1
|
Son E, Choi H, Mok J, Kang YA, Jeong D, Jeon D. Timing and predictors of death during treatment in patients with multidrug/rifampin-resistant tuberculosis in South Korea. Korean J Intern Med 2024; 39:640-649. [PMID: 38910510 PMCID: PMC11236803 DOI: 10.3904/kjim.2024.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/28/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND/AIMS This study aimed to investigate the timing and predictors of death during treatment among patients with multidrug/rifampin-resistant tuberculosis (MDR/RR-TB) in South Korea. METHODS This was a retrospective cohort study that included MDR/RR-TB cases notified between 2011 and 2017 in South Korea. RESULTS Among 7,226 MDR/RR-TB cases, 699 (9.7%) died at a median of 167 days (IQR 51-358 d) from the initiation of MDR-TB treatment. The cumulative proportion of all-cause death was 35.5% at 90 days and 52.8% at 180 days from treatment initiation. TB-related deaths occurred at a median of 133 days (IQR 32-366 d), which was significantly earlier than the median of 184 days (IQR 68-356 d) for non-TB-related deaths (p = 0.002). In a multivariate analysis, older age was the factor most strongly associated with death, with those aged ≥ 75 years being 68 times more likely to die (aHR 68.11, 95% CI 21.75-213.26), compared those aged ≤ 24 years. In addition, male sex, comorbidities (cancer, human immunodeficiency virus, and end stage renal disease), the lowest household income class, and TB-specific factors (previous history of TB treatment, smear positivity, and fluoroquinolone resistance) were identified as independent predictors of all-cause death. CONCLUSION This nationwide study highlights increased deaths during the intensive phase and identifies high-risk groups including older people and those with comorbidities or socioeconomic vulnerabilities. An integrated and comprehensive strategy is required to reduce mortality in patients with MDR/RR-TB, particularly focusing on the early stages of treatment and target populations.
Collapse
Affiliation(s)
- Eunjeong Son
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Hongjo Choi
- Division of Health Policy and Management, Korea University College of Health Science, Seoul, Korea
| | - Jeongha Mok
- Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dawoon Jeong
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Doosoo Jeon
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| |
Collapse
|
2
|
Bwembya J, Kumar R, Musonda V, Chimzizi R, Kasese-Chanda N, Goma L, Kabaso M, Mihova R, Nyimbili S, Makwambeni V, Nyirenda S, Mwinga A, Lungu P. Mortality among persons with tuberculosis in Zambian hospitals: A retrospective cohort study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003329. [PMID: 38885238 PMCID: PMC11182540 DOI: 10.1371/journal.pgph.0003329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 05/19/2024] [Indexed: 06/20/2024]
Abstract
Tuberculosis (TB) mortality in Zambia remains high at 86 per 100,000 populations, translating to approximately 15,000 TB-related deaths annually. We conducted a nationwide retrospective cohort study to understand predictors, time to death, and probable causes of mortality among persons on TB treatment in Zambia. We reviewed medical records for persons with TB registered in 54 purposively selected hospitals in Zambia between January and December 2019. We fitted a Cox proportional hazards model to identify predictors of mortality. Of the 13,220 records abstracted, 10,987 were analyzed after excluding records of persons who transferred in from other hospitals, those with inconsistent dates and those whose treatment outcome was not evaluated. The majority of persons with TB were men, (61.5%, n = 6,761) with a median age of 36 years (IQR: 27-46 years). Overall, 1,063 (9.7%) died before completing TB treatment (incidence rate = 16.9 deaths per 1,000 person-months). Median age at death was 40 years (IQR: 31-52). The majority of deaths (75.7%, n = 799) occurred in the first two months of TB treatment, with a median time to death of 21 days (IQR: 6-57). Independent risk factors for TB mortality included age >54 years, being treated in Eastern, Southern, Western, Muchinga and Central provinces, receiving treatment from a third-level or mission hospital, methods of diagnosis other than Xpert MTB/RIF, extrapulmonary TB (EPTB), and positive HIV status. Probable causes of death were septic shock (18.8%), TB Immune Reconstitution Inflammatory Syndrome (TB IRIS) (17.8%), end-organ damage (13.4%), pulmonary TB (11.4%), anemia (9.6%) and TB meningitis (7.8%). These results show high mortality among people undergoing TB treatment in Zambia. Interventions targeted at persons most at risk such as the elderly, those with EPTB, and those living with HIV, can help reduce TB-related mortalities in Zambia.
