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Chizimu JY, Solo ES, Bwalya P, Kapalamula TF, Mwale KK, Squarre D, Shawa M, Lungu P, Barnes DA, Yamba K, Mufune T, Chambaro H, Kamboyi H, Munyeme M, Hang'ombe BM, Kapata N, Mukonka V, Chilengi R, Thapa J, Nakajima C, Suzuki Y. Genomic Analysis of Mycobacterium tuberculosis Strains Resistant to Second-Line Anti-Tuberculosis Drugs in Lusaka, Zambia. Antibiotics (Basel) 2023; 12:1126. [PMID: 37508222 PMCID: PMC10376136 DOI: 10.3390/antibiotics12071126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/25/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
The emergence of pre-extensively drug-resistant tuberculosis (pre-XDR-TB) is a threat to TB control programs in developing countries such as Zambia. Studies in Zambia have applied molecular techniques to understand drug-resistance-associated mutations, circulating lineages and transmission patterns of multi-drug-resistant (MDR) Mycobacterium tuberculosis. However, none has reported genotypes and mutations associated with pre-XDR TB. This study characterized 63 drug-resistant M. tuberculosis strains from the University Teaching Hospital between 2018 and 2019 using targeted gene sequencing and conveniently selected 50 strains for whole genome sequencing. Sixty strains had resistance mutations associated to MDR, one polyresistant, and two rifampicin resistant. Among MDR strains, seven percent (4/60) had mutations associated with pre-XDR-TB. While four, one and nine strains had mutations associated with ethionamide, para-amino-salicylic acid and streptomycin resistances, respectively. All 50 strains belonged to lineage 4 with the predominant sub-lineage 4.3.4.2.1 (38%). Three of four pre-XDR strains belonged to sub-lineage 4.3.4.2.1. Sub-lineage 4.3.4.2.1 strains were less clustered when compared to sub-lineages L4.9.1 and L4.3.4.1 based on single nucleotide polymorphism differences. The finding that resistances to second-line drugs have emerged among MDR-TB is a threat to TB control. Hence, the study recommends a strengthened routine drug susceptibility testing for second-line TB drugs to stop the progression of pre-XDR to XDR-TB and improve patient treatment outcomes.
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Affiliation(s)
- Joseph Yamweka Chizimu
- Division of Bioresources, Hokkaido University International Institute for Zoonosis Control, Sapporo 001-0020, Hokkaido, Japan
- Zambia National Public Health Institute, Ministry of Health, Lusaka 10101, Zambia
| | | | - Precious Bwalya
- Division of Bioresources, Hokkaido University International Institute for Zoonosis Control, Sapporo 001-0020, Hokkaido, Japan
- University Teaching Hospital, Ministry of Health, Lusaka 10101, Zambia
| | - Thoko Flav Kapalamula
- Department of Pathobiology, Faculty of Veterinary Medicine, Lilongwe University of Agriculture and Natural Resources, Lilongwe 207203, Malawi
| | | | - David Squarre
- Department of Veterinary Services, Ministry of Fisheries and Livestock, Lusaka 10101, Zambia
| | - Misheck Shawa
- Division of Bioresources, Hokkaido University International Institute for Zoonosis Control, Sapporo 001-0020, Hokkaido, Japan
| | - Patrick Lungu
- National TB Control Program, Ministry of Health, Lusaka 10101, Zambia
| | - David Atomanyi Barnes
- Division of Bioresources, Hokkaido University International Institute for Zoonosis Control, Sapporo 001-0020, Hokkaido, Japan
| | - Kaunda Yamba
- University Teaching Hospital, Ministry of Health, Lusaka 10101, Zambia
| | - Tiza Mufune
- Provincial Health Office, Central Province, Ministry of Health, Kabwe 10101, Zambia
| | - Herman Chambaro
- Department of Veterinary Services, Ministry of Fisheries and Livestock, Lusaka 10101, Zambia
| | - Harvey Kamboyi
- Division of Bioresources, Hokkaido University International Institute for Zoonosis Control, Sapporo 001-0020, Hokkaido, Japan
| | - Musso Munyeme
- Department of Disease Control, School of Veterinary Medicine, The University of Zambia, Lusaka 10101, Zambia
| | - Bernard Mudenda Hang'ombe
- Department of Para-Clinical Studies, School of Veterinary Medicine, The University of Zambia, Lusaka 10101, Zambia
| | - Nathan Kapata
- Zambia National Public Health Institute, Ministry of Health, Lusaka 10101, Zambia
| | - Victor Mukonka
- School of Public Health and Environmental Sciences, Levy Mwanawasa Medical University, Ministry of Health, Lusaka 10101, Zambia
| | - Roma Chilengi
- Zambia National Public Health Institute, Ministry of Health, Lusaka 10101, Zambia
| | - Jeewan Thapa
- Division of Bioresources, Hokkaido University International Institute for Zoonosis Control, Sapporo 001-0020, Hokkaido, Japan
| | - Chie Nakajima
- Division of Bioresources, Hokkaido University International Institute for Zoonosis Control, Sapporo 001-0020, Hokkaido, Japan
- International Collaboration Unit, Hokkaido University International Institute for Zoonosis Control, Sapporo 001-0020, Hokkaido, Japan
- Institute for Vaccine Research and Development, Hokkaido University, Sapporo 001-0020, Hokkaido, Japan
| | - Yasuhiko Suzuki
- Division of Bioresources, Hokkaido University International Institute for Zoonosis Control, Sapporo 001-0020, Hokkaido, Japan
