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Oyewusi L, Zeng C, Seung KJ, Mpinda S, Kunda M, Mitnick CD, Kanu M, Tamirat M, Makaka J, Mofolo M, Maime R, Maama L, Senyo N, Oguntoyinbo B, Mayombo L, Franke MF. Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho. Glob Health Action 2024; 17:2305930. [PMID: 38305025 PMCID: PMC10840591 DOI: 10.1080/16549716.2024.2305930] [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: 06/03/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND A low body mass index (BMI) at the start of treatment for rifampicin- or multidrug-resistant tuberculosis (MDR/RR-TB) is associated with poor treatment outcomes and may contribute to delayed sputum culture conversion, thereby prolonging the period of potential transmission to others. Whether the relative importance of low BMI in predicting treatment outcomes differs by HIV status is unclear. OBJECTIVES We evaluated the association between low BMI and two dependent variables, sputum culture conversion and end-of-treatment outcome, among patients receiving treatment for MDR/RR-TB in Lesotho, a setting with a high prevalence of HIV infection. METHODS Secondary data from a prospective cohort of patients initiating a longer (18-20 months) treatment containing bedaquiline and/or delamanid under routine programmatic conditions in Lesotho were analysed. Risk ratios and differences were adjusted for potential confounders using multivariable logistic regression, and estimates were stratified by HIV status. RESULTS Of 264 patients, 105 and 250 were eligible for culture conversion and end-of-treatment analyses, respectively. Seventy-one per cent of patients (74/105) experienced culture conversion within six months, while 74% (184/250) experienced a favourable end-of-treatment outcome. Low BMI was associated with a lower frequency of culture conversion at six months among those who were not living with HIV (relative risk [RR]: 0.50 [95% CI: 0.21, 0.79]); this association was attenuated among those living with HIV (RR: 0.88 [95% CI: 0.68, 1.23]). A low BMI was moderately associated with a lower frequency of treatment success (RR = 0.89 [95% CI: 0.77, 1.03]), regardless of HIV status. CONCLUSIONS Low BMI was common and associated with the frequency of six-month culture conversion and end-of-treatment outcomes. The association with culture conversion was more pronounced among those not living with HIV. Addressing the myriad factors that drive low BMI in this setting could hasten culture conversion and improve end-of-treatment outcomes. This will require a multipronged approach focused on alleviating food insecurity and enabling prompt diagnosis and treatment of HIV and TB.
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Affiliation(s)
- Lawrence Oyewusi
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | - Chengbo Zeng
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - KJ Seung
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Stephanie Mpinda
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | - Mikanda Kunda
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | - Carole D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Makelele Kanu
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | - Meseret Tamirat
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | - Joalane Makaka
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | | | - Refiloe Maime
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | - Llang Maama
- National TB and Leprosy Programme, Lesotho Ministry of Health, Maseru, Lesotho
| | - Ninza Senyo
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | | | - Lwayi Mayombo
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Zou L, Kang W, Guo C, Du J, Chen Q, Shi Z, Tang X, Liang L, Tang P, Pan Q, Zhu Q, Yang S, Chang Z, Guo Z, Wu G, Tang S. Treatment Outcomes and Associated Influencing Factors Among Patients with Rifampicin-Resistant Tuberculosis: A Multicenter, Retrospective, Cohort Study in China. Infect Drug Resist 2024; 17:3737-3749. [PMID: 39221187 PMCID: PMC11366237 DOI: 10.2147/idr.s467971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024] Open
Abstract
Objective Rifampin-resistant tuberculosis (RR-TB) remains a serious global public health concern. We assessed treatment outcomes and associated influencing factors among RR-TB patients in China. Methods This research enrolled 1339 patients who started RR-TB treatment between May 2018 and April 2020 in China retrospectively. Data were collected from the electronic medical records. Multivariable logistic regression analysis was used to identify the influencing factors related to unfavorable outcomes. Results Of the 1339 RR-TB patients, 78.8% (1055/1339) achieved treatment success (cured or treatment completed), 5.1% (68/1339) experienced treatment failure, 1.1% (15/1339) died during treatment, 10.1% (135/1339) were lost to follow-up, and 4.9% (66/1339) were not evaluated. About 67.7% (907/1339) of patients experienced at least one adverse event (AE). The most common AE was hypohepatia (507/1339, 37.9%), followed by hyperuricemia (429/1339, 32.0%), anemia (368/1339, 27.5%), electrolyte disturbance (318/1339, 23.7%), peripheral neuritis (245/1339, 18.3%), and gastrointestinal reactions (203/1339, 15.2%). Multivariate analysis showed that age ≥60 years [adjusted odds ratio (aOR): 1.96, 95% confidence interval (CI): 1.39-2.77], national minority (aOR: 2.36, 95% CI: 1.42-3.93), smoking (aOR: 1.50, 95% CI: 1.10-2.04), cardiopathy (aOR: 2.90, 95% CI: 1.33-6.31), tumors (aOR: 9.84, 95% CI: 2.27-42.67), immunocompromise (aOR: 2.17, 95% CI: 1.21-3.91), re-treated TB (aOR: 1.46, 95% CI: 1.08-1.97), and experienced gastrointestinal reactions (aOR: 2.27, 95% CI: 1.52-3.40) were associated with unfavorable outcomes. Body mass index (BMI) ≥18.5 kg/m2, regimens containing bedaquiline and experienced adverse events (AEs) such as hypohepatia, leukopenia, peripheral neuritis, and optic neuritis were associated with favorable outcomes. Conclusion High rates of treatment success were achieved for RR-TB patients at tertiary tuberculosis hospitals in China. Age ≥60 years, national minority, smoking status, comorbidities, re-treated TB, and experienced gastrointestinal reactions were independent prognostic factors for unfavorable treatment outcomes.
