1
|
Walker EF, Flook M, Rodger AJ, Fielding KL, Stagg HR. Quantifying non-adherence to anti-tuberculosis treatment due to early discontinuation: a systematic literature review of timings to loss to follow-up. BMJ Open Respir Res 2024; 11:e001894. [PMID: 38359965 PMCID: PMC10875541 DOI: 10.1136/bmjresp-2023-001894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/15/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND The burden of non-adherence to anti-tuberculosis (TB) treatment is poorly understood. One type is early discontinuation, that is, stopping treatment early. Given the implications of early discontinuation for treatment outcomes, we undertook a systematic review to estimate its burden, using the timing of loss to follow-up (LFU) as a proxy measure. METHODS Web of Science, Embase and Medline were searched up to 14 January 2021 using terms covering LFU, TB and treatment. Studies of adults (≥ 18 years) on the standard regimen for drug-sensitive TB reporting the timing of LFU (WHO definition) were included. A narrative synthesis was conducted and quality assessment undertaken using an adapted version of Downs and Black. Papers were grouped by the percentage of those who were ultimately LFU who were LFU by 2 months. Three groups were created: <28.3% LFU by 2 months, ≥28.3-<38.3%, ≥38.3%). The percentage of dose-months missed due to early discontinuation among (1) those LFU, and (2) all patients was calculated. RESULTS We found 40 relevant studies from 21 countries. The timing of LFU was variable within and between countries. 36/40 papers (90.0%) reported the percentage of patients LFU by the end of 2 months. 31/36 studies (86.1%) reported a higher than or as expected percentage of patients becoming LFU by 2 months. The percentage of dose-months missed by patients who became LFU ranged between 37% and 77% (equivalent to 2.2-4.6 months). Among all patients, the percentage of dose-months missed ranged between 1% and 22% (equivalent to 0.1-1.3 months). CONCLUSIONS A larger than expected percentage of patients became LFU within the first 2 months of treatment. These patients missed high percentages of dose months of treatment due to early discontinuation. Interventions to promote adherence and retain patients in care must not neglect the early months of treatment. PROSPERO REGISTRATION NUMBER CRD42021218636.
Collapse
Affiliation(s)
| | - Mary Flook
- Faculty of Life and Health Sciences, University of Liverpool, Liverpool, UK
| | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | - Katherine L Fielding
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
- School of Public Health, University of the Witwatersrand- Johannesburg, Johannesburg, South Africa
| | - Helen R Stagg
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
2
|
Getachew RG, Tolossa T, Teklemariam Z, Ayele A, Roba HS. Incidence and predictors of treatment interruption among patients on anti-tuberculosis treatment in Nekemte public healthcare facilities, Oromia, Western Ethiopia. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1234865. [PMID: 38455888 PMCID: PMC10910942 DOI: 10.3389/fepid.2023.1234865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/08/2023] [Indexed: 03/09/2024]
Abstract
Introduction Tuberculosis treatment interruption increases the risk of poor treatment outcomes and the occurrence of drug resistant Tuberculosis. However, data on the incidence and predictors of tuberculosis treatment interruption are still scarce in Ethiopia, as well as in the study area. Therefore, this study aimed to assess the incidence and predictors of treatment interruption among patients on tuberculosis treatment in Nekemte public healthcare facilities, Oromia region, Western Ethiopia, from July 1, 2017, to June 30, 2021. Methods A retrospective cohort study design was conducted among 800 patients enrolled in anti-tuberculosis treatment during the study period. Data were collected from patient cards who were enrolled in treatment from July 1, 2017 to June 30, 2021. Epidata version 3.2 was used for data entry, and STATA version 14 was used for analysis. A multivariable Cox regression model with a 95% confidence interval (CI) and adjusted hazard ratio (AHR) was used to identify the significant predictors at a p value < 0.05. Finally, the log likelihood ratio, and a Cox-Snell residual graph was used to check the adequacy of the model. Results A total of 800 patients were followed for a median time of 2.3 (95% CI: 2.20-2.36) months, and with a maximum follow-up time of 11.7 months. The overall incidence rate of treatment interruption was 27.4 per 1000 (95% CI: 22.8-32.8) person-month observations. Age 18-34 years (AHR = 1.8, 95% CI: 1.02-3.18), male (AHR = 1.63, 95% CI: 1.1-2.42), rural residence (AHR = 3, 95% CI: 1.98-4.64), presence of comorbidity (AHR = 10, 95% CI: 5.47-18.27) and lack of treatment supporters on the treatment follow-up (AHR = 2.82, 95% CI: 1.9-4.41) were found to be significant predictors of treatment interruption. Conclusion A high incidence rate of interruption was observed among TB patients in public health facilities in Nekemte town. Health facilities should provide supportive care for patients with co-morbidities and consider interventions that target middle-aged patients from rural areas that reduce treatment interruptions.
Collapse
Affiliation(s)
- Robsan Gudeta Getachew
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Zelalem Teklemariam
- School of Medical Laboratory Sciences, College Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Angefa Ayele
- School of Public Health, Institute of Health Sciences, Bule Hora University, Bule Hora, Ethiopia
| | - Hirbo Shore Roba
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- School of Health and Medical Sciences, University of Southern Queensland, Toowoomba, QLD, Australia
| |
Collapse
|
3
|
Paikray E, Das P, Pattnaik M, Mishra V. Adverse Drug Reaction Monitoring in Multidrug-Resistant Tuberculosis Patients Receiving Bedaquiline and Delamanid-Based Regimen. Cureus 2022; 14:e30764. [DOI: 10.7759/cureus.30764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 11/05/2022] Open
|
4
|
Atif M, Fatima R, Ahmad N, Babar ZUD. Treatment outcomes of extrapulmonary tuberculosis in Bahawalpur, Pakistan; a record review. J Pharm Policy Pract 2020; 13:35. [PMID: 32724657 PMCID: PMC7382058 DOI: 10.1186/s40545-020-00227-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background There is limited published data form Pakistan on treatment success rate among extrapulmonary tuberculosis (EPTB) patients. The aim of this study was to assess clinical form, treatment outcomes, and identify the factors associated with unfavorable treatment outcome among EPTB patients. Methods A retrospective study was conducted at the Chest Disease Unit of the Bahawal Victoria Hospital, Pakistan. Medical records of EPTB patients, registered at the study site from January 1, 2015 to September 30, 2017, were reviewed to obtain the data. Final treatment outcomes among EPTB patients were evaluated in accordance with the standard Word Health Organization (WHO) criteria. Multivariate binary logistic regression analysis was used to identify the factors associated with unfavorable treatment outcome. Results A total of 651 EPTB patients were included in the study. Highest proportion of patients had pleural TB (n = 217, 33.3%). Out of the total 651 patients, 463 (71.1%) successfully completed the treatment. Among 177 (27.2%) patients with unfavorable treatment outcome, 10 (1.5%) died, while 165 (25.4%) lost to follow-up the treatment. Lymph node TB (AOR 0.65, 95% CI 0.422, 0.989) and meningeal TB (AOR 2.1, 95% CI 1.065, 4.144) were significantly associated with unfavorable treatment outcome. Conclusion The treatment success (favorable outcome) rate among EPTB patients was less than the target (i.e., ≥ 90%) set by the WHO. Highest proportion of patients lost to follow-up during the treatment.
