melbourne, Australia
| | | | | | | | | | | | | | | | - Cono Ariti
- Cardiff University School of Medicine, Cardiff, UK
| | - Khasan Safaev
- Specialized Scientific Practical Medical Center of Phthisiology and Pulmonology, Tashkent, Uzbekistan
| | | | - Nargiza Parpieva
- Specialized Scientific Practical Medical Center of Phthisiology and Pulmonology, Tashkent, Uzbekistan
| | - Mirzagalib Tillashaikhov
- Specialized Scientific Practical Medical Center of Phthisiology and Pulmonology, Tashkent, Uzbekistan
| | - Jay Achar
- Manson Unit, Médecins Sans Frontières, London, UK,Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
25
|
Li Q, Lu M, Hsieh E, Wu L, Wu Y, Wang M, Wang L, Zhao G, Xie L, Qian HZ. Time to sputum culture conversion and its predictors among patients with multidrug-resistant tuberculosis in Hangzhou, China: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e23649. [PMID: 33327347 PMCID: PMC7738096 DOI: 10.1097/md.0000000000023649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022] Open
Abstract
The objective is to investigate the time to initial sputum culture conversion (SCC) and its predictors among multidrug-resistant tuberculosis (MDR-TB) patients in Hangzhou, China.A retrospective cohort study was conducted among patients who initiated MDR-TB treatment from 2011 to 2015 in Hangzhou, China. Successful achievement of initial SCC was defined as 2 consecutive negative cultures taken at least 30 days apart after initiation of treatment of MDR-TB. Successful treatment outcomes included being cured and completing treatment, while poor treatment outcomes included treatment failure, loss to follow-up, and death. Time to initial SCC was analyzed using the Kaplan-Meier method, and Cox proportional hazards regression was used to identify predictors of SCC.Among 384 patients enrolled with MDR-TB, 359 (93.5%) successfully achieved initial SCC after a median of 85 days (interquartile range, 40-112 days). A higher rate of SCC was observed in participants with successful treatment outcomes than those with poor treatment outcomes (P<.01). Multivariate analysis showed that age 25 to 64 years (compared with age<25; adjusted odds ratio [AOR], 0.7; 95% confidence interval [CI], 0.5-0.9; P < .01), age ≥65 years (compared with age < 25; AOR, 0.5; 95% CI, 0.3-0.8; P < .01), and household registration in Hangzhou (compared with non-Hangzhou registration; AOR, 1.3; 95% CI, 1.0-1.5; P < .05) were found to be associated with SCC.Although high SCC and treatment success rates were observed among MDR-TB patients in Hangzhou, the prolonged duration to initial SCC underscores the importance of emphasizing measures for infection control. A new policy of shifting outpatient treatment to inpatient treatment in China may reduce the risk of transmission from patients in the time window prior to SCC.
Collapse
Affiliation(s)
- Qingchun Li
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Min Lu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Evelyn Hsieh
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Limin Wu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Yifei Wu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Meng Wang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Le Wang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Gang Zhao
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Li Xie
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Han-Zhu Qian
- SJTU-Yale Joint Center for Biostatistics and Data Science, Shanghai Jiao Tong University (SJTU), Shanghai, China
- Department of Biostatistics, Yale School of Public Health, New Haven, CT
| |
Collapse
|
26
|
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.
