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Rafique S, Ahmad N, Khan S, Khan A, Atif M, Wahid A, Khan A, Waheed H. Frequency, management and impact of adverse events on treatment outcomes in patients with multidrug resistant tuberculosis in Balochistan, Pakistan. J Pharm Policy Pract 2024; 17:2332878. [PMID: 38572376 PMCID: PMC10989201 DOI: 10.1080/20523211.2024.2332878] [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] [Indexed: 04/05/2024] Open
Abstract
Background Early detection, monitoring, and managing adverse events (AEs) are crucial in optimising treatment for multidrug-resistant tuberculosis (MDR-TB) patients. Objectives To investigate the incidence, factors, management, and impact of AEs on treatment outcomes in MDR-TB patients. Methods This study reviewed the medical records of 275 MDR-TB patients at Fatimah Jinnah Institute of Chest Diseases in Quetta, Pakistan. Patient information was collected using a designed data collection form. Mann-Whitney U and Kruskal-Wallis tests examined the difference in AEs occurrences based on patients' characteristics. Multiple binary logistic regression identified factors associated with unsuccessful outcomes, with statistical significance set at a p-value < 0.05. Results Almost all patients (99.6%) experienced at-least one AE (median = 4/patient, interquartile range:3-6). The most common were GI disturbance (95.3%), arthralgia (80.4%), body pain and headache (61.8%), ototoxicity (61.4%), psychiatric disturbance (44%), hypokalaemia (40.4%), dermatological reactions (26.2%) and hypothyroidism (21.5%). AEs led to treatment modification in 7.3% patients. Educated patients, those with a history of TB treatment, previous use and resistance to any second-line drug had significantly higher number of AEs. A total of 64.0% were declared cured, 3.6% completed treatment, 19.6% died and 12.7.9% were lost to follow-up. Patients' age of 41-60(OR = 9.225) and >60 years(OR = 23.481), baseline body weight of 31-60 kg(OR = 0.180), urban residence(OR = 0.296), and experiencing ototoxicity (OR = 0.258) and hypothyroidism (OR = 0.136) were significantly associated with unsuccessful treatment outcomes. Conclusion AEs were highly prevalent but did not negatively impact treatment outcomes. Patients at higher risk of developing AEs and unsuccessful outcomes should receive special attention for its early management.
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Affiliation(s)
- Sara Rafique
- Department of Pharmacy Practice, Faculty of Biological, Pharmaceutical and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Biological, Pharmaceutical and Health Sciences, University of Balochistan, Quetta, Pakistan
| | | | - Amjad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Abdul Wahid
- Department of Pharmacy Practice, Faculty of Biological, Pharmaceutical and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Asad Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Hira Waheed
- Department of Pharmacy Practice, Faculty of Biological, Pharmaceutical and Health Sciences, University of Balochistan, Quetta, Pakistan
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Afful P, Vechey GA, Leta PK, Gbafu FB, Aku FY. Predictors of multidrug-resistant tuberculosis in a teaching hospital in Ghana: A case-control study. PLoS One 2023; 18:e0294928. [PMID: 38019801 PMCID: PMC10686500 DOI: 10.1371/journal.pone.0294928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023] Open
Abstract
Multidrug-resistant Tuberculosis (MDR-TB) remains a global health concern. The disease results in a prolonged treatment and hence, poses a financial burden to affected individuals and their families. The Ghana National TB Control Programme (NTP) has made extensive efforts to control the menace, however, it remains a concern. This study, therefore, aimed to determine the predictors of multidrug-resistant TB in the Cape Coast Teaching Hospital of Ghana. An unmatched case-control study involving 37 cases and 111 controls was conducted using data of TB cases registered for treatment between January 2018 and December 2020 at the Cape Coast Teaching Hospital. Socio-demographic, individual level and social characteristics information were collected from respondents through telephone surveys, face-to-face interviews and review of records using a structured questionnaire built in the Kobo Collect Toolbox. The data was exported to Stata version 16.0 for analysis. Chi-square test and multiple logistic regression were used to determine the predictors of MDR-TB. Associations were considered statistically significant at a 95% confidence interval with a p-value of less than 0.05. The results revealed that the majority (25 [67.6%]) of MDR-TB cases and controls (76 [68.5%]) were aged 30 years and above with a median age of 36.5 (IQR: 28-50) years for all respondents, while 20 (54.1%) of MDR-TB cases and 33 (29.7%) of controls lived in households with one room residences for their families. The following predictors for MDR-TB were identified: BCG vaccination status (AOR = 0.17,95% CI:0.07-0.45), long distance to health facility (AOR = 4.11, 95% CI: 1.55-10.87), number of rooms in residence (AOR = 0.37,95% CI: 0.14-0.99) and first place of visit upon noticing TB symptom (AOR = 4.22,95% CI:1.31-13.64). Predictors of MDR-TB in the current study were multi-faceted. Measures to control MDR-TB should target socio-demographic, health-seeking behaviour and social-related concerns.
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Affiliation(s)
- Philomina Afful
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe Campus, Hohoe, Ghana
- Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Godwin Adjei Vechey
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe Campus, Hohoe, Ghana
| | - Peter Kipo Leta
- Nkoranza South Municipal Health Directorate, Bono East Region, Nkoranza, Ghana
| | | | - Fortress Yayra Aku
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe Campus, Hohoe, Ghana
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Wang Z, Tang Z, Heidari H, Molaeipour L, Ghanavati R, Kazemian H, Koohsar F, Kouhsari E. Global status of phenotypic pyrazinamide resistance in Mycobacterium tuberculosis clinical isolates: an updated systematic review and meta-analysis. J Chemother 2023; 35:583-595. [PMID: 37211822 DOI: 10.1080/1120009x.2023.2214473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/01/2023] [Accepted: 05/11/2023] [Indexed: 05/23/2023]
Abstract
Pyrazinamide (PZA) is an essential first-line tuberculosis drug for its unique mechanism of action active against multidrug-resistant-TB (MDR-TB). Thus, the aim of updated meta-analysis was to estimate the PZA weighted pooled resistance (WPR) rate in M. tuberculosis isolates based on publication date and WHO regions. We systematically searched the related reports in PubMed, Scopus, and Embase (from January 2015 to July 2022). Statistical analyses were performed using STATA software. The 115 final reports in the analysis investigated phenotypic PZA resistance data. The WPR of PZA was 57% (95% CI 48-65%) in MDR-TB cases. According to the WHO regions, the higher WPRs of PZA were reported in the Western Pacific (32%; 95% CI 18-46%), South East Asian region (37%; 95% CI 31-43%), and the Eastern Mediterranean (78%; 95% CI 54-95%) among any-TB patients, high risk of MDR-TB patients, and MDR-TB patients, respectively. A negligible increase in the rate of PZA resistance were showed in MDR-TB cases (55% to 58%). The rate of PZA resistance has been rising in recent years among MDR-TB cases, underlines the essential for both standard and novel drug regimens development.