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Affiliation(s)
- Liping Zou
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, People’s Republic of China
| | - Wanli Kang
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, People’s Republic of China
| | - Chunhui Guo
- Department of Tuberculosis, Harbin Chest Hospital, Harbin, People’s Republic of China
| | - Juan Du
- Department of Tuberculosis, Wuhan Pulmonary Hotel, Wuhan, People’s Republic of China
| | - Qing Chen
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, People’s Republic of China
| | - Zhengyu Shi
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, People’s Republic of China
| | - Xianzhen Tang
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, People’s Republic of China
| | - Li Liang
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, People’s Republic of China
| | - Peijun Tang
- Department of Tuberculosis, the Fifth People’s Hospital of Suzhou, Suzhou, People’s Republic of China
| | - Qing Pan
- Department of Respiratory and Critical Care Medicine, Anqing Municipal Hospital, Anqing, People’s Republic of China
| | - Qingdong Zhu
- Department of Tuberculosis, the Fourth People’s Hospital of Nanning, Nanning, People’s Republic of China
| | - Song Yang
- General Internal Medicine Department, Chongqing Public Health Medical Center, Chongqing, People’s Republic of China
| | - Zhanlin Chang
- Department of Surgery, the Third People’s Hospital of Tibet Autonomous Region, Lasa, People’s Republic of China
| | - Zhouli Guo
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, People’s Republic of China
| | - Guihui Wu
- Department of Tuberculosis, Public Health Clinical Center of Chengdu, Chengdu, People’s Republic of China
| | - Shenjie Tang
- Beijing Chest Hospital, Capital Medical University, Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing, People’s Republic of China
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Salehi Z, Askari M, Jafari A, Ghosn B, Surkan PJ, Hosseinzadeh-Attar MJ, Pouraram H, Azadbakht L. Dietary patterns and micronutrients in respiratory infections including COVID-19: a narrative review. BMC Public Health 2024; 24:1661. [PMID: 38907196 PMCID: PMC11193220 DOI: 10.1186/s12889-024-18760-y] [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: 02/12/2023] [Accepted: 05/02/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND COVID-19 is a pandemic caused by nCoV-2019, a new beta-coronavirus from Wuhan, China, that mainly affects the respiratory system and can be modulated by nutrition. METHODS This review aims to summarize the current literature on the association between dietary intake and serum levels of micronutrients, malnutrition, and dietary patterns and respiratory infections, including flu, pneumonia, and acute respiratory syndrome, with a focus on COVID-19. We searched for relevant articles in various databases and selected those that met our inclusion criteria. RESULTS Some studies suggest that dietary patterns, malnutrition, and certain nutrients such as vitamins D, E, A, iron, zinc, selenium, magnesium, omega-3 fatty acids, and fiber may have a significant role in preventing respiratory diseases, alleviating symptoms, and lowering mortality rates. However, the evidence is not consistent and conclusive, and more research is needed to clarify the mechanisms and the optimal doses of these dietary components. The impact of omega-3 and fiber on respiratory diseases has been mainly studied in children and adults, respectively, and few studies have examined the effect of dietary components on COVID-19 prevention, with a greater focus on vitamin D. CONCLUSION This review highlights the potential of nutrition as a modifiable factor in the prevention and management of respiratory infections and suggests some directions for future research. However, it also acknowledges the limitations of the existing literature, such as the heterogeneity of the study designs, populations, interventions, and outcomes, and the difficulty of isolating the effects of single nutrients from the complex interactions of the whole diet.
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Affiliation(s)
- Zahra Salehi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, IR, Iran
| | - Mohammadreza Askari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, IR, Iran
| | - Alireza Jafari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, IR, Iran
| | - Batoul Ghosn
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, IR, Iran
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mohammad Javad Hosseinzadeh-Attar
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran
- Department of Nutrition and Biochemistry, School of Public Health, Tehran University of Medical Sciences, Tehran, IR, Iran
| | - Hamed Pouraram
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, IR, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, IR, Iran.
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, IR, Iran.
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, IR, Iran.
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Pedersen OS, Butova T, Kapustnyk V, Miasoiedov V, Kuzhko M, Hryshchuk L, Kornaha S, Borovok N, Raznatovska O, Fedorec A, Bogomolov A, Tkhorovskiy M, Akymenko O, Klymenko I, Kulykova O, Karpenko Z, Shapoval T, Chursina N, Kondratyuk N, Parkhomenko O, Sazonenko I, Ostrovskyy M, Makoida I, Markovtsiy L, Skryp V, Lubenko V, Hrankina N, Bondarenko L, Hlynenko V, Dahl VN, Butov D. Treatment outcomes and risk factors for an unsuccessful outcome among patients with highly drug-resistant tuberculosis in Ukraine. Clin Microbiol Infect 2024; 30:360-367. [PMID: 38065363 DOI: 10.1016/j.cmi.2023.12.001] [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: 10/23/2023] [Revised: 11/28/2023] [Accepted: 12/02/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES To describe demographics, clinical features, and treatment outcomes of patients with highly drug-resistant tuberculosis (TB) in Ukraine, and to evaluate risk factors for an unsuccessful outcome. METHODS Data from patients with multi-, pre-extensively, or extensively drug-resistant TB were collected prospectively from TB dispensaries in 15 out of 24 Ukrainian oblasts (regions) from 2020 to 2021. Treatment outcomes were evaluated using WHO definitions. Risk factors for an unsuccessful outcome were identified using a multivariable logistic regression model. RESULTS Among 1748 patients, the overall proportion of successful outcomes was 58% (95% confidence interval [95% CI] 56-60) (n = 1015/1748), ranging from 65% (95% CI: 62-69) (n = 531/814) for multidrug-resistant TB to 54% (95% CI: 49-58) (n = 301/563) for pre-extensively drug-resistant TB and 49% (95% CI: 44-55) (n = 183/371) for extensively drug-resistant TB. Results were similar across oblasts, with few exceptions. The strongest risk factors for an unsuccessful outcome were extensively drug-resistant TB (adjusted OR [aOR] 3.23; 95% CI: 1.88-5.53), total serum protein below 62 g/L in adults and below 57 g/L for children and adolescents (aOR 2.79; 95% CI: 1.93-4.04), psychiatric illness (aOR 2.79; 95% CI: 1.46-5.33), age at TB diagnosis >65 years (aOR 2.50; 95% CI: 1.42-4.42), and alcohol misuse (aOR 2.48; 95% CI: 1.89-3.26). DISCUSSION The overall proportion of successful outcomes among Ukrainians treated for highly drug-resistant TB was 58%, notably better compared with previous years, but still low for extensively drug-resistant TB. Risk factors for unsuccessful outcomes highlight that addressing socioeconomic factors in TB management is crucial. Efforts in maintaining TB dispensaries during and following the ongoing war are highly warranted.
