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Nagarajan K, Kumarswamy K, Begum R, Panibatla V, Singarajipura A, Adepu R, Munjattu JF, Sellapan S, Arangba S, Goswami A, Swamickan R, Basha J, Dsouza PM, Muniyandi M. Self-driven solutions and resilience adapted by people with drug-resistant tuberculosis and their caregivers in Bengaluru and Hyderabad, India: a qualitative study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 22:100372. [PMID: 38420270 PMCID: PMC10900834 DOI: 10.1016/j.lansea.2024.100372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/08/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
Background One-fifth of people with drug-resistance tuberculosis (DR-TB) who were initiated on newer shorter treatment regimen (with injection) had unfavourable treatment outcomes in India as on 2020. Evidence on self-driven solutions and resilience adapted by people with DR-TB (PwDR-TB) towards their multi-dimensional disease and treatment challenges are scarce globally, which we aimed to understand. Methods In this qualitative study using positive deviance framework, we conducted semi-structured in-depth interviews among consenting adult PwDR-TB (7 women, 13 men) who completed shorter treatment regimen (including injections) with maximum treatment adherence. The study was conducted in the southern districts of Bengaluru and Hyderabad, India between June 2020 and December 2022. Caregivers (14 women, 6 men) and health providers (8 men, 2 women) of PwDR-TB were also interviewed. Interviews were conducted in local language (Kannada, Tamil, Telugu, Urdu and Hindi) and inquired about practices, behaviours, experiences, perceptions and attributes which enabled maximum adherence and resilience of PwDR-TB. Interviews were audio recorded, transcribed, and translated to English and coded for thematic analysis using inductive approach. Findings Distinctive themes explanatory of the self-driven solutions and resilience exhibited by PwDR-TB and their caregivers were identified: (i) Self-adaptation towards the biological consequences of drugs, by personalised nutritional and adjuvant practices, which helped to improve drug ingestion and therapeutic effects. Also home remedies and self-plans for ameliorating injection pain. (ii) Perceptual adaptation towards drugs aversion and fatigue, by their mind diversion practices, routinisation and normalisation of drug intake process. and constant reinforcement and re-interpretation of bodily signs of disease recovery (iii) Family caregivers intense and participatory care for PwDR-TB, by aiding their essential life activities and ensuring survival, learning and fulfilling special nutritional needs and goal oriented actions to aid drug intake (iv) Health care providers care, marked by swift and timely risk mitigation of side-effects and crisis response (v) Acquired self-efficacy of PwDR-TB, by their decisive family concerns resulting in attitudinal change. Also being sensitised on the detrimental consequences of disease and being motivated through positive examples. Interpretation Synthesised findings on self-driven solutions and resilience towards the multi-dimensional DR-TB challenges provides opportunity for developing and testing new interventions for its effectiveness in DR-TB care settings globally. Designing and testing personalised cognitive interventions for PwDR-TB: to inculcate attitudinal change and self-efficacy towards medication, developing cognitive reinforcements to address the perception burden of treatment, skill building and mainstreaming the role of family caregivers as therapeutic partners of PwDR-TB, curating self-adaptive behaviours and practices of PwDR-TB to normalise their drug consumptions experiences could be the way forward in building resilience towards DR-TB. Funding United States Agency for International Development (USAID) through Karnataka Health Promotion Trust (KHPT), Bengaluru, India.