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Affiliation(s)
- Zheming Wang
- Department of Pharmacy, Shaoxing People's Hospital, Shaoxing, China
| | - Zhihua Tang
- Department of Pharmacy, Shaoxing People's Hospital, Shaoxing, China
| | - Hamid Heidari
- Department of Microbiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Leila Molaeipour
- Department of Epidemiology, School of Public Health, University of Medical Sciences, Tehran, Iran
| | | | - Hossein Kazemian
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Faramarz Koohsar
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ebrahim Kouhsari
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran
- Department of Laboratory Sciences, Faculty of Paramedicine, Golestan University of Medical Sciences, Gorgan, Iran
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Massud A, Khan AH, Syed Sulaiman SA, Ahmad N, Shafqat M, Ming LC. Unsuccessful treatment outcome and associated risk factors. A prospective study of DR-TB patients from a high burden country, Pakistan. PLoS One 2023; 18:e0287966. [PMID: 37561810 PMCID: PMC10414635 DOI: 10.1371/journal.pone.0287966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 06/19/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION Tuberculosis (TB), a curable and preventable infectious disease, becomes difficult to treat if resistance against most effective and tolerable first line anti-TB drugs is developed. The objective of the present study was to evaluate the treatment outcomes and predictors of poor outcomes among drug-resistant tuberculosis (DR-TB) patients treated at a programmatic management unit of drug resistant tuberculosis (PMDT) unit, Punjab, Pakistan. METHODS This prospective observational study was conducted at a a PMDT unit in Multan, Punjab, Pakistan. A total of 271 eligible culture positive DR-TB patients enrolled for treatment at the study site between January 2016 and May 2017 were followed till their treatment outcomes were recorded. World Health Organization's (WHO) defined criteria was used for categorizing treatment outcomes. The outcomes of cured and treatment completed were collectively placed as successful outcomes, while death, lost to follow-up (LTFU) and treatment failure were grouped as unsuccessful outcomes. Multivariable binary logistic regression analysis was employed for getting predictors of unsuccessful treatment outcomes. A p-value <0.05 was considered statistically significant. RESULTS Of the 271 DR-TB patients analysed, nearly half (51.3%) were males. The patient's (Mean ± SD) age was 36.75 ± 15.69 years. A total of 69% patients achieved successful outcomes with 185 (68.2%) patients being cured and 2 (0.7%) completed therapy. Of the remaining 84 patients with unsuccessful outcomes, 48 (17.7%) died, 2 (0.7%) were declared treatment failure, 34 (12.5%) were loss to follow up. After adjusting for confounders, patients' age > 50 years (OR 2.149 (1.005-4.592) with p-value 0.048 and baseline lung cavitation (OR 7.798 (3.82-15.919) with p-value <0.001 were significantly associated with unsuccessful treatment outcomes. CONCLUSIONS The treatment success rate (69%) in the current study participants was below the target set by WHO (>75%). Paying special attention and timely intervention in patients with high risk of unsuccessful treatment outcomes may help in improving treatment outcomes at the study site.
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Affiliation(s)
- Asif Massud
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
- Faculty of Pharmaceutical Sciences, Government College University, Faisalabad, Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Nafees Ahmad
- Faculty of Pharmacy, University of Balochistan, Quetta, Pakistan
| | - Muhammad Shafqat
- Programmatic Management of Drug-Resistant Tuberculosis (PMDT) Unit, Nishtar Medical University Hospital, Multan, Pakistan
| | - Long Chiau Ming
- School of Medical and Life Sciences, Sunway University, Sunway City, Selangor Darul Ehsan, Malaysia
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Kyrbashov B, Kulzhabaeva A, Kadyrov A, Toktogonova A, Timire C, Satyanarayana S, Istamov K. Time to Treatment and Risk Factors for Unsuccessful Treatment Outcomes among People Who Started Second-Line Treatment for Rifampicin-Resistant or Multi-Drug-Resistant Tuberculosis in the Kyrgyz Republic, 2021. Trop Med Infect Dis 2023; 8:407. [PMID: 37624346 PMCID: PMC10459505 DOI: 10.3390/tropicalmed8080407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
The Kyrgyz Republic is a high-burden country for rifampicin resistant/multi-drug resistant tuberculosis (RR/MDR-TB). TB control efforts rely on early diagnosis and initiation of people on effective regimens. We studied the interval from diagnosis of RR-TB to starting treatment and risk factors for unsuccessful outcomes among people who started RR/MDR-TB treatment in 2021. We conducted a cohort study using country-wide programme data and used binomial regression to determine associations between unsuccessful outcomes and predictor variables. Of the 535 people included in the study, three-quarters were in the age category 18-59 years, and 68% had past history of TB. The median (IQR) time from onset of TB symptoms to diagnosis was 30 (11-62) days, 1 (0-4) days from diagnosis to starting treatment, and 35 (24-65) days from starting treatment to receipt of second-line drug susceptibility test (SL-DST) results. Overall, 136 (25%) had unsuccessful outcomes. Risk factors for unsuccessful outcomes were being homeless, fluroquinolone resistance, having unknown HIV status, past TB treatment, male gender and being unemployed. Treatment outcomes and the interval from diagnosis to starting treatment were commendable. Further reductions in unsuccessful outcomes by be achieved through ensuring timely diagnosis and access to SL-DSTs and by reducing the proportion of people who are lost to follow-up.
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Affiliation(s)
- Bolot Kyrbashov
- National Center for Phthisiology, Bishkek 720020, Kyrgyzstan; (A.K.); (A.T.)
| | - Aizat Kulzhabaeva
- Public Foundation KNCV-KG, Bishkek 720000, Kyrgyzstan;
- Public Health Department, Kyrgyz State Medical Academy, Bishkek 720020, Kyrgyzstan
| | - Abdullaat Kadyrov
- National Center for Phthisiology, Bishkek 720020, Kyrgyzstan; (A.K.); (A.T.)
| | - Atyrkul Toktogonova
- National Center for Phthisiology, Bishkek 720020, Kyrgyzstan; (A.K.); (A.T.)
| | - Collins Timire
- International Union against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (C.T.); (S.S.)
| | - Srinath Satyanarayana
- International Union against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France; (C.T.); (S.S.)
| | - Kylychbek Istamov
- School of Medicine, Osh State University, Osh City 723500, Kyrgyzstan;
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Akalu TY, Clements AC, Wolde HF, Alene KA. Prevalence of long-term physical sequelae among patients treated with multi-drug and extensively drug-resistant tuberculosis: a systematic review and meta-analysis. EClinicalMedicine 2023; 57:101900. [PMID: 36942158 PMCID: PMC10023854 DOI: 10.1016/j.eclinm.2023.101900] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Physical sequelae related to multi-drug resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) are emerging and under-recognised global challenges. This systematic review and meta-analysis aimed to quantify the prevalence and the types of long-term physical sequelae associated with patients treated for MDR- and XDR-TB. METHODS We systematically searched CINAHL (EBSCO), MEDLINE (via Ovid), Embase, Scopus, and Web of Science from inception through to July 1, 2022, and the last search was updated to January 23, 2023. We included studies reporting physical sequelae associated with all forms of drug-resistant TB, including rifampicin-resistant TB (RR-TB), MDR-TB, Pre-XDR-TB, and XDR-TB. The primary outcome of interest was long-term physical sequelae. Meta-analysis was conducted using a random-effect model to estimate the pooled proportion of physical sequelae. The sources of heterogeneity were explored through meta-regression using study characteristics as covariates. The research protocol was registered in PROSPERO (CRD42021250909). FINDINGS From 3047 unique publications identified, 66 studies consisting of 37,380 patients conducted in 30 different countries were included in the meta-analysis. The overall pooled estimate was 44.4% (95% Confidence Interval (CI): 36.7-52.1) for respiratory sequelae, 26.7% (95% CI: 23.85-29.7) for hearing sequelae, 10.1% (95% CI: 7.0-13.2) for musculoskeletal sequelae, 8.4% (95% CI: 6.5-10.3) for neurological sequelae, 8.1% (95% CI: 6.3-10.0) for renal sequelae, 7.3% (95% CI: 5.1-9.4) for hepatic sequelae, and 4.5% (95% CI: 2.7-6.3) for visual sequelae. There was substantial heterogeneity in the estimates. The stratified analysis showed that the pooled prevalence of hearing sequelae was 26.6% (95% CI: 12.3-40.9), neurological sequelae was 31.5% (95% CI: 5.5-57.5), and musculoskeletal sequelae were 21.5% (95% CI: 9.9-33.1) for patients with XDR-TB, which were higher than the pooled prevalence of sequelae among patients with MDR-TB. Respiratory sequelae were the highest in low-income countries (59.3%) and after completion of MDR-TB treatment (57.7%). INTERPRETATION This systematic review found that long-term physical sequelae such as respiratory, hearing, musculoskeletal, neurological, renal, hepatic, and visual sequelae were common among survivors of MDR- and XDR-TB. There was a significant difference in the prevalence of sequelae between patients with MDR- and XDR-TB. Post-MDR- and XDR-TB treatment surveillance for adverse outcomes needs to be incorporated into the current programmatic management of MDR-TB to enable early detection and prevention of post-treatment sequelae. FUNDING Australian National Health and Medical Research Council, through an Emerging Leadership Investigator grant, and the Curtin University Higher Degree Research scholarship.