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Affiliation(s)
- Ole Skouvig Pedersen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Tetiana Butova
- Outpatient Department, Merefa Central District Hospital, Merefa, Ukraine
| | | | | | - Mykhailo Kuzhko
- Department of Chemoresistant Tuberculosis, National Institute of Phthisiology and Pulmonology named after F. G. Yanovskyi NAMS of Ukraine, Kiev, Ukraine
| | - Leonid Hryshchuk
- Department of Internal Medicine Propedeutics and Phthisiology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Svitlana Kornaha
- Department of Internal Medicine Propedeutics and Phthisiology, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Natalia Borovok
- Medical Department No. 3, Regional Anti-tuberculosis Dispensary No 1 in Kharkiv, Kharkiv, Ukraine
| | - Olena Raznatovska
- Phthisiology and Pulmonology, Zaporizhzhia State Medical and Pharmaceutical University, Zaporizhzhia, Ukraine
| | - Andrii Fedorec
- The Pulmonary Tuberculosis Department No. 2, Zaporizhzhia Regional Phthisiology and Pulmonology Clinical Treatment and Diagnostic Center, Zaporizhzhia, Ukraine
| | - Artemii Bogomolov
- Phthisiology, Clinical Immunology and Allergology, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Mykhaylo Tkhorovskiy
- Phthisiology, Clinical Immunology and Allergology, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Oleksandra Akymenko
- Medical Department No. 3, Regional Anti-tuberculosis Dispensary No 1 in Kharkiv, Kharkiv, Ukraine
| | | | - Olena Kulykova
- Outpatient Department, Regional Clinical Tuberculosis Dispensary, Kramatorsk, Ukraine
| | - Zhanna Karpenko
- Phthisiatry Center, Chernihiv Regional Hospital, Chernihiv, Ukraine
| | - Tetiana Shapoval
- Phthisiatry Center, Chernihiv Regional Hospital, Chernihiv, Ukraine
| | | | - Natalia Kondratyuk
- Bacteriological Laboratory, Volyn Regional Phthisiopulmonological Center, Lutsk, Ukraine
| | - Olha Parkhomenko
- Mykolaiv Regional Phthisio-pulmonological Medical Center, Mykolaiv, Ukraine
| | - Inna Sazonenko
- Phthisiology, Mykolaiv Regional Phthisiology and Pulmonology Medical Center, Mykolaiv, Ukraine
| | - Mykola Ostrovskyy
- Phthisiology and Pulmonology Rate of Occupational Diseases, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | - Iryna Makoida
- Phthisiology and Pulmonology Rate of Occupational Diseases, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
| | | | - Vasyl Skryp
- Center of Pulmonary Diseases, Uzhhorod, Ukraine
| | - Victoriya Lubenko
- Information and Analytical Department, Phthisiopulmonology Center, Kyiv, Ukraine
| | - Nataliia Hrankina
- Infectious Diseases and Phthisiology, Krivoy Rig Tuberculosis Dispensary, Dnipro, Ukraine
| | - Leonid Bondarenko
- Administration, Sumy Regional Clinical Anti-tuberculosis Dispensary, Sumy, Ukraine
| | - Valentyna Hlynenko
- Outpatient Department, Sumy Regional Clinical Anti-tuberculosis Dispensary, Sumy, Ukraine
| | - Victor Næstholt Dahl
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; Center for Global Health, Aarhus University (GloHAU), Aarhus, Denmark; International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.
| | - Dmytro Butov
- Infectious Diseases and Phthisiology, Kharkiv National Medical University, Kharkiv, Ukraine
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Cheng Q, Dang T, Nguyen TA, Velen K, Nguyen VN, Nguyen BH, Vu DH, Long CH, Do TT, Vu TM, Marks GB, Yapa M, Fox GJ, Wiseman V. mHealth application for improving treatment outcomes for patients with multidrug-resistant tuberculosis in Vietnam: an economic evaluation protocol for the V-SMART trial. BMJ Open 2023; 13:e076778. [PMID: 38081668 PMCID: PMC10729151 DOI: 10.1136/bmjopen-2023-076778] [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] [Received: 06/16/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION The Strengthen the Management of Multidrug-Resistant Tuberculosis in Vietnam (V-SMART) trial is a randomised controlled trial of using mobile health (mHealth) technologies to improve adherence to medications and management of adverse events (AEs) in people with multidrug-resistant tuberculosis (MDR-TB) undergoing treatment in Vietnam. This economic evaluation seeks to quantify the cost-effectiveness of this mHealth intervention from a healthcare provider and societal perspective. METHODS AND ANALYSIS The V-SMART trial will recruit 902 patients treated for MDR-TB across seven participating provinces in Vietnam. Participants in both intervention and control groups will receive standard community-based therapy for MDR-TB. Participants in the intervention group will also have a purpose-designed App installed on their smartphones to report AEs to health workers and to facilitate timely management of AEs. This economic evaluation will compare the costs and health outcomes between the intervention group (mHealth) and the control group (standard of care). Costs associated with delivering the intervention and health service utilisation will be recorded, as well as patient out-of-pocket costs. The health-related quality of life (HRQoL) of study participants will be captured using the 36-Item Short Form Survey (SF-36) questionnaire and used to calculate quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratios (ICERs) will be based on the primary outcome (proportion of patients with treatment success after 24 months) and QALYs gained. Sensitivity analysis will be conducted to test the robustness of the ICERs. A budget impact analysis will be conducted from a payer perspective to provide an estimate of the total budget required to scale-up delivery of the intervention. ETHICS AND DISSEMINATION Ethical approval for the study was granted by the University of Sydney Human Research Ethics Committee (2019/676), the Scientific Committee of the Ministry of Science and Technology, Vietnam (08/QD-HDQL-NAFOSTED) and the Institutional Review Board of the National Lung Hospital, Vietnam (13/19/CT-HDDD). Study findings will be published in peer-reviewed journals and conference proceedings. TRIAL REGISTRATION NUMBER ACTRN12620000681954.
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Affiliation(s)
- Qinglu Cheng
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Tho Dang
- Woolcock Institute of Medical Research, Hanoi, Vietnam
| | - Thu-Anh Nguyen
- Woolcock Institute of Medical Research, Hanoi, Vietnam
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kavindhran Velen
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Binh Hoa Nguyen
- Vietnam National Tuberculosis Control Program, Hanoi, Vietnam
| | - Dinh Hoa Vu
- Hanoi University of Pharmacy, Hanoi, Vietnam
| | | | - Thu Thuong Do
- Vietnam National Tuberculosis Control Program, Hanoi, Vietnam
| | - Truong-Minh Vu
- Ho Chi Minh City Institute for Development Studies, Ho Chi Minh City, Vietnam
| | - Guy B Marks
- Woolcock Institute of Medical Research, Hanoi, Vietnam
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Manisha Yapa
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gregory J Fox
- Woolcock Institute of Medical Research, Hanoi, Vietnam
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Virginia Wiseman
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Ma JB, Zeng LC, Ren F, Dang LY, Luo H, Wu YQ, Yang XJ, Li R, Yang H, Xu Y. Development and validation of a prediction model for unsuccessful treatment outcomes in patients with multi-drug resistance tuberculosis. BMC Infect Dis 2023; 23:289. [PMID: 37147607 PMCID: PMC10161636 DOI: 10.1186/s12879-023-08193-0] [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: 06/07/2022] [Accepted: 03/23/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND The World Health Organization has reported that the treatment success rate of multi-drug resistance tuberculosis is approximately 57% globally. Although new drugs such as bedaquiline and linezolid is likely improve the treatment outcome, there are other factors associated with unsuccessful treatment outcome. The factors associated with unsuccessful treatment outcomes have been widely examined, but only a few studies have developed prediction models. We aimed to develop and validate a simple clinical prediction model for unsuccessful treatment outcomes in patients with multi-drug resistance pulmonary tuberculosis (MDR-PTB). METHODS This retrospective cohort study was performed between January 2017 and December 2019 at a special hospital in Xi'an, China. A total of 446 patients with MDR-PTB were included. Least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were used to select prognostic factors for unsuccessful treatment outcomes. A nomogram was built based on four prognostic factors. Internal validation and leave-one-out cross-validation was used to assess the model. RESULTS Of the 446 patients with MDR-PTB, 32.9% (147/446) cases had unsuccessful treatment outcomes, and 67.1% had successful outcomes. After LASSO regression and multivariate logistic analyses, no health education, advanced age, being male, and larger extent lung involvement were identified as prognostic factors. These four prognostic factors were used to build the prediction nomograms. The area under the curve of the model was 0.757 (95%CI 0.711 to 0.804), and the concordance index (C-index) was 0.75. For the bootstrap sampling validation, the corrected C-index was 0.747. In the leave-one-out cross-validation, the C-index was 0.765. The slope of the calibration curve was 0.968, which was approximately 1.0. This indicated that the model was accurate in predicting unsuccessful treatment outcomes. CONCLUSIONS We built a predictive model and established a nomogram for unsuccessful treatment outcomes of multi-drug resistance pulmonary tuberculosis based on baseline characteristics. This predictive model showed good performance and could be used as a tool by clinicians to predict who among their patients will have an unsuccessful treatment outcome.