Collapse
Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab Pakistan
| | - Razia Fatima
- Research Unit, National TB Control Program, Islamabad, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy, University of Baluchistan, Quetta, Pakistan
| | | |
Collapse
|
5
|
Padmasawitri TIA, Saragih SM, Frederix GW, Klungel O, Hövels AM. Managing Uncertainties Due to Limited Evidence in Economic Evaluations of Novel Anti-Tuberculosis Regimens: A Systematic Review. PHARMACOECONOMICS - OPEN 2020; 4:223-233. [PMID: 31297751 PMCID: PMC7248140 DOI: 10.1007/s41669-019-0162-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Limited evidence for the implementation of new health technologies in low- and middle-income countries (LMICs) may lead to uncertainties in economic evaluations and cause the evaluations to produce inaccurate information for decision making. We performed a systematic review of economic evaluations on implementing new short-course regimens (SCR) for drug-sensitive and drug-resistant tuberculosis (TB), to explore how uncertainties due to the limited evidence in the studies were dealt with and to identify useful information for decision making from these studies. METHODS We searched in electronic databases PubMed, EMBASE, NHSEED, and CEA registry for economic evaluations addressing the implementation of new anti-TB SCRs in LMICs published until September 2018. We included studies addressing both the cost and outcomes of implementing a new regimen for drug-sensitive and drug-resistant TB with a shorter treatment duration than the currently used regimens. The quality of the included studies was assessed using The Consensus Health Economic Criteria checklist. We extracted information from the included studies on uncertainties and how they were managed. The management of uncertainties was compared with approaches used in early health technology assessments (HTAs), including sensitivity analyses and pragmatic scenario analyses. We extracted information that could be useful for decision making such as cost-effectiveness conclusions, and barriers to implementing the intervention. RESULTS Four of the 322 studies found in the search met the eligibility criteria. Three studies were model-based studies that investigated the cost effectiveness of a new first-line SCR. One study was an empirical study investigating the cost effectiveness of new regimens for drug-resistant TB. The model-based studies addressed uncertainties due to limited evidence through various sensitivity analyses as in early HTAs. They performed a deterministic sensitivity analysis and found the main drivers of the cost-effectiveness outcomes, that is, the rate of treatment default and treatment delivery costs. Additionally, two of the model-based studies performed a pragmatic scenario analysis and found a potential barrier to implementing the new first-line SCR, that is, a weak health system with a low TB care utilization rate. The empirical study only performed a few scenario analyses with different regimen prices and volumes of TB care utilization. Therefore, the study could only provide information on the main cost drivers. CONCLUSION Using an approach similar to that used in early HTAs, where uncertainties due to the limited evidence are rigorously explored upfront, the economic evaluations could inform not only the decision to implement the intervention but also how to manage risks and implementation barriers.
Collapse
Affiliation(s)
- T I Armina Padmasawitri
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Pharmacology and Clinical Pharmacy Research Group, School of Pharmacy, Institut Teknologi Bandung, Bandung, Indonesia
| | - Sarah Maria Saragih
- Department of Health Policy and Health Economics, Faculty of Social Sciences, Eötvös Loránd University (ELTE), Budapest, Hungary
- Department of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Gerardus W Frederix
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
| | - Olaf Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
| | - Anke M Hövels
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
6
|
Kansal S, Chakravarty J, Kumar A, Malaviya P, Boelaert M, Hasker E, Ostyn B, Sundar S. Risk Factors associated with defaulting from visceral leishmaniasis treatment: analysis under routine programme conditions in Bihar, India. Trop Med Int Health 2017; 22:1037-1042. [PMID: 28594453 DOI: 10.1111/tmi.12906] [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: 11/29/2022]
Abstract
OBJECTIVE To assess the rate of default from treatment in the visceral leishmaniasis (VL) elimination programme and to identify risk factors and its underlying causes. METHODS Case-control study conducted between December 2009 and June 2012 in three primary health centres (PHCs) of Muzaffarpur district, India. Patients who defaulted from treatment from the PHCs were considered as 'cases' and those who completed their treatment as 'controls'. Two controls were included in the study for each case. Respondents' opinion and satisfaction with the services provided at the PHCs were also elicited. Logistic regression was performed to assess the contribution of sociodemographic variables on patient status, and a discriminant analysis was used (after decomposing the original data) to identify factors that can predict the patient status as defaulter or not, based on factor scores of the components as predictor variables. RESULTS During the study period, 16.3% (89/544) of patients defaulted; 87 cases and 188 controls were interviewed through a semistructured questionnaire. Women tended to be more at risk for default (OR, 1.6, 95% CI (0.9 -2.9). Treatment received was miltefosine in 55.6% and sodium stibogluconate (SSG) in 44.4%. Most (86%) defaulters completed their treatment at other healthcare facilities; 70% of them preferred non-governmental institutions. Most cited reasons for default were seeking a second opinion for VL treatment and preferring to be treated in specialised VL centres. Discriminant analysis showed only one significant predictor: dissatisfaction with the medical care received in PHCs. CONCLUSION Efforts are needed to enhance the quality of VL care at PHC level, which will be beneficial in increasing treatment completion rates.
Collapse
Affiliation(s)
- S Kansal
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - J Chakravarty
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - A Kumar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - P Malaviya
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - M Boelaert
- Institute Tropical Medicine, Antwerp, Belgium
| | - E Hasker
- Institute Tropical Medicine, Antwerp, Belgium
| | - B Ostyn
- Institute Tropical Medicine, Antwerp, Belgium
| | - S Sundar
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| |
Collapse
|
7
|
Kigozi G, Heunis C, Chikobvu P, Botha S, van Rensburg D. Factors influencing treatment default among tuberculosis patients in a high burden province of South Africa. Int J Infect Dis 2016; 54:95-102. [PMID: 27894985 DOI: 10.1016/j.ijid.2016.11.407] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 11/14/2016] [Accepted: 11/20/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To determine and describe the factors influencing treatment default of tuberculosis (TB) patients in the Free State Province of South Africa. METHODS A retrospective records review of pulmonary TB cases captured in the ETR.Net electronic TB register between 2003 and 2012 was performed. Subjects were >15 years of age and had a recorded pre-treatment smear result. The demographic and clinical characteristics of defaulters were described. Multivariate logistic regression analysis was used to determine factors associated with treatment default. The odds ratios (OR) together with their corresponding 95% confidence intervals (CI) were estimated. Statistical significance was considered at 0.05. RESULTS A total of 7980 out of 110 349 (7.2%) cases defaulted treatment. Significantly higher proportions of cases were male (8.3% vs. female: 5.8%; p<0.001), <25 years old (9.1% vs. 25-34 years: 8.7%; 35-44 years: 7.0%; 45-54 years: 5.2%; 55-64 years: 4.4%; >64 years: 3.9%; p<0.001), undergoing TB retreatment (11.0% vs. new cases: 6.3%; p<0.001), had a negative pre-treatment sputum smear result (7.8% vs. positive smear results: 7.1%; p<0.001), were in the first 2 months of treatment (95.5% vs. >2 months: 4.8%; p<0.001), and had unknown HIV status (7.8% vs. HIV-positive: 7.0% and HIV-negative: 5.7%; p<0.001). After controlling for potential confounders, multivariate analysis revealed a two-fold increased risk of defaulting treatment when being retreated compared to being treated for the first time for TB (adjusted OR (AOR) 2.0, 95% CI 1.85-2.25). Female cases were 40% less likely to default treatment compared to their male counterparts (AOR 0.6, 95% CI 0.51-0.71). Treatment default was less likely among cases >24 years old compared to younger cases (25-34 years: AOR 0.8, 95% CI 0.77-0.87; 35-44 years: AOR 0.6, 95% CI 0.50-0.64; 45-54 years: AOR 0.4, 95% CI 0.32-0.49; 55-64 years: AOR 0.3, 95% CI 0.21-0.43; >64 years: AOR 0.3, 95% CI 0.19-0.35). Co-infected cases receiving antiretroviral therapy (ART) were 40% less likely to default TB treatment relative to those whose ART status was unknown (AOR 0.6, 95% CI 0.46-0.57). CONCLUSIONS Salient factors influence TB patient treatment default in the Free State Province. Therefore, the strengthening of clinical and programmatic interventions for patients at high risk of treatment default is recommended. In particular, ART provision to co-infected cases facilitates TB treatment adherence and outcomes.