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Affiliation(s)
- Temesgen Yihunie Akalu
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Corresponding author. School of Population Health, Faculty of Health Sciences, Curtin University, Kent St, Bentley, WA 6102, Western Australia, Australia.
| | - Archie C.A. Clements
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Haileab Fekadu Wolde
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kefyalew Addis Alene
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Abbas S, Kermode M, Khan MD, Denholm J, Adetunji H, Kane S. What Makes People With Chronic Illnesses Discontinue Treatment? A Practice Theory Informed Analysis of Adherence to Treatment among Patients With Drug-Resistant Tuberculosis in Pakistan. Int J Health Policy Manag 2023; 12:6576. [PMID: 37579474 PMCID: PMC10125133 DOI: 10.34172/ijhpm.2022.6576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/27/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Non-adherence to treatment is a frequently observed phenomenon amongst those on long-term treatment for chronic illnesses. This qualitative study draws upon the tenets of 'practice theory' to reveal what shapes patients' ability to adhere to the demanding treatment for drug-resistant tuberculosis (DR-TB) at three treatment sites in Khyber-Pakhtunkhwa (KP) province of Pakistan. METHODS This qualitative study involved observation of service provision over a period of nine months of stay at, and embedment within the three treatment sites and in-depth interviews with 13 service providers and 22 patients who became non-adherent to their treatment. RESULTS Consistent with the extensive research based on the barriers and facilitator approach, both patients, and providers in our study also talked of patients' doubts about diagnosis and treatment efficacy, side-effects of drugs, economic constraints, unreliable disbursements of monetary incentive, attitude of providers and co-morbidities as reasons for non-adherence to treatment. Applying a practice theory perspective yielded more contextualised insights; inadequate help with patients' physical complaints, unempathetic responses to their queries, and failure to provide essential information, created conditions which hindered the establishment and maintenance of the 'practice' of adhering to treatment. These supply-side gaps created confusion, bred resentment, and exacerbated pre-existing distrust of public health services among patients, and ultimately drove them to disengage with the TB services and stop their treatment. CONCLUSION We argue that the lack of supply-side 'responsiveness' to patient needs beyond the provision of a few material inputs is what is lacking in the existing DR-TB program in Pakistan. We conclude that unless Pakistan's TB program explicitly engages with these supply side, system level gaps, patients will continue to struggle to adhere to their treatments and the TB program will continue to lose patients. Conceptually, we make a case for reimagining the act of adherence (or not) to long-term treatment as a 'Practice.'
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Affiliation(s)
- Shazra Abbas
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Michelle Kermode
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Justin Denholm
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC, Australia
| | - Hamed Adetunji
- Faculty of Public Health & Health Informatics, Umm Al Qura University, Makkah Almukarramah, Saudi Arabia
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Dai Z, Sadiq M, Kannaiah D, Khan N, Shabbir MS, Bilal K, Tabash MI. The dynamic impacts of environmental-health and MDR-TB diseases and their influence on environmental sustainability at Chinese hospitals. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:40531-40541. [PMID: 35353303 DOI: 10.1007/s11356-022-19593-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
The purpose of this study is to identify at what extent multidrug-resistant tuberculosis (MDR-TB) diseases effect on environmental health issues in selected provinces of Chinese hospitals. In survival analysis approach, this study employs the Cox proportional hazard model (CPM) to incorporate the duration of event, probability of occurrence of an event, and the issue of right censoring. An advantage of using CPM is that one does not need to specify the distribution of baseline hazard H0 (t) as it considers a common value for all units in population. The results indicate that male and travel expenditures have negative association with the duration of cure. Furthermore, the medical expenditures and the spatial characteristic of time expenditure have positive association with the duration of cure of MDR-TB patients. The inconsistent behavior of males in taking medicines as compared to females and males is also more prone to tuberculosis (TB).
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Affiliation(s)
- Zong Dai
- Institute for Development of Central China /Wuhan University, Wuhan, 430072, China
| | - Misbah Sadiq
- Department of Management Sciences, Al-Qasimia University, Sharjah, United Arab Emirates
| | - Desti Kannaiah
- C. H. Sandage School of Business, Graceland University, Lamoni, IA, 50140, USA
| | - Nasir Khan
- Institute of Business and Management Sciences, The University of Agriculture Peshawar, Peshawar, Pakistan
| | - Malik Shahzad Shabbir
- Department of Management Sciences, Riphah International University, Islamabad, Pakistan.
| | - Kanwal Bilal
- Department of Management Sciences, Comsat University, Lahore Campus, Lahore, Pakistan
| | - Mosab I Tabash
- College of Business, Al Ain University, Al-Ain, United Arab Emirates
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Moxifloxacin Concentration Correlate with QTc Interval in Rifampicin-Resistant Tuberculosis Patients on Shorter Treatment Regimens. J Clin Tuberc Other Mycobact Dis 2022; 28:100320. [PMID: 35706565 PMCID: PMC9189108 DOI: 10.1016/j.jctube.2022.100320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Drug-resistant tuberculosis (DR-TB) continues to be a global threat. Moxifloxacin is one of the components of the shorter treatment regimen which is suspected to increase the risk of QT prolongation, although it is also likely to be the most effective against DR-TB. A study to evaluate the correlation between the concentration of moxifloxacin and QTc interval in RR-TB patients who received shorter regimens is needed. Methods This was an observational study in 2 groups of RR-TB patients on shorter treatment regimens (intensive phase and continuation phase), contain moxifloxacin with body weight-adjusted dose. Blood samples were collected at 2 h after taking the 48th-hour dose and 1 h before taking the 72nd-hour dose. Results Forty-five RR-TB patients were included in this study. At 2 h after taking the 48th-hour dose, the mean of QTc interval in intensive phase and continuation phase was 444.38 ms vs. 467.94 ms, p = 0.026, while mean of moxifloxacin concentration in intensive phase and continuation phase was 4.3 µg/mL vs. 4.61 µg/mL, p = 0.686). At 1 h before taking the 72nd-hour dose, both moxifloxacin concentration and QTc interval in intensive phase and continuation showed no significant difference with p-value of 0.610 and 0.325, respectively. At 2 h after taking the 48th-dose, moxifloxacin concentration did not correlate with QTc interval, both in intensive phase (p = 0.576) and in continuation phase (p = 0.691). At 1 h before taking the 72nd-hour dose, moxifloxacin concentration also did not correlate with QTc interval in intensive phase (p = 0.531) and continuation phase (p = 0.209). Conclusions Our study found that moxifloxacin concentration did not correlate with QTc interval, which indicates the safe use of moxifloxacin on QTc interval. In addition to close monitoring of QTc interval, the clinicians should also consider other variables which potentially increase risk for QTc prolongation in DR-TB patients who received shorter treatment regimens.
