Knowledge of tuberculosis-treatment prescription of health workers: a systematic review

Near-infrared molecular sensor for visualizing and tracking ONOO- during the process of anti-tuberculosis drug-induced liver damage

Isoniazid (INH) and pyrazinamide (PZA) are both the first-line anti-tuberculosis drugs in clinical treatment. It is notable that there are serious side effects of the drugs along with upregulation of reactive nitrogen species, mainly including peripheral neuritis, gastrointestinal reactions, and acute drug-induced liver injury (DILI). Among them, DILI is the most common clinical symptom as well as the basic reason of treatment interruption, protocol change, and drug resistance. As vital reactive nitrogen species (RNS), peroxynitrite (ONOO-) has been demonstrated as a biomarker for evaluation and pre-diagnosis of drug-induced liver injury (DILI). In this work, we developed a red-emitting D-π-A type fluorescence probe DIC-NP which was based on 4'-hydroxy-4-biphenylcarbonitrile modified with dicyanoisophorone as a fluorescent reporter and diphenyl phosphinic chloride group as the reaction site for highly selective and sensitive sensing ONOO-. Probe DIC-NP displayed a low detection limit (14.9 nM) and 60-fold fluorescent enhancement at 669 nm in the sensing of ONOO-. Probe DIC-NP was successfully applied to monitor exogenous and endogenous ONOO- in living HeLa cells and zebrafish. Furthermore, we verified the toxicity of isoniazid (INH) and pyrazinamide (PZA) by taking the oxidative stress induced by APAP as a reference, and successfully imaged anti-tuberculosis drug-induced endogenous ONOO- in HepG2 cells. More importantly, we developed a series of mice models of liver injury and investigated the hepatotoxicity caused by the treatment of anti-tuberculosis drugs. At the same time, H&E of mice organs (heart, liver, spleen, lung, kidney) further confirmed the competence of probe DIC-NP for estimating the degree of drug-induced liver injury, which laid a solid foundation for medical research.

Cross-sectional community-based assessment of knowledge, attitude and practices on tuberculosis in Osun State, South-west, Nigeria

Tuberculosis (TB) has continued to be a global public health issue, especially in developing countries, where Nigeria accounts for 4% of the global TB burden. However, to achieve the Sustainable Development Goals targets for 2030, there is a need for adequate and robust awareness campaigns to ensure that individuals in the communities are aware of the total TB program package. This study assessed the knowledge, attitudes and practices (KAP) towards TB of the residents of two communities affected by the TB scourge in Osun State, Nigeria. An interviewer-administered, semi-structured questionnaire adapted from the WHO-KAP study guide was employed, and the data generated were analysed using the SPSS statistical package. A total of 280 respondents participated in the study comprising 162 (57.9%) males and 118 (42.1%) females, a large percentage of the respondents (273/97.5%) know about TB and know that anybody can be infected (63.6%). However, in this study, we obtained the following KAP scores: overall good knowledge of TB: 60% (Iwo- 54.7% and Ikire-65.2%), overall good attitude towards TB: 50% (Iwo- 53.3% and Ikire- 46.7%) and overall good TB preventive practices 65.2% (Iwo- 66.6% and Ikire- 63.8%). Ikire respondents were significantly more knowledgeable than Iwo respondents (p = .002), while Iwo respondents had better TB attitudes than Ikire respondents (p = .03). Predictors of good KAP scores were accommodation type, education, age and main source of income of respondents. This study assessed the level of community TB-KAP and reinforced the need for a more robust awareness campaign for better TB health service utilisation.

Effect of mobile-phone messaging on patient and health-worker knowledge and adherence to the isoniazid preventive therapy guideline in HIV clinics in Southeast, Nigeria

BACKGROUND

HIV-infected persons are at increased risk of developing tuberculosis and Isoniazid preventive therapy has been shown to reduce the occurrence of tuberculosis among this group of persons. M-health technology has been reported to increase both knowledge and implementation of various health services including Isoniazid preventive therapy implementation. This study aimed to determine the effect of m-health on health worker knowledge and adherence to isoniazid preventive therapy (IPT) guidelines and on patient knowledge and adherence to isoniazid treatment.

METHODS

This was a quasi-experimental study that was carried out in six health facilities in Ebonyi State, southeast Nigeria. Three health facilities were assigned to each arm (intervention and control arms) and all eligible health workers (total population of 45 and 41 in intervention and control arms respectively) were recruited. Data were also collected from 200 patients (100 per arm). The intervention consisted of mobile phone messages and reminders for health workers on the IPT guideline. Chi-square test was carried out at p < 0.05 and 95% confidence interval.