Collapse
Affiliation(s)
- G Kigozi
- Centre for Health Systems Research & Development, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa.
| | - C Heunis
- Centre for Health Systems Research & Development, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa
| | - P Chikobvu
- Department of Community Health, University of the Free State, Bloemfontein, South Africa; Free State Department of Health, Bloemfontein, South Africa
| | - S Botha
- JPS- Africa NPC, Pretoria,South Africa
| | - D van Rensburg
- Centre for Health Systems Research & Development, University of the Free State, PO Box 339, Bloemfontein, 9300, South Africa
| |
Collapse
|
8
|
Fagundez G, Perez-Freixo H, Eyene J, Momo JC, Biyé L, Esono T, Ondó Mba Ayecab M, Benito A, Aparicio P, Herrador Z. Treatment Adherence of Tuberculosis Patients Attending Two Reference Units in Equatorial Guinea. PLoS One 2016; 11:e0161995. [PMID: 27622461 PMCID: PMC5021284 DOI: 10.1371/journal.pone.0161995] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/16/2016] [Indexed: 11/19/2022] Open
Abstract
Equatorial Guinea has one of the highest burden of tuberculosis (TB) in Africa. Incomplete adherence to TB treatment has been identified as one of the most serious remaining problem in tuberculosis control. The following study is aimed at determining the adherence to anti-tuberculosis treatment in Equatorial Guinea and its determinants, as well as at assessing the knowledge of the people about the disease. In this cross-sectional study, participants were recruited by non-probabilistic consecutive sampling amongst patients who attended the reference units for TB in Bata and Malabo between March and July 2015. Socio-demographic and clinical data were collected. Adherence to treatment and knowledge about TB were assessed by Morisky-Green-Levine and Batalla tests and a questionnaire on adherence related factors specifically prepared for this research. Descriptive statistics were computed to summarize the data and bivariate analyses by adherence profile were performed with χ2 test for categorical data. A total of 98 patients with TB were interviewed. 63.27% of interviewees had good knowledge about TB (Batalla test) while 78.57% of respondents were adherent according to the Morisky-Green-Levine test. A low educational level, lack of family support and lack of medical advice about the disease were significantly associated to lower adherence level. Patients with re-infection (due to relapse or treatment failure) and those who have suffered from drug shortages were also less adherents. The National Programme for TB Control should consider improving the early diagnosis and follow-up of TB cases, as well as the implementation of all components of DOTS (Directly observed Treatment, short-course) strategy all over the country.
Collapse
Affiliation(s)
- Gabriela Fagundez
- Department of Preventive Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Hugo Perez-Freixo
- Department of Preventive Medicine, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Eyene
- National Tuberculosis and Leprosy Control Program (PNLP in Spanish), Ministry of Health and Social Welfare, Malabo, Equatorial Guinea
| | - Juan Carlos Momo
- National Tuberculosis and Leprosy Control Program (PNLP in Spanish), Ministry of Health and Social Welfare, Malabo, Equatorial Guinea
| | - Lucia Biyé
- National Tuberculosis and Leprosy Control Program (PNLP in Spanish), Ministry of Health and Social Welfare, Malabo, Equatorial Guinea
| | - Teodoro Esono
- National Tuberculosis and Leprosy Control Program (PNLP in Spanish), Ministry of Health and Social Welfare, Malabo, Equatorial Guinea
| | - Marcial Ondó Mba Ayecab
- National Tuberculosis and Leprosy Control Program (PNLP in Spanish), Ministry of Health and Social Welfare, Malabo, Equatorial Guinea
| | - Agustín Benito
- National Centre of Tropical Medicine, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- The Spanish Tropical Diseases Research Network (RICET in Spanish), Madrid, Spain
| | - Pilar Aparicio
- National Centre of Tropical Medicine, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- The Spanish Tropical Diseases Research Network (RICET in Spanish), Madrid, Spain
| | - Zaida Herrador
- National Centre of Tropical Medicine, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- The Spanish Tropical Diseases Research Network (RICET in Spanish), Madrid, Spain
- * E-mail:
| |
Collapse
|
9
|
Kehbila J, Ekabe CJ, Aminde LN, Noubiap JJN, Fon PN, Monekosso GL. Prevalence and correlates of depressive symptoms in adult patients with pulmonary tuberculosis in the Southwest Region of Cameroon. Infect Dis Poverty 2016; 5:51. [PMID: 27268138 PMCID: PMC4895984 DOI: 10.1186/s40249-016-0145-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 05/10/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a global health challenge and depression is a significant contributor to the global burden of disease. Current evidence suggests that there is an association between depressive symptoms and TB, lower adherence to treatment, and increased morbidity and mortality. However, there is paucity of data regarding these associations in Cameroon. This study aimed to determine the prevalence and correlates of depression in adult patients with pulmonary TB (PTB) in the Southwest Region of Cameroon. METHODS A hospital-based cross-sectional study involving 265 patients with PTB was conducted from 2(nd) January to 31(st) March 2015 in the Limbe Regional Hospital and the Kumba District Hospital. Depression was diagnosed using the standard nine-item Patient Health Questionnaire, and classified as none, mild or moderate. Logistic regressions were used to investigate correlates of depression in these patients. RESULTS Of the 265 patients (mean age 36.9 ± 10 years) studied, 136 (51.3 %) were female. The prevalence of depression was 61.1 % (95 % CI: 55.1-66.8), with a significant proportion (36.6 %) having mild depression. Multivariable logistic regression analysis showed that being female (aOR = 3.0, 95 % CI (1.7-5.5), P < 0.001), having a family history of mental illness (aOR = 2.5, 95 % CI: 1.3-5.4, P > 0.05), being on retreatment for TB (aOR = 11.2, 95 % CI: 5.2-31.1, P < 0.001), having discontinued treatment (aOR = 8.2, 95 % CI: 1.1-23.3, P < 0.05) and having a HIV/TB co-infection (aOR = 2.5, 95 % CI: 1.2-6.5, P < 0.001) were factors associated with having a higher chance of being depressed. CONCLUSION Our study suggests that there is a high prevalence of depression among PTB patients, with more than one in two patients affected. Multidisciplinary care for TB patients involving mental health practitioners is highly encouraged, especially for high-risk groups.