Collapse
Affiliation(s)
- Josphat Bwembya
- Eradicate TB, PATH, Lusaka, Zambia
- Zambart, UNZA Ridgeway, Lusaka, Zambia
| | - Ramya Kumar
- Eradicate TB, PATH, Lusaka, Zambia
- Zambart, UNZA Ridgeway, Lusaka, Zambia
| | | | - Rhehab Chimzizi
- Ministry of Health, Lusaka, Zambia
- USAID STAR Project, Lusaka, Zambia
| | | | | | - Mushota Kabaso
- Ministry of Health, Lusaka, Zambia
- USAID STAR Project, Lusaka, Zambia
| | | | | | | | | | | | | |
Collapse
|
3
|
Suhairi MH, Mohamad M, Isa MR, Mohd Yusoff MAS, Ismail N. Risk factors for tuberculosis-related death among adults with drug-sensitive pulmonary tuberculosis in Selangor, Malaysia from 2013 to 2019: a retrospective cohort study using surveillance data. BMJ Open 2024; 14:e080144. [PMID: 38413152 PMCID: PMC10900436 DOI: 10.1136/bmjopen-2023-080144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES Due to the paucity of literature on risk factors for tuberculosis (TB)-related death, we determine the sociodemographic and clinical risk factors associated with TB-related deaths among adult pulmonary TB (PTB) patients on treatment in Selangor, Malaysia. DESIGN Retrospective cohort study. SETTING Routinely collected primary care data from all government TB clinics in Selangor. PARTICIPANTS Data of 24 570 eligible adult PTB patients from 2013 to 2019 were obtained from Selangor's State Health Department surveillance records. We included PTB patients aged at least 15 years old at the time of diagnosis with complete documentation of the dates of diagnosis, treatment initiation, end of treatment/follow-up and treatment outcomes. We excluded patients whose diagnoses were changed to non-TB, post-mortem TB diagnosis and multidrug-resistant TB (MDR-TB) patients. PRIMARY AND SECONDARY OUTCOME MEASURES TB-related death, determined from the recorded physicians' consensus during the TB mortality meeting. RESULTS TB-related death was significantly associated with far (adjusted HR (aHR) 9.98, 95% CI 4.28 to 23.28) and moderately advanced (aHR 3.23, 95% CI 1.43 to 7.31) radiological findings at diagnosis; concurrent TB meningitis (aHR 7.67, 95% CI 4.53 to 12.98) and miliary TB (aHR 6.32, 95% CI 4.10 to 9.74) involvement; HIV positive at diagnosis (aHR 2.81, 95% CI 2.21 to 3.57); Hulu Selangor (aHR 1.95, 95% CI 1.29 to 2.93), Klang (aHR 1.53, 95% CI 1.18 to 1.98) and Hulu Langat (aHR 1.31, 95% CI 1.03 to 1.68) residing districts; no formal education (aHR 1.70, 95% CI 1.23 to 2.35); unemployment (aHR 1.54, 95% CI 1.29 to 1.84), positive sputum smear acid-fast bacilli (AFB) at diagnosis (aHR 1.51, 95% CI 1.22 to 1.85); rural residency (aHR 1.39, 95% CI 1.13 to 1.72) and advancing age (aHR 1.03, 95% CI 1.02 to 1.03). CONCLUSIONS Far and moderately advanced radiological findings, concurrent TB meningitis and miliary TB involvement, HIV positive, Hulu Selangor, Klang and Hulu Langat residing districts, no formal education, unemployment, positive sputum smear AFB, rural residency and advancing age are risk factors of TB-related death. Our findings should assist in identifying high-risk patients requiring interventions against TB-related death.
Collapse
Affiliation(s)
- Mohammad Haikal Suhairi
- Department of Public Health Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
- Bahagian Pengurusan Latihan Kementerian Kesihatan Malaysia, Putrajaya, Malaysia
| | - Mariam Mohamad
- Department of Public Health Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | - Mohamad Rodi Isa
- Department of Public Health Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| | | | - Nurhuda Ismail
- Department of Public Health Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia
| |
Collapse
|
4
|
Giridharan P, Selvaraju S, Rao R, Rade K, Thiruvengadam K, Asthana S, Balachandar R, Dipak Bangar S, Bansal AK, Bhat J, Chakraborty D, Chopra V, Das D, Dutta S, Rekha Devi K, Kumar S, Laxmaiah A, Madhukar M, Mahapatra A, Mohanty SS, Rangaraju C, Turuk J, Zaman K, Krishnan R, Shanmugam S, Kumar N, Panduranga Joshi R, Narasimhaiah S, Chandrasekaran P, Gangakhedkar RR, Bhargava B. Recurrence of pulmonary tuberculosis in India: Findings from the 2019-2021 nationwide community-based TB prevalence survey. PLoS One 2023; 18:e0294254. [PMID: 38127931 PMCID: PMC10734941 DOI: 10.1371/journal.pone.0294254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023] Open
Abstract
Recurrent Tuberculosis patients contribute to a significant proportion of TB burden in India. A nationwide survey was conducted during 2019-2021 across India among adults to estimate the prevalence of TB. A total of 322480 individuals were screened and 1402 were having TB. Of this, 381 (27.1%) had recurrent TB. The crude prevalence (95% CI) of recurrent TB was 118 (107-131) per 100,000 population. The median duration between episodes of TB was 24 months. The proportion of drug resistant TB was 11.3% and 3.6% in the recurrent group and new TB patients respectively. Higher prevalence of recurrent TB was observed in elderly, males, malnourished, known diabetics, smokers, and alcohol users. (p<0.001). To prevent TB recurrence, all treated tuberculosis patients must be followed at least for 24 months, with screening for Chest X-ray, liquid culture every 6 months, smoking cessation, alcohol cessation, nutritional interventions and good diabetic management.
Collapse
Affiliation(s)
| | - Sriram Selvaraju
- ICMR- National Institute for Research in Tuberculosis, Chetpet, Chennai, India
| | - Raghuram Rao
- Central TB Division, Ministry of Health and Family Welfare, New Delhi, India
| | - Kiran Rade
- National Professional Officer, WHO Country Office, New Delhi, India
| | | | - Smita Asthana
- ICMR- National Institute for Cancer Prevention and Research, Noida, Uttar Pradesh, India
| | - Rakesh Balachandar
- ICMR- National Institute for Occupational Health, Ahmedabad, Gujarat, India
| | | | - Avi Kumar Bansal
- ICMR- National JALMA Institute of Leprosy and other Mycobacterial diseases, Agra, Uttar Pradesh, India
| | - Jyothi Bhat
- ICMR- National Institute for research in Tribal Health, Jabalpur, Madhya Pradesh, India
| | - Debjit Chakraborty
- ICMR- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Vishal Chopra
- State TB Training and Demonstration Centre (STDC), TB Hospital, Lahori, Punjab, India
| | - Dasarathi Das
- ICMR- Regional Medical Research Centre, Bhubaneshwar, Odisha, India
| | - Shanta Dutta
- ICMR- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | | | | | - Avula Laxmaiah
- ICMR- National Institute for Research in Nutrition, Hyderabad, Telangana, India
| | - Major Madhukar
- ICMR- Rajendra Memorial Research Institute of Medical Sciences Agamkuan, Patna, India
| | | | - Suman Sundar Mohanty
- ICMR- ICMR-National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, India
| | | | | | - Kamran Zaman
- ICMR- Regional Medical Research Centre, Gorakhpur
| | - Rajendran Krishnan
- ICMR- National Institute for Research in Tuberculosis, Chetpet, Chennai, India
| | - Sivakumar Shanmugam
- ICMR- National Institute for Research in Tuberculosis, Chetpet, Chennai, India