Collapse
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
| |
Collapse
|
27
|
Wen S, Yin J, Sun Q. Impacts of social support on the treatment outcomes of drug-resistant tuberculosis: a systematic review and meta-analysis. BMJ Open 2020; 10:e036985. [PMID: 33033087 PMCID: PMC7545632 DOI: 10.1136/bmjopen-2020-036985] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To assess the effectiveness of social support on treatment success promotion or lost to follow-up (LTFU) reduction for patients with drug-resistant tuberculosis (DR-TB). DESIGN We searched Pubmed, Web of Science, Embase, Scopus and Medline databases until 18 June 2020 for interventional or mixed-method studies which reported social support and treatment outcomes of DR-TB patients. Two independent reviewers extracted data and disagreements were resolved by consensus with a third reviewer. Random-effects meta-analysis was performed to calculate the OR and 95% CI for the effects of social support on the improvement of treatment outcomes and the heterogeneity and risk of bias were assessed. SETTING Low-income and middle-income countries. PARTICIPANTS DR-TB patients. OUTCOMES Treatment success is defined as the combination of the cured and treatment completion, and LTFU is measured as treatment being interrupted for two consecutive months or more. RESULTS Among 173 articles selected for full-text review, 162 were excluded through independent review (kappa=0.87) and 10 studies enrolling 1621 DR-TB patients in eight countries were included for qualitative analysis. In these studies, the most frequently introduced social support was material support (10 studies), followed by informational (eight studies), emotional (seven studies) and companionship support (four studies). Seven studies that reported treatment outcomes in both intervention arm and control arm are qualified for meta-analysis. An encouraging improvement on treatment success rate (OR: 2.58; 95% CI: 1.80 to 3.69) was found when material support was integrated into social support packages and no heterogeneity was observed (I1 of 0%, Q test p=0.72). Reduction on LTFU rate (OR: 0.17; 95% CI: 0.05 to 0.55) was also noted when material support was available but substantial heterogeneity was found (I2 of 80%, Q test p=0.002). CONCLUSION Material support appeared feasible and effective to improve treatment success for DR-TB patients combined with other social support interventions. PROSPERO REGISTRATION NUMBER CRD42019140824.
Collapse
Affiliation(s)
- Shuqin Wen
- Centre for Health Management and Policy Research, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Jia Yin
- Centre for Health Management and Policy Research, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Qiang Sun
- Centre for Health Management and Policy Research, School of Public Health, Shandong University Cheeloo College of Medicine, Jinan, Shandong, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| |
Collapse
|
28
|
Chen X, Du L, Wu R, Xu J, Ji H, Zhang Y, Zhu X, Zhou L. The effects of family, society and national policy support on treatment adherence among newly diagnosed tuberculosis patients: a cross-sectional study. BMC Infect Dis 2020; 20:623. [PMID: 32831050 PMCID: PMC7445902 DOI: 10.1186/s12879-020-05354-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/17/2020] [Indexed: 11/19/2022] Open
Abstract
Background Non-adherence to tuberculosis (TB) treatment is the most important cause of poor TB outcomes, and improving support for TB patients is a primary priority for governments, but there has been little research on the effects of family, social and national policy support factors on TB treatment adherence. The current study evaluated treatment adherence among newly diagnosed TB patients in Dalian, north-eastern China, and determined the effects of family, society, and national policy support factors on treatment adherence. Methods A cross-sectional survey was conducted among newly diagnosed TB patients treated at the outpatient department of Dalian Tuberculosis Hospital from September 2019 to January 2020. Data were collected using a questionnaire that measured medication adherence, family support, social support, and national policy support and so on. Differences between groups were assessed using Chi-square tests and Fisher’s exact tests. Ordinal logistic regression analysis was used to determine the predictors of adherence. Results A total of 481 newly diagnosed TB patients were recruited, of whom 45.7% had good adherence, and 27.4 and 26.8% had moderate and low adherence, respectively. Patients who had family members who frequently supervised medication (OR:0.34, 95% CI:0.16–0.70), family members who often provided spiritual encouragement (OR:0.13, 95% CI:0.02–0.72), a good doctor-patient relationship (OR:0.61, 95% CI:0.40–0.93), more TB-related knowledge (OR:0.49, 95% CI:0.33–0.72) and a high need for TB treatment policy support (OR:0.38, 95% CI:0.22–0.66) had satisfactory medication adherence. However, patients who had a college degree or higher (OR:1.69, 95% CI:1.04–2.74) and who suffered adverse drug reactions (OR:1.45, 95% CI:1.00–2.11) were more likely to have lower adherence. Conclusions Our findings suggested that non-adherence was high in newly diagnosed TB patients. Patients who had family members who frequently supervised medication and provided spiritual encouragement and a good doctor-patient relationship and TB-related knowledge and a high need for policy support contributed to high adherence. It is recommended to strengthen medical staff training and patient and family health education and to increase financial support for improving adherence.