Collapse
Affiliation(s)
- Jules Kehbila
- Department of Medicine, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Cyril Jabea Ekabe
- Department of Medicine, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Leopold Ndemnge Aminde
- Clinical Research Education, Networking and Consultancy, BP 3480, Douala, Cameroon. .,School of Public Health, Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Australia.
| | - Jean Jacques N Noubiap
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.,Medical Diagnostic Center, Yaoundé, Cameroon
| | - Peter Nde Fon
- Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Gottlieb Lobe Monekosso
- Department of Medicine, Faculty of Health Sciences, University of Buea and Global Health Dialogue Foundation, Buea, Cameroon
| |
Collapse
|
10
|
Ogundele OA, Moodley D, Pillay AW, Seebregts CJ. An ontology for factors affecting tuberculosis treatment adherence behavior in sub-Saharan Africa. Patient Prefer Adherence 2016; 10:669-81. [PMID: 27175067 PMCID: PMC4854235 DOI: 10.2147/ppa.s96241] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Adherence behavior is a complex phenomenon influenced by diverse personal, cultural, and socioeconomic factors that may vary between communities in different regions. Understanding the factors that influence adherence behavior is essential in predicting which individuals and communities are at risk of nonadherence. This is necessary for supporting resource allocation and intervention planning in disease control programs. Currently, there is no known concrete and unambiguous computational representation of factors that influence tuberculosis (TB) treatment adherence behavior that is useful for prediction. This study developed a computer-based conceptual model for capturing and structuring knowledge about the factors that influence TB treatment adherence behavior in sub-Saharan Africa (SSA). METHODS An extensive review of existing categorization systems in the literature was used to develop a conceptual model that captured scientific knowledge about TB adherence behavior in SSA. The model was formalized as an ontology using the web ontology language. The ontology was then evaluated for its comprehensiveness and applicability in building predictive models. CONCLUSION The outcome of the study is a novel ontology-based approach for curating and structuring scientific knowledge of adherence behavior in patients with TB in SSA. The ontology takes an evidence-based approach by explicitly linking factors to published clinical studies. Factors are structured around five dimensions: factor type, type of effect, regional variation, cross-dependencies between factors, and treatment phase. The ontology is flexible and extendable and provides new insights into the nature of and interrelationship between factors that influence TB adherence.
Collapse
Affiliation(s)
- Olukunle Ayodeji Ogundele
- UKZN/CSIR Meraka Centre for Artificial Intelligence Research and Health Architecture Laboratory, School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Deshendran Moodley
- UKZN/CSIR Meraka Centre for Artificial Intelligence Research and Health Architecture Laboratory, School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Anban W Pillay
- UKZN/CSIR Meraka Centre for Artificial Intelligence Research and Health Architecture Laboratory, School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Christopher J Seebregts
- UKZN/CSIR Meraka Centre for Artificial Intelligence Research and Health Architecture Laboratory, School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Jembi Health Systems NPC, Cape Town, South Africa
| |
Collapse
|
11
|
Balkissou AD, Pefura-Yone EW, Netong Gamgne M, Endale Mangamba LM, Onana Ngono I, Poka Mayap V, Evouna Mbarga A, Assamba Mpom SA, Kanko NF, Fodjeu G, Tagne Kamdem PE, Fogang D, Kuaban C. [Residual pleural opacity in patients treated for pleural tuberculosis in Yaounde]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:115-121. [PMID: 26651928 DOI: 10.1016/j.pneumo.2015.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 06/23/2015] [Accepted: 09/15/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The aim of this study was to evaluate the incidence and risk factors of residual pleural opacity (RPO) at the end and after 6 months (M12) of antituberculosis treatment (ATT) in adults with pleural tuberculosis. METHODS In this prospective cohort study, all patients admitted for pleural tuberculosis between September 2010 and August 2012 in the pneumology A unit of Yaounde Jamot Hospital were included. Each patient was then followed up for 12 months. RPO was considered significant if it was measured 10mm or more on standard chest X-ray. The logistic regression model was used to investigate the risk factors of significant RPO at the end of antituberculosis treatment. RESULTS Of the 193 patients included, median (interquartile range) age of 33 (25-42) years, 115 (59.6%) were men. The incidence (95% CI) of significant RPO was 22.0% (14.9-29.1) and 11.0% (4.9-17.1) at the end of ATT and at M12 respectively. In multivariate analysis, the risk factors of the occurrence of a significant RPO at the end of ATT and at M12 were smoking, associated parenchymal lesions, and hypoglycopleuria. CONCLUSION Cumulative incidence of RPO ≥ 10 mm was 22% at the end of ATT and 11% after 12 months from the beginning of treatment. Patients with risk factors of RPO ≥ 10 mm should benefit from greater surveillance and appropriate management.
Collapse
Affiliation(s)
- A D Balkissou
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun; Hôpital Jamot de Yaoundé, Yaoundé, Cameroun.
| | - E W Pefura-Yone
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun; Hôpital Jamot de Yaoundé, Yaoundé, Cameroun
| | - M Netong Gamgne
- Centre de diagnostic d'imagerie médicale et de conseils en radioprotection, Yaoundé, Cameroun
| | - L-M Endale Mangamba
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun; Hôpital Laquintinie, Douala, Cameroun
| | - I Onana Ngono
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - V Poka Mayap
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - A Evouna Mbarga
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - S A Assamba Mpom
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - N F Kanko
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - G Fodjeu
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - P E Tagne Kamdem
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun
| | - D Fogang
- Hôpital Jamot de Yaoundé, Yaoundé, Cameroun
| | - C Kuaban
- Département de médecine interne et spécialités, faculté de médecine et des sciences biomédicales, université de Yaoundé I, Yaoundé, Cameroun; Faculté de sciences de la santé, Bamenda, Cameroun
| |
Collapse
|
12
|
Weaver MS, Lönnroth K, Howard SC, Roter DL, Lam CG. Interventions to improve adherence to treatment for paediatric tuberculosis in low- and middle-income countries: a systematic review and meta-analysis. Bull World Health Organ 2015; 93:700-711B. [PMID: 26600612 PMCID: PMC4645428 DOI: 10.2471/blt.14.147231] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 05/01/2015] [Accepted: 05/07/2015] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the design, delivery and outcomes of interventions to improve adherence to treatment for paediatric tuberculosis in low- and middle-income countries and develop a contextual framework for such interventions. Methods We searched PubMed and Cochrane databases for reports published between 1 January 2003 and 1 December 2013 on interventions to improve adherence to treatment for tuberculosis that included patients younger than 20 years who lived in a low- or middle-income country. For potentially relevant articles that lacked paediatric outcomes, we contacted the authors of the studies. We assessed heterogeneity and risk of bias. To evaluate treatment success – i.e. the combination of treatment completion and cure – we performed random-effects meta-analysis. We identified areas of need for improved intervention practices. Findings We included 15 studies in 11 countries for the qualitative analysis and of these studies, 11 qualified for the meta-analysis – representing 1279 children. Of the interventions described in the 15 studies, two focused on education, one on psychosocial support, seven on care delivery, four on health systems and one on financial provisions. The children in intervention arms had higher rates of treatment success, compared with those in control groups (odds ratio: 3.02; 95% confidence interval: 2.19–4.15). Using the results of our analyses, we developed a framework around factors that promoted or threatened treatment completion. Conclusion Various interventions to improve adherence to treatment for paediatric tuberculosis appear both feasible and effective in low- and middle-income countries.