| | - Nishant Kumar
- Central TB Division, Ministry of Health and Family Welfare, New Delhi, India
| | | | | | | | | | | |
Collapse
|
5
|
Acosta F, Saldaña R, Miranda S, Candanedo D, Sambrano D, Morán M, Bejarano S, De Arriba Y, Reigosa A, De Dixon E, Atencio M, Castillo R, Goodridge A. Heterogeneity of Mycobacterium tuberculosis Strains Circulating in Panama's Western Region. Am J Trop Med Hyg 2023; 109:740-747. [PMID: 37604472 PMCID: PMC10551089 DOI: 10.4269/ajtmh.23-0039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/08/2023] [Indexed: 08/23/2023] Open
Abstract
Tuberculosis remains a challenge in both rural and urban areas. Although a majority of countries display a higher burden in urban areas compared with rural areas, Panama continues to report the highest mortality rate in Central America. Urban areas, such as Panama City, report a high tuberculosis burden, whereas Panama's western region, including the provinces of Chiriquí, Bocas del Toro (both semiurban) and Ngäbe-Bugle (rural), show a lower burden. We aimed to identify highly transmitted Mycobacterium tuberculosis strains within rural and semiurban settings of Panama's western region during a 3-year period (2017, 2019, 2021). We randomly selected 87 M. tuberculosis isolates from a biobank from Panama's western region and analyzed them using allele-specific oligonucleotide polymerase chain reaction and 24-mycobacterial interspersed repetitive unit-variable number tandem repeat (MIRU-VNTR). Our results show only 11.7% (10/85) of M. tuberculosis strains identified as prevalent A-Beijing, B-Haarlem, or C-LAM Strains. We found a low prevalence of A, B, and C M. tuberculosis strains in both rural and semirural settings compared with isolates collected from the Eastern Colon Province. MIRU-VNTR genotyping revealed a high degree of diversity with no clusters with single loci variation of ≥ 2 loci. These results support the notion that tuberculosis prevalence in the rural and semiurban western region of Panama are not due to previously described highly transmitted strains but is influenced instead by other health determinants, including poor health system access and a lack of systematic transmission chain monitoring. For remote rural and semiurban settings, we recommend allocating resources to reinforce efforts to prevent tuberculosis spread.
Collapse
Affiliation(s)
- Fermin Acosta
- Tuberculosis Biomarker Research Unit at Centro de Biologia Celular y Molecular de Enfermedades (CBCME) Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama
| | - Ricardo Saldaña
- Hospital Materno Infantil José Domingo de Obaldía, David City, Provincia de Chiriquí, Panama
| | - Sara Miranda
- Tuberculosis Biomarker Research Unit at Centro de Biologia Celular y Molecular de Enfermedades (CBCME) Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama
- Universidad Autónoma de Chiriqui (UNACHI), David City, Provincia de Chiriquí, Panama
| | - Daniela Candanedo
- Tuberculosis Biomarker Research Unit at Centro de Biologia Celular y Molecular de Enfermedades (CBCME) Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama
| | - Dilcia Sambrano
- Tuberculosis Biomarker Research Unit at Centro de Biologia Celular y Molecular de Enfermedades (CBCME) Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama
| | - Mitchelle Morán
- Tuberculosis Biomarker Research Unit at Centro de Biologia Celular y Molecular de Enfermedades (CBCME) Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama
| | - Saily Bejarano
- Hospital Materno Infantil José Domingo de Obaldía, David City, Provincia de Chiriquí, Panama
| | - Yeraldine De Arriba
- Hospital Materno Infantil José Domingo de Obaldía, David City, Provincia de Chiriquí, Panama
| | - Angel Reigosa
- Hospital Materno Infantil José Domingo de Obaldía, David City, Provincia de Chiriquí, Panama
| | - Elizabeth De Dixon
- Hospital Materno Infantil José Domingo de Obaldía, David City, Provincia de Chiriquí, Panama
| | - María Atencio
- Hospital Materno Infantil José Domingo de Obaldía, David City, Provincia de Chiriquí, Panama
| | - Ramón Castillo
- Programa Regional de Tuberculosis de la Provincia de Chiriquí, Ministerio de Salud, David City, Provincia de Chiriquí, Panama
| | - Amador Goodridge
- Tuberculosis Biomarker Research Unit at Centro de Biologia Celular y Molecular de Enfermedades (CBCME) Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT-AIP), City of Knowledge, Panama City, Panama
| |
Collapse
|
6
|
Nowbuth AA, Asombang AW, Tazinkeng NN, Makinde OY, Sheets LR. Antimicrobial resistance from a One Health perspective in Zambia: a systematic review. Antimicrob Resist Infect Control 2023; 12:15. [PMID: 36869351 PMCID: PMC9982795 DOI: 10.1186/s13756-023-01224-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 02/23/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is widely acknowledged as a global health problem, yet its extent is not well evaluated, especially in low-middle income countries. It is challenging to promote policies without focusing on healthcare systems at a local level, therefore a baseline assessment of the AMR occurrence is a priority. This study aimed to look at published papers relating to the availability of AMR data in Zambia as a means of establishing an overview of the situation, to help inform future decisions. METHODS PubMed, Cochrane Libraries, Medical Journal of Zambia and African Journals Online databases were searched from inception to April 2021 for articles published in English in accordance with the PRISMA guidelines. Retrieval and screening of article was done using a structured search protocol with strict inclusion/exclusion criteria. RESULTS A total of 716 articles were retrieved, of which 25 articles met inclusion criteria for final analysis. AMR data was not available for six of the ten provinces of Zambia. Twenty-one different isolates from the human health, animal health and environmental health sectors were tested against 36 antimicrobial agents, across 13 classes of antibiotics. All the studies showed a degree of resistance to more than one class of antimicrobials. Majority of the studies focused on antibiotics, with only three studies (12%) highlighting antiretroviral resistance. Antitubercular drugs were addressed in only five studies (20%). No studies focused on antifungals. The most common organisms tested, across all three sectors, were Staphylococcus aureus, with a diverse range of resistance patterns found; followed by Escherichia coli with a high resistance rate found to cephalosporins (24-100%) and fluoroquinolones (20-100%). CONCLUSIONS This review highlights three important findings. Firstly, AMR is understudied in Zambia. Secondly, the level of resistance to commonly prescribed antibiotics is significant across the human, animal, and environmental sectors. Thirdly, this review suggests that improved standardization of antimicrobial susceptibility testing in Zambia could help to better delineate AMR patterns, allow comparisons across different locations and tracking of AMR evolution over time.