Collapse
Affiliation(s)
- Xu Chen
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Liang Du
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Ruiheng Wu
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Jia Xu
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Haoqiang Ji
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Yu Zhang
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Xuexue Zhu
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Ling Zhou
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China.
| |
Collapse
|
29
|
Li Q, Shi CX, Lu M, Wu L, Wu Y, Wang M, Wang L, Zhao G, Xie L, Qian HZ. Treatment outcomes of multidrug-resistant tuberculosis in Hangzhou, China, 2011 to 2015. Medicine (Baltimore) 2020; 99:e21296. [PMID: 32791713 PMCID: PMC7387009 DOI: 10.1097/md.0000000000021296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Treatment of multidrug-resistant tuberculosis (MDR-TB) is challenging. More research is needed to understand treatment outcomes and associated factors.A retrospective cohort study was conducted to assess trends and predictors of treatment success among 398 MDR-TB and extensively drug resistant TB patients who started treatment in 2011 to 2015 in Hangzhou, China. Sociodemographic and clinical characteristic data were obtained from the national reporting database. Chi-square test for trend was used to evaluate changes in treatment success rates over the study years, and Cox regression analysis was used to identify predictors for poor treatment outcomes.The treatment success rate was 76% (301/398) for all participants, 77% (298/387) for MDR-TB cases and 27% (3/11) for extensively drug-resistant tuberculosis -TB cases. Treatment success increased significantly from 66% among patients who started treatment in 2011 to 85% in 2015 (P < .01). Of the 97 (24.4%) patients with unsuccessful treatment outcomes, 10 (2.5%) died, 64 (16.1%) failed treatment, and 23 (5.8%) were lost to follow-up. Patients who started treatment in 2013 to 2015 were less likely to have unsuccessful outcomes than those who started in 2011-2012 (adjusted odds ratio [AOR] 0.4, 95% confidence interval [CI] 0.3-0.6), patients ≥25 years were more likely to have unsuccessful outcomes than younger patients (AOR 1.6, 95% CI 1.3-2.1), and cases with kanamycin resistance was associated with three times the odds of having unsuccessful outcomes than kanamycin-susceptible cases (AOR 3.0, 95% CI 1.5-5.8).With proper case management of MDR-TB, patients can achieve a high treatment success rate. Hangzhou's program offers clinical evidence that can be used to inform MDR-TB programs elsewhere in China and abroad.
Collapse
Affiliation(s)
- Qingchun Li
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Cynthia X. Shi
- Center for Interdisciplinary Research on AIDS and Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Min Lu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Limin Wu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Yifei Wu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Meng Wang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Le Wang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Gang Zhao
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Li Xie
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Han-Zhu Qian
- SJTU-Yale Joint Center for Biostatistics and Data Science, Shanghai Jiao Tong University, Shanghai, China
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
30
|
Treatment quality and outcome for multidrug-resistant tuberculosis patients in four regions of China: a cohort study. Infect Dis Poverty 2020; 9:97. [PMID: 32682446 PMCID: PMC7368741 DOI: 10.1186/s40249-020-00719-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/09/2020] [Indexed: 12/01/2022] Open
Abstract
Background China incurs an extremely low treatment coverage of multidrug-resistant tuberculosis (MDR-TB). This study aimed to understand the experience of MDR-TB patients on quality of health care, and the clinical impact through an up to six-year follow-up. Methods Cohorts of MDR-TB patients were built in TB/MDR-TB designated hospitals in four regions of China from 2014 to 2015. Patients were followed up during treatment course, and yearly confirmation afterward until 2019. Delay in MDR-TB diagnosis and treatment was calculated upon bacteriological confirmation and treatment initiation. Risk factors for unfavourable outcomes were identified by multivariate logistic regression. Results Among 1168 bacteriological-positive TB patients identified from a 12-million population, 58 (5.0%) MDR-TB cases were detected. The median delay for MDR-TB diagnosis was 90.0 days, with 13.8% having a delay above 180.0 days. MDR-TB treatment was only recommended to 19 (32.8%) participants, while the rest continued with regimen for drug-susceptible TB. In MDR-TB treatment group, 36.8% achieved treatment success, while the others had incomplete treatment (21.1%), loss to follow-up (36.8%) and TB relapse (5.3%). For non-MDR-TB treatment group, 33.3% succeeded, 25.6% relapsed, 2.6% failed, 23.1% died, and 15.4% were lost to follow-up. Overall, only 35.7% (20/56) of detected MDR-TB patients had favourable outcomes and higher education level was positively associated with it (adjusted odds ratio [aOR]: 3.60, 95% confidence interval [CI]: 1.04–12.5). Conclusions A large proportion of patients did not receive MDR-TB treatment and had unfavourable outcomes. Delayed MDR-TB diagnosis resulted in poor quality of MDR-TB care. Rapid diagnosis, regulated patient management and high-quality MDR-TB treatment should be enhanced in China.