Collapse
Affiliation(s)
- Meaghann S Weaver
- St Jude Children's Research Hospital, 262 Danny Thomas Place, MS 721, Memphis, TN 38105, United States of America (USA)
| | - Knut Lönnroth
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | | | - Debra L Roter
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Catherine G Lam
- St Jude Children's Research Hospital, 262 Danny Thomas Place, MS 721, Memphis, TN 38105, United States of America (USA)
| |
Collapse
|
13
|
Pefura-Yone EW, Kengne AP, Tagne-Kamdem PE, Afane-Ze E. Clinical significance of low forced expiratory flow between 25% and 75% of vital capacity following treated pulmonary tuberculosis: a cross-sectional study. BMJ Open 2014; 4:e005361. [PMID: 25056978 PMCID: PMC4120340 DOI: 10.1136/bmjopen-2014-005361] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess the prevalence and determinants of post-tuberculosis chronic respiratory signs, as well as the clinical impact of a low forced expiratory flow between 25% and 75% (FEF25-75%) in a group of individuals previously treated successfully for pulmonary tuberculosis. DESIGN This was a cross-sectional study involving individuals in their post-tuberculosis treatment period. They all underwent a spirometry following the 2005 criteria of the American Thoracic Society/European Respiratory Society. Distal airflow obstruction (DAO) was defined by an FEF25-75% <65% and a ratio forced expiratory volume during the first second (FEV1)/forced vital capacity (FVC) ≥ 0.70. Logistic regression models were used to investigate the determinants of persisting respiratory symptoms following antituberculous treatment. SETTING This study was carried out in the tuberculosis diagnosis and treatment centre at Yaounde Jamot Hospital, which serves as a referral centre for tuberculosis and respiratory diseases for the capital city of Cameroon (Yaounde) and surrounding areas. PARTICIPANTS All consecutive patients in their post-tuberculosis treatment period were consecutively enrolled between November 2012 and April 2013. RESULTS Of the 177 patients included, 101 (57.1%) were men, whose median age (25th-75th centiles) was 32 (24-45.5) years. At least one chronic respiratory sign was present in 110 (62.1%) participants and DAO was found in 67 (62.9%). Independent determinants of persisting respiratory signs were the duration of symptoms prior to tuberculosis diagnosis higher than 12 weeks (adjusted OR 2.91; 95% CI 1.12 to 7.60, p=0.029) and presence of DAO (2.22; 1.13 to 4.38, p=0.021). CONCLUSIONS FEF25-75%<65% is useful for the assessment and diagnosis of post-tuberculous DAO. Mass education targeting early diagnosis of pulmonary tuberculosis can potentially reduce the prevalence of post-tuberculosis respiratory signs and distal airflow obstruction.
Collapse
Affiliation(s)
- Eric Walter Pefura-Yone
- Faculty of Medicine and Biomedical Sciences, Department of Internal Medicine and Subspecialties, University of Yaounde I, Yaounde, Cameroon
- Pneumology Service, Yaounde Jamot Hospital, Yaounde, Cameroon
| | - Andre Pascal Kengne
- South African Medical Research Council and University of Cape Town, Cape Town, South Africa
| | - Pierre Eugene Tagne-Kamdem
- Faculty of Medicine and Biomedical Sciences, Department of Internal Medicine and Subspecialties, University of Yaounde I, Yaounde, Cameroon
| | - Emmanuel Afane-Ze
- Faculty of Medicine and Biomedical Sciences, Department of Internal Medicine and Subspecialties, University of Yaounde I, Yaounde, Cameroon
- Pneumology Service, Yaounde Jamot Hospital, Yaounde, Cameroon
| |
Collapse
|
14
|
Pefura-Yone EW, Kengne AP, Kuaban C. Non-conversion of sputum culture among patients with smear positive pulmonary tuberculosis in Cameroon: a prospective cohort study. BMC Infect Dis 2014; 14:138. [PMID: 24618155 PMCID: PMC3984706 DOI: 10.1186/1471-2334-14-138] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 02/27/2014] [Indexed: 11/29/2022] Open
Abstract
Background We investigated the determinants of sputum culture non-conversion following intensive phase of treatment, and assessed the effects on the outcome among patients treated for a first episode of smear positive tuberculosis (TB). Methods This was a prospective cohort study spanning October 2009 to May 2012, among patients treated for a first episode of smear positive pulmonary tuberculosis in the Chest service of the Yaounde Jamot Hospital, Cameroon. Logistic regressions models were used to relate baseline characteristics with non-conversion of sputum cultures after the intensive phase of treatment. Results A total of 953 patients were admitted to the service during the study period, including 97 (10.2%) who had a positive sputum smear at the end of the intensive phase of anti-tuberculosis treatment. Eighty-six patients with persistent of smear positive sputa at the end of intensive phase of TB treatment were included, among whom 46 (53%) had positive sputum culture for Mycobacterium tuberculosis (C+). The absence of haemoptysis [adjusted odd ratio 4.65 (95% confidence intervals: 1.14-18.95)] and current smoking [7.26 (1.59-33.23)] were the main determinants of sputum culture non-conversion. Of the 46C + patients, 7 (15%) were resistant to at least one anti-tuberculosis drug. Treatment failure rate was 28% among C + patients and 8% among C– patients (p = 0.023). The sensitivity and specificity were 78.6% and 55.4% for culture non-conversion after intensive treatment, in predicting anti-TB treatment failure. Conclusions Failure rate is high among patients with positive sputum culture after intensive treatment, even in the absence of multi-drug resistant bacilli. Treatment should be closely monitored in these patients and susceptibility to anti-tuberculosis drugs tested in the presence of persistent positive smears following the intensive phase of treatment.
Collapse
Affiliation(s)
- Eric Walter Pefura-Yone
- Department of Internal Medicine and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
| | | | | |
Collapse
|
15
|
Pefura-Yone EW, Kuaban C, Assamba-Mpom SA, Moifo B, Kengne AP. Derivation, validation and comparative performance of a simplified chest X-ray score for assessing the severity and outcome of pulmonary tuberculosis. CLINICAL RESPIRATORY JOURNAL 2014; 9:157-64. [PMID: 24460763 DOI: 10.1111/crj.12112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/21/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To derive and validate against the Ralph et al. score, a simplified chest X-ray (CXR) score (SCS) for predicting the outcome of smear-positive pulmonary tuberculosis (SPPTB) among patients with high prevalence of human immunodeficiency virus (HIV) infection. METHODS CXR for 636 SPPTB patients (377 men, median age 31 years) from the Yaounde Jamot Hospital (Cameroon) were examined for the presence of tuberculosis lesions, and estimation of the proportion of lungs affected. SPPTB's evolution was based on sputum smear examination after 2 months of treatments. Logistic regressions were used to derive the SCS with internal validation via bootstrap resampling. Receiver operating characteristic curves (AUC) analyses were used to validate, determine of the optimal cut-offs and compare models' performance. RESULTS HIV co-infection was present in 191 (30%) patients. Sputum smear non-conversion was found in 45 (7.1) patients after 2 months of treatment. The SCS was expressed as proportion of lung affected plus 23 if cavitation is present. The AUC (95% confidence interval) was 0.718 (0.640-0.795), with little variation in bootstrap validation, and no sizable difference from the Ralph et al. model [0.714 (0.633-0.7860), P = 0.717 for the difference). Both models had good calibration (Hosmer-Lemeshow P ≥ 0.183). The optimal cut-off for predicting non-conversion of the sputum at 2 months was 52 for the SCS (sensitivity/specificity 66.7%/62.8%) and 74.5 (62.2%/74.3%) with Ralph et al. score. CONCLUSIONS The outcome of SPPTB among patients with high prevalence of HIV can acceptably be predicted by simple scores comprising baseline CXR variables, including the Ralph et al. score and the SCS from this study.