- International Collaboration Unit, Hokkaido University International Institute for Zoonosis Control, Sapporo 001-0020, Hokkaido, Japan
- Institute for Vaccine Research and Development, Hokkaido University, Sapporo 001-0020, Hokkaido, Japan
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Demographic and Clinical Determinants of Tuberculosis and TB Recurrence: A Double-Edged Retrospective Study from Pakistan. J Trop Med 2022; 2022:4408306. [DOI: 10.1155/2022/4408306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/29/2022] Open
Abstract
Objective. TB recurrence is the second episode of TB after initial treatment bringing about an additional 7% load in TB burden intensified by 17.7% of multidrug-resistant recurrent cases. It is necessary to curb recurrence so that attempts to deal with active disease can be made more effective. This study aimed to characterize sociodemographic and clinical factors associated with recurrent TB in a high-burden setting. Methodology. A retrospective case-control study was carried out at two hospitals in Rawalpindi, Pakistan. TB patients and controls were included in the study. Sociodemographic and clinical data were collected by questionnaire from all subjects. Multivariate regression analysis was performed to determine factors associated with TB and TB recurrence respectively. Results. In our study cohort, factors significantly associated with TB were low BMI (OR: 0.961 (CI 0.954–0.968),
), female gender (OR: 2.065 (CI 1.922–2.219),
), being single/unmarried (OR: 1.214 (CI 1.109–1.328),
), middle-income status (OR: 1.935 (CI 1.616–2.323),
), smoking (OR: 1.567 (CI 1.435–1.710),
), and diabetes mellitus (OR: 1.142 (CI 1.017–1.278),
). TB recurrence constituted 11.2% of patients presenting to the hospital. Compared with the first episode of TB, cases with recurrence were more likely to be older (OR: 1.011 (CI 1.004–1.017),
), have disease awareness (OR: 1.906 (CI 1.486–2.437),
), smear positive (OR: 2.384 (CI 1.650–3.536),
), and be drug-resistant (OR: 5.615 (CI 4.265–7.386),
). Conclusion. In the present study cohort, low BMI, female gender, being single, middle-income status, being unemployed, smoking, and being diabetic came out to be the sociodemographic and clinical risk factors for TB. Further exploring the TB cases increasing age, drug resistance and smear positivity stood out to be the major sociodemographic and clinical factors of TB recurrence despite high disease awareness.
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Getnet F, Demissie M, Worku A, Gobena T, Tschopp R, Farah AM, Seyoum B. Challenges in delivery of tuberculosis Services in Ethiopian Pastoralist Settings: clues for reforming service models and organizational structures. BMC Health Serv Res 2021; 21:627. [PMID: 34193133 PMCID: PMC8246683 DOI: 10.1186/s12913-021-06662-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background The End-TB strategy aims to see a world free of tuberculosis (TB) by the coming decade through detecting and treating all cases irrespective of socioeconomic inequalities. However, case detections and treatment outcomes have not been as they should be in Somali pastoral settings of Ethiopia. Hence, this study aimed to explore the challenges that hinder the delivery and utilization of TB services in pastoral areas. Methods A qualitative study was conducted between December 2017 and October 2018 among pastoralist patients with delay of ≥2 months in seeking healthcare, healthcare providers and programme managers. Data were collected from different sources using 41 in-depth interviews, observations of facilities and a review meeting of providers from 50 health facilities. The data were transcribed, coded and analyzed to identify pre-defined and emerging sub-themes. ATLAS.ti version 7.0 was used for coding data, categorizing codes, and visualizing networks. Results Poor knowledge of TB and its services, limited accessibility (unreachability, unavailability and unacceptability), pastoralism, and initial healthcare-seeking at informal drug vendors that provide improper medications were the key barriers hindering the uptake of TB medical services. Inadequate infrastructure, shortage of trained and enthused providers, interruptions of drugs and laboratory supplies, scarce equipment, programme management gaps, lack of tailored approach, low private engagement, and cross-border movement were the major challenges affecting the provision of TB services for pastoral communities. The root factors were limited potential healthcare coverage, lack of zonal and district TB units, mobility and drought, strategy and funding gaps, and poor development infrastructure. Conclusion In pastoral settings of Ethiopia, the major challenges of TB services are limited access, illicit medication practices, inadequate resources, structural deficits, and lack of tailored approaches. Hence, for the pastoral TB control to be successful, mobile screening and treatment modalities and engaging rural drug vendors will be instrumental in enhancing case findings and treatment compliance; whereas, service expansion and management decentralization will be essential to create responsive structures for overcoming challenges. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06662-3.
