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TannousTahan T, Rossoni AMDO, Lugarini G, de Oliveira SP, Taques J, Santos MBD, Gabardo BMA, Hirose TE, Rodrigues CDO. Tuberculosis preventive treatment in newborns. J Pediatr (Rio J) 2024:S0021-7557(24)00091-3. [PMID: 39127460 DOI: 10.1016/j.jped.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/21/2024] [Accepted: 06/25/2024] [Indexed: 08/12/2024] Open
Abstract
OBJECTIVE To describe the reported cases of newborns subjected to tuberculosis preventive treatment (TPT) in the state of Paraná, Brazil, and to evaluate the safety and effectiveness in preventing the progression of TB disease in this population. METHOD Observational, descriptive case series, with secondary data. The characteristics of the participants were analyzed from the information systems of preventive treatment of TB (of Paraná), between 2009 and 2016. To evaluate which children had developed tuberculosis later or died, we used the data from the information systems of TB (in Brazil), and mortality (in Paraná), covering the years 2009 to 2018. RESULTS A total of 24 children underwent TPT with the age at treatment onset ranging from 0 to 87 days (median: 23 days). In 95.8 %, the exposure occurred at home, and in 33.3 % of cases, the mother was the source of the infection. A total of 20.8 % of the children tested positive for tuberculosis test at 3 months of age, 83.3 % completed treatment, and 2 experienced adverse events (gastrointestinal issues). No children developed TB or died during the minimum of a 2-year evaluation period through the official databases. CONCLUSIONS In this case series, the adherence to the plan was high, with few adverse events and 100 % protection against infection.
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Affiliation(s)
| | | | | | | | - Juliana Taques
- Secretaria de Saúde do Estado do Paraná, Curitiba, PR, Brazil
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2
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Lienhardt C, Dooley KE, Nahid P, Wells C, Ryckman TS, Kendall EA, Davies G, Brigden G, Churchyard G, Cirillo DM, Di Meco E, Gopinath R, Mitnick C, Scott C, Amanullah F, Bansbach C, Boeree M, Campbell M, Conradie F, Crook A, Daley CL, Dheda K, Diacon A, Gebhard A, Hanna D, Heinrich N, Hesseling A, Holtzman D, Jachym M, Kim P, Lange C, McKenna L, Meintjes G, Ndjeka N, Nhung NV, Nyang’wa BT, Paton NI, Rao R, Rich M, Savic R, Schoeman I, Makokotlela BS, Spigelman M, Sun E, Svensson E, Tisile P, Varaine F, Vernon A, Diul MY, Kasaeva T, Zignol M, Gegia M, Mirzayev F, Schumacher SG. Target regimen profiles for tuberculosis treatment. Bull World Health Organ 2024; 102:600-607. [PMID: 39070602 PMCID: PMC11276158 DOI: 10.2471/blt.24.291881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 07/30/2024] Open
Abstract
Simpler, shorter, safer and more effective treatments for tuberculosis that are easily accessible to all people with tuberculosis are desperately needed. In 2016, the World Health Organization (WHO) developed target regimen profiles for the treatment of tuberculosis to make drug developers aware of both the important features of treatment regimens, and patient and programmatic needs at the country level. In view of recent ground-breaking advances in tuberculosis treatment, WHO has revised and updated these regimen profiles. We used a similar process as for the 2016 profiles, including a baseline treatment landscape analysis, an initial stakeholder survey, modelling studies estimating the impact and cost-effectiveness of novel tuberculosis treatment regimens, and an extensive stakeholder consultation. We developed target regimen profiles for the treatment of rifampicin-susceptible and rifampicin-resistant tuberculosis, as well as a pan-tuberculosis regimen that would be appropriate for patients with any type of tuberculosis. We describe the revised target regimen profile characteristics, with specific minimal and optimal targets to be met, rationale and justification, and aspects relevant to all target regimen profiles (drug susceptibility testing, adherence and forgiveness, treatment strategies, post-tuberculosis lung disease, and cost and access considerations). We discuss the trade-offs of proposed characteristics for decision-making at developmental or operational levels. We expect that, following these target regimen profile revisions, tuberculosis treatment developers will produce regimens that are quality-assured, affordable and widely available, and that meet the needs of affected populations.
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Affiliation(s)
- Christian Lienhardt
- French National Research Institute for Sustainable Development, Montpellier, France
| | - Kelly E Dooley
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, United States of America (USA)
| | - Payam Nahid
- Institute for Global Health, University of California San Francisco, San Francisco, USA
| | - Charles Wells
- Bill & Melinda Gates Medical Research Institute, Boston, USA
| | - Theresa S Ryckman
- Infectious Disease Division, School of Medicine, John Hopkins University, Baltimore, USA
| | - Emily A Kendall
- Infectious Disease Division, School of Medicine, John Hopkins University, Baltimore, USA
| | - Gerry Davies
- Institute of Infection and Global Health, University of Liverpool, Liverpool, England
| | - Grania Brigden
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | | | - Daniela Maria Cirillo
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | - Eugenia Di Meco
- European Medicines Agency, Amsterdam, Kingdom of the Netherlands
| | - Ramya Gopinath
- Division of Anti-Infectives, Food and Drug Administration, WashingtonDC, USA
| | | | | | | | | | - Martin Boeree
- University Medical Center, Radboud University, Amsterdam, Kingdom of the Netherlands
| | | | | | - Angela Crook
- MRC Clinical Trials Unit, University College of London, London, England
| | - Charles L Daley
- Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, USA
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, University of Cape Town, Cape Town, South Africa
| | | | | | - Debra Hanna
- Global Health Division, Bill & Melinda Gates Foundation, Seattle, USA
| | - Norbert Heinrich