Collapse
Affiliation(s)
- Eric Walter Pefura-Yone
- Department of Internal Medicine and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon; Pneumology Service, Yaounde Jamot Hospital, Yaounde, Cameroon
| | | | | | | | | |
Collapse
|
16
|
Djibuti M, Mirvelashvili E, Makharashvili N, Magee MJ. Household income and poor treatment outcome among patients with tuberculosis in Georgia: a cohort study. BMC Public Health 2014; 14:88. [PMID: 24476154 PMCID: PMC3908381 DOI: 10.1186/1471-2458-14-88] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poverty is associated with increased risk of active tuberculosis (TB) disease onset, but the relation between household income and TB treatment outcomes is not well understood. The objective of this study was to determine household income characteristics associated with poor TB treatment outcome among newly diagnosed patients with pulmonary TB in the country of Georgia. METHODS A prospective cohort study was conducted among newly diagnosed smear positive pulmonary TB patients. Clinical and household data were collected from all consecutive patients seeking care at TB facilities in two major cities and one rural region in Georgia. Patients were followed prospectively during anti-TB regimens to determine treatment outcome. Bivariate analyses were used to determine the association of individual patient and household level characteristics with poor TB treatment outcome. A multivariable logistic model was used to estimate the adjusted association between patient household characteristics and poor TB treatment outcome. RESULTS After six months TB therapy, treatment outcome was available for 193 of 202 enrolled patients, of these 155 (80.3%) had a favorable TB treatment outcome. Compared to TB patients with poor treatment outcome, those with favorable treatment outcomes were younger (median 33.0 vs. 42.5 years), reported higher household monthly income (median $137 USD vs. $85 USD), were less likely to be unemployed (38.7 vs. 47.4%), and had higher level of education (38.7% vs. 31.6% with college education or greater). In multivariable analysis adjusted for age, sex, and socio-economic indicators, only low household income was remained statistically significantly associated with poor TB treatment outcome. Compared with patients from households with the highest tertile of monthly income, those in the middle tertile (aOR 4.28 95% CI 1.36, 13.53) and those in the lowest category of income (aOR 6.18 95% CI 1.83, 20.94) were significantly more likely to have poor treatment outcomes. CONCLUSION We demonstrated that TB patients in Georgia with lower household income were at greater risk of poor TB treatment outcomes. Providing targeted social assistance to TB patients and their households may improve clinical response to anti-TB therapy.
Collapse
Affiliation(s)
- Mamuka Djibuti
- International School of Public Health, Tbilisi State Medical University, 33 Vazha-Pshavela Ave, 0177 Tbilisi, Georgia.
| | | | | | | |
Collapse
|
17
|
Pefura-Yone EW, Soh E, Kengne AP, Balkissou AD, Kuaban C. Non-adherence to antiretroviral therapy in Yaounde: prevalence, determinants and the concordance of two screening criteria. J Infect Public Health 2013; 6:307-15. [PMID: 23806707 DOI: 10.1016/j.jiph.2013.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 02/09/2013] [Accepted: 02/12/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To assess the prevalence and determinants of non-adherence to antiretroviral therapy (ART) as well as the concordance of two screening criteria in a major center for human immunodeficiency virus (HIV) treatment in Yaounde, Cameroon. METHODS In 2011, we conducted a cross-sectional study involving a random sample of 889 adults (age > 18 years, 67.9% women) infected with HIV who were receiving chronic care at the Yaounde Jamot Hospital. Adherence was assessed via self-administered questionnaires using the Community Programs for Clinical Research on AIDS (CPCRA) index and the Center for Adherence Support Evaluation (CASE) index. RESULTS The prevalence of non-adherence to ART was 22.5% based on the CPCRA index and 34.9% based on the CASE index, with a low agreement between the two indexes [kappa = 0.37 (95% confidence interval 0.31-0.44)]. Independent determinants of CPCRA-diagnosed non-adherence were as follows: being a remunerated employee [odds ratio (95% confidence interval): 1.61 (1.14-2.28)], Pentecostal Christianity [2.18 (1.25-3.80)], alcohol consumption [1.65 (1.16-2.34)] and non-adherence to cotrimoxazole prophylaxis [5.73 (3.92-8.38)]. The equivalents for CASE-diagnosed non-adherence were [1.59 (1.19-2.12)], [1.83 (1.36-2.47)], [1.70 (1.27-2.28)], respectively, in addition to association with changes to the ART regimen [1.61 (1.17-2.20)]. CONCLUSIONS Non-adherence to ART remains high in this population. The careful evaluation of patients for the presence of determinants of non-adherence identified in this study may aid ART optimization.
Collapse
Affiliation(s)
- Eric Walter Pefura-Yone
- Department of Internal Medicine and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon.
| | | | | | | | | |
Collapse
|
18
|
Tachfouti N, Slama K, Berraho M, Elfakir S, Benjelloun MC, El Rhazi K, Nejjari C. Determinants of tuberculosis treatment default in Morocco: results from a national cohort study. Pan Afr Med J 2013; 14:121. [PMID: 23734266 PMCID: PMC3670204 DOI: 10.11604/pamj.2013.14.121.2335] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 03/07/2013] [Indexed: 01/03/2023] Open
Abstract
Introduction Studies have shown an association between smoking and tuberculosis (TB) infection, disease and TB-related mortality. We thus documented the impact of smoking and others factors on TB treatment default. Methods A cohort of 1039 new TB cases matched on smoking status was followed between 2004 and 2009 in eight Moroccan regions. Treatment default was defined according to international criteria. Univariate analyses were used to assess associations of treatment default with smoking status and demographic characteristics. Multivariate logistic regression was used to adjust for potential confounding. Results Patients’ mean age was 35.0 ±13.2 years. The rate of treatment default was 30.2%. Default was significantly higher among men, smokers, persons living in urban areas and non-religious Muslims. After adjusting for confounding variables, factors that remained significantly associated with treatment default were: being male (OR = 3.2; 95% CI: 1.2-8.7), being a non-religious Muslim (OR = 2.0; 95% CI: 1.4-2.9) and living in an urban area OR = 3.0; 95% CI: 1.8-4.9). Conclusion The high rate found for default suggests important program's inadequacies and an urgent need for change. Therefore continued research of predictors of default and strategies to reinforce adherence is recommended.