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Affiliation(s)
- Karikalan Nagarajan
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | - Karthikeyan Kumarswamy
- Karnataka Health Promotion Trust, IT Park, Rajajinagar Industrial Area, Bengaluru, Karnataka, 560044, India
| | - Rehana Begum
- Karnataka Health Promotion Trust, IT Park, Rajajinagar Industrial Area, Bengaluru, Karnataka, 560044, India
| | - Vikas Panibatla
- TB Alert India, Hyderabad, West Marredpally, Secunderabad, Telangana, 500026, India
| | - Anil Singarajipura
- State TB Office, 2nd Floor, Arogya Soudha, Magadi Road, Bengaluru, Karnataka, 560023, India
| | - Rajesham Adepu
- State TB Office, Directorate of Medical & Health Services, Hyderabad, Telangana, 500095, India
| | - Joseph Francis Munjattu
- Karnataka Health Promotion Trust, IT Park, Rajajinagar Industrial Area, Bengaluru, Karnataka, 560044, India
| | - Senthil Sellapan
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | - Stephen Arangba
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | | | | | - Javeed Basha
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | - Pearl Maria Dsouza
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
| | - Malaisamy Muniyandi
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, Tamil Nadu, 600031, India
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Manoharan A, Siti Nur Farhana H, Manimaran K, Khoo EM, Koh WM. Facilitators and barriers for tuberculosis preventive treatment among patients with latent tuberculosis infection: a qualitative study. BMC Infect Dis 2023; 23:624. [PMID: 37740196 PMCID: PMC10517541 DOI: 10.1186/s12879-023-08612-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 09/14/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Various factors influence tuberculosis preventive treatment (TPT) decisions thus it is important to understand the health beliefs and concerns of patients before starting TPT to ensure treatment compliance. This study aims to explore facilitators and barriers for TPT among patients diagnosed with Latent Tuberculosis infection (LTBI) attending six primary healthcare clinics in Selangor, Malaysia. METHOD In-depth interviews were conducted face-to-face or via telephone among patients with a clinical diagnosis of LTBI using a semi-structured topic guide developed based on the common-sense model of self-regulation and literature review. Audio recordings of interviews were transcribed verbatim and analysed thematically. RESULTS We conducted 26 In-depth interviews; Good knowledge of active tuberculosis (TB) and its associated complications, including the perceived seriousness and transmissibility of active TB, facilitates treatment. LTBI is viewed as a concern when immune status is compromised, thus fostering TPT. However, optimal health is a barrier for TPT. Owing to the lack of knowledge, patients rely on healthcare practitioners (HCPs) to determine their treatment paths. HCPs possessing comprehensive knowledge play a role in facilitating TPT whereas barriers to TPT encompass misinterpretation of tuberculin skin test (TST), inadequate explanation of TST, and apprehensions about potential medication side effects. CONCLUSIONS Knowledge of LTBI can influence TPT uptake and patients often entrust their HCPs for treatment decisions. Improving knowledge of LTBI both among patients and HCPs can lead to more effective doctor-patient consultation and consequently boost the acceptance of TPT. Quality assurance should be enhanced to ensure the effective usage of TST as a screening tool.
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Affiliation(s)
- Anusha Manoharan
- Bandar Botanic Health Clinic, Bandar Botanic, Klang, Selangor, 42000, Malaysia
| | - H Siti Nur Farhana
- Institute for Health Behavioural Research, National Institutes of Health, Ministry of Health Malaysia, Block B3, Kompleks NIH, No 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, Shah Alam, Selangor, 40170, Malaysia
| | - K Manimaran
- Institute for Health Behavioural Research, National Institutes of Health, Ministry of Health Malaysia, Block B3, Kompleks NIH, No 1, Jalan Setia Murni U13/52, Seksyen U13, Setia Alam, Shah Alam, Selangor, 40170, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Wen Ming Koh
- Rawang Health Clinic, Jalan Rawang Perdana, Taman Rawang Perdana, Rawang, Selangor, 48000, Malaysia.