- Division of Infectious Diseases and Tropical Medicine, LMU University Hospital, LMU, Munich, Germany
| | - Anneke Hesseling
- Desmond Tutu TB Centre, Stellenbosch University, Stellenbosch, South Africa
| | - David Holtzman
- Bill & Melinda Gates Medical Research Institute, Boston, USA
| | - Mathilde Jachym
- Centre Hospitalier de Bligny, Fontenay-lès-Briis, Paris, France
| | - Peter Kim
- French National Research Institute for Sustainable Development, Montpellier, France
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, United States of America (USA)
| | - Christoph Lange
- French National Research Institute for Sustainable Development, Montpellier, France
- Institute for Global Health, University of California San Francisco, San Francisco, USA
| | - Lindsay McKenna
- French National Research Institute for Sustainable Development, Montpellier, France
- Bill & Melinda Gates Medical Research Institute, Boston, USA
| | - Graeme Meintjes
- French National Research Institute for Sustainable Development, Montpellier, France
- Infectious Disease Division, School of Medicine, John Hopkins University, Baltimore, USA
| | - Norbert Ndjeka
- French National Research Institute for Sustainable Development, Montpellier, France
- Institute of Infection and Global Health, University of Liverpool, Liverpool, England
| | - Nguyen Viet Nhung
- French National Research Institute for Sustainable Development, Montpellier, France
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Bern-Thomas Nyang’wa
- French National Research Institute for Sustainable Development, Montpellier, France
- Aurum Institute, Johannesburg, South Africa
| | - Nicholas I Paton
- French National Research Institute for Sustainable Development, Montpellier, France
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | - Raghuram Rao
- French National Research Institute for Sustainable Development, Montpellier, France
- European Medicines Agency, Amsterdam, Kingdom of the Netherlands
| | - Michael Rich
- French National Research Institute for Sustainable Development, Montpellier, France
- Division of Anti-Infectives, Food and Drug Administration, WashingtonDC, USA
| | - Rada Savic
- Institute for Global Health, University of California San Francisco, San Francisco, USA
| | - Ingrid Schoeman
- French National Research Institute for Sustainable Development, Montpellier, France
- School of Medicine, Harvard Medical School, Boston, USA
| | | | - Mel Spigelman
- French National Research Institute for Sustainable Development, Montpellier, France
- Indus Hospital, Karachi, Pakistan
| | - Eugene Sun
- French National Research Institute for Sustainable Development, Montpellier, France
- Indus Hospital, Karachi, Pakistan
| | - Elin Svensson
- University Medical Center, Radboud University, Amsterdam, Kingdom of the Netherlands
| | - Phumeza Tisile
- French National Research Institute for Sustainable Development, Montpellier, France
- School of Medicine, Harvard Medical School, Boston, USA
| | - Francis Varaine
- French National Research Institute for Sustainable Development, Montpellier, France
- ChinaCat Enterprises, Gig Harbor, USA
| | - Andrew Vernon
- French National Research Institute for Sustainable Development, Montpellier, France
- University Medical Center, Radboud University, Amsterdam, Kingdom of the Netherlands
| | - Mukadi Ya Diul
- French National Research Institute for Sustainable Development, Montpellier, France
- Clinton Health Access Initiative, Boston, USA
| | - Tereza Kasaeva
- French National Research Institute for Sustainable Development, Montpellier, France
- Wits Health Consortium, Johannesburg, South Africa
| | - Matteo Zignol
- French National Research Institute for Sustainable Development, Montpellier, France
- Wits Health Consortium, Johannesburg, South Africa
| | - Medea Gegia
- French National Research Institute for Sustainable Development, Montpellier, France
- Wits Health Consortium, Johannesburg, South Africa
| | - Fuad Mirzayev
- French National Research Institute for Sustainable Development, Montpellier, France
- Wits Health Consortium, Johannesburg, South Africa
| | - Samuel G Schumacher
- French National Research Institute for Sustainable Development, Montpellier, France
- Wits Health Consortium, Johannesburg, South Africa
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3
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Naidoo K, Perumal R, Cox H, Mathema B, Loveday M, Ismail N, Omar SV, Georghiou SB, Daftary A, O'Donnell M, Ndjeka N. The epidemiology, transmission, diagnosis, and management of drug-resistant tuberculosis-lessons from the South African experience. THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00144-0. [PMID: 38527475 DOI: 10.1016/s1473-3099(24)00144-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/29/2024] [Accepted: 02/20/2024] [Indexed: 03/27/2024]
Abstract
Drug-resistant tuberculosis (DR-TB) threatens to derail tuberculosis control efforts, particularly in Africa where the disease remains out of control. The dogma that DR-TB epidemics are fueled by unchecked rates of acquired resistance in inadequately treated or non-adherent individuals is no longer valid in most high DR-TB burden settings, where community transmission is now widespread. A large burden of DR-TB in Africa remains undiagnosed due to inadequate access to diagnostic tools that simultaneously detect tuberculosis and screen for resistance. Furthermore, acquisition of drug resistance to new and repurposed drugs, for which diagnostic solutions are not yet available, presents a major challenge for the implementation of novel, all-oral, shortened (6-9 months) treatment. Structural challenges including poverty, stigma, and social distress disrupt engagement in care, promote poor treatment outcomes, and reduce the quality of life for people with DR-TB. We reflect on the lessons learnt from the South African experience in implementing state-of-the-art advances in diagnostic solutions, deploying recent innovations in pharmacotherapeutic approaches for rapid cure, understanding local transmission dynamics and implementing interventions to curtail DR-TB transmission, and in mitigating the catastrophic socioeconomic costs of DR-TB. We also highlight globally relevant and locally responsive research priorities for achieving DR-TB control in South Africa.