Collapse
Affiliation(s)
- Avis A Nowbuth
- Lusaka Apex Medical University, Lusaka, Zambia. .,School of Medicine, University of Missouri-Columbia, Columbia, MO, USA. .,Pan-African Organization for Health, Education and Research, Manchester, USA.
| | - Akwi W Asombang
- Pan-African Organization for Health, Education and Research, Manchester, USA.,Massachusetts General Hospital, Boston, USA
| | - Nkengeh N Tazinkeng
- Pan-African Organization for Health, Education and Research, Manchester, USA.,Massachusetts General Hospital, Boston, USA.,Central Administration University of Buea, Buea, Cameroon
| | - Opeoluwa Y Makinde
- Pan-African Organization for Health, Education and Research, Manchester, USA.,Obafemi Awolowo University, Ife, Osun State, Nigeria
| | - Lincoln R Sheets
- School of Medicine, University of Missouri-Columbia, Columbia, MO, USA.,Pan-African Organization for Health, Education and Research, Manchester, USA
| |
Collapse
|
7
|
Moyo N, Tay EL, Trauer JM, Burke L, Jackson J, Commons RJ, Boyd SC, Singh KP, Denholm JT. Tuberculosis notifications in regional Victoria, Australia: Implications for public health care in a low incidence setting. PLoS One 2023; 18:e0282884. [PMID: 36943855 PMCID: PMC10030020 DOI: 10.1371/journal.pone.0282884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/24/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Regionality is often a significant factor in tuberculosis (TB) management and outcomes worldwide. A wide range of context-specific factors may influence these differences and change over time. We compared TB treatment in regional and metropolitan areas, considering demographic and temporal trends affecting TB diagnosis and outcomes. METHODS Retrospective analyses of data for patients notified with TB in Victoria, Australia, were conducted. The study outcomes were treatment delays and treatment outcomes. Multivariable Cox proportional hazard model analyses were performed to investigate the effect of regionality in the management of TB. Six hundred and eleven (7%) TB patients were notified in regional and 8,163 (93%) in metropolitan areas between 1995 and 2019. Of the 611 cases in the regional cohort, 401 (66%) were overseas-born. Fifty-one percent of the overseas-born patients in regional Victoria developed TB disease within five years of arrival in Australia. Four cases of multidrug-resistant tuberculosis were reported in regional areas, compared to 97 cases in metropolitan areas. A total of 3,238 patients notified from 2012 to 2019 were included in the survival analysis. The time follow-up for patient delay started at symptom onset date, and the event was the presentation to the healthcare centre. For healthcare system delay, follow-up time began at the presentation to the healthcare centre, and the event was commenced on TB treatment. Cases with extrapulmonary TB in regional areas have a non-significantly longer healthcare system delay than patients in metropolitan (median 64 days versus 54 days, AHR = 0.8, 95% CI 0.6-1.0, P = 0.094). CONCLUSION Tuberculosis in regional Victoria is common among the overseas-born population, and patients with extrapulmonary TB in regional areas experienced a non-significant minor delay in treatment commencement with no apparent detriment to treatment outcomes. Improving access to LTBI management in regional areas may reduce the burden of TB.
Collapse
Affiliation(s)
- Nompilo Moyo
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, Victoria, Australia
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | - Ee Laine Tay
- Communicable Diseases Epidemiology and Surveillance Unit, Health Protection Branch, Public Health Division, Department of Health, Melbourne, Victoria, Australia
| | - James M Trauer
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Leona Burke
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, Victoria, Australia
| | - Justin Jackson
- Department of Medicine, Albury-Wodonga Health, Wodonga, Victoria, Australia
- Faculty of Medicine, University of New South Wales Rural Clinical School, Albury Campus, Albury, New South Wales, Australia
| | - Robert J Commons
- Internal Medicine Services, Ballarat Health Services, Ballarat, Victoria, Australia
- Global and Tropical Health Division, Menzies School of Health Research and Charles Darwin University, Darwin, Northern Territory, Australia
| | - Sarah C Boyd
- Royal Brisbane and Women's Hospital, Brisbane, South Australia, Australia
| | - Kasha P Singh
- Department of Infectious Diseases, Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Victoria, Australia
| | - Justin T Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
8
|
Matulyte E, Davidaviciene E, Kancauskiene Z, Diktanas S, Kausas A, Velyvyte D, Urboniene J, Lipnickiene V, Laurencikaite M, Danila E, Costagliola D, Matulionyte R. The socio-demographic, clinical characteristics and outcomes of tuberculosis among HIV infected adults in Lithuania: A thirteen-year analysis. PLoS One 2023; 18:e0282046. [PMID: 36952578 PMCID: PMC10035857 DOI: 10.1371/journal.pone.0282046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 02/06/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is a public health problem in Lithuania, among the 18 high-priority TB countries in the European region, and the most common AIDS-indicative disease with the highest proportion in the EU/EEA since 2015. The study aimed to identify socio-demographic, clinical characteristics and their relationship with TB outcomes in TB-HIV co-infected patients in Lithuania. METHODS A retrospective chart review analysed the characteristics of TB-HIV co-infected adults registered in State Information System of Tuberculosis over 2008-2020. The factors associated with drug-resistant TB and unsuccessful treatment outcome were identified by multivariable logistic regression. RESULTS The study included 345 cases in 311 patients (239 new, 106 previously treated cases), median age 40 years (IQR 35-45), 80.7% male. 67.8% patients knew their HIV-positive status before TB diagnosis, median time to TB diagnosis was 8 years (IQR 4-12). 83.6% were unemployed, 50.5%-anytime intravenous drug users (IDU), 34.9% abused alcohol. Drug-resistant TB rates in new and previously treated TB cases were 38.1% and 61.3%, respectively. In multivariable analysis, higher risk of drug-resistant TB was associated with imprisonment in new (aOR 3.35; 95%CI 1.17-9.57) and previously treated (aOR 6.63; 95%CI 1.09-40.35) cases. In 52.3% of new TB cases and in 42.5% previously treated TB cases the treatment outcomes were unsuccessful. In multivariable analysis of new TB cases, current imprisonment (aOR 2.77; 95%CI 1.29-5.91) and drug-resistant TB (aOR 2.18; 95%CI 1.11-4.28) were associated with unsuccessful treatment outcome. In multivariable analysis of previously treated TB cases, female gender (aOR 11.93; 95%CI 1.86-76.69), alcohol abuse (aOR 3.17; 95%CI 1.05-9.58), drug-resistant TB (aOR 4.83; 95%CI 1.53-15.28) were associated with unsuccessful treatment outcome. CONCLUSIONS In the TB-HIV-infected adult cohort in Lithuania, unemployment, imprisonment, IDU, alcohol abuse, known to be risk factors for TB, were very frequent. Drug resistance was an undeniable risk factor for unsuccessful treatment outcome and imprisonment was associated with drug resistant TB.