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Atif M, Ahmed W, Nouman Iqbal M, Ahmad N, Ahmad W, Malik I, Al-Worafi YM. Frequency and Factors Associated With Adverse Events Among Multi-Drug Resistant Tuberculosis Patients in Pakistan: A Retrospective Study. Front Med (Lausanne) 2022; 8:790718. [PMID: 35300176 PMCID: PMC8922404 DOI: 10.3389/fmed.2021.790718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background Treatment of multi-drug resistant tuberculosis (MDR-TB) for a prolonged period with comparatively less effective and more toxic second-line anti-TB drugs is associated with greater incidence of adverse events. Study aim This study aimed to evaluate the frequency and factors associated with occurrence of adverse events among patients with MDR-TB attending the Bahawal Victoria Hospital, Bahawalpur, Pakistan. Study design This retrospective study included all patients with MDR-TB who were registered and treated at the study site between June 2014 and December 2016 and had their treatment outcomes available at the time of data collection (i.e., November 2018). Measures and outcomes The Electronic Nominal Record System (ERNS) records, medical charts of patients, and laboratory reports were reviewed to obtain the data. Adverse events were reported as per the standard criteria recommended by the WHO. Multivariate binary logistic regression was used to find the independent factors associated with the occurrence of adverse events. Results A total of 179 patients with MDR-TB were included in the final analysis. Out of these, 114 (63.7%) patients experienced at least one adverse event during the course of their treatment. Depression was the most common adverse events (33%), followed by nausea and vomiting (27.4%) and arthralgia (27.4%). The factors associated with the occurrence of adverse events included presence of comorbidity (adjusted odds ratio [AOR] 2.951; 95% CI 1.423, 6.118) and being employed (AOR 3.445; 95% CI 1.188, 9.993). Conclusion Adverse events were prevalent in this cohort, however, resolved with the effective management approaches. Patients with identified factors for occurrence of adverse events need special attention and enhanced clinical management.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Waqar Ahmed
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | | | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
| | - Wajiha Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Iram Malik
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Yaser Mohammed Al-Worafi
- College of Medical Sciences, Azal University for Human Development, Sana'a, Yemen.,Department of Clinical Pharmacy, University of Science and Technology of Fujairah, Fujairah, United Arab Emirates
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Naz F, Ahmad N, Wahid A, Ahmad I, Khan A, Abubakar M, Khan SA, Khan A, Latif A, Ghafoor A. High rate of successful treatment outcomes among childhood rifampicin/multidrug-resistant tuberculosis in Pakistan: a multicentre retrospective observational analysis. BMC Infect Dis 2021; 21:1209. [PMID: 34863099 PMCID: PMC8642947 DOI: 10.1186/s12879-021-06935-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/01/2021] [Indexed: 02/08/2023] Open
Abstract
Background There was a complete lack of information about the treatment outcomes of rifampicin/multidrug resistant (RR/MDR) childhood TB patients (age ≤ 14 years) from Pakistan, an MDR-TB 5th high burden country. Therefore, this study evaluated the socio-demographic characteristics, drug resistance pattern, treatment outcomes and factors associated with unsuccessful outcomes among childhood RR/MDR-TB patients in Pakistan. Methods This was a multicentre retrospective record review of all microbiologically confirmed childhood RR/MDR-TB patients (age ≤ 14 years) enrolled for treatment at seven units of programmatic management of drug-resistant TB (PMDT) in Pakistan. The baseline and follow-up information of enrolled participants from treatment initiation until the end of treatment were retrieved from electronic nominal recording and reporting system. World Health Organization (WHO) defined criterion was used for deciding treatment outcomes. The outcomes of “cured” and “treatment completed” were collectively grouped as successful, whereas “death”, “treatment failure” and “lost to follow-up” were grouped together as unsuccessful outcomes. Multivariable binary logistic regression analysis was used to find factors associated with unsuccessful outcomes. A p-value < 0.05 reflected statistically significant findings. Results A total of 213 children RR/MDR-TB (84 RR and 129 MDR-TB) were included in the study. Majority of them were females (74%), belonged to the age group 10–14 years (82.2%) and suffered from pulmonary TB (85.9%). A notable proportion (37.1%) of patients had no history of previous TB treatment. Patients were resistant to a median of two drugs (interquartile range: 1–4) and 23% were resistant to any second line anti-TB drug. A total of 174 (81.7%) patients achieved successful treatment outcomes with 144 (67.6%) patients being cured and 30 (14.1%) declared treatment completed. Among the 39 (18.3%) patients with unsuccessful outcomes, 35 (16.4%) died and 4 (1.9%) experienced treatment failure. In multivariable analysis, the use of ethambutol had statistically significant negative association with unsuccessful outcomes (odds ratio = 0.36, p-value = 0.02). Conclusions In this study, the WHO target of successful treatment outcomes (≥ 75%) among childhood RR/MDR-TB patients was achieved. The notable proportion of patients with no history of previous TB treatment (37.1%) and the disproportionately high number of female patients (74%) respectively stress for infection control measures and provision of early and high quality care for female drug susceptible TB patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06935-6.
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Affiliation(s)
- Farah Naz
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan.
| | - Abdul Wahid
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Izaz Ahmad
- Department of Biology, Syed Babar Ali School of Science and Engineering, Lahore University of Management Sciences, Lahore, Pakistan
| | - Asad Khan
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Muhammad Abubakar
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Shabir Ahmed Khan
- Pakistan Centre of Excellence in Vaccinology & Biotechnology, University of Balochistan, Quetta, Pakistan
| | - Amjad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
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Baluku JB, Mukasa D, Bongomin F, Stadelmann A, Nuwagira E, Haller S, Ntabadde K, Turyahabwe S. Gender differences among patients with drug resistant tuberculosis and HIV co-infection in Uganda: a countrywide retrospective cohort study. BMC Infect Dis 2021; 21:1093. [PMID: 34689736 PMCID: PMC8542192 DOI: 10.1186/s12879-021-06801-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/18/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Gender differences among patients with drug resistant tuberculosis (DRTB) and HIV co-infection could affect treatment outcomes. We compared characteristics and treatment outcomes of DRTB/HIV co-infected men and women in Uganda. METHODS We conducted a retrospective chart review of patients with DRTB from 16 treatment sites in Uganda. Eligible patients were aged ≥ 18 years, had confirmed DRTB, HIV co-infection and a treatment outcome registered between 2013 and 2019. We compared socio-demographic and clinical characteristics and tuberculosis treatment outcomes between men and women. Potential predictors of mortality were determined by cox proportional hazard regression analysis that controlled for gender. Statistical significance was set at p < 0.05. RESULTS Of 666 DRTB/HIV co-infected patients, 401 (60.2%) were men. The median (IQR) age of men and women was 37.0 (13.0) and 34.0 (13.0) years respectively (p < 0.001). Men were significantly more likely to be on tenofovir-based antiretroviral therapy (ART), high-dose isoniazid-containing DRTB regimen and to have history of cigarette or alcohol use. They were also more likely to have multi-drug resistant TB, isoniazid and streptomycin resistance and had higher creatinine, aspartate and gamma-glutamyl aminotransferase and total bilirubin levels. Conversely, women were more likely to be unemployed, unmarried, receive treatment from the national referral hospital and to have anemia, a capreomycin-containing DRTB regimen and zidovudine-based ART. Treatment success was observed among 437 (65.6%) and did not differ between the genders. However, mortality was higher among men than women (25.7% vs. 18.5%, p = 0.030) and men had a shorter mean (standard error) survival time (16.8 (0.42) vs. 19.0 (0.46) months), Log Rank test (p = 0.046). Predictors of mortality, after adjusting for gender, were cigarette smoking (aHR = 4.87, 95% CI 1.28-18.58, p = 0.020), an increase in alanine aminotransferase levels (aHR = 1.05, 95% CI 1.02-1.07, p < 0.001), and history of ART default (aHR = 3.86, 95% CI 1.31-11.37, p = 0.014) while a higher baseline CD4 count was associated with lower mortality (aHR = 0.94, 95% CI 0.89-0.99, p = 0.013 for every 10 cells/mm3 increment). CONCLUSION Mortality was higher among men than women with DRTB/HIV co-infection which could be explained by several sociodemographic and clinical differences.
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Affiliation(s)
- Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda ,grid.11194.3c0000 0004 0620 0548Makerere University Lung Institute, PO Box 26343, Kampala, Uganda
| | - David Mukasa
- grid.31501.360000 0004 0470 5905Complex Diseases and Genome Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Felix Bongomin
- grid.442626.00000 0001 0750 0866Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Anna Stadelmann
- grid.17635.360000000419368657Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN USA
| | - Edwin Nuwagira
- grid.33440.300000 0001 0232 6272Infectious Diseases Unit, Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Sabine Haller
- grid.7400.30000 0004 1937 0650Department of Public and Global Health, Epidemiology, Biostatistics, & Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Kauthrah Ntabadde
- grid.415861.f0000 0004 1790 6116MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Stavia Turyahabwe
- grid.415705.2National Tuberculosis and Leprosy Control Program, Ministry of Health, Kampala, Uganda
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Abbas S, Denholm J, Kermode M, Xiaoguang Y, Kane S. Receiving healthcare for drug-resistant TB: a cross-sectional survey from Pakistan. Public Health Action 2021; 11:114-119. [PMID: 34567986 DOI: 10.5588/pha.20.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe and quantify patients' self-reported experiences of receiving healthcare from Pakistan's Programmatic Management of Drug-Resistant Tuberculosis (PMDT) model of care, and to understand these experiences within the broader context of Pakistan's health system. METHOD This was a cross-sectional survey of patients attending three PMDT clinics in Khyber-Pakhtunkhwa Province in Pakistan. RESULTS The median consultation time at the PMDT clinics was 10 minutes. In their most recent visit to the PMDT clinic, 34.9% of patients spent >40% of their monthly income to access treatment. To specify, 71% of patients reported spending out-of-pocket for ancillary medicines and 44.7% for laboratory tests. In 10.5% of cases, medicines for drug-resistant TB (DR-TB) were dispensed without the patient attending the clinic. Only 43.7% of treatment supporters regularly accompanied patients to the clinic, and 6% supervised the patient's intake of medicines. Disbursement of financial support was irregular in 98.6% of cases. Only 6.2% of patients received their daily injections from a public facility, the rest went elsewhere. CONCLUSION Several shortcomings in PMDT services, including hurried consultations, irregularities in financial support, and gaps in Pakistan's broader health system undermined healthcare experience of patients with DR-TB. To improve health outcomes and patients' care experience these service gaps need to be addressed.