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Affiliation(s)
- Fentabil Getnet
- School of Public Health, Jigjiga University, Jigjiga, Ethiopia. .,School of Public Health, Haramaya University, Dire Dawa, Ethiopia.
| | - Meaza Demissie
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.,School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tesfaye Gobena
- School of Public Health, Haramaya University, Dire Dawa, Ethiopia
| | - Rea Tschopp
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Berhanu Seyoum
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Wang XX, Chen JY, Jiang H, Zhu AN, Long Q, Ji JS. Utilization and expenses of outpatient services among tuberculosis patients in three Chinese counties: an observational comparison study. Infect Dis Poverty 2019; 8:79. [PMID: 31581953 PMCID: PMC6777024 DOI: 10.1186/s40249-019-0590-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 08/22/2019] [Indexed: 11/19/2022] Open
Abstract
Background The China-Gates TB project Phase II implemented case-based payment reform in three Chinese counties in 2014, designed specifically for patients diagnosed with Tuberculosis (TB). This study aimed to examine the changes in utilization and expenses of outpatient services before and after the reform implementation, among TB patients in the three counties in China. Methods We collected quantitative data using surveys in 2013 (baseline year) and 2015 (final year). We used outpatient hospital records to measure service utilization and medical expenses of TB patients. We conducted qualitative interviews with local health authorities, officers of health insurance agencies, and hospital managers (n = 18). We utilized three focus group discussions with hospital staff and TB doctors and nurses. The χ2 tests and Mann-Whitney U tests were used to analyse quantitative data, and the thematic analysis using a framework approach was applied to analyse qualitative data. Results Dantu and Yangzhong counties enacted TB-specific case-based payment method in 2014. Jurong County maintained global budget payment but raised the reimbursement rate for TB care. Compared to the baseline, the percentage of TB patients in Dantu and Yangzhong with eight or above outpatient visits increased from 7.5 to 55.1% and from 22.1 to 53.1% in the final survey, respectively. Jurong experienced the opposite trend, decreasing from 63.0 to 9.8%. In the final survey, the total outpatient expenses per patient during a full treatment course in Dantu (RMB 2939.7) and Yangzhong (RMB 2520.6) were significantly higher than those in the baseline (RMB 690.4 and RMB 1001.5, respectively), while the total outpatient expenses in Jurong decreased significantly (RMB 1976.0 in the baseline and RMB 660.8 in the final survey). Health insurance agencies in Dantu and Yangzhong did not approve the original design with outpatient and inpatient expenses packaged together, revealed by qualitative interviews. Furthermore, staff at designated hospitals misunderstood that health insurance agencies would only reimburse actual expenses. Many TB doctors complained about their reduced salary, which might be due to decreased hospital revenue generated from TB care after the payment method reform. Conclusions The intended effect on cost containment of case-based payment was not evident in Dantu and Yangzhong. In Jurong, where the global budget payment system maintained with the reimbursement rate enhanced, we found an effect on cost containment, but the quality of TB care might be compromised. The TB-specific case-based payment method could be redesigned to combine payment on outpatient and inpatient expenses and to set an appropriate payment standard for TB care during a full treatment course. Local health insurance agencies have to provide explicit explanations on the payment method. TB care providers should be provided with proper incentives. Monitoring and evluaiton on the quality of TB care should be undertaken at regular intervals. Electronic supplementary material The online version of this article (10.1186/s40249-019-0590-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xuan-Xuan Wang
- School of Health Policy and Management, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166, Jiangsu Province, China
| | - Jia-Ying Chen
- Center for Health Policy Studies, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166, Jiangsu Province, China. .,Creative Health Policy Research Group, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166, Jiangsu Province, China.
| | - Hui Jiang
- Zhenjiang Center for Disease Control and Prevention, No. 9 Huangshan South Road, Zhenjiang, 212004, Jiangsu Province, China
| | - An-Na Zhu
- Environmental Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu Province, China
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu Province, China
| | - John S Ji
- Environmental Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu Province, China.,Nicholas School of the Environment, Duke University, Durham, NC, 27708, USA
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Management of hospitalized drug sensitive pulmonary tuberculosis patients during the Hajj mass gathering: A cross sectional study. Travel Med Infect Dis 2019; 32:101451. [PMID: 31310852 PMCID: PMC7110692 DOI: 10.1016/j.tmaid.2019.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/12/2019] [Accepted: 07/10/2019] [Indexed: 11/29/2022]
Abstract
Background To document the management of drug-sensitive TB patients during the Hajj and assess compliance with the Saudi TB management guidelines. Method The study was conducted in hospitals in Makkah during the 2016 and 2017 Hajj seasons. Structured questionnaire was used to collect data on relevant indices on TB management and a scoring system was developed to assess compliance with guidelines. Results Data was collected from 31 TB cases, 65.4% (17/26) were Saudi residents. Sputum culture was the only diagnostic test applied in 67.7% (21/31) of patients. Most (96.8%, 30/31) confirmed TB cases were isolated, but only 12.9% (4/28) were tested for HIV and merely 37% (10/27) received the recommended four 1st-line anti-TB drugs. Guideline compliance scores were highest for infection prevention and control and surveillance (9.6/10) and identifying TB suspects (7.2/10). The least scores were obtained for treating TB (5.0/10) and diagnosing TB (3.0/10). Conclusions Healthcare providers training and supervision are paramount to improve their knowledge and skill and ensure their compliance with existing TB management guidelines. However, there may be a need for the introduction of an international policy/guideline for TB control and management during mass gatherings such as the Hajj to guide providers’ choices and facilitate monitoring.