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Affiliation(s)
- Kogieleum Naidoo
- SAMRC-CAPRISA HIV/TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Rubeshan Perumal
- SAMRC-CAPRISA HIV/TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Helen Cox
- Institute of Infectious Diseases and Molecular Medicine, Wellcome Centre for Infectious Disease Research and Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Barun Mathema
- Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Marian Loveday
- South African Medical Research Council, Durban, South Africa
| | - Nazir Ismail
- School of Pathology, University of Witwatersrand, Johannesburg, South Africa
| | - Shaheed Vally Omar
- Centre for Tuberculosis, National & WHO Supranational TB Reference Laboratory, National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
| | | | - Amrita Daftary
- SAMRC-CAPRISA HIV/TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; School of Global Health and Dahdaleh Institute of Global Health Research, York University, Toronto, ON, Canada
| | - Max O'Donnell
- SAMRC-CAPRISA HIV/TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Irving Medical Center, New York City, NY, USA; Department of Epidemiology, Columbia University Irving Medical Center, New York City, NY, USA
| | - Norbert Ndjeka
- TB Control and Management, Republic of South Africa National Department of Health, Pretoria, South Africa
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Gupta A, Hughes MD, Cruz JL, Avihingsanon A, Mwelase N, Severe P, Omoz-Oarhe A, Masheto G, Moran L, Benson CA, Chaisson RE, Swindells S. Adverse Pregnancy Outcomes Among Women with Human Immunodeficiency Virus Taking Isoniazid Preventive Therapy During the First Trimester. Clin Infect Dis 2024; 78:667-673. [PMID: 37768207 PMCID: PMC10954322 DOI: 10.1093/cid/ciad583] [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: 06/28/2023] [Revised: 09/05/2023] [Accepted: 09/25/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Isoniazid preventive therapy (IPT) is recommended for tuberculosis prevention yet data on the safety of first-trimester pregnancy exposure are limited. METHODS Planned secondary analysis in a TB prevention trial of adverse pregnancy outcomes among participants assigned to 9-month IPT who became pregnant during (IPT-exposed) or after (unexposed) IPT. Regression models compared binary outcomes of a composite adverse outcome (any non-live birth, excluding induced abortion); preterm delivery <37 weeks; and low birth weight <2500 g) among exposure groups. Models were adjusted for latent TB infection, maternal age, CD4 count, and antiretroviral therapy (ART). RESULTS In total, 128 participants had a known pregnancy outcome; 39 IPT-exposed and 89 unexposed. At pregnancy outcome, ART use was lower in IPT-exposed (79%) than unexposed women (98%). Overall, 29 pregnancies ended in a composite adverse outcome (25 spontaneous abortions, 2 stillbirths and 2 ectopic pregnancies), 15 preterm deliveries, and 10 infants with low birth weight. IPT was associated with the composite adverse outcome adjusting for covariates at enrollment (adjusted relative risk [aRR] 1.98; 95% confidence interval [CI] 1.15, 3.41), but the effect was attenuated when adjusted for covariates at pregnancy outcome (aRR 1.47; 95% CI .84, 2.55); IPT was not associated with preterm delivery (relative risk [RR] 0.87; 95% CI .32-2.42) or low birth weight (RR 1.01; 95% CI .29, 3.56). CONCLUSIONS First-trimester IPT exposure was associated with nearly two-fold increased risk of fetal demise, mostly spontaneous abortion, though the association was attenuated when adjusted for covariates proximal to pregnancy outcome including ART use. Further study is needed to inform TB prevention guidelines.
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Affiliation(s)
- Amita Gupta
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael D Hughes
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Jorge Leon Cruz
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Anchalee Avihingsanon
- HIV-NAT, Thai Red Cross AIDS Research Centre and Center of Excellence in Tuberculosis, Faculty of Medicine Chulalongkorn University, Bangkok, Thailand
| | - Noluthando Mwelase
- Department of Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Patrice Severe
- Clinical Trials Unit, Les Centres GHESKIO, Port-au-Prince, Haiti
| | - Ayotunde Omoz-Oarhe
- Botswana Harvard AIDS Institute Partnership, Clinical Trials Unit, Gaborone, Botswana
| | - Gaerolwe Masheto
- Botswana Harvard AIDS Institute Partnership, Clinical Trials Unit, Gaborone, Botswana
| | - Laura Moran
- Public Health and Scientific Research Unit, Social & Scientific Systems, a DLH Company, Silver Spring, Maryland, USA
| | - Constance A Benson
- Division of Infectious Diseases, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Richard E Chaisson
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Swindells
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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5
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Lotia Farrukh I, Lachenal N, Adenov MM, Ahmed S, Algozhin Y, Coutisson S, Garavito ES, Hewison C, Holtzman D, Huerga H, Janmohamed A, Khan PY, Jacques GL, Lomtadze N, Melikyan N, Mitnick CD, Mussabekova G, Osso E, Perea S, Putri FA, Rashidov M, Rich ML, Sakhabutdinova Y, Seung KJ, Stambekova A, Vásquez DV, Franke MF, Khan U. Pregnancy and Birth Outcomes in Patients With Multidrug-Resistant Tuberculosis Treated With Regimens That Include New and Repurposed Drugs. Clin Infect Dis 2024; 78:144-148. [PMID: 37606512 PMCID: PMC10810705 DOI: 10.1093/cid/ciad445] [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: 05/15/2023] [Indexed: 08/23/2023] Open
Abstract
Among 43 pregnant women receiving multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) treatment with bedaquiline and/or delamanid, 98% had favorable treatment outcomes. Of 31 continued pregnancies, 81% had live births with no reported malformations, and 68% of neonates had normal birth weights. Effective MDR/RR-TB treatment during pregnancy can improve maternal outcomes without harming neonates.
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Affiliation(s)
| | - Nathalie Lachenal
- Pharmacovigilance Unit, Médecins Sans Frontières, Geneva, Switzerland
| | - Malik M Adenov
- National Scientific Center of Phthisiopulmonology, Ministry of Health, Republic of Kazakhstan, Almaty, Kazakhstan
| | - Saman Ahmed
- Interactive Research and Development Pakistan, Karachi, Pakistan
| | | | - Sylvine Coutisson
- Pharmacovigilance Unit, Médecins Sans Frontières, Geneva, Switzerland
| | | | | | | | - Helena Huerga
- Field Epidemiology Department, Epicentre, Paris, France
| | | | - Palwasha Y Khan
- Interactive Research and Development Pakistan, Karachi, Pakistan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Nino Lomtadze
- Surveillance and Strategic Planning, Ministry of Health, Tbilisi, Georgia
| | - Nara Melikyan
- Field Epidemiology Department, Epicentre, Yerevan, Armenia
| | - Carole D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners In Health, Boston, Massachusetts, USA
| | - Gulnaz Mussabekova
- National Scientific Center of Phthisiopulmonology, Ministry of Health, Republic of Kazakhstan, Almaty, Kazakhstan
| | - Elna Osso
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Perea
- Socios En Salud Sucursal Peru, Lima, Peru
| | | | | | - Michael L Rich
- Partners In Health, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Kwonjune J Seung
- Partners In Health, Boston, Massachusetts, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Uzma Khan
- Interactive Research and Development Pakistan, Karachi, Pakistan
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6
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du Cros P, Greig J, Alffenaar JWC, Cross GB, Cousins C, Berry C, Khan U, Phillips PPJ, Velásquez GE, Furin J, Spigelman M, Denholm JT, Thi SS, Tiberi S, Huang GKL, Marks GB, Turkova A, Guglielmetti L, Chew KL, Nguyen HT, Ong CWM, Brigden G, Singh KP, Motta I, Lange C, Seddon JA, Nyang'wa BT, Maug AKJ, Gler MT, Dooley KE, Quelapio M, Tsogt B, Menzies D, Cox V, Upton CM, Skrahina A, McKenna L, Horsburgh CR, Dheda K, Marais BJ. Standards for clinical trials for treating TB. Int J Tuberc Lung Dis 2023; 27:885-898. [PMID: 38042969 PMCID: PMC10719894 DOI: 10.5588/ijtld.23.0341] [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: 07/25/2023] [Accepted: 08/21/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND: The value, speed of completion and robustness of the evidence generated by TB treatment trials could be improved by implementing standards for best practice.METHODS: A global panel of experts participated in a Delphi process, using a 7-point Likert scale to score and revise draft standards until consensus was reached.RESULTS: Eleven standards were defined: Standard 1, high quality data on TB regimens are essential to inform clinical and programmatic management; Standard 2, the research questions addressed by TB trials should be relevant to affected communities, who should be included in all trial stages; Standard 3, trials should make every effort to be as inclusive as possible; Standard 4, the most efficient trial designs should be considered to improve the evidence base as quickly and cost effectively as possible, without compromising quality; Standard 5, trial governance should be in line with accepted good clinical practice; Standard 6, trials should investigate and report strategies that promote optimal engagement in care; Standard 7, where possible, TB trials should include pharmacokinetic and pharmacodynamic components; Standard 8, outcomes should include frequency of disease recurrence and post-treatment sequelae; Standard 9, TB trials should aim to harmonise key outcomes and data structures across studies; Standard 10, TB trials should include biobanking; Standard 11, treatment trials should invest in capacity strengthening of local trial and TB programme staff.CONCLUSION: These standards should improve the efficiency and effectiveness of evidence generation, as well as the translation of research into policy and practice.