RESULTS

At baseline, 54.5% and 63.4% of health workers in intervention and control arms respectively had good knowledge which improved significantly to 90.2% in the intervention arm after the intervention (χ² = 14.22, p < 0.0001). At baseline, 61.4% and 90.2% of health workers had good adherence to the guideline in intervention and control arms respectively which also improved in the intervention arm by 28.8% after intervention although not significant(χ² = 0.37, p = 0.54). More than 50% of the patients in both study arms had poor knowledge, with the intervention arm having a significantly higher proportion of respondents (68.0%) with poor knowledge at baseline (χ² = 4.71, p = 0.03). The proportion of patients with good knowledge however increased significantly (88.8%) in the intervention arm after intervention (χ² = 25.65, p < 0.001). Patients had good adherence to IPT in intervention and control arms before (100% and 84.2% respectively) and after (96.6% and 100% respectively) the study. There was no significant difference in adherence among patients in both arms.

CONCLUSIONS

Health worker knowledge and practice of guidelines as well as patient knowledge improved in the intervention arm in this study. These findings suggest the consideration for the inclusion of mobile phone reminders in the guideline for tuberculosis prevention among HIV patients.

Patient- and provider-related factors in the success of multidrug-resistant tuberculosis treatment in Colombia

Objective

To identify patient- and provider-related factors associated with the success of multidrug-resistant tuberculosis (MDR-TB) treatment in the six municipalities of Colombia with the highest number of MDR-TB cases.

Methods

Bivariate and multivariate logistic regressions were used to analyze the association between treatment success (cure or treatment completion) and characteristics of the patients and physicians, nursing professionals, and psychologists involved in their treatment. The importance of knowledge in the management of MDR-TB cases was explored through focus groups with these providers.

Results

Of 128 cases of TB-MDR, 63 (49.2%) experienced treatment success. Only 52.9% of the physicians and nursing professionals had satisfactory knowledge about MDR-TB. Logistic regression showed that being HIV negative, being affiliated with the contributory health insurance scheme, being cared for by a male physician, and being cared for by nursing professionals with sufficient knowledge were associated with a successful treatment outcome (p ≤ 0.05). Qualitative analysis showed the need for in-depth, systematic training of health personnel who care for patients with MDR-TB.

Conclusions

Some characteristics of patients and healthcare providers influence treatment success in MDR-TB cases. Physicians' and nurses' knowledge about MDR-TB must be improved, and follow-up of MDR-TB patients who are living with HIV and of those affiliated with the subsidized health insurance scheme in Colombia must be strengthened, as these patients have a lower likelihood of a successful treatment outcome.

[Patient- and provider-related factors in the success of multidrug tuberculosis treatment in ColombiaFatores de êxito do tratamento da tuberculose multirresistente relacionados com o paciente e com a equipe de saúde na Colômbia]

Objetivo.

Identificar los factores asociados con el éxito del tratamiento de tuberculosis multidrogorresistente (TB-MDR) relacionados con los pacientes y el personal sanitario en seis municipios de Colombia con mayor número de casos.

Métodos.

Mediante regresiones logísticas bifactorial y multifactorial se analizó la asociación entre el tratamiento exitoso (curación o cumplimiento del tratamiento) y las características de los pacientes, y de los médicos, profesionales de enfermería y psicólogos vinculados al tratamiento. Se exploró la importancia del conocimiento en el manejo de los casos de TB-MDR mediante grupos focales con esos profesionales.

Resultados.

De los 128 casos con TB-MDR, 63 (49,2%) tuvieron un tratamiento exitoso. Solo 52,9% de los médicos y profesionales de enfermería tenía conocimientos satisfactorios sobre TB-MDR. La regresión logística mostró que ser negativo al VIH, estar afiliado al régimen de aseguramiento de salud contributivo, estar atendido por un médico del sexo masculino y por profesionales de enfermería con conocimientos suficientes se asociaron con un desenlace exitoso del tratamiento (p ≤ 0,05). El análisis cualitativo mostró la necesidad de profundizar y sistematizar la capacitación del personal sanitario que atiende los casos de TB-MDR.

Conclusiones.