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Affiliation(s)
- J-B Ma
- Department of Drug-resistance tuberculosis, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - L-C Zeng
- Xi'an Center for Disease Control and Prevention, Xi'an, Shaanxi Province, China
| | - F Ren
- Department of Drug-resistance tuberculosis, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China.
| | - L-Y Dang
- Department of Drug-resistance tuberculosis, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - H Luo
- Department of Drug-resistance tuberculosis, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - Y-Q Wu
- Department of Drug-resistance tuberculosis, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - X-J Yang
- Department of Drug-resistance tuberculosis, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - R Li
- Department of Drug-resistance tuberculosis, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - H Yang
- Department of Clinical Laboratory, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - Y Xu
- Department of Drug-resistance tuberculosis, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
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Elduma AH, Holakouie-Naieni K, Almasi-Hashiani A, Rahimi Foroushani A, Mustafa Hamdan Ali H, Adam MAM, Elsony A, Ali Mansournia M. The Targeted Maximum Likelihood estimation to estimate the causal effects of the previous tuberculosis treatment in Multidrug-resistant tuberculosis in Sudan. PLoS One 2023; 18:e0279976. [PMID: 36649340 PMCID: PMC9844833 DOI: 10.1371/journal.pone.0279976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION This study used Targeted Maximum Likelihood Estimation (TMLE) as a double robust method to estimate the causal effect of previous tuberculosis treatment history on the occurrence of multidrug-resistant tuberculosis (MDR-TB). TMLE is a method to estimate the marginal statistical parameters in case-control study design. The aim of this study was to estimate the causal effect of the previous tuberculosis treatment on the occurrence of MDR-TB using TMLE in Sudan. METHOD A case-control study design combined with TMLE was used to estimate parameters. Cases were MDR-TB patients and controls were and patients who cured from tuberculosis. The history of previous TB treatment was considered the main exposure, and MDR-TB as an outcome. A designed questionnaire was used to collect a set of covariates including age, time to reach a health facility, number of times stopping treatment, gender, education level, and contact with MDR-TB cases. TMLE method was used to estimate the causal association of parameters. Statistical analysis was carried out with ltmle package in R-software. Result presented in graph and tables. RESULTS A total number of 430 cases and 860 controls were included in this study. The estimated risk difference of the previous tuberculosis treatment was (0.189, 95% CI; 0.161, 0.218) with SE 0.014, and p-value (<0.001). In addition, the estimated risk ratio was (16.1, 95% CI; 12.932, 20.001) with SE = 0.014 and p-value (<0.001). CONCLUSION Our findings indicated that previous tuberculosis treatment history was determine as a risk factor for MDR-TB in Sudan. Also, TMLE method can be used to estimate the risk difference and the risk ratio in a case-control study design.
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Affiliation(s)
- Adel Hussein Elduma
- Department of Epidemiology, National Public Health Laboratory, Khartoum, Sudan
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kourosh Holakouie-Naieni
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
- Traditional and Complementary Medicine Research Center (TCMRC), Arak University of Medical Sciences, Arak, Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamdan Mustafa Hamdan Ali
- Multidrug resistant Tuberculosis Unit- Communicable and Non-Communicable Diseases Control Directorate, Ministry of Health Sudan, Khartoum, Sudan
| | - Muatsim Ahmed Mohammed Adam
- National Tuberculosis Reference Laboratory, National Public Health Laboratory- Ministry of Health, Khartoum, Sudan
| | - Asma Elsony
- The Epidemiological Laboratory (Epi-Lab), Khartoum, Sudan
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Yan J, Luo H, Nie Q, Hu S, Yu Q, Wang X. A Scoring System Based on Laboratory Parameters and Clinical Features to Predict Unfavorable Treatment Outcomes in Multidrug- and Rifampicin-Resistant Tuberculosis Patients. Infect Drug Resist 2023; 16:225-237. [PMID: 36647452 PMCID: PMC9840374 DOI: 10.2147/idr.s397304] [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: 11/12/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
Background The growth of antibiotic resistance to Mycobacterium TB represents a major barrier to the goal of "Ending the global TB epidemics". This study aimed to develop and validate a simple clinical scoring system to predict the unfavorable treatment outcomes (UTO) in multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB) patients. Methods A total of 333 MDR/RR-TB patients were recruited retrospectively. The clinical, radiological and laboratory features were gathered and selected by lasso regression. These variables with area under the receiver operating characteristic curve (AUC)>0.6 were subsequently submitted to multivariate logistic analysis. The binomial logistic model was used for establishing a scoring system based on the nomogram at the training set (N = 241). Then, another independent set was used to validate the scoring system (N = 92). Results The new scoring system consists of age (8 points), education level (10 points), bronchiectasis (4 points), red blood cell distribution width-coefficient of variation (RDW-CV) (7 points), international normalized ratio (INR) (7 points), albumin to globulin ratio (AGR) (5 points), and C-reactive protein to prealbumin ratio (CPR) (6 points). The scoring system identifying UTO has a discriminatory power of 0.887 (95% CI=0.835-0.939) in the training set, and 0.805 (95% CI=0.714-0.896) in the validation set. In addition, the scoring system is used exclusively to predict the death of MDR/RR-TB and has shown excellent performance in both training and validation sets, with AUC of 0.930 (95% CI=0.872-0.989) and 0.872 (95% CI=0.778-0.967), respectively. Conclusion This novel scoring system based on seven accessible predictors has exhibited good predictive performance in predicting UTO, especially in predicting death risk.