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Affiliation(s)
- S Abbas
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - J Denholm
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC, Australia
| | - M Kermode
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Y Xiaoguang
- School of Public Health, Fudan University, Shanghai, China
| | - S Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Fu L, Weng T, Sun F, Zhang P, Li H, Li Y, Yang Q, Cai Y, Zhang X, Liang H, Chen X, Wang Z, Liu L, Zhang W, Deng G. Insignificant difference in culture conversion between bedaquiline-containing and bedaquiline-free all-oral short regimens for multidrug-resistant tuberculosis. Int J Infect Dis 2021; 111:138-147. [PMID: 34454119 DOI: 10.1016/j.ijid.2021.08.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) patients have been suffering long, ineffective, and toxic treatment until short-course injectable-free regimens emerged. However, the new WHO-recommended regimens might be less feasible in the real-world setting. Here, we evaluated two optimized all-oral short-course regimens in China. METHODS From April 2019 to August 2020, we conducted a prospective nonrandomized controlled trial and consecutively included 103 MDR-TB patients diagnosed with pulmonary MDR-TB in Shenzhen, China. A 4-5 drug regimen of 9-12 months was tailored to the strain's resistance patterns, patients' affordability, and tolerance to drugs. This was an interim analysis, focusing on the early treatment period. RESULTS 53.4% (55/103) of patients were prescribed linezolid, fluoroquinolone (FQ), clofazimine, cycloserine, and pyrazinamide, followed by a regimen in which clofazimine was replaced by bedaquiline (35/103, 34.0%). The culture conversion rate was 83.1% and 94.4% at two and four months, respectively, with no significant difference between bedaquiline-free and bedaquiline-containing cases and between FQ-susceptible and FQ-resistant cases. Among 41 patients who completed treatment, 40 (97.6%) patients had a favorable outcome and no relapse was observed. Peripheral neuropathy and arthralgia/myalgia were the most frequent AEs (56.3%, 58/103). 18 AEs caused permanent discontinuation of drugs, mostly due to pyrazinamide and linezolid. CONCLUSION Optimized all-oral short-course regimens showed satisfactory efficacy and safety in early treatment stage. Further research is needed to confirm these results.
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Affiliation(s)
- Liang Fu
- Pulmonary Diseases Department Two, National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Taoping Weng
- Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Feng Sun
- Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Peize Zhang
- Pulmonary Diseases Department Two, National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Hui Li
- Pulmonary Diseases Department Two, National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Yang Li
- Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Qianting Yang
- Guangdong Key Lab for Diagnosis &Treatment of Emerging Infectious Disease, Shenzhen Third People's Hospital, National clinical research center for infectious disease, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Yi Cai
- Department of Pathogen Biology, Guangdong Key Laboratory of Regional Immunity and Diseases, Shenzhen University School of Medicine, Shenzhen, 518060, China
| | - Xilin Zhang
- The Fourth People's Hospital of Foshan, Foshan, 528000, China
| | - Hancheng Liang
- Tuberculosis Diseases Department Two, The Sixth People's Hospital of Dongguan, Dongguan, 523000, China
| | - Xinchun Chen
- Department of Pathogen Biology, Guangdong Key Laboratory of Regional Immunity and Diseases, Shenzhen University School of Medicine, Shenzhen, 518060, China
| | - Zhaoqin Wang
- Pulmonary Diseases Department Two, National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China
| | - Lei Liu
- Pulmonary Diseases Department Two, National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China.
| | - Wenhong Zhang
- Departments of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Guofang Deng
- Pulmonary Diseases Department Two, National Clinical Research Center for Infectious Disease (Shenzhen), Guangdong Provincial Clinical Research Center for Infectious Diseases (Tuberculosis), Shenzhen Third People's Hospital, Southern University of Science and Technology, Shenzhen, 518112, China.
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Arif A, Ahmad E, Khan FN, Fatima R. A cohort study analyzing the impact of socioeconomic and spatial characteristics alongside treatment regimens on the environmental-health outcomes of the MDR-TB treatment in Pakistan. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:34953-34967. [PMID: 33661501 DOI: 10.1007/s11356-021-13196-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Abstract
This study identifies and analyzes a number of factors that correlate with the environmental-health outcome of multi-drug resistance tuberculosis (MDR-TB) treatment in Pakistan. Survival analysis is carried out by applying the multivariable Cox Proportional Hazard model on secondary data of 369 patients registered at three main MDR-TB sites in Pakistan during 2012-2017. Results show that there is no difference in survival of patients between the two treatment arms, hospital and ambulatory care. Male gender and travel expenditure are found to be negatively associated with the environmental-health outcome, whereas spatial characteristic of time expenditure is positively related to it supporting distance bias approach. Medical expenditure is also positively related to the environmental-health outcome. The study concludes that availability of affordable and accessible health services, better environmental conditions, and ambulatory care based on WHO recommendation as well as health education along with social protection schemes should be ensured by the government to improve environmental-health outcome in the resource-scarce setting in Pakistan.
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Affiliation(s)
- Ankasha Arif
- School of Economics, Quaid-i-Azam University, Islamabad, Pakistan.