En el éxito del tratamiento de los casos de TB-MDR influyen algunas características de los pacientes y el personal sanitario. Se requiere fortalecer los conocimientos sobre TB-MDR de médicos y enfermeros, y reforzar el seguimiento de los pacientes con TB-MDR positivos al VIH y de los que pertenecen al régimen subsidiado, dada su menor probabilidad de éxito al tratamiento.

Patients and Medical Staff Attitudes Toward the Future Inclusion of eHealth in Tuberculosis Management: Perspectives From Six Countries Evaluated using a Qualitative Framework

Background

Digitally delivering healthcare services is very attractive for tuberculosis (TB) management as this disease has a complex diagnosis and lengthy management and involves multiple medical and nonmedical specialists. Especially in low- and middle-income countries, eHealth could potentially offer cost-effective solutions to bridge financial, social, time, and distance challenges.

Objective

The goal of the research is to understand what would make eHealth globally applicable and gain insight into different TB situations, opportunities, and challenges.

Methods

We performed focus group interviews with TB experts and patients from 6 different countries on 4 different continents. The focus group interviews followed the theory of planned behavior framework to offer structured recommendations for a versatile eHealth solution. The focus group interviews were preceded by a general demographic and technology use questionnaire. Questionnaire results were analyzed using basic statistics in Excel (Microsoft Corporation). Focus group interview data were analyzed using ATLAS.ti 8 (ATLAS.ti Scientific Software Development GmbH) by assigning codes to quotations and grouping codes into the 5 domains within the framework.

Results

A total of 29 patients and 32 medical staff members were included in our study. All medical staff had used the internet, whereas 31% (9/61) of patients had never been online. The codes with the most quotations were information in relation to eHealth (144 quotations) and communication (67 quotations). The consensus among all participants from all countries is that there are important communication and information gaps that could be bridged by an eHealth app. Participants from different countries also highlighted different challenges, such as a majority of asylum-seeker patients or lack of infrastructure that could be addressed with an eHealth app.

Conclusions

Within the 6 countries interviewed, there is high enthusiasm toward eHealth in TB. A potential app could first target information and communication gaps in TB, with additional modules aimed at setting-specific challenges.

Conocimientos, prácticas y actitudes de enfermería para la atención de personas con tuberculosis

Introducción: La tuberculosis es un padecimiento con una gran carga económica y social; representa una de las 10 causas principales de mortalidad a nivel mundial. Múltiples factores intervienen en la adherencia al tratamiento y cura de la enfermedad. La atención de enfermería estudiada desde 3 indicadores (conocimiento, práctica y actitud), que son determinantes cruciales para el cumplimiento de una atención de calidad y para la implementación de nuevas tecnologías de cuidados, es imprescindible. Objetivo: Evaluar los conocimientos, prácticas y actitudes de enfermería relacionados con la atención de pacientes con tuberculosis. Metodología: Estudio cuantitativo, descriptivo, muestra no probabilística de 19 enfermeras(os) del primer nivel de atención. Se evaluaron los conocimientos básicos generales, los relacionados con el diagnóstico y con el tratamiento. Las prácticas comprendieron la identificación de recursos para el registro, las visitas, la elaboración de planes de cuidados de enfermería, además del uso de una herramienta digital que se brindó para facilitar la elaboración de dichos planes. En actitudes, se evaluaron tres componentes: cognitivo, conductual y afectivo. Resultados: Se identificó una base débil de conocimientos en tuberculosis; la mayor parte mostró un nivel de conocimiento medio y bajo. Poco más de la mitad de los participantes se ubicó con una práctica regular y, de manera general, la actitud al brindar los cuidados fue buena. Conclusiones: Se requiere fortalecer la atención de enfermería en tuberculosis desde los tres indicadores evaluados. Sin una base consolidada de conocimientos sobre la enfermedad es difícil alcanzar los objetivos de los programas y las políticas en salud pública; esto, a su vez, repercute de manera directa en la práctica y actitud de los profesionales.

Management of hospitalized drug sensitive pulmonary tuberculosis patients during the Hajj mass gathering: A cross sectional study

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.

Knowledge and practice of health workers about control and prevention of multidrug-resistant tuberculosis in referral hospitals, Ethiopia: a cross-sectional study

OBJECTIVE

The aim of this study was to assess the knowledge and practice of health workers about multidrug-resistant tuberculosis (MDR-TB) prevention and control.

STUDY DESIGN AND SETTINGS

A cross-sectional study was conducted at Gondar University Referral Hospital and Felege Hiwot Referral Hospital.