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Affiliation(s)
- P du Cros
- Burnet Institute, Melbourne, VIC, Monash Infectious Diseases, Monash Health, Melbourne, VIC, Australia
| | - J Greig
- Burnet Institute, Melbourne, VIC, Médecins Sans Frontières (MSF), Manson Unit, London, UK
| | - J-W C Alffenaar
- Sydney Infectious Diseases Institute (Sydney ID), and, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Westmead Hospital, Sydney, NSW
| | - G B Cross
- Burnet Institute, Melbourne, VIC, Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - C Cousins
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - C Berry
- Médecins Sans Frontières (MSF), Manson Unit, London, UK
| | - U Khan
- Interactive Research and Development Global, Singapore City, Singapore
| | - P P J Phillips
- UCSF Center for Tuberculosis, Division of Pulmonary and Critical Care Medicine, and
| | - G E Velásquez
- UCSF Center for Tuberculosis, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - J Furin
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA
| | - M Spigelman
- Global Alliance for TB Drug Development, New York, NY, USA
| | - J T Denholm
- Victorian Tuberculosis Program, Melbourne Health, Melbourne, VIC, Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - S S Thi
- Eswatini National TB Control Program, Mbabane, Kingdom of Eswatini
| | - S Tiberi
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, GlaxoSmithKline, London, UK
| | - G K L Huang
- Burnet Institute, Melbourne, VIC, Northern Health Infectious Diseases, Northern Health, Melbourne, VIC
| | - G B Marks
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
| | - A Turkova
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - L Guglielmetti
- Médecins Sans Frontières (MSF), Paris, Sorbonne Université, Institut national de la santé et de la recherche médicale, Unité 1135, Centre d'Immunologie et des Maladies Infectieuses, Paris, Assistance Publique Hôpitaux de Paris (APHP), Groupe Hospitalier Universitaire Sorbonne Université, Hôpital Pitié-Salpêtrière, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries, Paris, France
| | - K L Chew
- Department of Laboratory Medicine, National University Hospital, Singapore City, Singapore
| | - H T Nguyen
- Research Department, Friends for International TB Relief, Ha Noi, Vietnam
| | - C W M Ong
- Infectious Diseases Translational Research Programme, Department of Medicine, National University of Singapore, Singapore City, Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore City, Institute of Healthcare Innovation & Technology, National University of Singapore, Singapore City, Singapore
| | - G Brigden
- The Global Fund, Geneva, Switzerland
| | - K P Singh
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia, Victorian Infectious Disease Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - C Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, German Center for Infection Research (DZIF), TTU-TB, Borstel, Respiratory Medicine & International Health, University of Lübeck, Lübeck, Germany, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - J A Seddon
- Department of Infectious Disease, Imperial College London, London, UK, Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa
| | - B-T Nyang'wa
- Public Health Department, Operational Center Amsterdam (OCA), MSF, Amsterdam, The Netherlands
| | - A K J Maug
- Damien Foundation Bangladesh, Dhaka, Bangladesh
| | - M T Gler
- De La Salle Medical and Health Sciences Institute, Dasmariñas, the Philippines
| | - K E Dooley
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Quelapio
- Tropical Disease Foundation, Makati City, Manila, the Philippines, KNCV Tuberculosis Foundation, The Hague, The Netherlands
| | - B Tsogt
- Mongolian Anti-TB Coalition, Ulaanbaatar, Mongolia
| | - D Menzies
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute & McGill International TB Centre, Montreal, QC, Canada
| | - V Cox
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - C M Upton
- TASK Applied Science, Cape Town, South Africa
| | - A Skrahina
- The Republican Scientific and Practical Center for Pulmonology and TB, Minsk, Belarus
| | - L McKenna
- Treatment Action Group, New York, NY
| | - C R Horsburgh
- Departments of Global Health, Epidemiology, Biostatistics and Medicine, Schools of Public Health and Medicine, Boston University, Boston MA, USA
| | - K Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute & South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa, Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, UK
| | - B J Marais
- Sydney Infectious Diseases Institute (Sydney ID), and, The Children's Hospital at Westmead, Sydney, NSW, WHO Collaborating Centre in Tuberculosis, The University of Sydney, Sydney, NSW, Australia
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7
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Maugans C, Loveday M, Hlangu S, Waitt C, Van Schalkwyk M, van de Water B, Salazar-Austin N, McKenna L, Mathad JS, Kalk E, Hurtado R, Hughes J, Eke AC, Ahmed S, Furin J. Best practices for the care of pregnant people living with TB. Int J Tuberc Lung Dis 2023; 27:357-366. [PMID: 37143222 PMCID: PMC10171489 DOI: 10.5588/ijtld.23.0031] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND: Each year more than 200,000 pregnant people become sick with TB, but little is known about how to optimize their diagnosis and therapy. Although there is a need for further research in this population, it is important to recognize that much can be done to improve the services they currently receive.METHODS: Following a systematic review of the literature and the input of a global team of health professionals, a series of best practices for the diagnosis, prevention and treatment of TB during pregnancy were developed.RESULTS: Best practices were developed for each of the following areas: 1) screening and diagnosis; 2) reproductive health services and family planning; 3) treatment of drug-susceptible TB; 4) treatment of rifampicin-resistant/multidrug-resistant TB; 5) compassionate infection control practices; 6) feeding considerations; 7) counseling and support; 8) treatment of TB infection/TB preventive therapy; and 9) research considerations.CONCLUSION: Effective strategies for the care of pregnant people across the TB spectrum are readily achievable and will greatly improve the lives and health of this under-served population.