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Alotaibi B, Yassin Y, Mushi A, Maashi F, Thomas A, Mohamed G, Hassan A, Yezli S. Tuberculosis knowledge, attitude and practice among healthcare workers during the 2016 Hajj. PLoS One 2019; 14:e0210913. [PMID: 30682065 PMCID: PMC6347151 DOI: 10.1371/journal.pone.0210913] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/03/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Given the inherent characteristics of the Hajj pilgrimage, the event is a risk for tuberculosis (TB) infection. Early diagnosis and appropriate management of TB cases by knowledgeable and skilled healthcare workers (HCWs) are key in improving patients' outcome and preventing transmission during the Hajj mass gathering and globally. METHOD We conducted a cross-sectional study to assess knowledge, attitude and practice (KAP) of HCWs deployed during the 2016 Hajj regarding TB and its management using an anonymous self-administered questionnaire. RESULTS Data was collected from 540 HCWs from 13 hospitals. HCWs originated from 17 countries and included physicians, nurses and other non-administrative HCWs. Nearly half of HCWs declared having experience dealing with TB patients. In general, HCWs had average knowledge (mean knowledge score of 52%), above average attitude (mean attitude score of 73%) and good practice (mean practice score of 85%) regarding TB, based on our scoring system and cut-off points. Knowledge gaps were identified in relation to the definition of MDR-/XDR-TB and LTBI, smear microscopy results, length of standard TB treatment for drug-sensitive TB, 2nd line anti-TB drugs, BCG vaccination, and appropriate PPE to be used with active PTB patients. Poor attitudes were found in relation to willingness to work in TB clinic/ward and to the management and treatment of TB patients. Poor practices were reported for commencing anti-TB treatment on suspected TB cases before laboratory confirmation and not increasing natural ventilation in TB patients' rooms. Age, gender, nationality, occupation, length of work experience and experience dealing with TB patients were associated with knowledge scores. Age and occupation were associated with attitude scores while length of work experience and occupation were associated with practice scores. There was a weak but statistically significant positive correlation between score for knowledge and attitude (rs = 0.11, p = 0.009) and attitude and practice (rs = 0.13, p = 0.002). CONCLUSIONS While the results of the study are encouraging, important knowledge gaps and some poor attitudes and practices regarding TB were identified among HCWs during Hajj. This calls for multifaceted interventions to improve HCWs KAP regarding TB including tailored, periodic TB education and training aimed at boosting knowledge and improving behaviour.
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Affiliation(s)
- Badriah Alotaibi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Yara Yassin
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdulaziz Mushi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Fuad Maashi
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
| | - Abin Thomas
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Gamal Mohamed
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Amir Hassan
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Saber Yezli
- The Global Centre for Mass Gatherings Medicine, Ministry of Health, Riyadh, Saudi Arabia
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van de Water BJ, Silva SG, Prvu Bettger J, Humphreys J, Cunningham CK, Farley JE. Provision of guideline-based care for drug-resistant tuberculosis in South Africa: Level of concordance between prescribing practices and guidelines. PLoS One 2018; 13:e0203749. [PMID: 30395565 PMCID: PMC6218024 DOI: 10.1371/journal.pone.0203749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/27/2018] [Indexed: 11/19/2022] Open
Abstract
TITLE Provision of guideline-based care for drug-resistant tuberculosis in South Africa: Level of concordance between prescribing practices and guidelines. OBJECTIVE We examined the influence of individual and site characteristics on the concordance between prescribed treatment regimens and recommended standardized regimen according to national guidelines for patients with drug-resistant tuberculosis (DR-TB) in South Africa. METHODS Participants were 337 youth and adults treated for DR-TB between November 2014 and August 2016 at ten DR-TB treatment sites in Eastern Cape and KwaZulu Natal provinces, South Africa. Logistic regression was used to determine individual and system characteristics related to concordance at treatment initiation between the prescribed treatment regimens in terms of medication composition, dosage, and frequency and guideline-based standardized regimen that included four oral and one injectable medications. RESULTS The sample was 19% (n = 64) youth (15-24 years), 53% (n = 179) male, 73% (n = 243) HIV coinfected, and 51% (n = 169) with prior history of TB treatment. Guideline medications were correctly prescribed for 88% (n = 295) of patients, but only 33% (n = 103) received the correct medications and doses. Complete guideline adherence to medications, doses, and frequency was achieved for 30% (n = 95) of patients. Younger age, HIV coinfection, and rural treatment setting were associated with the prescription of correct medications. CONCLUSION Most individuals are prescribed the correct DR-TB medications, yet few individuals receive correct medications, dosages, and frequencies. Further study is needed to examine the root causes for treatment guideline deviations and opportunities for improvement.