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Maynard C, Tariq S, Sotgiu G, Migliori GB, van den Boom M, Field N. Psychosocial support interventions to improve treatment outcomes for people living with tuberculosis: a mixed methods systematic review and meta-analysis. EClinicalMedicine 2023; 61:102057. [PMID: 37457116 PMCID: PMC10338299 DOI: 10.1016/j.eclinm.2023.102057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023] Open
Abstract
Background People with tuberculosis (TB) face multi-dimensional barriers when accessing and engaging with care. There is evidence that providing psychosocial support within people-centered models of care can improve TB outcomes, however, there is limited consensus on what works. It remains important for such interventions to be rigorously assessed, and mixed methods systematic reviews are one way of synthesising data for policy makers to be able to access such evidence. Mixed methods reviews take a complexity perspective, with qualitative data being used to contextualise the quantitative findings and giving an insight into how interventions are contingent on variations in design and context. Methods Five electronic databases were searched from January 1 2015 to 14 January 2023 for randomised controlled trials, quasi-experimental trials, cohort studies and qualitative studies of interventions providing psychosocial support (material and/or psychological-based support) to adults with any clinical form of active TB. Studies with inpatient treatment as the standard of care were excluded. Quantitative studies reporting pre-specified standard TB outcomes were eligible. In line with established mixed methods review methodology, a convergent parallel-results synthesis design was followed: quantitative and qualitative syntheses were distinct and carried out using appropriate methods. A convergent coding matrix was then used to integrate the results. The protocol was registered on PROSPERO (CRD42021235211). Findings Twenty-three studies of interventions were included (12 quantitative, 10 qualitative, and 1 mixed methods study) were included. Most studies were conducted in low-and middle-income countries with a high-burden of TB. Three explanatory and contextual middle-range theories from the integration of qualitative and quantitative data were developed: effective interventions provide multi-dimensional support; psychological-based support is transformative but there is insufficient evidence that it improves treatment outcomes on its own; intervention delivery shapes a logic of care. Interpretation This review takes a complexity perspective to provide actionable and timely insight to inform the design and implementation of locally-appropriate and people-centered psychosocial support interventions within national TB programmes. Funding There was no funding source for this study.
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Affiliation(s)
| | | | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, University of Sassari, Italy
| | | | | | - Nigel Field
- UCL Institute for Global Health, UK
- Centre for Molecular Epidemiology and Translational Research, UCL Institute for Global Health, UK
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Mesic A, Ishaq S, Khan WH, Mureed A, Mar HT, Khaing EE, Bermudez-Aza E, Rose L, Lynen L, Seddiq MK, Amirzada HK, Keus K, Decroo T. Person-centred care and short oral treatment for rifampicin-resistant tuberculosis improve retention in care in Kandahar, Afghanistan. Trop Med Int Health 2022; 27:207-215. [PMID: 34978748 PMCID: PMC9306566 DOI: 10.1111/tmi.13716] [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] [Indexed: 12/01/2022]
Abstract
Objectives To describe the effect of adaptations to a person‐centred care with short oral regimens on retention in care for rifampicin‐resistant TB (RR‐TB) in Kandahar province, Afghanistan. Methods The study included people with RR‐TB registered in the programme between 01 October 2016 and 18 April 2021. From 19 November 2019, the programme implemented a trial investigating the safety and effectiveness of short oral RR‐TB regimens. During the trial, person‐centred care was adapted. We included the data from people living with RR‐TB treated in the period before and after the care model was adapted and applied Kaplan‐Meier statistics to compare rates of retention in care. Results Of 236 patients registered in the RR‐TB programme, 146 (61.9%) were registered before and 90 (38.1%) after the model of care was adapted. Before adaptations enhancing person‐centred care, pre‐treatment attrition was 23.3% (n = 34/146), whilst under the adapted care model it was 5.6% (n = 5/90). Attrition on treatment was 22.3% (n = 25/112) before adaptations, whilst during the study period none of the participants were lost‐to‐follow‐up on treatment and 3.3% died (n = 3/90). Conclusions As person‐centred care delivery and treatment regimens were adapted to better fit‐specific contextual challenges and the needs of the target population, retention in care improved amongst people with RR‐TB in Kandahar, Afghanistan.