Collapse
Affiliation(s)
- Elzbieta Matulyte
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Edita Davidaviciene
- State Information System of Tuberculosis, Public Health Department, Ministry of Health, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Zavinta Kancauskiene
- AIDS Centre, Department of Infectious Diseases, University Hospital of Klaipeda, Klaipeda, Lithuania
| | - Saulius Diktanas
- Tuberculosis Department, Republican Klaipeda Hospital, Klaipeda, Lithuania
| | - Aidas Kausas
- Adult Infectious Diseases Unit, Clinic of Conservative Medicine, Republican Siauliai County Hospital, Siauliai, Lithuania
| | - Daiva Velyvyte
- Department of Infectious Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Kaunas Hospital of the Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jurgita Urboniene
- Centre of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | | | - Edvardas Danila
- Clinic of Chest Diseases, Immunology, and Allergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie de Santé Publique, Paris, France
| | - Raimonda Matulionyte
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Centre of Infectious Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| |
Collapse
|
9
|
Chaaba E, Bwembya J, Nyambe E, Kumar R, Thior I, Seraphine K, Chongwe G, Makwambeni V, Musonda V, Kasese-Chanda P, Mwinga A. Mortality among persons receiving tuberculosis treatment in Itezhi-Tezhi District of Zambia: A retrospective cohort study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001234. [PMID: 36962999 PMCID: PMC10021721 DOI: 10.1371/journal.pgph.0001234] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 01/29/2023] [Indexed: 02/24/2023]
Abstract
Itezhi-Tezhi District in southern Zambia has been reporting tuberculosis (TB) mortality rates that are fourfold higher than the national average of six percent. We conducted a retrospective cohort study to establish the demographic and clinical characteristics associated with mortality among persons under treatment for TB in Itezhi-Tezhi District, as well as the likely causes and time to death. We reviewed medical records for persons with TB registered in 19 public health facilities in Itezhi-Tezhi District between January 2015 and December 2018. Of the 506 persons with TB registered in the study period, 426 were included in the analysis. Of these, 71 (16.7%) died before completing treatment. The overall mortality rate was 31.8 per 1,000 person-months of observation. Most of the deaths (53 [74.7%]) occurred in the first month of treatment (median: 16 days; interquartile range: 5-52 days). In a multivariate Cox regression model, type of TB was found to be an independent predictor of mortality while on TB treatment. The risk of dying was more than twice higher for persons with clinically diagnosed PTB compared to those with bacteriologically confirmed PTB (adjusted hazard ratio = 2.2, 95% CI: 1.4-3.6). In a sub-analysis of persons with clinically diagnosed PTB, persons with TB who were on a community-based DOT plan were more than twice more likely to die compared to those on facility-based DOT plan (adjusted hazard ratio = 2.21, 95% CI: 1.1-4.8). Common likely causes of death were pulmonary TB disease (66.0%), anemia (12.8%), cardiac failure (4.3%), pneumocystis jiroveci pneumonia (4.3%), and gastroenteritis (4.2%). These findings show that most deaths occurred during the first month of treatment. Clinical evaluation at initiation of anti-TB treatment and during follow-up care, especially in persons with clinically diagnosed PTB, should include screening and treatment of other conditions.