PARTICIPANTS

Randomly selected health workers (ie, medical doctor, nurse, health officer, pharmacy, medical laboratory and midwifery) were the study participants.

OUTCOME MEASURES

The main outcomes were knowledge and self-reported practice of health workers about MDR-TB.

RESULTS

A total of 377 health workers (with a response rate of 93.7%) participated in the study. The majority of respondents were nurses (52.5%, n=198) and medical doctors (15.6%, n=59). The mean knowledge score was seven out of 10; 149 (39.5%) of respondents scored seven or more which was considered as good knowledge. MDR-TB knowledge of health workers was significantly associated with having a postgraduate degree (adjusted odds ratio (AOR)=5.78; 95% CI 2.33 to 14.33), taking infection prevention training (AOR=1.79; 95% CI 1.00, to 3.17) and having a history of tuberculosis (TB) (AOR=1.85; 95% CI 1.12, to 3.03). The mean self-reported practice score was four out of seven; one-fifth (19.6%) of respondents scored four or more which was considered as good practice. Self-reported practice of health workers was significantly associated with working at internal medicine (AOR=4.64; 95% CI 1.99, to 10.81) and paediatrics (AOR=3.85; 95% CI 1.11, to 13.34) wards, being in the age groups of 26-30 years (AOR=2.70; 95% CI 1.27, to 5.76), and 30 years and above (AOR=4.42; 95% CI 1.77, to 11.00).

CONCLUSIONS

This study found low knowledge and self-reported practice score among health workers. MDR-TB knowledge of health workers was significantly associated with educational status, infection prevention training and previous history of TB. This finding highlights the potential of providing MDR-TB training for health workers to increase their knowledge about MDR-TB.

Tuberculosis knowledge, attitude and practice among healthcare workers during the 2016 Hajj

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.

Provision of guideline-based care for drug-resistant tuberculosis in South Africa: Level of concordance between prescribing practices and guidelines

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.

Will the European Union reach the United Nations Millennium declaration target of a 50% reduction of tuberculosis mortality between 1990 and 2015?

Background

The Millennium Development Goals (MDG) provide targets for 2015. MDG 6 includes a target to reduce the tuberculosis (TB) death rate by 50% compared with 1990. We aimed to assess whether this target was reached by the European Union (EU) and European Economic Area countries.

Methods

We used Eurostat causes of death data to assess whether the target was reached in the EU. We calculated the reduction in reported and adjusted death rates and the annual average percentage decline based on the available data.

Results

Between 1999 and 2014, the TB death rate decreased by 50%, the adjusted death rate by 56% and the annual average percentage decline was 5.43% (95% confidence interval 4.94–6.74) for the EU. Twenty of 26 countries reporting >5 TB deaths in the first reporting year reached the target of 50% reduction in adjusted death rate.

Conclusions

The EU reached the MDG target of a 50% reduction of the TB death rate and also the annual average percentage decline was larger than the 2.73% needed to reach the target. The World Health Organization ‘End TB Strategy’ requires a further reduction of the number of TB deaths of 35% by 2020 compared to 2015, which will challenge TB prevention and care services in the EU.

User experience analysis of e-TB Manager, a nationwide electronic tuberculosis recording and reporting system in Ukraine

Ukraine has successfully implemented e-TB Manager nationwide as its mandatory national tuberculosis registry after first introducing it in 2009. Our objective was to perform an end-of-programme evaluation after formal handover of the registry administration to Ukraine's Centre for Disease Control in 2015. We conducted a nationwide, cross-sectional, anonymous, 18-point user experience survey, and stratified the registry's transaction statistics to demonstrate usability. Contrary to initial implementation experience, older users (aged >50 years), often with limited or no computer proficiency prior to using the registry, had significantly better user experience scores for at least six of the 12 measures compared to younger users (aged 18-29 years). Using the registry for >3 years was associated with significantly higher scores for having capacity, adequacy of training received and satisfaction with the registry. Of the 5.9 million transactions over a 4-year period, nine out of 24 oblasts (regions) and Kiev city accounted for 62.5% of all transactions, and corresponded to 59% of Ukraine's tuberculosis burden. There were 437 unique active users in 486 rayons (districts) of Ukraine, demonstrating extensive reach. Our key findings complement the World Health Organization and European Respiratory Society's agenda for action on digital health to help implement the End TB Strategy.