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Affiliation(s)
- Jisong Yan
- Department of Respiratory and Critical Care Medicine, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430023, People’s Republic of China
| | - Hong Luo
- Department of Respiratory and Critical Care Medicine, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430023, People’s Republic of China
| | - Qi Nie
- Department of Respiratory and Critical Care Medicine, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430023, People’s Republic of China
| | - Shengling Hu
- Department of Infectious Diseases, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430023, People’s Republic of China
| | - Qi Yu
- Department of Infectious Diseases, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430023, People’s Republic of China,Correspondence: Qi Yu, Department of Infectious Diseases, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430023, People’s Republic of China, Email
| | - Xianguang Wang
- Department of Respiratory and Critical Care Medicine, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430023, People’s Republic of China,Xianguang Wang, Department of Respiratory and Critical Care Medicine, Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430023, People’s Republic of China, Email
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9
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Wahid A, Ghafoor A, Khan AW, Al-Worafi YM, Latif A, Shahwani NA, Atif M, Saleem F, Ahmad N. Comparative effectiveness of individualized longer and standardized shorter regimens in the treatment of multidrug resistant tuberculosis in a high burden country. Front Pharmacol 2022; 13:973713. [PMID: 36160454 PMCID: PMC9503836 DOI: 10.3389/fphar.2022.973713] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
Objective: To compare the effectiveness of second line injectables containing shorter (duration 9–12 months) and longer treatment regimens (LTR, duration ≥ 20 months) among multidrug-resistant tuberculosis (MDR-TB) patients with no documented resistance and history of treatment with any second-line anti-TB drug (SLD) for ≥ 1 month. Methods: This was an observational cohort study of MDR-TB patients treated at eight PMDT units in Pakistan. Patients’ data from baseline until treatment outcomes were collected from Electronic Nominal Recording and Reporting System. The treatment outcomes of “cured” and “treatment completed” were grouped together as successful, whereas “death,” “treatment failure,” and “lost to follow-up” were collectively grouped as unsuccessful outcomes. Time to sputum culture conversion (SCC) was analyzed using the Kaplan–Meier method and the differences between groups were compared through the log-rank test. Multivariate Cox proportional hazards and binary logistic regression analyses were used to find predictors of time to SCC and unsuccessful treatment outcomes. A p-value < 0.05 was considered statistically significant. Results: A total 701 eligible MDR-TB patients [313 treated with shorter treatment regimen (STR) and 388 treated with LTR at eight centres in Pakistan were evaluated]. Time to achieve SCC was significantly shorter in STR group [mean: 2.03 months, 95% confidence interval (CI):1.79–2.26] than in LTR group (mean: 2.69 months, 95% CI: 2.35–3.03) (p-value<0.001, Log-rank test). Treatment success was higher in STR (83.7%) than in LTR (73.2%) group (p-value <0.001) due to high cure (79.9% vs. 70.9%, p-value = 0.006) and low death (9.9% vs. 18.3%, p-value = 0.002) rates with STR. Treatment with STR emerged the only predictor of early SCC [adjusted Hazards ratio (aHR) = 0.815, p-value = 0.014], whereas, patient’s age of 41–60 (OR = 2.62, p-value<0.001) and >60 years (OR = 5.84, p-value<0.001), baseline body weight of 31–60 (OR = 0.36, p-value = 0.001) and >60 kg (OR = 0.23, p-value <0.001), and treatment with LTR (OR = 1.88, p-value = 0.001) had statistically significant association with unsuccessful treatment outcomes. Conclusion: STR exhibited superior anti-microbial activity against MDR-TB. When compared LTR, treatment with STR resulted in significantly early SCC, high cure, and lower death rates among MDR-TB patients who had no documented resistance and history of treatment with any SLD ≥ 1 month.
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Affiliation(s)
- Abdul Wahid
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | | | | | - Yaser Mohammed Al-Worafi
- Department of Clinical Pharmacy, University of Science and Technology of Fujairah, Fujairah, United Arab Emirates
| | | | - Nisar Ahmed Shahwani
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan
| | - Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Fahad Saleem
- 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
- *Correspondence: Nafees Ahmad,
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Ma JB, Zeng LC, Ren F, Dang LY, Luo H, Wu YQ, Yang XJ, Li R, Yang H, Xu Y. Treatment Outcomes and Risk Factors of Multidrug-Resistant Tuberculosis Patients in Xi’an China, a Retrospective Cohort Study. Infect Drug Resist 2022; 15:4947-4957. [PMID: 36060236 PMCID: PMC9438796 DOI: 10.2147/idr.s376177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jin-Bao Ma
- Department of Drug-Resistance Tuberculosis, Xi’an Chest Hospital, Xi’an, People’s Republic of China
| | - Ling-Cheng Zeng
- Xi’an Center for Disease Control and Prevention, Xi’an, People’s Republic of China
| | - Fei Ren
- Department of Drug-Resistance Tuberculosis, Xi’an Chest Hospital, Xi’an, People’s Republic of China
- Correspondence: Fei Ren; You Xu, Department of Drug-resistance tuberculosis, Xi’an Chest Hospital, West Section of HangTian Avenue, Yanta District, Xi’an, People’s Republic of China, Email ;
| | - Li-Yun Dang
- Department of Drug-Resistance Tuberculosis, Xi’an Chest Hospital, Xi’an, People’s Republic of China
| | - Hui Luo
- Department of Drug-Resistance Tuberculosis, Xi’an Chest Hospital, Xi’an, People’s Republic of China
| | - Yan-Qin Wu
- Department of Drug-Resistance Tuberculosis, Xi’an Chest Hospital, Xi’an, People’s Republic of China
| | - Xin-Jun Yang
- Department of Drug-Resistance Tuberculosis, Xi’an Chest Hospital, Xi’an, People’s Republic of China
| | - Rong Li
- Department of Drug-Resistance Tuberculosis, Xi’an Chest Hospital, Xi’an, People’s Republic of China
| | - Han Yang
- Department of Clinical Laboratory, Xi’an Chest Hospital, Xi’an, People’s Republic of China
| | - You Xu
- Department of Drug-Resistance Tuberculosis, Xi’an Chest Hospital, Xi’an, People’s Republic of China
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11
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Anley DT, Akalu TY, Merid MW, Tsegaye T. Development and Validation of a Nomogram for the Prediction of Unfavorable Treatment Outcome Among Multi-Drug Resistant Tuberculosis Patients in North West Ethiopia: An Application of Prediction Modelling. Infect Drug Resist 2022; 15:3887-3904. [PMID: 35903578 PMCID: PMC9317379 DOI: 10.2147/idr.s372351] [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: 04/26/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Multidrug-resistant tuberculosis (MDR-TB) is a global problem and a health security threat, which makes “Ending the global TB epidemic in 2035” unachievable. Globally, the unfavourable treatment outcome remains unacceptably high. Therefore, this study aimed to develop a risk prediction model for unfavorable treatment outcomes in MDR-TB patients, which can be used by clinicians as a simple clinical tool in their decision-making. Objective The objective of this study was to develop and validate a risk prediction model for the prediction of unfavorable treatment outcomes among MDR-TB patients in North-West Ethiopia. Methods We used MDR-TB data collected from the University of Gondar and Debre Markos referral hospitals. A retrospective follow-up study was conducted and a total of 517 patients were included in the study. STATA version 16 statistical software and R version 4.0.5 were used for the analysis. Descriptive statistics were carried out. A multivariable model was fitted using all potent predictors selected by the lasso regression method. A simplified risk prediction model (nomogram) was developed based on the binomial logit-based model, and its performance was described by assessing its discriminatory power and calibration. Finally, decision curve analysis (DCA) was done to evaluate the clinical and public health impact of the developed model. Results The developed nomogram comprised six predictors: baseline anemia, major adverse event, comorbidity, age, marital status, and treatment supporter. The model has a discriminatory power of 0.753 (95% CI: 0.708, 0.798) and calibration test of (P-value = 0.695). It was internally validated by bootstrapping method, and it has a relatively corrected discrimination performance (AUC = 0.744, 95CI: 0.699, 0.788). The optimism coefficient was found to be 0.009. The decision curve analysis showed the net benefit of the model as threshold probabilities varied. Conclusion The developed nomogram can be used for individualized prediction of unfavorable treatment outcomes in MDR-TB patients for it has a satisfactory level of accuracy and good calibration. The model is clinically interpretable and was found to have added benefits in clinical practice.