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Affiliation(s)
- Brittney J. van de Water
- Duke University School of Nursing, Duke University, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Susan G. Silva
- Duke University School of Nursing, Duke University, Durham, NC, United States of America
| | - Janet Prvu Bettger
- Duke University School of Nursing, Duke University, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Janice Humphreys
- Duke University School of Nursing, Duke University, Durham, NC, United States of America
| | - Coleen K. Cunningham
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States of America
| | - Jason E. Farley
- Department of Community Public Health, Johns Hopkins University School of Nursing, Baltimore, MD, United States of America
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Gamngoen R, Putim C, Salee P, Phunpae P, Butr-Indr B. A comparison of Rv0559c and Rv0560c expression in drug-resistant Mycobacterium tuberculosis in response to first-line antituberculosis drugs. Tuberculosis (Edinb) 2017. [PMID: 29523329 DOI: 10.1016/j.tube.2017.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Drug resistance to Mycobacterium tuberculosis is a major health problem worldwide. Mycobacterium tuberculosis can progress to be mono-drug resistant or multi-drug resistant by improper treatment. The chemical stress of M. tuberculosis was performed in this study. Rv0559c is an unknown secreted protein. Rv0560c is a putative benzoquinone methyltransferase of M. tuberculosis cell. Rv0559c gene is located downstream of Rv0560c gene. Both genes respond to salicylate stress. Drug susceptible, isoniazid resistant, rifampicin resistant and multi-drug resistant phenotypes of M. tuberculosis clinical isolates were used to determine the expression of Rv0559c and Rv0560c by qRT-PCR. In all of mycobacteria strains there was up-regulation in both genes when stressed with isoniazid. This study determined the expression of both genes, which may play important roles in the drug resistance mechanism of mycobacteria.
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Affiliation(s)
- Ratikorn Gamngoen
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chanyanuch Putim
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Parichat Salee
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Ponrut Phunpae
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Bordin Butr-Indr
- Division of Clinical Microbiology, Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Hoffman SJ, Guindon GE, Lavis JN, Randhawa H, Becerra-Posada F, Dejman M, Falahat K, Malek-Afzali H, Ramachandran P, Shi G, Yesudian CAK. Surveying the Knowledge and Practices of Health Professionals in China, India, Iran, and Mexico on Treating Tuberculosis. Am J Trop Med Hyg 2016; 94:959-970. [PMID: 26903613 PMCID: PMC4856627 DOI: 10.4269/ajtmh.15-0538] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 01/04/2016] [Indexed: 01/05/2023] Open
Abstract
Research evidence continues to reveal findings important for health professionals' clinical practices, yet it is not consistently disseminated to those who can use it. The resulting deficits in knowledge and service provision may be especially pronounced in low- and middle-income countries that have greater resource constraints. Tuberculosis treatment is an important area for assessing professionals' knowledge and practices because of the effectiveness of existing treatments and recognized gaps in professionals' knowledge about treatment. This study surveyed 384 health professionals in China, India, Iran, and Mexico on their knowledge and practices related to tuberculosis treatment. Few respondents correctly answered all five knowledge questions (12%) or self-reported performing all five recommended clinical practices "often or very often" (3%). Factors associated with higher knowledge scores included clinical specialization and working with researchers. Factors associated with better practices included training in the care of tuberculosis patients, being based in a hospital, trusting systematic reviews of randomized controlled double-blind trials, and reading summaries of articles, reports, and reviews. This study highlights several strategies that may prove effective in improving health professionals' knowledge and practices related to tuberculosis treatment. Facilitating interactions with researchers and training in acquiring systematic reviews may be especially helpful.
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Affiliation(s)
- Steven J. Hoffman
- Global Strategy Lab, Faculty of Law, University of Ottawa, Ottawa, Ontario, Canada; Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada; Pan American Health Organization, Washington, DC; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Valmar International, Mumbai, India; Department of Policy Research, Chinese Peasants' and Workers' Democratic Party, Beijing, China; Health Systems Consultant and Trainer, Mumbai, India
| | | | | | | | | | | | | | | | - Parasurama Ramachandran
- Global Strategy Lab, Faculty of Law, University of Ottawa, Ottawa, Ontario, Canada; Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada; Pan American Health Organization, Washington, DC; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Valmar International, Mumbai, India; Department of Policy Research, Chinese Peasants' and Workers' Democratic Party, Beijing, China; Health Systems Consultant and Trainer, Mumbai, India
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Zhang Q, Wan B, Zhou A, Ni J, Xu Z, Li S, Tao J, Yao Y. Whole genome analysis of an MDR Beijing/W strain of Mycobacterium tuberculosis with large genomic deletions associated with resistance to isoniazid. Gene 2016; 582:128-36. [DOI: 10.1016/j.gene.2016.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/30/2016] [Accepted: 02/02/2016] [Indexed: 11/16/2022]
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Huang F, Zhang H, Lv Q, Sato KD, Qu Y, Huan S, Cheng J, Zhao F, Wang L. Use of anti-tuberculosis drugs among newly diagnosed pulmonary tuberculosis inpatients in China: a retrospective study. Infect Dis Poverty 2016; 5:2. [PMID: 26792535 PMCID: PMC4720996 DOI: 10.1186/s40249-016-0098-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 01/04/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND China's national tuberculosis control program (NTP) provides free, first-line anti-tuberculosis (TB) drugs to pulmonary TB patients. This treatment regimen follows the World Health Organization's (WHO) guideline. The objective of this paper is to evaluate the current status of anti-TB drug use for newly diagnosed pulmonary TB inpatients treated in prefecture- and county-level designated hospitals. METHODS Three prefecture-level hospitals and nine county-level hospitals were selected for the study. All newly diagnosed pulmonary TB inpatient medical records from 2012 were reviewed and doubly examined by two