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Affiliation(s)
- C Maugans
- Sentinel Project on Pediatric Drug Resistant Tuberculosis, Boston, MA, USA
| | - M Loveday
- HIV and other Infectious Diseases Research Unit (HIDRU), South African Medical Research Council, Durban, South Africa
| | - S Hlangu
- HIV and other Infectious Diseases Research Unit (HIDRU), South African Medical Research Council, Durban, South Africa
| | - C Waitt
- Department of Pharmacology and Therapeutics, University of Liverpool, UK, and the Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - M Van Schalkwyk
- Division of Adult Infectious Diseases, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - B van de Water
- Boston College Connell School of Nursing, Chestnut Hill, MA, USA
| | - N Salazar-Austin
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L McKenna
- Treatment Action Group, New York, NY, USA
| | - J S Mathad
- Departments of Medicine and Obstetrics & Gynecology, Center for Global Health, Weill Cornell Medicine, New York, NY, USA
| | - E Kalk
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, South Africa
| | - R Hurtado
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA, Global Health Committee, Boston, MA, USA
| | - J Hughes
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A C Eke
- Division of Maternal Fetal Medicine, Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Ahmed
- Interactive Research and Development, Karachi, Pakistan
| | - J Furin
- Harvard Medical School, Department of Global Health and Social Medicine, Boston, MA, USA
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8
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Singh P, Moulton LH, Barnes GL, Gupta A, Msandiwa R, Chaisson RE, Martinson NA. Pregnancy in Women With HIV in a Tuberculosis Preventive Therapy Trial. J Acquir Immune Defic Syndr 2022; 91:397-402. [PMID: 36000934 PMCID: PMC9613590 DOI: 10.1097/qai.0000000000003078] [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: 02/05/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tuberculosis preventive therapy (TPT) is recommended for people with HIV infection, including during pregnancy. The effect of TPT exposure at conception and during pregnancy is poorly documented. METHODS We report pregnancy outcomes among South African women with HIV enrolled in a randomized trial of 4 TPT regimens (two 3-month regimens, rifapentine/isoniazid [3HP] or rifampin/isoniazid [3HR], isoniazid for 6 months, or isoniazid continuously). Descriptive statistics and risk ratios were assessed to examine relationships between study regimens and outcomes. RESULTS 216/896 women (24%) conceived during the study. Women who conceived were younger (27.9 vs 31.3 years) and had higher mean CD4 counts (589.1 vs 536.7). The odds of pregnancy were higher in women in the rifamycin-isoniazid arms than those in the isoniazid arms (3HP: relative risk [RR] 1.73, P = 0.001; 3HR:RR 1.55, P = 0.017) despite increased contraceptive use compared with the standard 6H therapy. Thirty-four women became pregnant while taking preventive treatment (8 rifamycin and 26 isoniazid monotherapy). Pregnancy outcomes in these women were as follows: 17 (50%) mother/baby healthy, 3 (9%) spontaneous abortions, 6 (18%) elective abortions, 1 (3%) premature delivery, 2 (6%) neonatal deaths [1 rifamycin-isoniazid and 1 isoniazid], and 5 (15%) unknown. CONCLUSIONS Pregnancy was common in women who had received TPT and more frequent in women who had received rifamycin-isoniazid-based regimens.
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Affiliation(s)
- Priya Singh
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lawrence H. Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Grace L. Barnes
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amita Gupta
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Reginah Msandiwa
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard E. Chaisson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Neil A. Martinson
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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9
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Hughes JA, Solans BP, Draper HR, Schaaf HS, Winckler JL, van der Laan L, Radtke KK, Fourie B, Wiesner L, Hesseling AC, Savic RM, Garcia-Prats AJ. Pharmacokinetics and Safety of Bedaquiline in Human Immunodeficiency Virus (HIV)-Positive and Negative Older Children and Adolescents With Rifampicin-Resistant Tuberculosis. Clin Infect Dis 2022; 75:1772-1780. [PMID: 35377434 PMCID: PMC9662178 DOI: 10.1093/cid/ciac252] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pharmacokinetic data for bedaquiline in children are limited. We described the pharmacokinetics and safety of bedaquiline in South African children and adolescents receiving treatment for multidrug/rifampicin-resistant tuberculosis (MDR/RR-TB) in routine care. METHODS In this observational cohort study, children aged 6-17 years receiving bedaquiline at recommended doses as part of MDR/RR-TB treatment underwent semi-intensive pharmacokinetic sampling. Bedaquiline and the M2 metabolite plasma concentrations were quantified, and nonlinear mixed-effects modeling performed. Pediatric data were described using a pre-established model of bedaquiline pharmacokinetics in adults. The exposure reference was 187 µg ⋅ h/mL, the median weekly area under the curve (AUC) of adults at week 24 of treatment with bedaquiline. Safety was assessed through monthly clinical, blood and electrocardiogram monitoring, and treatment outcomes described. RESULTS Fifteen children (3 human immunodeficiency virus [HIV]-positive) with median age 13.3 years (range 6.5-16.3) were included. A bedaquiline pharmacokinetic model was adapted to be allometrically scaled in clearance and volume, centered in the median child population weight. Bedaquiline bioavailability was 57% of that in adults. Overall bedaquiline exposures were below target, and AUC reference attainment was achieved in only 3 (20%) children. Ten children experienced 27 adverse events at least possibly related to bedaquiline; no adverse events led to bedaquiline withdrawal. Two adverse events (arthritis and arthralgia) were considered severe, and 2 children had mild QT interval corrected for heart rate using Fridericia's formula (QT) prolongation. CONCLUSIONS The evaluated doses of bedaquiline in children ≥ 6 years of age were safe but achieved slightly lower plasma concentrations compared to adults receiving the recommended dose, possibly due to delayed food intake relative to bedaquiline administration.