User experience analysis of an eHealth system for tuberculosis in resource-constrained settings: A nine-country comparison

BACKGROUND

e-TB Manager, a web-based eHealth system has been successfully institutionalized in 10 resource-constrained countries that account for one-third of the world's tuberculosis (TB) burden, but user experience has never been evaluated.

METHODS

A cross-sectional, anonymous survey in eight unique languages based on the targeted countries. e-TB Manager users included nurses, doctors, pharmacists, statisticians/data officers, laboratory professionals/assistants, health workers, and administrators.

RESULTS

With an 86.3% completion rate for all required questions, 1,511 completed responses were analyzed. Users had worked in TB programs for a median of five years and had used e-TB Manager for a median of two years. Overall, 60.2% of respondents were female, 65% were clustered in the age groups of 30-39 and 40-49 years old, and nearly half (49%) were using e-TB Manager at the district and sub-district levels of a country's health system. Older respondents aged over 50, regardless of location and with at least 6 or more years of experience in public-sector TB programs, had higher mean satisfaction scores than did their younger counterparts. Overall, those who had used e-TB Manager for more than two years had significantly higher mean scores for the majority of the survey statements than did those who had used e-TB Manager for less than two years. Ukraine had significantly higher mean scores for finding patient information available in e-TB Manager and in its benefit in improving patient care compared to Brazil, Armenia, Nigeria, and Indonesia. Brazil and Ukraine differed significantly from five other countries in that they did not need additional training, thereby demonstrating their institutional capacity after more than five years of using e-TB Manager.

CONCLUSION

Although users gave high ratings to e-TB Manager in terms of helping to improve patient care, found it to be reliable, and were generally satisfied, there is need for a combination of refresher training and e-learning methodologies to keep pace with programmatic changes.

Surveying the Knowledge and Practices of Health Professionals in China, India, Iran, and Mexico on Treating Tuberculosis

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.

Setting priorities for a research agenda to combat drug-resistant tuberculosis in children

SETTING

Numerous knowledge gaps hamper the prevention and treatment of childhood drug-resistant tuberculosis (TB). Identifying research priorities is vital to inform and develop strategies to address this neglected problem.

OBJECTIVE

To systematically identify and rank research priorities in childhood drug-resistant TB.

DESIGN

Adapting the Child Health and Nutrition Research Initiative (CHNRI) methodology, we compiled 53 research questions in four research areas, then classified the questions into three research types. We invited experts in childhood drug-resistant TB to score these questions through an online survey.

RESULTS

A total of 81 respondents participated in the survey. The top-ranked research question was to identify the best combination of existing diagnostic tools for early diagnosis. Highly ranked treatment-related questions centred on the reasons for and interventions to improve treatment outcomes, adverse effects of drugs and optimal treatment duration. The prevalence of drug-resistant TB was the highest-ranked question in the epidemiology area. The development type questions that ranked highest focused on interventions for optimal diagnosis, treatment and modalities for treatment delivery.

CONCLUSION

This is the first effort to identify and rank research priorities for childhood drug-resistant TB. The result is a resource to guide research to improve prevention and treatment of drug-resistant TB in children.

Multidrug-resistant tuberculosis in Europe, 2010-2011

Drug-resistant Mycobacterium tuberculosis is challenging elimination of tuberculosis (TB). We evaluated risk factors for TB and levels of second-line drug resistance in M. tuberculosis in patients in Europe with multidrug-resistant (MDR) TB. A total of 380 patients with MDR TB and 376 patients with non-MDR TB were enrolled at 23 centers in 16 countries in Europe during 2010-2011. A total of 52.4% of MDR TB patients had never been treated for TB, which suggests primary transmission of MDR M. tuberculosis. At initiation of treatment for MDR TB, 59.7% of M. tuberculosis strains tested were resistant to pyrazinamide, 51.1% were resistant to ≥1 second-line drug, 26.6% were resistant to second-line injectable drugs, 17.6% were resistant to fluoroquinolones, and 6.8% were extensively drug resistant. Previous treatment for TB was the strongest risk factor for MDR TB. High levels of primary transmission and advanced resistance to second-line drugs characterize MDR TB cases in Europe.

Diagnosis and Treatment of Childhood Pulmonary Tuberculosis: A Cross-Sectional Study of Practices among Paediatricians in Private Sector, Mumbai

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.

Lack of optimum practice among health care workers regarding tuberculosis in Iran: A knowledge, attitude, and practice study

BACKGROUND

Lack of knowledge toward tuberculosis (TB) among health care workers (HCWs) increases the risk of developing TB. The aim of this study was to assess the level of knowledge, attitude, and practice of HCWs in Iran.