| | - Eatzaz Ahmad
- School of Economics, Quaid-i-Azam University, Islamabad, Pakistan
| | | | - Razia Fatima
- National Tuberculosis Control Program, Ministry of Health, Pakistan, EPI building, F block, PM Health Complex, Chak Shahzad, Islamabad, Pakistan
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Bahraminia F, Azimi T, Zangiabadian M, Nasiri MJ, Goudarzi M, Dadashi M, Imani Fooladi AA. Rifampicin-resistant tuberculosis in Iran: A systematic review and meta-analysis. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2021; 24:720-725. [PMID: 34630948 PMCID: PMC8487596 DOI: 10.22038/ijbms.2021.47360.10901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 03/02/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Farhad Bahraminia
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Taher Azimi
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Moein Zangiabadian
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Abbas Ali Imani Fooladi
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Atif M, Ahmad W, Ahmad N, Malik I, Sarwar S. Treatment outcomes among multidrug-resistant TB patients in Bahawal Victoria Hospital, Bahawalpur, Pakistan: a retrospective record review. Trans R Soc Trop Med Hyg 2021; 114:733-741. [PMID: 32556195 DOI: 10.1093/trstmh/traa040] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/28/2020] [Accepted: 05/12/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study aims to evaluate the treatment outcomes and factors associated with unsuccessful treatment outcomes among multidrug-resistant TB (MDR-TB) patients. METHOD This was a retrospective observational study conducted at the Bahawal Victoria Hospital, Bahawalpur, Pakistan. The sociodemographic, clinical and treatment-related data of MDR-TB patients registered at the study site between June 2014 and December 2016 were retrospectively collected. Patients' treatment outcomes were categorized on the basis of WHO-recommended criteria. Multivariate binary logistic regression analysis was used to find the independent factors associated with unsuccessful treatment outcomes. RESULTS Out of 179 MDR-TB patients, 106 (59.2%) completed their treatment successfully. The remaining 73 patients (40.8%) had unsuccessful treatment outcomes, among whom 45 (25.1%) died, while 18 (10.1%) were lost to follow-up. Factors associated with unsuccessful treatment outcomes included age ≥40 y (AOR 4.310; p = 0.006), unsuccessful interim treatment outcomes (AOR 5.810; p = 0.032), occurrence of adverse events (AOR 0.290; p = 0.029) and ofloxacin resistance (AOR 2.952; p = 0.042). CONCLUSION The treatment success rate among the selected cohort of MDR-TB patients was less than the target of ≥75% set by the WHO in the End TB Strategy. The lower treatment success rate at the study site requires urgent attention from clinicians and program managers.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Wajiha Ahmad
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Nafees Ahmad
- Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Balochistan, Pakistan
| | - Iram Malik
- Department of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Punjab, Pakistan
| | - Sajjad Sarwar
- Department of Pulmonology, Bahawal Victoria Hospital, Bahawalpur, Punjab, Pakistan
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Saifullah A, Mallhi TH, Khan YH, Iqbal MS, Alotaibi NH, Alzarea AI, Rasheed M. Evaluation of risk factors associated with the development of MDR- and XDR-TB in a tertiary care hospital: a retrospective cohort study. PeerJ 2021; 9:e10826. [PMID: 33777510 PMCID: PMC7982078 DOI: 10.7717/peerj.10826] [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: 01/06/2020] [Accepted: 01/03/2021] [Indexed: 01/27/2023] Open
Abstract
Background Drug resistant tuberculosis (DR-TB) infringes substantial burden in terms of longer treatment duration, morbidity and mortality. Timely identification of patients at risks of DR-TB will aid individualized treatment. Current study was aimed to ascertain several factors associated with DR-TB among patients attending a tertiary care hospital. Methods This retrospective study was conducted among patients with confirmed diagnosis of DR-TB and drug susceptible TB (DS-TB) seeking medical care from a tertiary care hospital during 2014–2019. The types of DR-TB included were rifampicin resistant tuberculosis (RR-TB), Multidrug resistant tuberculosis (MDR-TB) and extensively drug resistant tuberculosis (XDR-TB). Appropriate statistical methods were implied to evaluate the factors associated with DR-TB. Results Out of 580 patients, DS-TB was diagnosed in 198 (34.1%) patients while DR-TB was present in 382 patients. Of resistance cases, RR-TB, MDR-TB and XDR-TB were diagnosed in 176 (30.3%), 195 (33.6%) and 11 (1.9%) patients, respectively. Significant differences (P < 0.05) in demographics and clinico-laboratory characteristics were observed between patients with DS-TB and DR-TB. Logistic regression analysis revealed age ≤38 years (OR: 2.5), single marital status (OR: 11.1), tobacco use (OR: 2.9), previous treatment (OR: 19.2), treatment failure (OR: 9.2) and cavity on chest X-ray (OR: 30.1) as independent risk factors for MDR-TB. However, XDR-TB was independently associated with age group of ≤38 years (OR: 13.6), students (OR: 13.0), previous treatment (OR: 12.5), cavity on chest X-ray (OR: 59.6). The independent risk factors associated with RR-TB are age ≤38 years (OR: 2.8), females (OR: 5.7), unemployed (OR: 41.5), treatment failure (OR: 4.9), previous treatment (OR: 38.2) and cavity on chest X-ray (OR: 4.3). ROC curve analysis accentuate the excellent predictive accuracy of all logistic regression models as shown by AUC (0.968, P < 0.001) for MDR-TB, AUC (0.941, P < 0.001) for XDR-TB and AUC (0.962, P < 0.001) for RR-TB. Conclusions Current study demonstrates a sizeable extent of resistant cases among pulmonary TB patients. This study presaged significant risk of DR-TB among females, young adults, unemployed, smokers, patients with previous treatment failure and cavitation on chest X-ray. Timely identification of high risk patients will give pronounced advantages regarding appropriate choices of prevention, treatment and disease control.
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Affiliation(s)
- Amna Saifullah
- Institute of Pharmacy, Lahore College for Women University, Lahore, Punjab, Pakistan.,Current Affiliation: Department of Pharmacy, University of Lahore, Chenab Campus, Gujrat, Pakistan
| | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-kharj, Saudi Arabia
| | - Nasser Hadal Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Abdulaziz Ibrahim Alzarea
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | - Maria Rasheed
- Institute of Pharmacy, Lahore College for Women University, Lahore, Punjab, Pakistan
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Abbas S, Kermode M, Kane S. Strengthening the response to drug-resistant TB in Pakistan: a practice theory-informed approach. Public Health Action 2020; 10:147-156. [PMID: 33437680 DOI: 10.5588/pha.20.0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background While Pakistan's Programmatic Management of Drug-Resistant Tuberculosis (PMDT) programme, launched in 2010, initially yielded significant gains in treatment outcomes, performance has since plateaued, and in some cases, regressed. Objective To critically investigate why the PMDT programme, well-structured and generously resourced as it is, could not improve upon or sustain this early success and to illustrate the use of practice theory as a framework to analyse functioning of health systems. Method A practice theory-informed ethnographic study was conducted at three PMDT clinics. The analysis drew on 9 months of participant observation and in-depth interviews with 13 healthcare providers and four managers. Results The PMDT model primarily focused on materialities such as infrastructure, drugs and numbers of people tested, and little on developing competencies of the PMDT staff to provide responsive care. This emphasis on materialities, and the linked focus of accountability processes, led the PMDT staff to create meanings that translated into prioritisation of certain easy-to-measure health-care practices at the expense of more difficult-to-measure practices related to responsiveness that are arguably also important for successful patient outcomes. Conclusion A narrow focus on measurable inputs, originating from priorities set at global and national levels, influence frontline care practices with negative consequences for quality of care and patient outcomes. Greater emphasis on improving routine process of care can enhance the effectiveness of the PMDT model of care. Practice theory provides a robust analytical framework to critically interrogate health systems and healthcare provision.
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Affiliation(s)
- S Abbas
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - M Kermode
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - S Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Li Q, Lu M, Hsieh E, Wu L, Wu Y, Wang M, Wang L, Zhao G, Xie L, Qian HZ. Time to sputum culture conversion and its predictors among patients with multidrug-resistant tuberculosis in Hangzhou, China: A retrospective cohort study. Medicine (Baltimore) 2020; 99:e23649. [PMID: 33327347 PMCID: PMC7738096 DOI: 10.1097/md.0000000000023649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022] Open
Abstract
The objective is to investigate the time to initial sputum culture conversion (SCC) and its predictors among multidrug-resistant tuberculosis (MDR-TB) patients in Hangzhou, China.A retrospective cohort study was conducted among patients who initiated MDR-TB treatment from 2011 to 2015 in Hangzhou, China. Successful achievement of initial SCC was defined as 2 consecutive negative cultures taken at least 30 days apart after initiation of treatment of MDR-TB. Successful treatment outcomes included being cured and completing treatment, while poor treatment outcomes included treatment failure, loss to follow-up, and death. Time to initial SCC was analyzed using the Kaplan-Meier method, and Cox proportional hazards regression was used to identify predictors of SCC.Among 384 patients enrolled with MDR-TB, 359 (93.5%) successfully achieved initial SCC after a median of 85 days (interquartile range, 40-112 days). A higher rate of SCC was observed in participants with successful treatment outcomes than those with poor treatment outcomes (P<.01). Multivariate analysis showed that age 25 to 64 years (compared with age<25; adjusted odds ratio [AOR], 0.7; 95% confidence interval [CI], 0.5-0.9; P < .01), age ≥65 years (compared with age < 25; AOR, 0.5; 95% CI, 0.3-0.8; P < .01), and household registration in Hangzhou (compared with non-Hangzhou registration; AOR, 1.3; 95% CI, 1.0-1.5; P < .05) were found to be associated with SCC.Although high SCC and treatment success rates were observed among MDR-TB patients in Hangzhou, the prolonged duration to initial SCC underscores the importance of emphasizing measures for infection control. A new policy of shifting outpatient treatment to inpatient treatment in China may reduce the risk of transmission from patients in the time window prior to SCC.