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Affiliation(s)
- Jennifer A Hughes
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Belén P Solans
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco Schools of Pharmacy and Medicine, San Francisco, California, USA
| | - Heather R Draper
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jana L Winckler
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Louvina van der Laan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kendra K Radtke
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco Schools of Pharmacy and Medicine, San Francisco, California, USA
| | - Barend Fourie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Radojka M Savic
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco Schools of Pharmacy and Medicine, San Francisco, California, USA
| | - Anthony J Garcia-Prats
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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10
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Court R, Gausi K, Mkhize B, Wiesner L, Waitt C, McIlleron H, Maartens G, Denti P, Loveday M. Bedaquiline exposure in pregnancy and breastfeeding in women with rifampicin-resistant tuberculosis. Br J Clin Pharmacol 2022; 88:3548-3558. [PMID: 35526837 PMCID: PMC9296589 DOI: 10.1111/bcp.15380] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/14/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
AIMS We aimed to explore the effect of pregnancy on bedaquiline pharmacokinetics (PK) and describe bedaquiline exposure in the breast milk of mothers treated for rifampicin-resistant tuberculosis (TB), where there are no human data available. METHODS We performed a longitudinal PK study in pregnant women treated for rifampicin-resistant TB to explore the effect of pregnancy on bedaquiline exposure. Pharmacokinetic sampling was performed at 4 time-points over 6 hours in the third trimester, and again at approximately 6 weeks postpartum. We obtained serial breast milk samples from breastfeeding mothers, and a single plasma sample taken from breastfed and nonbreastfed infants to assess bedaquiline exposure. We used liquid chromatography-tandem mass spectrometry to perform the breast milk and plasma bedaquiline assays, and population PK modelling to interpret the bedaquiline concentrations. RESULTS We recruited 13 women, 6 of whom completed the ante- and postpartum PK sampling. All participants were HIV-positive on antiretroviral therapy. We observed lower ante- and postpartum bedaquiline exposures than reported in nonpregnant controls. Bedaquiline concentrations in breast milk were higher than maternal plasma (milk to maternal plasma ratio: 14:1). A single random plasma bedaquiline and M2 concentration was available in 4 infants (median age: 6.5 wk): concentrations in the 1 breastfed infant were similar to maternal plasma concentrations; concentrations in the 3 nonbreastfed infants were detectable but lower than maternal plasma concentrations. CONCLUSION We report low exposure of bedaquiline in pregnant women treated for rifampicin-resistant TB. Bedaquiline significantly accumulates in breast milk; breastfed infants receive mg/kg doses of bedaquiline equivalent to maternal doses.
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Affiliation(s)
- Richard Court
- Division of Clinical Pharmacology, Department of MedicineUniversity of Cape Town
- Wellcome Centre for Infectious Diseases Research in Africa (CIDRI‐Africa), Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape Town
| | - Kamunkhwala Gausi
- Division of Clinical Pharmacology, Department of MedicineUniversity of Cape Town
| | - Buyisile Mkhize
- Division of Clinical Pharmacology, Department of MedicineUniversity of Cape Town
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of MedicineUniversity of Cape Town
| | - Catriona Waitt
- Department of Pharmacology and TherapeuticsUniversity of LiverpoolUK
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of MedicineUniversity of Cape Town
- Wellcome Centre for Infectious Diseases Research in Africa (CIDRI‐Africa), Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape Town
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of MedicineUniversity of Cape Town
- Wellcome Centre for Infectious Diseases Research in Africa (CIDRI‐Africa), Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape Town
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of MedicineUniversity of Cape Town
| | - Marian Loveday
- HIV Prevention Research Unit, South African Medical Research CouncilKwaZulu‐NatalSouth Africa
- CAPRISA‐MRC HIV‐TB Pathogenesis and Treatment Research UnitUniversity of KwaZulu‐NatalSouth Africa
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11
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Pediatric Tuberculosis Management: A Global Challenge or Breakthrough? CHILDREN 2022; 9:children9081120. [PMID: 36010011 PMCID: PMC9406656 DOI: 10.3390/children9081120] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 12/17/2022]
Abstract
Managing pediatric tuberculosis (TB) remains a public health problem requiring urgent and long-lasting solutions as TB is one of the top ten causes of ill health and death in children as well as adolescents universally. Minors are particularly susceptible to this severe illness that can be fatal post-infection or even serve as reservoirs for future disease outbreaks. However, pediatric TB is the least prioritized in most health programs and optimal infection/disease control has been quite neglected for this specialized patient category, as most scientific and clinical research efforts focus on developing novel management strategies for adults. Moreover, the ongoing coronavirus pandemic has meaningfully hindered the gains and progress achieved with TB prophylaxis, therapy, diagnosis, and global eradication goals for all affected persons of varying age bands. Thus, the opening of novel research activities and opportunities that can provide more insight and create new knowledge specifically geared towards managing TB disease in this specialized group will significantly improve their well-being and longevity.
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12
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Kalk E, Heekes A, Slogrove AL, Phelanyane F, Davies MA, Myer L, Euvrard J, Kroon M, Petro G, Fieggen K, Stewart C, Rhoda N, Gebhardt S, Osman A, Anderson K, Boulle A, Mehta U. Cohort profile: the Western Cape Pregnancy Exposure Registry (WCPER). BMJ Open 2022; 12:e060205. [PMID: 35768089 PMCID: PMC9244673 DOI: 10.1136/bmjopen-2021-060205] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The Western Cape Pregnancy Exposure Registry (PER) was established at two public sector healthcare sentinel sites in the Western Cape province, South Africa, to provide ongoing surveillance of drug exposures in pregnancy and associations with pregnancy outcomes. PARTICIPANTS Established in 2016, all women attending their first antenatal visit at primary care obstetric facilities were enrolled and followed to pregnancy outcome regardless of the site (ie, primary, secondary, tertiary facility). Routine operational obstetric and medical data are digitised from the clinical stationery at the healthcare facilities. Data collection has been integrated into existing services and information platforms and supports routine operations. The PER is situated within the Provincial Health Data Centre, an information exchange that harmonises and consolidates all health-related electronic data in the province. Data are contributed via linkage across a unique identifier. This relationship limits the missing data in the PER, allows validation and avoids misclassification in the population-level data set. FINDINGS TO DATE Approximately 5000 and 3500 pregnant women enter the data set annually at the urban and rural sites, respectively. As of August 2021, >30 000 pregnancies have been recorded and outcomes have been determined for 93%. Analysis of key obstetric and neonatal health indicators derived from the PER are consistent with the aggregate data in the District Health Information System. FUTURE PLANS This represents significant infrastructure, able to address clinical and epidemiological concerns in a low/middle-income setting.