METHODS

We conducted a cross-sectional study in 50 universities of medical sciences throughout Iran. A questionnaire was developed to assess the knowledge, attitude, and practice of participants. The values of Cronbach α coefficients for the knowledge and attitude questions were .76 and .75, respectively.

RESULTS

The mean scores of knowledge, attitude, and practice among TB laboratory staff regarding TB was 82.6 (95% confidence interval [CI], 82.0-83.7), 87.6 (95% CI, 87.1-88.0), and 57.9 (95% CI, 56.9-58.9), respectively. The mean scores of knowledge, attitude, and practice among non-TB laboratory staff regarding TB was 69.5 (95% CI, 67.9-71.1), 50.7 (95% CI, 50.1-51.4), and 40.82 (95% CI, 38.2-43.4), respectively.

CONCLUSION

TB laboratory staff scored relatively well in knowledge and attitude of TB, but they scored lower in practice regarding TB. Non-TB laboratory staff had lower scores than TB laboratory staff in knowledge, attitude, and practice. There is a major gap between knowledge and attitude and practice in both groups. It is therefore essential to plan for the continuing in-service training of HCWs and public training of the general population regarding TB.

Modeling the impact of tuberculosis interventions on epidemiologic outcomes and health system costs

Background

Tuberculosis (TB) programs must invest in a variety of TB specific activities in order to reach ambitious global targets. Uncertainty exists surrounding the potential impact of each of these activities. The objective of our study was to model different interventions and quantify their impact on epidemiologic outcomes and costs from the health system perspective.

Methods

Decision analysis was used to define the TB patient trajectory within the health system of three different countries. We considered up to seven different interventions that could affect either the natural history of TB, or patient trajectories within the health system. The expected impact of interventions were derived from published studies where possible. Epidemiologic outcomes and associated health system costs were projected for each scenario.

Results

With no specific intervention, TB related death rates are high and less than 10% of the population starts on correct treatment. Interventions that either prevent cases or affect all patients with TB disease early in their trajectory are expected to have the biggest impact, regardless of underlying epidemiologic characteristics of the setting. In settings with a private sector, improving diagnosis and appropriate treatment across all sectors is expected to have a major impact on outcomes.

Conclusion

In all settings, the greatest benefit will come from early diagnosis of all forms of TB. Once this has been achieved more specific interventions, such as those targeting HIV, drug resistance or the private sector can be integrated to increase impact.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1480-4) contains supplementary material, which is available to authorized users.

Prescription patterns for tuberculosis treatment and adherence to treatment guidelines: a population-based study in Taiwan

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.

Evaluation of adherence to national treatment guidelines among tuberculosis patients in three provinces of South Africa

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.

Tuberculosis among HIV-infected patients in Stockholm, Sweden, 1987-2010: treatment outcomes and adverse reactions

BACKGROUND

The treatment of patients co-infected with human immunodeficiency virus (HIV) and tuberculosis (TB) is challenging. The aim of this study was to compare socio-demographic and clinical characteristics among HIV-infected patients before and after the introduction of combined antiretroviral therapy (cART) in a Swedish cohort, and to identify factors associated with anti-TB treatment success as well as adverse reactions.

METHODS

This was a retrospective observational study of HIV/TB co-infected patients in Stockholm County from 1987 to 2010. The study population was stratified into an early and a late cohort (before and after the introduction of cART in 1996). Data were analyzed using descriptive statistics and multiple logistic regression analysis.

RESULTS

The study population comprised 127 patients; the majority were foreign-born (87%). The proportion of female patients more than doubled from the early to the late cohort, and anti-TB treatment success increased from 65% to 91%. The median duration of successful treatment was 8 months in both cohorts. Predictors of treatment success in the late cohort were cART (odds ratio (OR) 13.3, 95% confidence interval (CI) 1.5-114.8) and a CD4 cell count at TB diagnosis > 200 cells/μl (OR 17.2, 95% CI 1.2-236.6). Severe adverse reactions in the late cohort occurred in 23% and were associated with the initiation of cART after TB diagnosis (OR 13.3, 95% CI 1.6-112.4).

CONCLUSION

The introduction of cART was favourable for the treatment outcome of HIV-infected patients with concomitant TB. However, adverse reactions increased in patients who initiated cART during anti-TB treatment and these patients require careful attention.