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Affiliation(s)
- Qingchun Li
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Min Lu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Evelyn Hsieh
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Limin Wu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Yifei Wu
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Meng Wang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Le Wang
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Gang Zhao
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Li Xie
- Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Han-Zhu Qian
- SJTU-Yale Joint Center for Biostatistics and Data Science, Shanghai Jiao Tong University (SJTU), Shanghai, China
- Department of Biostatistics, Yale School of Public Health, New Haven, CT
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21
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Welekidan LN, Skjerve E, Dejene TA, Gebremichael MW, Brynildsrud O, Agdestein A, Tessema GT, Tønjum T, Yimer SA. Characteristics of pulmonary multidrug-resistant tuberculosis patients in Tigray Region, Ethiopia: A cross-sectional study. PLoS One 2020; 15:e0236362. [PMID: 32797053 PMCID: PMC7428183 DOI: 10.1371/journal.pone.0236362] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/03/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is among the top 10 causes of mortality and the first killer among infectious diseases worldwide. One of the factors fuelling the TB epidemic is the global rise of multidrug resistant TB (MDR-TB). The aim of this study was to determine the magnitude and factors associated with MDR-TB in the Tigray Region, Ethiopia. METHOD This study employed a facility-based cross-sectional study design, which was conducted between July 2018 and August 2019. The inclusion criteria for the study participants were GeneXpert-positive who were not under treatment for TB, PTB patients' ≥15 years of age and who provided written informed consent. A total of 300 participants were enrolled in the study, with a structured questionnaire used to collect data on clinical, sociodemographic and behavioral factors. Sputum samples were collected and processed for acid-fast bacilli staining, culture and drug susceptibility testing. Drug susceptibility testing was performed using a line probe assay. Logistic regression was used to analyze associations between outcome and predictor variables. RESULTS The overall proportion of MDR-TB was 16.7% (11.6% and 32.7% for new and previously treated patients, respectively). Of the total MDR-TB isolates, 5.3% were pre-XDR-TB. The proportion of MDR-TB/HIV co-infection was 21.1%. A previous history of TB treatment AOR 3.75; 95% CI (0.7-2.24), cigarette smoking AOR 6.09; CI (1.65-2.50) and patients who had an intermittent fever (AOR = 2.54, 95% CI = 1.21-5.4) were strongly associated with MDR-TB development. CONCLUSIONS The magnitude of MDR-TB observed among new and previously treated patients is very alarming, which calls for an urgent need for intervention. The high proportion of MDR-TB among newly diagnosed cases indicates ongoing transmission, which suggests the need for enhanced TB control program performance to interrupt transmission. The increased proportion of MDR-TB among previously treated cases indicates a need for better patient management to prevent the evolution of drug resistance. Assessing the TB control program performance gaps and an optimal implementation of the WHO recommended priority actions for the management of drug-resistant TB, is imperative to help reduce the current high MDR-TB burden in the study region.
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Affiliation(s)
- Letemichael Negash Welekidan
- Department of Para Clinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
- Department of Production Animal Medicine, Norwegian University of Life Sciences, Oslo, Norway
- Department of Medical Microbiology and Immunology, Division of Biomedical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Eystein Skjerve
- Department of Production Animal Medicine, Norwegian University of Life Sciences, Oslo, Norway
| | - Tsehaye Asmelash Dejene
- Department of Medical Microbiology and Immunology, Division of Biomedical Sciences, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | | | - Ola Brynildsrud
- Department of Para Clinical Sciences, Norwegian University of Life Sciences, Oslo, Norway
- Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway
| | | | | | - Tone Tønjum
- Department of Microbiology, Unit for Genome Dynamics, University of Oslo, Oslo, Norway
- Department of Microbiology, Unit for Genome Dynamics, Oslo University Hospital, Oslo, Norway
| | - Solomon Abebe Yimer
- Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway
- Department of Microbiology, Unit for Genome Dynamics, University of Oslo, Oslo, Norway
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Alene KA, Viney K, Gray DJ, McBryde ES, Xu Z, Clements ACA. Development of a risk score for prediction of poor treatment outcomes among patients with multidrug-resistant tuberculosis. PLoS One 2020; 15:e0227100. [PMID: 31899769 PMCID: PMC6941813 DOI: 10.1371/journal.pone.0227100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/12/2019] [Indexed: 11/18/2022] Open
Abstract
Background Treatment outcomes among patients treated for multidrug-resistant tuberculosis (MDR-TB) are often sub-optimal. Therefore, the early prediction of poor treatment outcomes may be useful in patient care, especially for clinicians when they have the ability to make treatment decisions or offer counselling or additional support to patients. The aim of this study was to develop a simple clinical risk score to predict poor treatment outcomes in patients with MDR-TB, using routinely collected data from two large countries in geographically distinct regions. Methods We used MDR-TB data collected from Hunan Chest Hospital, China and Gondar University Hospital, Ethiopia. The data were divided into derivation (n = 343; 60%) and validation groups (n = 227; 40%). A poor treatment outcome was defined as treatment failure, lost to follow up or death. A risk score for poor treatment outcomes was derived using a Cox proportional hazard model in the derivation group. The model was then validated in the validation group. Results The overall rate of poor treatment outcome was 39.5% (n = 225); 37.9% (n = 86) in the derivation group and 40.5% (n = 139) in the validation group. Three variables were identified as predictors of poor treatment outcomes, and each was assigned a number of points proportional to its regression coefficient. These predictors and their points were: 1) history of taking second-line TB treatment (2 points), 2) resistance to any fluoroquinolones (3 points), and 3) smear did not convert from positive to negative at two months (4 points). We summed these points to calculate the risk score for each patient; three risk groups were defined: low risk (0 to 2 points), medium risk (3 to 5 points), and high risk (6 to 9 points). In the derivation group, poor treatment outcomes were reported for these three groups as 14%, 27%, and 71%, respectively. The area under the receiver operating characteristic curve for the point system in the derivation group was 0.69 (95% CI 0.60 to 0.77) and was similar to that in the validation group (0.67; 95% CI 0.56 to 0.78; p = 0.82). Conclusion History of second-line TB treatment, resistance to any fluoroquinolones, and smear non-conversion at two months can be used to estimate the risk of poor treatment outcome in patients with MDR-TB with a moderate degree of accuracy (AUROC = 0.69).
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Affiliation(s)
- Kefyalew Addis Alene
- Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- * E-mail:
| | - Kerri Viney
- Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Darren J. Gray
- Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Emma S. McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Zuhui Xu
- Department of Tuberculosis Control, Tuberculosis Control Institute of Hunan Province, Changsha city, Hunan Province, China
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Chaves Torres NM, Quijano Rodríguez JJ, Porras Andrade PS, Arriaga MB, Netto EM. Factors predictive of the success of tuberculosis treatment: A systematic review with meta-analysis. PLoS One 2019; 14:e0226507. [PMID: 31881023 PMCID: PMC6934297 DOI: 10.1371/journal.pone.0226507] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/27/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To produce pooled estimates of the global results of tuberculosis (TB) treatment and analyze the predictive factors of successful TB treatment. METHODS Studies published between 2014 and 2019 that reported the results of the treatment of pulmonary TB and the factors that influenced these results. The quality of the studies was evaluated according to the Newcastle-Ottawa quality assessment scale. A random effects model was used to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) in February 2019 under number CRD42019121512. RESULTS A total of 151 studies met the criteria for inclusion in this review. The success rate for the treatment of drug-sensitive TB in adults was 80.1% (95% CI: 78.4-81.7). America had the lowest treatment success rate, 75.9% (95% CI: 73.8-77.9), and Oceania had the highest, 83.9% (95% CI: 75.2-91.0). In children, the success rate was 84.8% (95% CI: 77.7-90.7); in patients coinfected with HIV, it was 71.0% (95% CI: 63.7-77.8), in patients with multidrug-resistant TB, it was 58.4% (95% CI: 51.4-64.6), in patients with and extensively drug-resistant TB it was 27.1% (12.7-44.5). Patients with negative sputum smears two months after treatment were almost three times more likely to be successfully treated (OR 2.7; 1.5-4.8), whereas patients younger than 65 years (OR 2.0; 1.7-2.4), nondrinkers (OR 2.0; 1.6-2.4) and HIV-negative patients (OR 1.9; 1.6-2.5 3) were two times more likely to be successfully treated. CONCLUSION The success of TB treatment at the global level was good, but was still below the defined threshold of 85%. Factors such as age, sex, alcohol consumption, smoking, lack of sputum conversion at two months of treatment and HIV affected the success of TB treatment.