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Affiliation(s)
- Emma Kalk
- Centre for Infectious Disease Epidemiology & Research, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Alexa Heekes
- Centre for Infectious Disease Epidemiology & Research, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
- Health Intelligence Directorate, Western Cape Department of Health, Cape Town, South Africa
| | - Amy L Slogrove
- Ukwanda Centre for Rural Health, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Department of Paediatrics & Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Florence Phelanyane
- Centre for Infectious Disease Epidemiology & Research, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
- Health Intelligence Directorate, Western Cape Department of Health, Cape Town, South Africa
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology & Research, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
- Health Intelligence Directorate, Western Cape Department of Health, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Jonathan Euvrard
- Centre for Infectious Disease Epidemiology & Research, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
- Health Intelligence Directorate, Western Cape Department of Health, Cape Town, South Africa
| | - Max Kroon
- Department of Paediatrics & Child Health, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
- Neonatal Services, Mowbray Maternity Hospital, Cape Town, South Africa
| | - Greg Petro
- Department of Obstetrics & Gynaecology, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
- Maternity Services, New Somerset Hospital, Cape Town, South Africa
| | - Karen Fieggen
- Division of Human Genetics, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
- Medical Genetics Services, Groote Schuur Hospital, Cape Town, South Africa
| | - Chantal Stewart
- Department of Obstetrics & Gynaecology, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
- Maternity Services, Mowbray Maternity Hospital, Cape Town, South Africa
| | - Natasha Rhoda
- Department of Paediatrics & Child Health, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
- Neonatal Services, Mowbray Maternity Hospital, Cape Town, South Africa
| | - Stefan Gebhardt
- Department of Obstetrics & Gynaecology, Stellenbosch University, Stellenbosch, South Africa
- Maternity Services, Tygerberg Hospital, Cape Town, South Africa
| | - Ayesha Osman
- Department of Obstetrics & Gynaecology, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
- Maternity Services, Groote Schuur Hospital, Cape Town, South Africa
| | - Kim Anderson
- Centre for Infectious Disease Epidemiology & Research, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology & Research, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
- Health Intelligence Directorate, Western Cape Department of Health, Cape Town, South Africa
| | - Ushma Mehta
- Centre for Infectious Disease Epidemiology & Research, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
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13
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Den Boon S, Lienhardt C, Zignol M, Schwartzman K, Arinaminpathy N, Campbell JR, Nahid P, Penazzato M, Menzies D, Vesga JF, Oxlade O, Churchyard G, Merle CS, Kasaeva T, Falzon D. WHO target product profiles for TB preventive treatment. Int J Tuberc Lung Dis 2022; 26:302-309. [PMID: 35351234 PMCID: PMC7612716 DOI: 10.5588/ijtld.21.0667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND: The WHO has developed target product profiles (TPPs) describing the most appropriate qualities for future TPT regimens to assist developers in aligning the characteristics of new treatments with programmatic requirements.METHODS: A technical consultation group was convened by the WHO to determine regimen attributes with greatest potential impact for patients (i.e., improved risk/benefit profile) and populations (i.e., reduction in transmission and TB prevalence). The group categorised regimen attributes as 'priority´ or 'desirable´; and defined for each attribute the minimum requirements and optimal targets.RESULTS: Nine priority attributes were defined, including efficacy, treatment duration, safety, drug-drug interactions, barrier to emergence of drug resistance, target population, formulation, dosage, frequency and route of administration, stability and shelf life. Regimens meeting optimal targets were characterised, for example, as having superior efficacy, treatment duration of ≤2 weeks, and improved tolerability and safety profile compared with current regimens. The four desirable attributes included regimen cost, safety in special populations, treatment adherence and need for drug susceptibility testing in the index patient.DISCUSSION: It may be difficult for a single regimen to satisfy all characteristics so regimen developers may have to consider trade-offs. Additional operational aspects may be relevant to the feasibility and public health impact of new TPT regimens.
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Affiliation(s)
- S. Den Boon
- Global Tuberculosis Programme, World Health Organization (WHO), Geneva, Switzerland
| | - C. Lienhardt
- Unité Mixte Internationale TransVIHMI, Unité mixte internationale 233, Institut de recherche pour le développement, Unité 1175, Université de Montpellier, Institut de Recherche pour le Développement (INSERM), Montpellier, France,Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - M. Zignol
- Global Tuberculosis Programme, World Health Organization (WHO), Geneva, Switzerland
| | - K. Schwartzman
- McGill International Tuberculosis Centre, McGill University, Montréal, QC, Canada
| | | | - J. R. Campbell
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
| | - P. Nahid
- Center for Tuberculosis, University of California, San Francisco, CA, USA
| | - M. Penazzato
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, WHO, Geneva, Switzerland
| | - D. Menzies
- McGill International Tuberculosis Centre, McGill University, Montréal, QC, Canada
| | - J. F. Vesga
- MRC Centre for Global Infectious Disease Analysis
| | - O. Oxlade
- McGill International Tuberculosis Centre, McGill University, Montréal, QC, Canada
| | - G. Churchyard
- The Aurum Institute, Johannesburg, South Africa,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - C. S. Merle
- Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland
| | - T. Kasaeva
- Global Tuberculosis Programme, World Health Organization (WHO), Geneva, Switzerland
| | - D. Falzon
- Global Tuberculosis Programme, World Health Organization (WHO), Geneva, Switzerland
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14
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Sullivan A, Nathavitharana RR. Addressing TB-related mortality in adults living with HIV: a review of the challenges and potential solutions. Ther Adv Infect Dis 2022; 9:20499361221084163. [PMID: 35321342 PMCID: PMC8935406 DOI: 10.1177/20499361221084163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/12/2022] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis (TB) is the leading cause of death in people living with HIV (PLHIV) globally, causing 208,000 deaths in PLHIV in 2019. PLHIV have an 18-fold higher risk of TB, and HIV/TB mortality is highest in inpatient facilities, compared with primary care and community settings. Here we discuss challenges and potential mitigating solutions to address TB-related mortality in adults with HIV. Key factors that affect healthcare engagement are stigma, knowledge, and socioeconomic constraints, which are compounded in people with HIV/TB co-infection. Innovative approaches to improve healthcare engagement include optimizing HIV/TB care integration and interventions to reduce stigma. While early diagnosis of both HIV and TB can reduce mortality, barriers to early diagnosis of TB in PLHIV include difficulty producing sputum specimens, lower sensitivity of TB diagnostic tests in PLHIV, and higher rates of extra pulmonary TB. There is an urgent need to develop higher sensitivity biomarker-based tests that can be used for point-of-care diagnosis. Nonetheless, the implementation and scale-up of existing tests including molecular World Health Organization (WHO)-recommended diagnostic tests and urine lipoarabinomannan (LAM) should be optimized along with expanded TB screening with tools such as C-reactive protein and digital chest radiography. Decreased survival of PLHIV with TB disease is more likely with late HIV diagnosis and delayed start of antiretroviral (ART) treatment. The WHO now recommends starting ART within 2 weeks of initiating TB treatment in the majority of PLHIV, aside from those with TB meningitis. Dedicated TB treatment trials focused on PLHIV are needed, including interventions to improve TB meningitis outcomes given its high mortality, such as the use of intensified regimens using high-dose rifampin, new and repurposed drugs such as linezolid, and immunomodulatory therapy. Ultimately holistic, high-quality, person-centered care is needed for PLHIV with TB throughout the cascade of care, which should address biomedical, socioeconomic, and psychological barriers.