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Affiliation(s)
- Denekew Tenaw Anley
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Tsegaye
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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12
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Wu Y, Zhang Y, Wang Y, Wei J, Wang W, Duan W, Tian Y, Ren M, Li Z, Wang W, Zhang T, Wu H, Huang X. Bedaquiline and Linezolid improve anti-TB treatment outcome in drug-resistant TB patients with HIV: A systematic review and meta-analysis. Pharmacol Res 2022; 182:106336. [PMID: 35779814 DOI: 10.1016/j.phrs.2022.106336] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES We aimed to assess the effect of second-line anti-TB treatment and determine which drugs can achieve the greatest clinical benefit for DR-TB-HIV patients by comparing multiple chemotherapy regimens, to provide a basis for evidence-based practice. METHODS We searched three electronic databases (PubMed, Web of Science and Cochrane) for related English studies published since 2010. A random-effect model was used to estimate the pooled result for the treatment outcomes. Subgroup analysis based on possible factors, such as ART, baseline CD4 T-cell count, treatment regimens, and profiles of drug resistance, was also conducted to assess factors for favorable outcome. Outcomes were treatment success and mortality. RESULTS 38 studies, 40 cohorts with 9279 patients were included. The pooled treatment success, mortality, treatment failure, and default rates were 57.5 % (95 % CI 53.1-61.9), 21 % (95 % CI 17.8-24.6), 4.8 % (95 % CI 3.5-6.5), and 10.7 % (95 % CI 8.7-13.1), respectively, in patients with DR-TB and HIV co-infection. Subgroup analysis showed that BDQ and LZD based regimen, and ≥ 2 Group A drugs were associated with a higher treatment success rate. Besides, higher CD4 T-cell count at baseline was also correlated with higher treatment success rate, too. CONCLUSIONS Suboptimal anti-TB outcomes underlining the need to expand the application of effective drugs and better regimen in high HIV setting. BDQ and LZD based all-oral regimen and early ART could contribute to higher treatment success, particularly among XDR-TB-HIV patients. Given that all included studies were observational, our findings emphasize the need for high-quality studies to further investigate the optimal treatment regimen for DR-TB-HIV.
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Affiliation(s)
- Yaxin Wu
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Yuening Zhang
- Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Yingying Wang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Jiaqi Wei
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China; Beijing Key Laboratory for HIV/AIDS Research, Beijing Youan Hospital, Capital Medical University, Beijing100069, China
| | - Wenjing Wang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Wenshan Duan
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Yakun Tian
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Meixin Ren
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Zhen Li
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China; Beijing Key Laboratory for HIV/AIDS Research, Beijing Youan Hospital, Capital Medical University, Beijing100069, China
| | - Wen Wang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Tong Zhang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Hao Wu
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China
| | - Xiaojie Huang
- Clinical and Research Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, No 8 Xitoutiao, Youanmenwai, Feng Tai District, Beijing 100069, China.
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Belachew T, Yaheya S, Tilahun N, Gebrie E, Seid R, Nega T, Biset S. Multidrug-Resistant Tuberculosis Treatment Outcome and Associated Factors at the University of Gondar Comprehensive Specialized Hospital: A Ten-Year Retrospective Study. Infect Drug Resist 2022; 15:2891-2899. [PMID: 35686191 PMCID: PMC9172731 DOI: 10.2147/idr.s365394] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Multidrug-resistant tuberculosis (MDR-TB) remains a public health crisis and a health security threat worldwide. Poor public health infrastructure, inefficient infection control and mismanagement of TB treatment are among the reasons for the continuous emergence and spread of drug-resistant TB (DR-TB). The final treatment outcome is the most direct measurement of TB control programs. Therefore, this study sought to determine the proportions and predictors of TB treatment outcomes among MDR/RR-TB treated patients. Methods A 10-year, 2011 to 2021, hospital-based retrospective cohort study was conducted at the University of Gondar Comprehensive Specialized Hospital. The records of 408 MDR-TB patients, 389 with treatment outcome and 19 on treatment, were collected using a structured checklist. Results A total of 389 patients with a recorded MDR/RR-TB treatment outcome were included. The treatment success rate was 77.12%, with 58.35% cured and 18.76% treatment completed. The proportion of death rate, treatment default loss to follow-up, treatment failure, and unknown treatment outcome was 9.25%, 6.94%, 3.1%, and 3.6%, respectively. Regarding the patient category, the most successful treatment outcome (83.5%) came from patients diagnosed with relapse cases, followed by new cases (81.8%). An unsuccessful treatment outcome was significantly associated with patients aged >44 years (AOR, 3.3, 95% CI = 1.55–6.99). Conclusion and Recommendations This study indicated that nearly 23% of MDR/RR-TB patients had unsuccessful treatment outcomes and being older was significantly correlated with these outcomes. For better outcomes, it is recommended to strengthen combined treatment adherence interventions and evaluate treatment regimens and administration options. A prospective cohort study may be required to investigate the full range of potential causes of unfavorable outcomes.