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Affiliation(s)
- Ninfa Marlen Chaves Torres
- Department of Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Medicine, Nueva Granada Military University, Bogotá, D.C., Colombia
| | | | | | - María Belen Arriaga
- Gonzalo Moniz Institute, Gonzalo Cruz Foundation, Salvador, Bahia, Brazil
- Department of Epidemiology, José Silveira Foundation, Salvador, Bahia, Brazil
| | - Eduardo Martins Netto
- Department of Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Department of Epidemiology, José Silveira Foundation, Salvador, Bahia, Brazil
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Bhering M, Duarte R, Kritski A. Predictive factors for unfavourable treatment in MDR-TB and XDR-TB patients in Rio de Janeiro State, Brazil, 2000-2016. PLoS One 2019; 14:e0218299. [PMID: 31747405 PMCID: PMC6867644 DOI: 10.1371/journal.pone.0218299] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/31/2019] [Indexed: 11/18/2022] Open
Abstract
SETTING The State of Rio de Janeiro stands out as having the second highest incidence and the highest mortality rate due to TB in Brazil. This study aims at identifying the factors associated with the unfavourable treatment of MDR/XDR-TB patients in that State. METHOD Data on 2269 MDR-TB cases reported in 2000-2016 in Rio de Janeiro State were collected from the Tuberculosis Surveillance System. Bivariate and multivariate logistic regressions were run to estimate the factors associated with unfavourable outcomes (failure, default, and death) and, specifically, default and death. RESULTS The proportion of unfavourable outcomes was 41.9% among MDR-TB and 81.5% among XDR-TB. Having less than 8 years of schooling, and being an Afro-Brazilian, under 40 years old and drug user were associated with unfavourable outcome and default. Bilateral disease, HIV positive, and comorbidities were associated with death. XDR-TB cases had a 4.7-fold higher odds of an unfavourable outcome, with 29.3% of such cases being not treated for multidrug resistance in the past. CONCLUSION About 30% of XDR-TB cases may have occurred by primary transmission. The high rates of failure and death in this category reflect the limitation of treatment options. This highlights the urgency to incorporate new drugs in the treatment.
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Affiliation(s)
- Marcela Bhering
- School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Brazilian Tuberculosis Research Network / REDE TB, Rio de Janeiro, Brazil
| | - Raquel Duarte
- EPIUnit, Public Health Institute, University of Porto, Porto, Portugal
- Public Health Science and Medical Education Department, School of Medicine, University of Porto, Porto, Portugal
| | - Afrânio Kritski
- School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Brazilian Tuberculosis Research Network / REDE TB, Rio de Janeiro, Brazil
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Arroyo LH, Ramos ACV, Yamamura M, Berra TZ, Alves LS, Belchior ADS, Santos DT, Alves JD, Campoy LT, Arcoverde MAM, Bollela VR, Bombarda S, Nunes C, Arcêncio RA. Predictive model of unfavorable outcomes for multidrug-resistant tuberculosis. Rev Saude Publica 2019; 53:77. [PMID: 31553380 PMCID: PMC6752648 DOI: 10.11606/s1518-8787.2019053001151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/26/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE to analyze the temporal trend, identify the factors related and elaborate a predictive model for unfavorable treatment outcomes for multidrug-resistant tuberculosis (MDR-TB). METHODS Retrospective cohort study with all cases diagnosed with MDR-TB between the years 2006 and 2015 in the state of São Paulo. The data were collected from the state system of TB cases notifications (TB-WEB). The temporal trend analyzes of treatment outcomes was performed through the Prais-Winsten analysis. In order to verify the factors related to the unfavorable outcomes, abandonment, death with basic cause TB and treatment failure, the binary logistic regression was used. Pictorial representations of the factors related to treatment outcome and their prognostic capacity through the nomogram were elaborated. RESULTS Both abandonment and death have a constant temporal tendency, whereas the failure showed it as decreasing. Regarding the risk factors for such outcomes, using illicit drugs doubled the odds for abandonment and death. Besides that, being diagnosed in emergency units or during hospitalizations was a risk factor for death. On the contrary, having previous multidrug-resistant treatments reduced the odds for the analyzed outcomes by 33%. The nomogram presented a predictive model with 65% accuracy for dropouts, 70% for deaths and 80% for failure. CONCLUSIONS The modification of the current model of care is an essential factor for the prevention of unfavorable outcomes. Through predictive models, as presented in this study, it is possible to develop patient-centered actions, considering their risk factors and increasing the chances for cure.
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Affiliation(s)
- Luiz Henrique Arroyo
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | | | - Mellina Yamamura
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Thais Zamboni Berra
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Luana Seles Alves
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | | | - Danielle Talita Santos
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Josilene Dália Alves
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Laura Terenciani Campoy
- Universidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | | | - Valdes Roberto Bollela
- Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Ribeirão Preto, SP, Brasil
| | - Sidney Bombarda
- Secretaria de Estado da Saúde de São Paulo. São Paulo, SP, Brasil
| | - Carla Nunes
- Universidade NOVA de Lisboa. Escola Nacional de Saúde Pública. Lisboa, Portugal
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Khan I, Ahmad N, Khan S, Muhammad S, Ahmad Khan S, Ahmad I, Khan A, Gulalai, Atif M. Evaluation of treatment outcomes and factors associated with unsuccessful outcomes in multidrug resistant tuberculosis patients in Baluchistan province of Pakistan. J Infect Public Health 2019; 12:809-815. [PMID: 31056438 DOI: 10.1016/j.jiph.2019.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/15/2018] [Accepted: 04/11/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Evaluating treatment outcomes of a cohort of patients is an effective way for analyzing the effectiveness of a program. Information regarding drug resistance pattern, detailed management, treatment outcomes and factors associated with unsuccessful outcomes in multidrug resistant (MDR-TB) patients is missing from Baluchistan province of Pakistan. METHODS This study was carried out at Programmatic Management of Drug Resistant TB unit at Fatimah Jinnah General and Chest Hospital Quetta. All eligible 186 MDR-TB patients enrolled at the study site from January 1, 2012 to April 30, 2016 were retrospectively followed until the treatment outcomes were reported. Data was abstracted through a standardized data collection form and analysed by SPSS 20. Multivariate binary logistic regression (MVBLR) analysis was used to evaluate factors associated with i) death and treatment failure and ii) lost to follow up. A p-value of <0.05 was considered statistically significant. RESULTS The study participants were resistant to a median of four drugs (range 2-8) with majority being resistant to any second-line anti-TB drug (SLD) (55.5%). Among SLD, resistance was highest for ofloxacin (52.2%). The study site had an overall treatment success rate of 71.6%. A total of 129 (69.4%) patients were cured, four (2.2%) completed treatment, 37 died (19.9%), 14 (7.5%) were lost to follow up and two (1.1%) were declared treatment failures. In MVBLR analysis, patients' age of >40 years (OR = 4.249, p-value = 0.001) had statistically significant positive and baseline body weight of >40 kg (OR = 0.256, p-value = 0.002) had statistically significant negative association with death and treatment failure. No factor had statistical significant association with lost to follow up. CONCLUSION Overall treatment success rate was promising but did not achieve the target success rate (>75%) set by World Health Organization. It can be further improved by paying special attention and providing enhanced management to the patients with risk factors for unsuccessful outcomes.
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Affiliation(s)
- Imran Khan
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Baluchistan Quetta, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Baluchistan Quetta, Pakistan.
| | | | - Shafi Muhammad
- Department of Pharmacognosy, Faculty of Pharmacy and Health Sciences, University of Baluchistan Quetta, Pakistan
| | - Shabir Ahmad Khan
- Centre of excellence in Vaccinology & Biotechnology, University of Baluchistan Quetta, Pakistan
| | - Izaz Ahmad
- Department of Biology, Syed Babar Ali School of Science and Engineering, Lahore University of Management Sciences Lahore, Pakistan
| | - Asad Khan
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Baluchistan Quetta, Pakistan
| | - Gulalai
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Baluchistan Quetta, Pakistan
| | - Muhammad Atif
- Department of Pharmacy, The Islamia University Bahawalpur, Bahawalpur, Pakistan
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