Collapse
|
31
|
Darisheva M, Tracy M, Terlikbayeva A, Zhussupov B, Schluger N, McCrimmon T. Knowledge and attitudes towards ambulatory treatment of tuberculоsis in Kazakhstan. BMC Health Serv Res 2020; 20:563. [PMID: 32571356 PMCID: PMC7310255 DOI: 10.1186/s12913-020-05413-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/09/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Ambulatory based treatment of tuberculosis has been recently introduced in Kazakhstan. We sought to assess the attitudes of the general population, TB patients and their household members towards ambulatory TB treatment and identify how knowledge of TB is associated with these attitudes. METHODS New pulmonary TB cases and their household and community controls were recruited from three regions of Kazakhstan in 2012-2014. 1083 participants completed audio computer-assisted self interviews to assess their knowledge of TB and attitudes towards ambulatory care. Mixed effects logistic regression models were used to identify factors associated with attitudes toward ambulatory TB treatment. RESULTS The proportion of people who considered ambulatory TB treatment as appropriate was very low (24.9%). Positive attitudes towards ambulatory TB treatment were significantly associated with region of residence, higher level of education, family support and experience with TB. The association between sufficient tuberculosis knowledge and favorable attitude toward ambulatory treatment was stronger among community controls compared to TB patients and their family members. CONCLUSIONS This study provides insight into attitudes toward ambulatory TB treatment among different groups and the specific influence of TB knowledge on these attitudes. Our findings can inform the process of integration of new TB treatment strategies and the development of appropriate education and advocacy programs in the general population.
Collapse
Affiliation(s)
- Meruyert Darisheva
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan.
| | - Melissa Tracy
- School of Public Health, Department of Epidemiology and Biostatistics, University at Albany, Albany, NY, USA
| | - Assel Terlikbayeva
- Columbia University Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | | | - Neil Schluger
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Tara McCrimmon
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, USA
| |
Collapse
|
32
|
Furin J, Loveday M, Hlangu S, Dickson-Hall L, le Roux S, Nicol M, Cox H. "A very humiliating illness": a qualitative study of patient-centered Care for Rifampicin-Resistant Tuberculosis in South Africa. BMC Public Health 2020; 20:76. [PMID: 31952494 PMCID: PMC6969445 DOI: 10.1186/s12889-019-8035-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patient-centered care is pillar 1 of the "End TB" strategy, but little has been documented in the literature about what this means for people living with rifampicin-resistant (RR-TB). Optimizing care for such individuals requires a better understanding of the challenges they face and the support they need. METHODS A qualitative study was done among persons living with RR-TB and members of their support network. A purposive sample was selected from a larger study population and open-ended interviews were conducted using a semi-standard interview guide. Interviews were recorded and transcribed and the content analyzed using an iterative thematic analysis based in grounded theory. RESULTS 16 participants were interviewed from three different provinces. Four distinct periods in which support was needed were identified: 1) pre-diagnosis; 2) pre-treatment; 3) treatment; and 4) post-treatment. Challenges common in all four periods included: socioeconomic issues, centralized care, and the need for better counseling at multiple levels. CONCLUSIONS Beyond being a "very humiliating illness", RR-TB robs people of their physical, social, economic, psychological, and emotional well-being far beyond the period when treatment is being administered. Efforts to tackle these issues are as important as new drugs and diagnostics in the fight against TB.
Collapse
Affiliation(s)
- Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA.