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Affiliation(s)
- Teshome Belachew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Seid Yaheya
- School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Nehemia Tilahun
- School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Eshet Gebrie
- School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Rim Seid
- School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Tilahun Nega
- University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Sirak Biset
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
- Correspondence: Sirak Biset, Tel +251-911-598-568, Email
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Thu NN, Mai TT, Trang TTT, Tuan NA, Quyen TC, Hanh NL, Hoan NH, Lan BTH, Hau PT, Tue HH, Dung TV, Tsuji R, Watanabe Y, Yamamoto N, Kanauchi O. Impact of Infectious Disease after Lactococcus lactis Strain Plasma Intake in Vietnamese Schoolchildren: A Randomized, Placebo-Controlled, Double-Blind Study. Nutrients 2022; 14:nu14030552. [PMID: 35276914 PMCID: PMC8839753 DOI: 10.3390/nu14030552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
Lactococcus lactis strain Plasma (LC-Plasma) is reported to have anti-viral effects via direct activation of plasmacytoid dendritic cells, which upregulate the production of type I and III interferons. A randomized, placebo-controlled, double-blind, parallel group study was designed for elementary schoolchildren, grades 1 to 3, in Vietnam. LC-Plasma or a control were administered to schoolchildren as a beverage (1.0 × 1011 count LC-Plasma/day/person). The primary endpoint was to determine the efficacy of LC-Plasma in reducing the cumulative days absent from school due to upper respiratory disease (URID) and gastrointestinal disease (GID), and the secondary endpoint was to evaluate the potency of LC-Plasma on URID/GID symptoms and general well-being scores. LC-Plasma intake significantly reduced the cumulative days absent from school due to URID/GID (Odds ratio (OR) = 0.57, p = 0.004) and URID alone (OR = 0.56, p = 0.005); LC-Plasma also significantly reduced the number of cumulative fever positive days during the first 4 weeks of intervention (OR = 0.58, p = 0.001) and cumulative days with diarrhea during the last 4 weeks of the intervention period (OR = 0.78, p = 0.01). The number of positive general wellbeing days was significantly improved in the LC-Plasma group compared with the control throughout the intervention period (OR = 0.93, 0.93, p = 0.03, 0.04 in the first and last 4 weeks of the intervention, respectively). These data suggest that LC-Plasma seems to improve the health condition of elementary schoolchildren and reduces school absenteeism due to infectious disease, especially URID.
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Affiliation(s)
- Nghiem Nguyet Thu
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Truong Tuyet Mai
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
- Correspondence: ; Tel.: +84-94-677-7176
| | - Tran Thị Thu Trang
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Nguyen Anh Tuan
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Tran Chau Quyen
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Nguyen Lien Hanh
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Nguyen Huu Hoan
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Bui Thi Huong Lan
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Phung Thi Hau
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Ha Huy Tue
- National Institute of Nutrition, 48B Tang Bat Ho, Hanoi 100000, Vietnam; (N.N.T.); (T.T.T.T.); (N.A.T.); (T.C.Q.); (N.L.H.); (N.H.H.); (B.T.H.L.); (P.T.H.); (H.H.T.)
| | - Truong Viet Dung
- Hanoi Medical University, 1 Ton That Tung, Dong Da, Hanoi 100000, Vietnam;
| | - Ryohei Tsuji
- Kirin Central Research Institute, Kirin Holdings Co., Ltd., 1-13-5 Fukuura Kanazawa-ku, Kanagawa, Yokohama-shi 236-0004, Japan;
| | - Yuta Watanabe
- Research and Development Strategy Department, Kirin Holdings Co., Ltd., 4-10-2 Nakano, Nakano-ku, Tokyo 164-0001, Japan; (Y.W.); (O.K.)
| | - Naoki Yamamoto
- Genome Medical Sciences Project, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa-shi, Chiba 272-8516, Japan;
- Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Osamu Kanauchi
- Research and Development Strategy Department, Kirin Holdings Co., Ltd., 4-10-2 Nakano, Nakano-ku, Tokyo 164-0001, Japan; (Y.W.); (O.K.)
- Interfood Shareholding Company, 127 Lo Duc, Hanoi 100000, Vietnam
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Wrohan I, Nguyen TA, Nguyen VN, Nguyen BH, Hoang TTT, Nguyen PC, Velen K, Marks GB, Fox GJ. Predictors of treatment outcomes among patients with multidrug-resistant tuberculosis in Vietnam: a retrospective cohort study. BMC Infect Dis 2022; 22:68. [PMID: 35057754 PMCID: PMC8772201 DOI: 10.1186/s12879-021-06992-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Improving treatment outcomes for multidrug-resistant tuberculosis (MDR-TB) is a leading priority for global TB control. This retrospective cohort study evaluated the factors associated with treatment success among patients treated for MDR-TB in two provinces in Vietnam.
Methods
Treatment outcomes were evaluated for adult patients treated in Hanoi and Thanh Hoa provinces between 2014 and 2016. The primary outcome was the proportion of patients with treatment success, defined as cure or treatment completion. Logistic regression analysis was used to evaluate the relationship between patient clinical and microbiological characteristics and treatment success.
Results
Treatment outcomes were reported in 612 of 662 patients; of these, 401 (65.5)% were successfully treated. The odds of treatment success were lower for male patients (aOR 0.56, 95% CI 0.34–0.90), for people living with HIV (aOR 0.44, 95% CI 0.20–1.00), and for patients treated for extensive antibiotic resistance (pre-XDR-/XDT-TB) (aOR 0.53, 95% CI 0.29–0.97), compared with others. Patients who achieved culture conversion in the first 4 months of treatment had increased odds (aOR 2.93, 95% CI 1.33–6.45) of treatment success. In addition, loss to follow-up was less common among patients covered by social health insurance compared to those who paid for treatment out-of-pocket (aOR 0.55, 95% CI 0.32–0.95).
Conclusions
Among patients with MDR-TB, males, people living with HIV, and those with more extensive antibiotic resistance at diagnosis are at greatest risk of an unsuccessful treatment outcome. Efforts to optimise the management of co-morbidities (such as HIV), ensure rapid bacteriological conversion, and provide financial support for patients promise to improve treatment outcomes.
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Puerto Castro GM, Montes Zuluaga FN, Alcalde-Rabanal JE, Pérez F. Patient- and provider-related factors in the success of multidrug-resistant tuberculosis treatment in Colombia. Rev Panam Salud Publica 2021; 45:e74. [PMID: 34168683 PMCID: PMC8216496 DOI: 10.26633/rpsp.2021.74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/30/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To identify patient- and provider-related factors associated with the success of multidrug-resistant tuberculosis (MDR-TB) treatment in the six municipalities of Colombia with the highest number of MDR-TB cases. Methods Bivariate and multivariate logistic regressions were used to analyze the association between treatment success (cure or treatment completion) and characteristics of the patients and physicians, nursing professionals, and psychologists involved in their treatment. The importance of knowledge in the management of MDR-TB cases was explored through focus groups with these providers. Results Of 128 cases of TB-MDR, 63 (49.2%) experienced treatment success. Only 52.9% of the physicians and nursing professionals had satisfactory knowledge about MDR-TB. Logistic regression showed that being HIV negative, being affiliated with the contributory health insurance scheme, being cared for by a male physician, and being cared for by nursing professionals with sufficient knowledge were associated with a successful treatment outcome (p ≤ 0.05). Qualitative analysis showed the need for in-depth, systematic training of health personnel who care for patients with MDR-TB. Conclusions Some characteristics of patients and healthcare providers influence treatment success in MDR-TB cases. Physicians' and nurses' knowledge about MDR-TB must be improved, and follow-up of MDR-TB patients who are living with HIV and of those affiliated with the subsidized health insurance scheme in Colombia must be strengthened, as these patients have a lower likelihood of a successful treatment outcome.