Collapse
Affiliation(s)
- Eutra Chaaba
- Ministry of Health, Itezhi-Tezhi District Health Office, Itezhi-Tezhi, Zambia
| | - Josphat Bwembya
- USAID Eradicate TB Project, PATH, Lusaka, Zambia
- Zambart, Lusaka, Zambia
| | - Eness Nyambe
- Ministry of Health, Itezhi-Tezhi District Health Office, Itezhi-Tezhi, Zambia
| | - Ramya Kumar
- USAID Eradicate TB Project, PATH, Lusaka, Zambia
- Zambart, Lusaka, Zambia
| | - Ibou Thior
- PATH, Seattle, Washington, United States of America
| | | | | | | | | | | | | |
Collapse
|
10
|
Edessa D, Adem F, Hagos B, Sisay M. Incidence and predictors of mortality among persons receiving second-line tuberculosis treatment in sub-Saharan Africa: A meta-analysis of 43 cohort studies. PLoS One 2021; 16:e0261149. [PMID: 34890421 PMCID: PMC8664218 DOI: 10.1371/journal.pone.0261149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/27/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Drug resistance remains from among the most feared public health threats that commonly challenges tuberculosis treatment success. Since 2010, there have been rapid evolution and advances to second-line anti-tuberculosis treatments (SLD). However, evidence on impacts of these advances on incidence of mortality are scarce and conflicting. Estimating the number of people died from any cause during the follow-up period of SLD as the incidence proportion of all-cause mortality is the most informative way of appraising the drug-resistant tuberculosis treatment outcome. We thus aimed to estimate the pooled incidence of mortality and its predictors among persons receiving the SLD in sub-Saharan Africa. METHODS We systematically identified relevant studies published between January, 2010 and March, 2020, by searching PubMed/MEDLINE, EMBASE, SCOPUS, Cochrane library, Google scholar, and Health Technology Assessment. Eligible English-language publications reported on death and/or its predictors among persons receiving SLD, but those publications that reported death among persons treated for extensively drug-resistant tuberculosis were excluded. Study features, patients' clinical characteristics, and incidence and/or predictors of mortality were extracted and pooled for effect sizes employing a random-effects model. The pooled incidence of mortality was estimated as percentage rate while risks of the individual predictors were appraised based on their independent associations with the mortality outcome. RESULTS A total of 43 studies were reviewed that revealed 31,525 patients and 4,976 deaths. The pooled incidence of mortality was 17% (95% CI: 15%-18%; I2 = 91.40; P = 0.00). The studies used varied models in identifying predictors of mortality. They found diagnoses of clinical conditions (RR: 2.36; 95% CI: 1.82-3.05); excessive substance use (RR: 2.56; 95% CI: 1.78-3.67); HIV and other comorbidities (RR: 1.96; 95% CI: 1.65-2.32); resistance to SLD (RR: 1.75; 95% CI: 1.37-2.23); and male sex (RR: 1.82; 95% CI: 1.35-2.44) as consistent predictors of the mortality. Few individual studies also reported an increased incidence of mortality among persons initiated with the SLD after a month delay (RR: 1.59; 95% CI: 0.98-2.60) and those persons with history of tuberculosis (RR: 1.21; 95% CI: 1.12-1.32). CONCLUSIONS We found about one in six persons who received SLD in sub-Saharan Africa had died in the last decade. This incidence of mortality among the drug-resistant tuberculosis patients in the sub-Saharan Africa mirrors the global average. Nevertheless, it was considerably high among the patients who had comorbidities; who were diagnosed with other clinical conditions; who had resistance to SLD; who were males and substance users. Therefore, modified measures involving shorter SLD regimens fortified with newer or repurposed drugs, differentiated care approaches, and support of substance use rehabilitation programs can help improve the treatment outcome of persons with the drug-resistant tuberculosis. TRIAL REGISTRATION NUMBER CRD42020160473; PROSPERO.
Collapse
Affiliation(s)
- Dumessa Edessa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fuad Adem
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bisrat Hagos
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| |
Collapse
|
11
|
Qiu B, Tao B, Liu Q, Li Z, Song H, Tian D, Wu J, Wu Z, Zhan M, Lu W, Wang J. A Prospective Cohort Study on the Prevalent and Recurrent Tuberculosis Isolates Using the MIRU-VNTR Typing. Front Med (Lausanne) 2021; 8:685368. [PMID: 34595184 PMCID: PMC8476766 DOI: 10.3389/fmed.2021.685368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/23/2021] [Indexed: 11/30/2022] Open
Abstract
The study aims to describe the clustering characteristics of Mycobacterium tuberculosis (M.tb) strains circulating in eastern China and determine the ratio of relapse and reinfection in recurrent patients. We recruited sputum smear-positive pulmonary tuberculosis cases from five cities of Jiangsu Province, China, during August 2013 and December 2015. Patients were followed for the treatment outcomes and recurrence based on a cohort design. M.tb strains were isolated and genotyped using the 12-locus MIRU-VNTR. The Beijing family was identified by the extended Region of Difference (RD) analysis. The Hunter-Gaston Discriminatory Index (HGDI) was used to judge the resolution ability of MIRU-VNTR. The odds ratio (OR) together with 95% confidence interval (CI) were used to estimate the strength of association. We performed a cluster analysis on 2098 M.tb isolates and classified them into 545 genotypes and five categories (I, 0.19%; II, 0.43%; III, 3.34%; IV, 77.46%; V, 18.59%). After adjusting for potential confounders, the Beijing family genotype (OR = 118.63, 95% CI: 79.61–176.79, P = 0.001) was significantly related to the dominant strain infections. Patients infected with non-dominant strains had a higher risk of the pulmonary cavity (OR = 1.39, 95% CI: 1.01–1.91, P = 0.046). Among 37 paired recurrent cases, 22 (59.46%) were determined as endogenous reactivation, and 15 (40.54%) were exogenous reinfection. The type of M.tb strains prevalent in Jiangsu Province is relatively single. Beijing family strains infection is dominant in local tuberculosis cases. Endogenous reactivation appears to be a major cause of recurrent tuberculosis in Eastern China. This finding emphasizes the importance of case follow-up and monitoring after the completion of antituberculosis treatment.
Collapse
Affiliation(s)
- Beibei Qiu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Bilin Tao
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Qiao Liu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Zhongqi Li
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Huan Song
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Dan Tian
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jizhou Wu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhuchao Wu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Mengyao Zhan
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Wei Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Jianming Wang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| |
Collapse
|
12
|
Baluku JB, Nakazibwe B, Twinomugisha B, Najjuuko R, Isabella N, Nassozi S, Namiiro S, Katagira W, Byonanebye DM, Sekaggya-Wiltshire C, Muchiri J, Ndungu E, Anguzu G, Mayanja-Kizza H, Andia-Biraro I. One dollar incentive improves tuberculosis treatment outcomes in programmatic settings in rural Uganda. Sci Rep 2021; 11:19346. [PMID: 34588552 PMCID: PMC8481464 DOI: 10.1038/s41598-021-98770-7] [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] [Received: 03/24/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
The study aim was to determine the association of a one United States dollar (USD) dollar incentive and tuberculosis (TB) treatment outcomes among people with TB receiving treatment at a rural hospital in Uganda under programmatic settings. We conducted a quasi-experiment in which people with TB were randomised (1:1 ratio) to receive either a one USD incentive at months 0, 2, 5 and 6 (Dollar arm) or routine care (Routine arm). A second control group (Retrospective controls) consisted of participants who had a treatment outcome in the preceding 6 months. Treatment outcomes were compared between the intervention and control groups using Pearson’s chi-square and Fisher’s exact tests. The association between the incentive and treatment outcomes was determined using Poisson regression analysis with robust variances. Between November 2018 and October 2019, we enrolled 180 participants (60 in the Dollar arm and 120 in the Control group). TB cure (33.3% vs. 20.8%, p = 0.068) and treatment success (70.0% vs. 59.2% p = 0.156) were higher in the Dollar arm than the Control group, while loss-to-follow-up was lower in the Dollar arm (10.0% vs. 20.8% p = 0.070). Participants in the Dollar arm were more likely to be cured (adjusted incidence rate ratio (aIRR): 1.59, 95% CI 1.04–2.44, p = 0.032) and less likely to be lost to follow-up (aIRR: 0.44, 95% CI 0.20–0.96, p = 0.040). A one-dollar incentive was associated with higher TB cure and lower loss-to-follow-up among people with TB in rural Uganda.