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Affiliation(s)
- Anita Mesic
- Médecins Sans Frontières, Amsterdam, The Netherlands.,Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | | | | | | | | | | | | | | | - Lutgarde Lynen
- Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | | | - Hashim Khan Amirzada
- National Tuberculosis Control Programme, Ministry of Public Health, Kabul, Afghanistan
| | - Kees Keus
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Tom Decroo
- Institute of Tropical Medicine Antwerp, Antwerp, Belgium.,Research Foundation Flanders, Brussels, Belgium
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Wharton-Smith A, Horter S, Douch E, Gray N, James N, Nyang'wa BT, Singh J, Nusratovna PN, Tigay Z, Kazounis E, Allanazarova G, Stringer B. Optimising recruitment to a late-phase tuberculosis clinical trial: a qualitative study exploring patient and practitioner experiences in Uzbekistan. Trials 2021; 22:881. [PMID: 34863253 PMCID: PMC8645116 DOI: 10.1186/s13063-021-05850-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 11/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Addressing the global burden of multidrug-resistant tuberculosis (MDR-TB) requires identification of shorter, less toxic treatment regimens. Médecins Sans Frontières (MSF) is currently conducting a phase II/III randomised controlled clinical trial, to find more effective, shorter and tolerable treatments for people with MDR-TB. Recruitment to the trial in Uzbekistan has been slower than expected; we aimed to study patient and health worker experiences of the trial, examining potential factors perceived to impede and facilitate trial recruitment, as well as general perceptions of clinical research in this context. METHODS We conducted a qualitative study using maximum variation, purposive sampling of participants. We carried out in-depth interviews (IDIs) and focus group discussions (FGDs) guided by semi-structured topic guides. In December 2019 and January 2020, 26 interviews were conducted with patients, Ministry of Health (MoH) and MSF staff and trial health workers, to explore challenges and barriers to patient recruitment as well as perceptions of the trial and research in general. Preliminary findings from the interviews informed three subsequent focus group discussions held with patients, nurses and counsellors. Focus groups adopted a person-centred design, brainstorming potential solutions to problems and barriers. Interviews and FGDs were audio recorded, translated and transcribed verbatim. Thematic analysis, drawing on constant comparison, was used to analyse the data. RESULTS Health system contexts may compete with new approaches especially when legislative health regulations or policy around treatment is ingrained in staff beliefs, perceptions and practice, which can undermine clinical trial recruitment. Trust plays a significant role in how patients engage with the trial. Decision-making processes are dynamic and associated with relationship to diagnosis, assimilation of information, previous knowledge or experience and influence of peers and close relations. CONCLUSIONS This qualitative analysis highlights ways in which insights developed together with patients and healthcare workers might inform approaches towards improved recruitment into trials, with the overall objective of delivering evidence for better treatments.
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Affiliation(s)
| | - Shona Horter
- Manson Unit, Médecins Sans Frontières, London, UK
| | - Emma Douch
- Manson Unit, Médecins Sans Frontières, London, UK
| | - Nell Gray
- Manson Unit, Médecins Sans Frontières, London, UK
| | - Nicola James
- Manson Unit, Médecins Sans Frontières, London, UK
| | - Bern-Thomas Nyang'wa
- Manson Unit, Médecins Sans Frontières, London, UK.,Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Jatinder Singh
- Public Health Department, Médecins Sans Frontières-OCA, Tashkent, Uzbekistan
| | - Parpieva Nargiza Nusratovna
- Republican Specialised Scientific-Practical Medical Centre of Phtisiology and Pulmonology, Tashkent, Uzbekistan
| | - Zinaida Tigay
- Republican Phtisiology Hospital No.2, Nukus, Uzbekistan
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Yuldashev S, Parpieva N, Alimov S, Turaev L, Safaev K, Dumchev K, Gadoev J, Korotych O, Harries AD. Scaling Up Molecular Diagnostic Tests for Drug-Resistant Tuberculosis in Uzbekistan from 2012-2019: Are We on the Right Track? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094685. [PMID: 33924862 PMCID: PMC8124440 DOI: 10.3390/ijerph18094685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022]
Abstract
Uzbekistan has a large burden of drug-resistant tuberculosis (TB). To deal with this public health threat, the National TB Program introduced rapid molecular diagnostic tests such as Xpert MTB/RIF (Xpert) and line probe assays (LPAs) for first-line and second-line drugs. We documented the scale-up of Xpert and LPAs from 2012–2019 and assessed whether this led to an increase in patients with laboratory-confirmed multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) and extensively drug-resistant TB (XDR-TB). This was a descriptive study using secondary program data. The numbers of GeneXpert instruments cumulatively increased from six to sixty-seven, resulting in annual assays increasing from 5574 to 107,330. A broader use of the technology resulted in a lower proportion of tests detecting Mycobacterium tuberculosis with half of the positive results showing rifampicin resistance. LPA instruments cumulatively increased from two to thirteen; the annual first-line assays for MDR-TB increased from 2582 to 6607 while second-line assays increased from 1435 in 2016 to 6815 in 2019 with about one quarter to one third of diagnosed patients showing second-line drug resistance. Patient numbers with laboratory-confirmed MDR-TB remained stable (from 1728 to 2060) but there was a large increase in patients with laboratory-confirmed XDR-TB (from 31 to 696). Programmatic implications and ways forward are discussed.