national senior physicians. The rational use of anti-TB drugs was evaluated based on criteria in line with WHO's guideline. RESULTS Of the 2,060 total treatment regimens for TB, 53.1 % were found to be rational (1093/2060). The percentages in prefecture-level and county-level hospitals were 50.3 % (761/1513) and 60.7 % (332/547), respectively. The difference between the two levels of hospitals was statistically significant (Chi-square value = 17.44, P < 0.01). The percentages of rational treatment regimens for first-time hospitalizations and for two or more hospitalizations were 59.5 % (983/1653) and 27.0 % (110/407), respectively, with a statistically significant difference (Chi-square value = 138.00, P < 0.01). The overall use of second-line drugs (SLD) was 54.9 % (1131/2060). The percentages for prefecture-level and county-level hospitals were 50.6 % (766/1513) and 66.7 % (365/547), respectively. A statistically significant difference was found (Chi-square value = 42.06, P < 0.01). The use of SLD for inpatients hospitalized once and inpatients hospitalized twice or more was 58.4 % (966/1653) and 40.5 % (165/407), respectively, with a statistically significant difference (Chi-square value = 42.26, P < 0.01). CONCLUSIONS Half of inpatients might be treated with irrational regimens, and the use of SLD was more appropriately dispensed in city-level hospitals than in county-level hospitals. Trainings and guidelines for health personnel, supervision led by health authorities and increased investment to designated hospitals may help to improve the rational use of anti-TB drugs.
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Affiliation(s)
- Fei Huang
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Hui Zhang
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Qing Lv
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | | | - Yan Qu
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Shitong Huan
- Bill & Melinda Gates Foundation, Beijing office, Beijing, China.
| | - Jun Cheng
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Fei Zhao
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
| | - Lixia Wang
- National Center for TB control and prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China.
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Diagnosis and Treatment of Childhood Pulmonary Tuberculosis: A Cross-Sectional Study of Practices among Paediatricians in Private Sector, Mumbai. Interdiscip Perspect Infect Dis 2015; 2015:960131. [PMID: 26379705 PMCID: PMC4563113 DOI: 10.1155/2015/960131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/04/2015] [Indexed: 11/18/2022] Open
Abstract
Majority of children with tuberculosis are treated in private sector in India with no available data on management practices. The study assessed diagnostic and treatment practices related to childhood pulmonary tuberculosis among paediatricians in Mumbai's private sector in comparison with International Standards for Tuberculosis Care (ISTC) 2009. In this cross-sectional study, 64 paediatricians from private sector filled self-administered questionnaires. Cough was reported as a symptom of childhood TB by 77.8% of respondents. 38.1% request sputum smear or culture for diagnosis and fewer (32.8%) use it for patients positive on chest radiographs and 32.8% induce sputum for those unable to produce it. Sputum negative TB suspect is always tested with X-ray or tuberculin skin test. 61.4% prescribe regimen as recommended in ISTC and all monitor progress to treatment clinically. Drug-resistance at beginning of treatment is suspected for child in contact with a drug-resistant patient (67.7%) and with prior history of antitubercular treatment (12.9%). About half of them (48%) request drug-resistance test for rifampicin in case of nonresponse after two to three months of therapy and regimen prescribed by 41.7% for multidrug-resistant TB was as per ISTC. The study highlights inappropriate diagnostic and treatment practices for managing childhood pulmonary TB among paediatricians in private sector.
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Migliori GB, Lienhardt C, Weyer K, van der Werf MJ, Blasi F, Raviglione MC. Ensuring rational introduction and responsible use of new TB tools: outcome of an ERS multisector consultation. Eur Respir J 2015; 44:1412-7. [PMID: 25435528 DOI: 10.1183/09031936.00132114] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Giovanni Battista Migliori
- WHO Collaborating Centre for TB and lung diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy
| | | | - Karin Weyer
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | - Francesco Blasi
- Dept of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Cà Granda, Milan, Italy
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Updating the International Standards for Tuberculosis Care. Entering the era of molecular diagnostics. Ann Am Thorac Soc 2014; 11:277-85. [PMID: 24673691 DOI: 10.1513/annalsats.201401-004ar] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The International Standards for Tuberculosis Care, first published in 2006 (Lancet Infect Dis 2006;6:710-725.) with a second edition in 2009 ( www.currytbcenter.ucsf.edu/international/istc_report ), was produced by an international coalition of organizations funded by the United States Agency for International Development. Development of the document was led jointly by the World Health Organization and the American Thoracic Society, with the aim of promoting engagement of all care providers, especially those in the private sector in low- and middle-income countries, in delivering high-quality services for tuberculosis. In keeping with World Health Organization recommendations regarding rapid molecular testing, as well as other pertinent new recommendations, the third edition of the Standards has been developed. After decades of dormancy, the technology available for tuberculosis care and control is now rapidly evolving. In particular, rapid molecular testing, using devices with excellent performance characteristics for detecting Mycobacterium tuberculosis and rifampin resistance, and that are practical and affordable for use in decentralized facilities in low-resource settings, is being widely deployed globally. Used appropriately, both within tuberculosis control programs and in private laboratories, these devices have the potential to revolutionize tuberculosis care and control, providing a confirmed diagnosis and a determination of rifampin resistance within a few hours, enabling appropriate treatment to be initiated promptly. Major changes have been made in the standards for diagnosis. Additional important changes include: emphasis on the recognition of groups at increased risk of tuberculosis; updating the standard on antiretroviral treatment in persons with tuberculosis and human immunodeficiency virus infection; and revising the standard on treating multiple drug-resistant tuberculosis.