Collapse
Affiliation(s)
- Nabil Tachfouti
- Laboratory of Epidemiology, Clinical Research and Community Health, Faculty of Medicine University Sidi Mohammed Ben Abdallah, Fez, Morocco
| | | | | | | | | | | | | |
Collapse
|
19
|
[Thirty years of tuberculosis control in Cameroon: alternating "vertical" and "horizontal" health care delivery systems]. Rev Epidemiol Sante Publique 2013; 61:129-38. [PMID: 23499297 DOI: 10.1016/j.respe.2012.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 07/31/2012] [Accepted: 10/11/2012] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, tuberculosis remains endemic despite reforms of health systems and the tuberculosis control organization carried out in the last decades. METHODS We conducted a retrospective study of tuberculosis control in Cameroon from the period 2009 back to 1980. Data were collected from documents and activity reports of tuberculosis control, and interviews with managers of the National tuberculosis control program. FINDINGS The history of tuberculosis control in Cameroon from 2009 back to 1980 can be divided into three main periods. The first period, from 1980 to 1994, corresponded to the implementation of the 'primary health care' policy. At that time, tuberculosis case management was delivered free of charge, but centralized in specialized services with a gradual and mild increase in new cases detected. The second period, from 1995 to 2000, was characterized by the implementation of the 'primary health care reorientation' policy that decentralized tuberculosis care to all health facilities, but introduced cost recovery --which came along with a dramatic drop in the number of tuberculosis cases detected. The National tuberculosis control program, established in 1996, entrusted health facilities--especially hospitals--with the responsibility of tuberculosis diagnosis and treatment, and referred to them as tuberculosis diagnosis and treatment centers. During the third period, from 2001 to 2009, owing to major support from global health initiatives, the number of tuberculosis diagnosis and treatment centers was increased (reaching 216 centers in 2009), with a significant increase of new cases detected that peaked in 2006, from where the situation started declining till 2009. CONCLUSION Tuberculosis control indicators have never been optimal in Cameroon, despite the generally positive trend from 1980 to 2009. The strategy of tuberculosis diagnosis and treatment centers, which are essentially nested within hospitals, seems to have reached its intrinsic limitations. Better performance in tuberculosis control will henceforth require greater decentralization of tuberculosis detection and treatment to health centers. This careful decentralization will improve access for tuberculosis patients and lead to a comprehensive use of hospital technical expertise for tuberculosis care.
Collapse
|
20
|
Ifebunandu NA, Ukwaja KN. Tuberculosis treatment default in a large tertiary care hospital in urban Nigeria: prevalence, trend, timing and predictors. J Infect Public Health 2012; 5:340-5. [PMID: 23164562 DOI: 10.1016/j.jiph.2012.06.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/29/2012] [Accepted: 06/01/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES Few studies have investigated tuberculosis treatment default in tertiary care settings. We aimed to determine the prevalence, trend, timing and predictors of defaulting from tuberculosis treatment in a Nigerian tertiary hospital. METHODS Data entered from 2006 to 2010 in the Federal Medical Centre, Abakaliki, tuberculosis treatment register were sorted into six treatment outcomes. Five outcomes were combined into one variable called 'non-defaulters' and were compared with "defaulters". The statistical analysis was conducted using SPSS. RESULTS Of 671 tuberculosis patients, 192 (28.6%) defaulted. Of these, 126 (66%) were ≥30 years old, and 115 (60%) had pulmonary tuberculosis. Furthermore, 106 (55%) were males, and 125 (65%) lived in a rural area. The annual proportion of defaulters dropped from 34.8% to 20.6%, but the decreasing trend was not statistically significant (P=0.132 for trend). Of the defaulters, 148 (77.1%) defaulted during their intensive phase of treatment. The median default time was 7 (IQR 5-8) weeks. The independent predictors of treatment default were older age (aOR 1.5), rural residence (aOR 2.3), and HIV seropositivity (aOR, 2.8). CONCLUSION TB treatment default is high and must be reduced. This may be achieved through improved rural DOT, further patient education, and enhanced coordination of TB/HIV care.
Collapse
Affiliation(s)
- Ngozi A Ifebunandu
- Department of Medicine, Federal Medical Centre (FMC), Abakaliki, Ebonyi State, Nigeria
| | | |
Collapse
|
21
|
Yone EWP, Kengne AP, Moifo B, Kuaban C. Prevalence and determinants of extrapulmonary involvement in patients with pulmonary tuberculosis in a Sub-Saharan African country: a cross-sectional study. ACTA ACUST UNITED AC 2012; 45:104-11. [PMID: 22992019 DOI: 10.3109/00365548.2012.714905] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Determinants of extrapulmonary involvement during pulmonary tuberculosis (PTB) have not been extensively investigated. We assessed the prevalence and determinants of extrapulmonary involvement during PTB in a Sub-Saharan African country with a high prevalence of both TB and human immunodeficiency virus (HIV) infection. METHODS The medical records of patients aged ≥ 15 y, admitted for a first episode of TB to the Pneumology Service of Yaoundé Jamot Hospital, Cameroon, between 2009 and 2010 were considered. Determinants of extrapulmonary involvement were investigated through logistic regression. RESULTS A total of 984 patients (58.9% male), with a median age (25(th)-75(th) percentiles) of 32 (25-41) y were admitted for a first episode of TB, including 629 (63.9%) with isolated PTB, 127 (12.9%) with isolated extrapulmonary TB (EPTB), and 228 (23.2%) with both PTB and EPTB (PTB/EPTB). Therefore, the prevalence of EPTB among those with PTB was 26.6% (228/857). The main determinants of EPTB among patients with PTB were male sex (adjusted odds ratio (OR) 2.71, 95% confidence interval (95% CI) 1.71-4.03), HIV infection (OR 2.20, 95% CI 1.36-3.55), absence of fibrotic lung lesions (OR 1.96, 95% CI 1.23-3.14), smear-negative PTB (OR 7.20, 95% CI 4.13-12.56), anaemia (OR 1.60, 95% CI 1.03-2.50), and leukopenia (OR 2.59, 95% CI 1.12-5.98). CONCLUSIONS About a quarter of patients with PTB in this setting also have extrapulmonary involvement. EPTB is less contagious, less frequent than PTB, and less well addressed by programs in developing countries, while its identification is important for optimizing care. The presence of determinants of EPTB among patients with PTB should motivate active investigation of extrapulmonary involvement in order to improve management.
Collapse
Affiliation(s)
- Eric Walter Pefura Yone
- Department of Internal Medicine and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
| | | | | | | |
Collapse
|
22
|
Influence of HIV infection on the clinical presentation and outcome of adults with acute community-acquired pneumonia in Yaounde, Cameroon: a retrospective hospital-based study. BMC Pulm Med 2012; 12:46. [PMID: 22935579 PMCID: PMC3495717 DOI: 10.1186/1471-2466-12-46] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 08/27/2012] [Indexed: 11/30/2022] Open
Abstract
Background The impact of HIV infection on the evolution of acute community-acquired pneumonia (CAP) is still controversial. The aim of this study was to investigate possible differences in the clinical presentation and in-hospital outcomes of patients with CAP with and without HIV infection in a specialised service in Yaounde. Methods Medical files of 106 patients (51 men) aged 15 years and above, admitted to the Pneumology service of the Yaounde Jamot Hospital between January 2008 and May 2012, were retrospectively studied. Results Sixty-two (58.5%) patients were HIV infected. The median age of all patients was 40 years (interquartile range: 31.75-53) and there was no difference in the clinical and radiological profile of patients with and without HIV infection. The median leukocyte count (interquartile range) was 14,600/mm3 (10,900-20,600) and 10,450/mm3 (6,400-16,850) respectively in HIV negative and HIV positive patients (p = 0.002). Median haemoglobin level (interquartile range) was 10.8 g/dl (8.9-12) in HIV negative and 9.7 g/dl (8–11.6) in HIV positive patients (p = 0.025). In-hospital treatment failure on third day (39.5% vs. 25.5.1%, p = 0.137) and mortality rates (9% vs. 14.5%, p = 0.401) were similar between HIV negative and HIV positive patients. Conclusion Clinical and radiological features as well as response to treatment and in hospital fatal outcomes are similar in adult patients hospitalised with acute community-acquired pneumonia in Yaounde. In contrast, HIV infected patients tend to be more anaemic and have lower white cell counts than HIV negative patients. Larger prospective studies are needed to consolidate these findings.