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Affiliation(s)
- Gloria Mercedes Puerto Castro
- Colombia National Network for Tuberculosis Research Innovation and Knowledge Management, National Institute of Health Bogotá Colombia Colombia National Network for Tuberculosis Research Innovation and Knowledge Management, National Institute of Health, Bogotá, Colombia
| | | | - Jacqueline Elizabeth Alcalde-Rabanal
- Mexico National Institute of Public Health, Health Systems Research Center, Cuernavaca Morelos Mexico Mexico National Institute of Public Health, Health Systems Research Center, Cuernavaca, Morelos, Mexico
| | - Freddy Pérez
- Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization Washington, DC USA Department of Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization, Washington, DC, USA
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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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Puerto Castro GM, Montes Zuluaga FN, Alcalde-Rabanal JE, Pérez F. [Patient- and provider-related factors in the success of multidrug tuberculosis treatment in ColombiaFatores de êxito do tratamento da tuberculose multirresistente relacionados com o paciente e com a equipe de saúde na Colômbia]. Rev Panam Salud Publica 2021; 45:e5. [PMID: 33833785 PMCID: PMC8021208 DOI: 10.26633/rpsp.2021.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/30/2020] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Identificar los factores asociados con el éxito del tratamiento de tuberculosis multidrogorresistente (TB-MDR) relacionados con los pacientes y el personal sanitario en seis municipios de Colombia con mayor número de casos. Métodos. Mediante regresiones logísticas bifactorial y multifactorial se analizó la asociación entre el tratamiento exitoso (curación o cumplimiento del tratamiento) y las características de los pacientes, y de los médicos, profesionales de enfermería y psicólogos vinculados al tratamiento. Se exploró la importancia del conocimiento en el manejo de los casos de TB-MDR mediante grupos focales con esos profesionales. Resultados. De los 128 casos con TB-MDR, 63 (49,2%) tuvieron un tratamiento exitoso. Solo 52,9% de los médicos y profesionales de enfermería tenía conocimientos satisfactorios sobre TB-MDR. La regresión logística mostró que ser negativo al VIH, estar afiliado al régimen de aseguramiento de salud contributivo, estar atendido por un médico del sexo masculino y por profesionales de enfermería con conocimientos suficientes se asociaron con un desenlace exitoso del tratamiento (p ≤ 0,05). El análisis cualitativo mostró la necesidad de profundizar y sistematizar la capacitación del personal sanitario que atiende los casos de TB-MDR. Conclusiones. En el éxito del tratamiento de los casos de TB-MDR influyen algunas características de los pacientes y el personal sanitario. Se requiere fortalecer los conocimientos sobre TB-MDR de médicos y enfermeros, y reforzar el seguimiento de los pacientes con TB-MDR positivos al VIH y de los que pertenecen al régimen subsidiado, dada su menor probabilidad de éxito al tratamiento.
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Affiliation(s)
- Gloria Mercedes Puerto Castro
- Red Nacional de Investigación Innovación y Gestión del Conocimiento en Tuberculosis, Instituto Nacional de Salud Bogotá Colombia Red Nacional de Investigación Innovación y Gestión del Conocimiento en Tuberculosis, Instituto Nacional de Salud, Bogotá, Colombia
| | - Fernando Nicolás Montes Zuluaga
- Secretaría Municipal de Salud, Alcaldía de Medellín Medellín Colombia Secretaría Municipal de Salud, Alcaldía de Medellín, Medellín, Colombia
| | - Jacqueline Elizabeth Alcalde-Rabanal
- Instituto Nacional de Salud Pública de México, Centro de Investigación en Sistemas de Salud CuernavacaMorelos México Instituto Nacional de Salud Pública de México, Centro de Investigación en Sistemas de Salud, Cuernavaca, Morelos, México
| | - Freddy Pérez
- Departamento de Enfermedades Transmisibles y Determinantes Ambientales de la Salud, Organización Panamericana de la Salud Washington, DC Estados Unidos de América Departamento de Enfermedades Transmisibles y Determinantes Ambientales de la Salud, Organización Panamericana de la Salud, Washington, DC, Estados Unidos de América
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Kassa GM, Merid MW, Muluneh AG, Fentie DT. Sputum smear grading and associated factors among bacteriologically confirmed pulmonary drug-resistant tuberculosis patients in Ethiopia. BMC Infect Dis 2021; 21:238. [PMID: 33663408 PMCID: PMC7934369 DOI: 10.1186/s12879-021-05933-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/24/2021] [Indexed: 11/21/2022] Open
Abstract
Background The sputum smear bacilliary load is a fundamental indicator of the level of infectiousness in DR-TB patients. However, evidence on DR-TB sputum smear grading and its factors in the study setting is limited. This study was aimed to determine the level of sputum smear grading and associated factors among DR-TB patients in Ethiopia. Methods This was an institution based cross-sectional study on 520 bacteriological confirmed pulmonary DR-TB patients from September 2010 to December 2017 in the northwest Ethiopia. Epidata 4.2.00 and SPSS 20 were used for data entry and management, respectively. Ordinary logistic regression was fitted. A cut of p-value less than 0.05 in the multivariable ordinary logistic regression was considered to declare statistically significant variables. Results Of all 520 bacteriological confirmed pulmonary DR-TB patients; 34.42% had 3+, 15.77% had 2+, 18.27% had 1+, 15.19% had scanty, and 16.35% had negative sputum smear grading results. The odds of having higher sputum smear grades were significantly associated with the patient’s educational status of secondary (Adjusted Odds Ratio (AOR) = 0.43, 95% Confidence Interval (CI): 0.21, 0.89), body mass index of 16 to 18.49 kg/m2 (AOR = 1.81, 95%CI: 1.16, 2.84), and TB treatment history of two and more times (AOR = 1.78, 95%CI: 1.24, 2.55). Conclusions More than a third of the bacteriological confirmed pulmonary DR-TB patients in the study setting was highly infectious with the highest bacillary load. The odds of having a high bacillary load were significantly associated with the patient’s TB treatment history, nutritional, and educational status.
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Affiliation(s)
- Getahun Molla Kassa
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Atalay Goshu Muluneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dawit Tefera Fentie
- Gondar City Health Department, Amhara Regional State Health Bureau, Ministry of Health-Ethiopia, Gondar, Ethiopia
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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.
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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
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