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Wang SI, Shen GH, Shi HC, Chiou SJ. Prescription patterns for tuberculosis treatment and adherence to treatment guidelines: a population-based study in Taiwan. Pharmacoepidemiol Drug Saf 2014; 23:1273-80. [PMID: 24962738 DOI: 10.1002/pds.3665] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 05/12/2014] [Accepted: 05/28/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE Tuberculosis is a health threat in Taiwan. Previous research is mainly focused on patients' compliance, and research on medicines prescribed by physicians is limited. This study endeavors to present the prescription patterns of Tuberculosis treatment and its adherence to the guidelines. METHODS Newly diagnosed Tuberculosis patients in 2008 were selected from the National Health Insurance claims database. We divided prescriptions into standard prescriptions, non-standard prescriptions, and second-line medicines on the basis of the fourth edition of Taiwan's guidelines for the diagnosis and treatment of Tuberculosis. We first described the distribution of these prescriptions of TB regimen in the first 2 months among the new patients. Furthermore, a graphical presentation was used to visualize physician's complex prescription behavior. RESULTS In total, 11,164 patients were included in this analysis; 28,291 prescriptions were prescribed during the first 2 months after diagnosis. Among these prescriptions, 53.34% were standard prescriptions, 45.81% were non-standard prescriptions, and 0.84% were second-line medicines. Prescribing medicines for 28 days at the first visit was the most common scenario. Approximately 35 patterns can be derived from the prescriptions in Taiwan. CONCLUSIONS The prescriptions suggested in the guideline are considered to have better therapeutic effects. However, this study revealed that approximately 55% prescriptions adhered to the regimen recommended by the guidelines. The Pharmacoepidemiology and Drug Safety results of this study can help to explore possible reasons to the poor control of the disease.
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Affiliation(s)
- Shiow-Ing Wang
- National Health Research Institutes, National Environmental Health Research Center, Miaoli County, Taiwan
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Evaluation of adherence to national treatment guidelines among tuberculosis patients in three provinces of South Africa. S Afr Med J 2014; 104:362-8. [PMID: 25212205 DOI: 10.7196/samj.7655] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 11/06/2013] [Indexed: 11/08/2022] Open
Abstract
SETTING Standardised tuberculosis (TB) treatment through directly observed therapy (DOT) is available in South Africa, but the level of adherence to standardised TB treatment and its impact on treatment outcomes is unknown. OBJECTIVES To describe adherence to standardised TB treatment and provision of DOT, and analyse its impact on treatment outcome. METHODS We utilised data collected for an evaluation of the South African national TB surveillance system. A treatment regimen was considered appropriate if based on national treatment guidelines. Multivariate log-binomial regression was used to evaluate the association between treatment regimens, including DOT provision, and treatment outcome. RESULTS Of 1 339 TB cases in the parent evaluation, 598 (44.7%) were excluded from analysis owing to missing outcome or treatment information. The majority (697, 94.1%) of the remaining 741 patients received an appropriate TB regimen. Almost all patients (717, 96.8%) received DOT, 443 (59.8%) throughout the treatment course and 274 (37.0%) during the intensive (256, 34.6%) or continuation (18, 2.4%) phase. Independent predictors of poor outcome were partial DOT (adjusted risk ratio (aRR) 3.1, 95% confidence interval (CI) 2.2 - 4.3) and previous treatment default (aRR 2.3, 95% CI 1.1 - 4.8). CONCLUSION Patients who received incomplete DOT or had a history of defaulting from TB treatment had an increased risk of poor outcomes.