Collapse
|
23
|
Pefura Yone EW, Kuaban C, Kengne AP. HIV testing, HIV status and outcomes of treatment for tuberculosis in a major diagnosis and treatment centre in Yaounde, Cameroon: a retrospective cohort study. BMC Infect Dis 2012; 12:190. [PMID: 22894713 PMCID: PMC3482584 DOI: 10.1186/1471-2334-12-190] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 06/20/2012] [Indexed: 01/27/2023] Open
Abstract
Background Human immuno-deficiency virus (HIV) infection and tuberculosis are common and often co-occurring conditions in sub-Saharan Africa (SSA). We investigated the effects of HIV testing and HIV status on the outcomes of tuberculosis treatment in a major diagnosis and treatment centre in Yaounde, Cameroon. Methods Participants were 1647 adults with tuberculosis registered at the Yaounde Jamot’s Hospital between January and December 2009. Multinomial logistic regression models were used to relate HIV testing and HIV status to the outcomes of tuberculosis treatment during follow-up, with adjustment for potential covariates. Results Mean age of participants was 35.5 years (standard deviation: 13.2) and 938 (57%) were men. Clinical forms of tuberculosis were: smear-positive (73.8%), smear-negative (9.4%) and extra-pulmonary (16.8%). Outcomes of tuberculosis treatment were: cure/completion (68.1%), failure (0.4%), default (20.1%), death (5.2%) and transfer (6.3%). Using cure/completion as reference, not testing for HIV was associated with adjusted odds ratio of 2.30 (95% confidence interval: 1.65-3.21), 2.26 (1.29-3.97) and 2.69 (1.62-4.46) for the risk of failure/default, death and transfer respectively. The equivalents for a positive test among those tested (1419 participants) were 1.19 (0.88-1.59), 6.35 (3.53-11.45) and 1.14 (0.69-1.86). Conclusions Non-consent for HIV testing in this setting is associated with all unfavourable outcomes of tuberculosis treatment. However been tested positive was the strongest predictor of fatal outcome. Efforts are needed both to improve acceptance of HIV testing among patients with tuberculosis and optimise the care of those tested positive.
Collapse
Affiliation(s)
- Eric Walter Pefura Yone
- Department of Internal Medicine and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon.
| | | | | |
Collapse
|
24
|
Pefura Yone EW, Evouna Mbarga A, Kuaban C. [The impact of HIV infection on childhood tuberculosis in Yaounde, Cameroon]. Rev Mal Respir 2012. [PMID: 23200581 DOI: 10.1016/j.rmr.2012.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To define the prevalence of HIV infection in childhood tuberculosis and investigate its impact on the clinical presentation, radiographic findings and outcomes among children suffering from tuberculosis in Yaounde. METHODS The medical records of 101 children aged less than 15years, hospitalized with tuberculosis in the chest clinic of the Yaounde Jamot Hospital between January 2005 and June 2010, were retrospectively reviewed. RESULTS Twenty-five (24.8%) of the 101 patients were HIV positive. The occurrence of concomitant intrathoracic and extrathoracic tuberculosis was more frequently observed in HIV infected children (P=0.021). Parenchymal pulmonary lesions were bilateral in 20 (90.9%) of the HIV infected children against 31 (56.1%) in the non-infected children (P=0.003). Cavitating lesions were present in 49.1% of the cases in HIV negative group versus 13.6% in HIV positive group (P=0.004), but sub-group analysis restricted to those with confirmed tuberculosis no longer showed a significant difference. The success rate of treatment was 78.9% among HIV negative patients and 56% among HIV positive patients (P=0.024). CONCLUSION HIV infection modifies the clinical presentation and radiographic features of tuberculosis in children. The treatment success rate is lower in HIV positive children, indicating a stricter medical supervision of these children and more targeted education of their parents.
Collapse
Affiliation(s)
- E W Pefura Yone
- Service de pneumologie, hôpital Jamot de Yaoundé, BP 4021 Yaoundé, Cameroun.
| | | | | |
Collapse
|
25
|
Pefura Yone EW, Kengne AP, Ashuntantang G, Betyoumin AF, Ngogang J. Dyslipidaemia in HIV-1-infected patients receiving protease inhibitors after initial treatment with first-line-based non-nucleoside reverse transcriptase inhibitors: a cross-sectional study. BMJ Open 2012; 2:bmjopen-2012-001317. [PMID: 22874631 PMCID: PMC3425906 DOI: 10.1136/bmjopen-2012-001317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Lipid abnormalities associated with antiretroviral therapy in people with HIV infection are more frequent with protease inhibitors (PI)-based regimens. Whether effects extend to patients receiving a PI subsequent to failure on non-nucleoside reverse-transcriptase inhibitors (NNRTI)-based regimen is still unknown. We investigated the effects of secondary treatment with a PI on the lipid profile in a group of patients with HIV infection in Cameroon. DESIGN This was a cross-sectional study. SETTING This study was carried out at the registered centre for HIV treatment of the Yaounde Jamot Hospital in Cameroon. PARTICIPANTS Participants were consecutively recruited between November 2009 and January 2010. There were 138 HIV-1 patients on initial treatment with an NNRTI regimen and 66 HIV patients on secondary treatment with a PI for at least 12 months. Lipid abnormalities were based on the National Cholesterol Education Program, Adult Treatment Panel III criteria. OUTCOME MEASURES Levels of lipid parameters among patients on PI and NNRTI. RESULTS Median (IQR) levels (mg/dl), NNRTI-treated versus PI-treated patients were 185 (149-225) and 189 (147-244) for total cholesterol, 46 (27-66) and 42 (28-82) for high-density lipoprotein (HDL)-cholesterol, 121 (90-169) and 126.9 (71-176) for low-density lipoprotein (LDL)-cholesterol, 134 (98-174) and 138 (111-167) for triglycerides, and 4.3 (2.9-6.2) and 5.1 (2.6-7.9) for total/HDL-cholesterol ratio (all p>0.32). The most frequent lipid abnormality in the two groups was high LDL-cholesterol (46.4% (NNRTI) vs 54.5% (PI)). The occurrence of lipid abnormalities was similar in the two groups (all p>0.29). CONCLUSIONS The use of PI does not appear to deteriorate the lipid profile of HIV patients above and beyond abnormalities induced by an unsuccessful initial treatment with NNRTI. Monitoring of lipid profile during HIV treatment regardless of the regimens would improve timely detection and management of abnormalities, to mitigate related risks.
Collapse
Affiliation(s)
- Eric Walter Pefura Yone
- Department of Internal Medicine and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
- Service of Pneumology, Yaounde Jamot Hospital, Yaounde, Cameroon
| | - André Pascal Kengne
- South African Medical Research Council & University of Cape Town, Cape Town, South Africa
| | - Gloria Ashuntantang
- Department of Internal Medicine and Subspecialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
- Service of Internal Medicine, Yaounde General Hospital, Yaounde, Cameroon
| | | | - Jeanne Ngogang
- Department of Biochemistry, Yaounde University Centre, Yaounde, Cameroon
- Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| |
Collapse
|