Collapse
Affiliation(s)
- Joseph Baruch Baluku
- Department of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda. .,Makerere University Lung Institute, Kampala, Uganda. .,Directorate of Programs, Mildmay Uganda, Wakiso, PO Box 26343, Kampala, Uganda.
| | | | | | | | | | - Sylvia Nassozi
- Department of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda
| | | | | | | | - Christine Sekaggya-Wiltshire
- Department of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda.,MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Joseph Muchiri
- Department of Community Health, School of Public health, Mount Kenya University, Thika, Kenya
| | - Elizabeth Ndungu
- Department of Community Health Nursing, Mount Kenya University, Thika, Kenya
| | - Godwin Anguzu
- Makerere University Infectious Disease Institute, Kampala, Uganda
| | | | - Irene Andia-Biraro
- Department of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda.,MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Clinical Research, Faculty of Infectious and Tropical Disease (ITD), London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
13
|
Sahiratmadja E, Rini IA, Penggoam S, Charles A, Maskoen AM, Parwati I. Acetylator Status Among Newly Diagnosed and Recurrent Tuberculosis Patients from Kupang, Eastern Part of Indonesia. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2021; 14:737-744. [PMID: 34188520 PMCID: PMC8235940 DOI: 10.2147/pgpm.s311952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/31/2021] [Indexed: 11/23/2022]
Abstract
Purpose N-acetyltransferase-2 enzyme in the liver, encoded by NAT2 gene, plays a central role in metabolizing tuberculosis (TB) drug isoniazid (INH). Low compliance of patients toward six-month TB therapy and internal host factors, ie comorbid diseases, immune status, and genetic profiles, are factors leading to treatment failure and recurrence of pulmonary TB infection. This study aimed to explore the NAT2 acetylator status among newly diagnosed and recurrent pulmonary TB patients in eastern part of Indonesia. Patients and Methods Archived DNA of TB patients (n=124) and healthy controls (n=124) were sequenced, and NAT2 acetylator status was determined, then categorized as fast, intermediate, or slow acetylators. Pulmonary TB patients who had no previous TB treatment history were designated as newly diagnosed pulmonary TB, whereas patients with a history of TB treatment were designated as recurrent pulmonary TB. The demographic, clinical, and microbiological data between pulmonary TB groups were compared, and acetylator status was described among groups. Results Male was more significantly prevalent in the recurrent pulmonary TB group (p=0.025), and anemia was more prevalent in new pulmonary TB (p=0.003). The acetylator status in pulmonary TB patients compared to healthy controls were rapid (33.9% vs 48.1%), intermediate (57.8% vs 33.0%), and slow acetylators (8.3% vs 18.9%), respectively. Interestingly, the rapid and intermediate acetylator were significantly more prevalent in pulmonary TB patients than in healthy controls (p=0.023, OR=2.58 (1.12–5.97). Furthermore, no differences were found in acetylator status between new and recurrent pulmonary (p=0.776). Conclusion Rapid and intermediate acetylators status predominated the pulmonary TB patients in Kupang, eastern part of Indonesia, postulating different genetic makeup in this area. As the pulmonary TB patients in Kupang exhibit more rapid acetylator phenotype, the acetylator status might be relevant to be checked before TB therapy for adjusting treatment dose to prevent drug resistances.
Collapse
Affiliation(s)
- Edhyana Sahiratmadja
- Division of Biochemistry and Molecular Biology, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Ika Agus Rini
- Health Research Unit, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Simeon Penggoam
- Laboratorium Mikrobiologi, RSUD Prof. Dr. WZ Johannes, Kupang, Indonesia
| | - Afandi Charles
- Health Research Unit, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Ani Melani Maskoen
- Division of Biochemistry and Molecular Biology, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Health Research Unit, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Ida Parwati
- Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| |
Collapse
|
14
|
Ewetola R, Shah GH, Maluantesa L, Etheredge G, Waterfield K, Mulenga A, Kilundu A. Disparities in HIV Clinical Stages Progression of Patients at Outpatient Clinics in Democratic Republic of Congo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105341. [PMID: 34067847 PMCID: PMC8156374 DOI: 10.3390/ijerph18105341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 12/03/2022]
Abstract
Context: In this era of patient-centered care, it is increasingly important for HIV/AIDS care and treatment programs to customize their services according to patients’ clinical stage progression and other risk assessments. To enable such customization of HIV care and treatment delivery, the research evidence explaining factors associated with patients’ clinical stages is needed. Objectives: The primary objective of this study was to produce such scientific evidence by analyzing the most recent data for patients at outpatient clinics in the provinces of Kinshasa and Haut-Katanga and to examine the patient characteristics associated with WHO stages of disease progression. Methods: Using a quantitative retrospective cohort study design, we analyzed data from 49,460 people living with HIV (PLHIV) on antiretroviral therapy (ART) from 241 HIV/AIDS clinics located in Haut-Katanga and Kinshasa provinces of the Democratic Republic of Congo. We performed Chi-square and multinomial logistic regression analyses. Results: A small proportion (i.e., 4.4%) of PLHIV were at WHO’s clinical progression stage 4, whereas 30.7% were at clinical stage 3, another 22.9% at stage 2, and the remaining 41.9% were at stage 1, the least severe stage. After controlling for other demographic and clinical factors included in the model, the likelihood of being at stage 1 rather than stage 3 or 4 was significantly higher (at p ≤ 0.05) for patients with no tuberculosis (TB) than those with TB co-infection (adjusted odds ratio or AOR, 5.73; confidence interval or CI, 4.98–6.59). The odds of being at stage 1 were significantly higher for female patients (AOR, 1.35; CI, 1.29–1.42), and those with the shorter duration on ART (vs. greater than 40.37 months). Patents in rural health zones (AOR, 0.32) and semi-rural health zones (AOR, 0.79) were less likely to be at stage 1, compared to patients in urban health zones. Conclusions: Our study showed that TB co-infection raised the risk for PLHIV to be at the severe stages of clinical progression of HIV. Such variation supports the thesis that customized HIV management approaches and clinical regimens may be imperative for this high-risk population. We also found significant variation in HIV clinical progression stages by geographic location and demographic characteristics. Such variation points to the need for more targeted efforts to address the disparities, as the programs attempt to improve the effectiveness of HIV care and treatment. The intersectionality of vulnerabilities from HIV, TB, and COVID-19-related hardships has elevated the need for customized care and treatment even more in the COVID-19 era.