| | - Marian Loveday
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sindisiwe Hlangu
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Lindy Dickson-Hall
- Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape town, South Africa
| | - Sacha le Roux
- Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape town, South Africa
| | - Mark Nicol
- Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape town, South Africa
- Institute of Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa
- Division of Infection and Immunity, School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - Helen Cox
- Division of Medical Microbiology, Department of Pathology, University of Cape Town, Cape town, South Africa
- Institute of Infectious Disease and Molecular Medicine and Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
33
|
Mobile Health Technologies May Be Acceptable Tools for Providing Social Support to Tuberculosis Patients in Rural Uganda: A Parallel Mixed-Method Study. Tuberc Res Treat 2020; 2020:7401045. [PMID: 31969998 PMCID: PMC6969997 DOI: 10.1155/2020/7401045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 12/12/2019] [Indexed: 12/23/2022] Open
Abstract
Background Social support has been shown to mitigate social barriers to medication adherence and improve tuberculosis (TB) treatment success rates. The use of mobile technology to activate social support systems among TB patients, however, has not been well explored. Moreover, studies that tie supportive SMS (Short Message Service) texts to electronic monitoring of TB medication adherence are lacking. Objective To explore TB patients' current access to social support and perceptions of utilizing real-time adherence monitoring interventions to support medication adherence. Methods We purposively selected TB patients who owned phones, had been taking TB medications for ≥1 month, were receiving their treatment from Mbarara Regional Referral Hospital, and reported having ≥1 social supporter. We interviewed these patients and their social supporters about their access to and perceptions of social support. We used STATA 13 to describe participants' sociodemographic and social support characteristics. Qualitative data were analyzed using content analysis to derive categories describing accessibility and perceptions. Results TB patients report requesting and receiving a variety of different forms of social support, including instrumental (e.g., money for transport and other needs and medication reminders), emotional (e.g., adherence counselling), and informational (e.g., medication side effects) support through mobile phones. Participants felt that SMS notifications may motivate medication adherence by creating a personal sense of obligation to take medications regularly. Participants anticipated that limited financial resources and relationship dynamics could constrain the provision of social support especially when patients and social supporters are not oriented about their expectations. Conclusion Mobile telephones could provide alternative approaches to providing social support for TB medication adherence especially where patients do not stay close to their social supporters. Further efforts should focus on optimized designs of mobile phone-based applications for providing social support to TB patients and training of TB patients and social supporters to match their expectations.
Collapse
|
34
|
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.
Collapse
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
| | | |
Collapse
|
35
|
Fang XH, Dan YL, Liu J, Jun L, Zhang ZP, Kan XH, Ma DC, Wu GC. Factors influencing completion of treatment among pulmonary tuberculosis patients. Patient Prefer Adherence 2019; 13:491-496. [PMID: 31114167 PMCID: PMC6497847 DOI: 10.2147/ppa.s198007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/12/2019] [Indexed: 12/20/2022] Open
Abstract
Objective: This study aimed to understand the influencing factors of treatment completion among pulmonary tuberculosis (PTB) patients in Anhui province, eastern People's Republic of China, in order to provide scientific evidence for improving the follow-up rate and treatment completion rate. Methods: A total of 262 PTB patients in six counties (districts) of Anhui province were investigated by questionnaire, and data about treatment interruption were collected. Results: The main causes of treatment interruption were forgetting to take medicine (24.5%), drug side effects (23.3%), and symptomatic improvement (19.5%). The education background, patient type, cause of interruption, and tracking method were factors influencing completion of treatment (all P<0.05). The education level was positively associated with the treatment completion rate. New smear-positive patients had a significantly higher completion rate than others. The patients interrupted by drug side effects had the highest risk of interruption. In terms of the tracking method, the completion rate of patients tracked by the rural medical staff was significantly lower. Conclusions: The management of PTB patients by medication supervision should be strengthened, especially for those with low education level and who had drug side effects, in order to improve their treatment completion rate.
Collapse
Affiliation(s)
- Xue-Hui Fang
- Department of Science and Education, Anhui Provincial TB Institute, Hefei, Anhui, People’s Republic of China
| | - Yi-Lin Dan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, People’s Republic of China
| | - Jie Liu
- Department of Science and Education, Anhui Provincial TB Institute, Hefei, Anhui, People’s Republic of China
| | - Lei Jun
- Department of Science and Education, Anhui Provincial TB Institute, Hefei, Anhui, People’s Republic of China
| | - Zhi-Ping Zhang
- Department of Tuberculosis Prevention, Anqing Center for Disease Control and Prevention, Anqing, Anhui, People’s Republic of China
| | - Xiao-Hong Kan
- Department of Science and Education, Anhui Provincial TB Institute, Hefei, Anhui, People’s Republic of China
| | - Dong-Chun Ma
- Department of Science and Education, Anhui Provincial TB Institute, Hefei, Anhui, People’s Republic of China
- Correspondence: Dong-Chun MaDepartment of Science and Education, Anhui Provincial TB Institute, Hefei, Anhui, 230022, People’s Republic of ChinaEmail
| | - Guo-Cui Wu
- School of Nursing, Anhui Medical University, Hefei, Anhui, People’s Republic of China
- Guo-Cui WuSchool of Nursing, Anhui Medical University, 15 Feicui Road, Hefei, Anhui, 230601, People’s Republic of ChinaEmail
| |
Collapse
|