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Affiliation(s)
- Sharofiddin Yuldashev
- Republican Specialized Scientific Practical Medical Centre of Phthisiology and Pulmonology under Ministry of Health of the Republic of Uzbekistan, 1 Majlisiy str, Tashkent 100086, Uzbekistan; (N.P.); (S.A.); (L.T.); (K.S.)
- Correspondence: ; Tel.: +998-90-175-18-48
| | - Nargiza Parpieva
- Republican Specialized Scientific Practical Medical Centre of Phthisiology and Pulmonology under Ministry of Health of the Republic of Uzbekistan, 1 Majlisiy str, Tashkent 100086, Uzbekistan; (N.P.); (S.A.); (L.T.); (K.S.)
| | - Salikhdjan Alimov
- Republican Specialized Scientific Practical Medical Centre of Phthisiology and Pulmonology under Ministry of Health of the Republic of Uzbekistan, 1 Majlisiy str, Tashkent 100086, Uzbekistan; (N.P.); (S.A.); (L.T.); (K.S.)
| | - Laziz Turaev
- Republican Specialized Scientific Practical Medical Centre of Phthisiology and Pulmonology under Ministry of Health of the Republic of Uzbekistan, 1 Majlisiy str, Tashkent 100086, Uzbekistan; (N.P.); (S.A.); (L.T.); (K.S.)
| | - Khasan Safaev
- Republican Specialized Scientific Practical Medical Centre of Phthisiology and Pulmonology under Ministry of Health of the Republic of Uzbekistan, 1 Majlisiy str, Tashkent 100086, Uzbekistan; (N.P.); (S.A.); (L.T.); (K.S.)
| | - Kostyantyn Dumchev
- The Charitable Organization “Ukrainian Institute of Public Health Policy”, Biloruska St, 5, 02000 Kyiv, Ukraine;
| | - Jamshid Gadoev
- World Health Organization Country Office to Uzbekistan, M. Tarobiy St, 16, Tashkent 100100, Uzbekistan;
| | - Oleksandr Korotych
- World Health Organization Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen, Denmark;
| | - Anthony D. Harries
- International Union against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France;
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Safaev K, Parpieva N, Liverko I, Yuldashev S, Dumchev K, Gadoev J, Korotych O, Harries AD. Trends, Characteristics and Treatment Outcomes of Patients with Drug-Resistant Tuberculosis in Uzbekistan: 2013-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094663. [PMID: 33925705 PMCID: PMC8124452 DOI: 10.3390/ijerph18094663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 01/02/2023]
Abstract
Uzbekistan has a high burden of drug-resistant tuberculosis (TB). Although conventional treatment for multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) has been available since 2013, there has been no systematic documentation about its use and effectiveness. We therefore documented at national level the trends, characteristics, and outcomes of patients with drug-resistant TB enrolled for treatment from 2013–2018 and assessed risk factors for unfavorable treatment outcomes (death, failure, loss to follow-up, treatment continuation, change to XDR-TB regimen) in patients treated in Tashkent city from 2016–2017. This was a cohort study using secondary aggregate and individual patient data. Between 2013 and 2018, MDR-TB numbers were stable between 2347 and 2653 per annum, while XDR-TB numbers increased from 33 to 433 per annum. At national level, treatment success (cured and treatment completed) for MDR-TB decreased annually from 63% to 57%, while treatment success for XDR-TB increased annually from 24% to 57%. On multivariable analysis, risk factors for unfavorable outcomes, death, and loss to follow-up in drug-resistant TB patients treated in Tashkent city included XDR-TB, male sex, increasing age, previous TB treatment, alcohol abuse, and associated comorbidities (cardiovascular and liver disease, diabetes, and HIV/AIDS). Reasons for these findings and programmatic implications are discussed.