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Bose A, Kalita S, Rose W, Tharyan P. Intermittent versus daily therapy for treating tuberculosis in children. Cochrane Database Syst Rev 2014; 2014:CD007953. [PMID: 24470141 PMCID: PMC6532685 DOI: 10.1002/14651858.cd007953.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Childhood tuberculosis (TB) is a neglected global public health problem. Short treatment courses with rifampicin-containing anti-TB drugs given daily for six-months cure over 90% of infected children, but poor adherence reduces treatment success. Intermittent, short-course anti-TB regimens, given two or three times a week under direct observation, are associated with higher adherence in observational studies; but how they compare with daily treatment in relation to cure is unclear. Current international and national recommendations differ on use of intermittent regimens to treat TB in children. OBJECTIVES To compare the efficacy and safety of intermittent, short-course anti-TB regimens (twice- or thrice-weekly) with daily short-course anti-TB regimens in treating childhood TB. SEARCH METHODS We searched the Cochrane Infectious Disease Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS, clinical trials registries, regional databases, conference proceedings, and references without language restrictions up to 30 May 2013; and contacted experts for relevant published, unpublished, and on-going trials. SELECTION CRITERIA Randomized controlled trials (RCTs) and quasi-RCTs of children aged 15 years or younger, diagnosed with TB (according to the World Health Organization diagnostic categories 1, 2, or 3), who were treated with intermittent twice-weekly or thrice-weekly, short-course anti-TB regimens compared to daily short-course anti-TB treatment regimens. All regimens had to contain rifampicin for at least the first two months. DATA COLLECTION AND ANALYSIS The review authors independently screened and selected trials, assessed risk of bias, and extracted data. We sought clarifications from trial authors. We pooled relative risks with their 95% confidence intervals and used a random-effects model where there was significant heterogeneity. We assessed overall evidence-quality using the GRADE approach. MAIN RESULTS We included four trials published between 1996 to 2000 that randomized 563 children (465 evaluable) aged five months to 15 years to intermittent twice-weekly versus daily anti-TB treatment. Two trials were from India, one from South Africa, and one from Turkey. All trials used rifampicin and isoniazid, three trials used pyrazinamide, and one trial used streptomycin. The drug combination, and the duration of intermittent and daily treatments differed between trials, and no trials used drug combinations and schedules currently recommended for childhood TB. No trial reported if any child was HIV-positive.In comparisons of twice-weekly versus daily anti-TB treatment regimens, the trials did not detect differences in the number of patients cured, but trials were small, and the comparator regimens were not standard (four trials, 465 children; very low quality evidence). Trials were underpowered to provide estimates for death (two trials, 213 participants, very low quality evidence), relapse (one trial, 214 participants,very low quality evidence), and treatment limiting adverse events (four trials, 441 participants, very low quality evidence)Reported adherence to treatment was similar (87% versus 84%; four trials, 458 children, very low quality evidence)We did not find trials comparing the commonly used thrice-weekly anti-TB short-course regimen with the daily treatment regimen. AUTHORS' CONCLUSIONS Trials conducted to date are insufficient to support or refute the use of intermittent twice- or thrice-weekly, short-course treatment regimens over daily short-course treatment in children with TB. Further randomized trials conducted in high TB-transmission settings will help inform policy and practice.
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Affiliation(s)
- Anuradha Bose
- Christian Medical CollegeDepartment of Community HealthVelloreIndia632002
| | - Soumik Kalita
- GlaxoSmithKline Consumer HealthcareFamily NutritionPlot 67, Sector 32GurgaonHaryanaIndia122001
| | - Winsley Rose
- Christian Medical CollegeDepartment of Child HealthVelloreIndia632004
| | - Prathap Tharyan
- Christian Medical CollegeSouth Asian Cochrane Network & Centre, Prof. BV Moses & ICMR Advanced Centre for Research & Training in Evidence Informed Health CareCarman Block II FloorCMC Campus, BagayamVelloreTamil NaduIndia632002
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Direct observation therapy with appropriate treatment regimens was associated with a decline in second-line drug-resistant tuberculosis in Taiwan. Eur J Clin Microbiol Infect Dis 2013; 33:941-8. [DOI: 10.1007/s10096-013-2030-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
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Do we need a new Fleming époque: The nightmare of drug-resistant tuberculosis. Int J Mycobacteriol 2013; 2:123-5. [DOI: 10.1016/j.ijmyco.2013.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 07/01/2013] [Indexed: 11/16/2022] Open
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van der Werf MJ, Langendam MW, Huitric E, Manissero D. Knowledge of tuberculosis-treatment prescription of health workers: a systematic review. Eur Respir J 2011; 39:1248-55. [PMID: 22183482 PMCID: PMC3342767 DOI: 10.1183/09031936.00125611] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Treating tuberculosis (TB) patients with inappropriate treatment regimens can lead to treatment failure and, thus, patients who have not been cured and/or to the development of (multi)-drug resistance. A systematic review was performed to assess the knowledge of appropriate TB drug regimens among all categories of healthcare workers (HCWs). In January 2011, MEDLINE, EMBASE and other databases were searched for relevant articles. Observational studies published as of the year 2000 that assessed HCW knowledge of TB treatment were selected. A treatment regimen, drug dosage or treatment duration was considered inappropriate if it was not recommended by national guidelines or by the World Health Organization (WHO). Of 1,896 studies, 31 were included from 14 different countries. No study was performed in Europe. In all studies, HCWs with inappropriate knowledge of treatment regimens (8–100%) or treatment duration (5–99%) were observed. The few studies providing detailed data showed that HCWs mainly reported giving treatment regimens with too many drugs and for too long. Knowledge of appropriate doses was also insufficient in most studies. The available studies show that there is a lack of knowledge of national or international TB treatment guidelines and recommendations. Generalisation of the findings to other settings and countries should be done with caution.
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