Collapse
Affiliation(s)
- Raimi Ewetola
- Division of Global HIV and Tuberculosis, CDC, Atlanta, GA 30329, USA;
| | - Gulzar H. Shah
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA;
- Correspondence: ; Tel.: +1-(001)-912-478-2419
| | - Lievain Maluantesa
- FHI 360, Kinshasa 1015, Democratic Republic of the Congo; (L.M.); (A.M.)
| | | | - Kristie Waterfield
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA 30460, USA;
| | - Astrid Mulenga
- FHI 360, Kinshasa 1015, Democratic Republic of the Congo; (L.M.); (A.M.)
| | - Apolinaire Kilundu
- National AIDS Control Program (PNLS), HIV Program, Ministry of Health, Kinshasa 316, Democratic Republic of the Congo;
| |
Collapse
|
15
|
Edessa D, Sisay M, Dessie Y. Unfavorable outcomes to second-line tuberculosis therapy among HIV-infected versus HIV-uninfected patients in sub-Saharan Africa: A systematic review and meta-analysis. PLoS One 2020; 15:e0237534. [PMID: 32797110 PMCID: PMC7428180 DOI: 10.1371/journal.pone.0237534] [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: 04/17/2020] [Accepted: 07/28/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Drug resistance is a key obstacle to the global target set to end tuberculosis by 2030. Clinical complexities in drug-resistant tuberculosis and HIV-infection co-management could worsen outcomes of second-line anti-tuberculosis drugs. A comprehensive estimate for risks of unsuccessful outcomes to second-line tuberculosis therapy in HIV-infected versus HIV-uninfected patients is mandatory to address such aspects in segments of the target set. Therefore, this meta-analysis was aimed to estimate the pooled risk ratios of unfavorable outcomes to second-line tuberculosis therapy between HIV-infected and HIV-uninfected patients in sub-Saharan Africa. METHODS We conducted a literature search from PubMed/MEDLINE, EMBASE, SCOPUS and Google Scholar. We screened the retrieved records by titles and abstracts. Finally, we assessed eligibility and quality of full-text articles for the records retained by employing appraisal checklist of the Joanna Briggs Institute. We analyzed the data extracted from the included studies by using Review Manager Software, version 5.3 and presented our findings in forest and funnel plots. Protocol for this study was registered on PROSPERO (ID: CRD42020160473). RESULTS A total of 19 studies with 1,766 from 4,481 HIV-infected and 1,164 from 3,820 HIV-uninfected patients had unfavorable outcomes. The risk ratios we estimated between HIV-infected and HIV-uninfected drug-resistant tuberculosis patients were 1.18 (95% CI: 1.07-1.30; I2 = 48%; P = 0.01) for the overall unfavorable outcome; 1.50 (95% CI: 1.30-1.74) for death; 0.66 (95% CI: 0.38-1.13) for treatment failure; and 0.82 (95% CI: 0.74-0.92) for loss from treatment. Variable increased risks of unfavorable outcomes estimated for subgroups with significance in mixed-age patients (RR: 1.22; 95% CI: 1.10-1.36) and eastern region of sub-Saharan Africa (RR: 1.47; 95% CI: 1.23-1.75). CONCLUSIONS We found a higher risk of unfavorable treatment outcome in drug-resistant tuberculosis patients with death highly worsening in HIV-infected than in those HIV-uninfected patients. The risks for the unfavorable outcomes were significantly higher in mixed-age patients and in the eastern region of sub-Saharan Africa. Therefore, special strategies that reduce the risks of death should be discovered and implemented for HIV and drug-resistant tuberculosis co-infected patients on second-line tuberculosis therapy with optimal integration of the two programs in the eastern region of sub-Saharan Africa.
Collapse
Affiliation(s)
- Dumessa Edessa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Oromia, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Oromia, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Oromia, Ethiopia
| |
Collapse
|
16
|
Chakaya JM, Marais B, du Cros P, Ntoumi F, Mfinanga S, Kapata N, Hasnain SE, Nathavitharana R, Zumla A. Programmatic versus personalised approaches to managing the global epidemic of multidrug-resistant tuberculosis. THE LANCET RESPIRATORY MEDICINE 2020; 8:334-335. [PMID: 32113573 DOI: 10.1016/s2213-2600(20)30104-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Jeremiah Muhwa Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, 19692-00202 Nairobi, Kenya.
| | - Ben Marais
- The Children's Hospital at Westmead, University of Sydney, Sydney, NSW, Australia
| | | | - Francine Ntoumi
- Université Marien Ngouabi, Fondation Congolaise pour la Recherche Médicale, Brazzaville, Congo; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - Sayoki Mfinanga
- National Institute for Medical Research, Dar-Es-Salaam, Tanzania; Muhimbili University of Health and Allied Sciences, Dar-Es-Salaam, Tanzania; Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania; Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nathan Kapata
- Zambia Public Health Institute, Ministry of Health, Lusaka, Zambia
| | | | - Ruvandhi Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA; TB Proof, Cape Town, South Africa
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London, London, UK; National Institute for Health Research Biomedical Research Centre, University College London Hospitals National Health Service Foundation Trust, London, UK
| |
Collapse
|