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Affiliation(s)
- Khasan Safaev
- Republican Specialized Scientific Practical Medical Centre of Phthisiology and Pulmonology under Ministry of Health of the Republic of Uzbekistan, 1 Majlisiy Str., Tashkent 100086, Uzbekistan; (N.P.); (I.L.); (S.Y.)
- Correspondence: ; Tel.: +998-931-844-282
| | - Nargiza Parpieva
- Republican Specialized Scientific Practical Medical Centre of Phthisiology and Pulmonology under Ministry of Health of the Republic of Uzbekistan, 1 Majlisiy Str., Tashkent 100086, Uzbekistan; (N.P.); (I.L.); (S.Y.)
| | - Irina Liverko
- Republican Specialized Scientific Practical Medical Centre of Phthisiology and Pulmonology under Ministry of Health of the Republic of Uzbekistan, 1 Majlisiy Str., Tashkent 100086, Uzbekistan; (N.P.); (I.L.); (S.Y.)
| | - Sharofiddin Yuldashev
- Republican Specialized Scientific Practical Medical Centre of Phthisiology and Pulmonology under Ministry of Health of the Republic of Uzbekistan, 1 Majlisiy Str., Tashkent 100086, Uzbekistan; (N.P.); (I.L.); (S.Y.)
| | - Kostyantyn Dumchev
- The Charitable Organization “Ukrainian Institute on Public Health Policy”, 02000 Kyiv, Ukraine;
| | - Jamshid Gadoev
- World Health Organization Country Office Uzbekistan, 16, M.Tarobiy Str., Tashkent 100100, Uzbekistan
| | - Oleksandr Korotych
- World Health Organization Regional Office for Europe, UN City, Marmorvej 51, DK-2100 Copenhagen, Denmark
| | - Anthony D. Harries
- International Union against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France;
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Treatment Compliance of Multidrug Resistant Tuberculosis in Uzbekistan: Does Practice Follow Policy? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084071. [PMID: 33921547 PMCID: PMC8070610 DOI: 10.3390/ijerph18084071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022]
Abstract
Compliance with treatment guidelines is essential to achieve successful outcomes in tuberculosis patients. Thus, we assessed if multidrug-resistant tuberculosis treatment practices from 2012-2018 in Uzbekistan were compliant with national guidelines in terms of regimens prescribed, weight-based drug dosages used, and documentation of treatment changes (such as prolongation of intensive phase, change of drugs, and their reasons) in the treatment card and Consilium form. A total of 1481 patients were included. Of them, only 25% received standardized regimens as per guidelines and the remaining received individualized regimens. There was an increasing trend in using standardized regimens from 2% in 2012 to 44% in 2018. Compliance to recommended weight-based drug dosages was observed in 85% of the patients during the intensive phase and 84% in the continuation phase-ranged 71-91% over the years. Prolongation of the intensive phase was done in 42% of patients. The treatment was changed in 44% of patients during the intensive phase and 34% of patients during the continuation phase. The documentation of treatment changes was suboptimal (42-75%) during the initial years (2012-2014); however, it improved significantly during later years (86-100%). Future research should explore reasons for non-compliance so that the quality of patient care can be improved.
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