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Affiliation(s)
- Amanda Sullivan
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Ruvandhi R. Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
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15
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Affiliation(s)
- Maunank Shah
- From the Johns Hopkins University School of Medicine and the Baltimore City Health Department - both in Baltimore (M.S.); and the Medical University of South Carolina, Charleston, and the South Carolina Department of Health and Environmental Control, Columbia (S.E.D.)
| | - Susan E Dorman
- From the Johns Hopkins University School of Medicine and the Baltimore City Health Department - both in Baltimore (M.S.); and the Medical University of South Carolina, Charleston, and the South Carolina Department of Health and Environmental Control, Columbia (S.E.D.)
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16
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Weld ED, Waitt C, Barnes K, Garcia Bournissen F. Twice neglected? Neglected diseases in neglected populations. Br J Clin Pharmacol 2021; 88:367-373. [PMID: 34888909 DOI: 10.1111/bcp.15148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 01/20/2023] Open
Abstract
It is unfortunately true that clinicians lack the necessary evidence to know how to use medications properly in large sections of the population and do not have optimal treatments to use for many neglected tropical diseases (NTDs). NTDs often disproportionately affect neglected populations that are left out of research efforts, such as children and pregnant women. As reliable access to safe, effective preventives and treatments can break the cycle of poverty, illness, and ensuing debility that further perpetuates poverty, it is of paramount importance to investigate and develop new medicines for neglected populations suffering from NTDs. Furthermore, there is not only a need to develop and evaluate novel therapies, but also to ensure that these are affordable, available, and adapted to the communities who need them. The NIH has proposed a "4 C's" framework which is relevant for neglected diseases and populations and should be leveraged for the study of the Twice Neglected: Consider inclusion; Collect data from neglected populations with neglected conditions; Characterize differences through meaningful analysis; Communicate findings pertaining to neglected diseases and populations. With this editorial, the British Journal of Clinical Pharmacology hereby launches a call for high-quality articles focusing on NTDs in special populations, to facilitate and encourage the reversal of this dual neglect.
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Affiliation(s)
- Ethel D Weld
- Department of Medicine, Division of Infectious Diseases and Division of Clinical Pharmacology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Catriona Waitt
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Infectious Disease Institute, Makerere University College of Health Sciences, Kampala, Uganda.,Royal Liverpool University Hospital, Liverpool, UK
| | - Karen Barnes
- Division of Clinical Pharmacology, The University of Cape Town, Cape Town, South Africa
| | - Facundo Garcia Bournissen
- Division of Pediatric Clinical Pharmacology, Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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17
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Lyerly AD, Beigi R, Bekker L, Chi BH, Cohn SE, Diallo DD, Eron J, Faden R, Jaffe E, Kashuba A, Kasule M, Krubiner C, Little M, Mfustso‐Bengo J, Mofenson L, Mwapasa V, Mworeko L, Myer L, Penazzato M, Rid A, Shapiro R, Singh JA, Sullivan K, Vicari M, Wambui J, White A, Wickremsinhe M, Wolf L. Ending the evidence gap for pregnancy, HIV and co-infections: ethics guidance from the PHASES project. J Int AIDS Soc 2021; 24:e25846. [PMID: 34910846 PMCID: PMC8673925 DOI: 10.1002/jia2.25846] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/21/2021] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION While pregnant people have been an important focus for HIV research, critical evidence gaps remain regarding prevention, co-infection, and safety and efficacy of new antiretroviral therapies in pregnancy. Such gaps can result in harm: without safety data, drugs used may carry unacceptable risks to the foetus or pregnant person; without pregnancy-specific dosing data, pregnant people face risks of both toxicity and undertreatment; and delays in gathering evidence can limit access to beneficial next-generation drugs. Despite recognition of the need, numerous barriers and ethical complexities have limited progress. We describe the process, ethical foundations, recommendations and applications of guidance for advancing responsible inclusion of pregnant people in HIV/co-infections research. DISCUSSION The 26-member international and interdisciplinary Pregnancy and HIV/AIDS: Seeking Equitable Study (PHASES) Working Group was convened to develop ethics-centred guidance for advancing timely, responsible HIV/co-infections research with pregnant people. Deliberations over 3 years drew on extensive qualitative research, stakeholder engagement, expert consultation and a series of workshops. The guidance, initially issued in July 2020, highlights conceptual shifts needed in framing research with pregnant people, and articulates three ethical foundations to ground recommendations: equitable protection from drug-related risks, timely access to biomedical advances and equitable respect for pregnant people's health interests. The guidance advances 12 specific recommendations, actionable within the current regulatory environment, addressing multiple stakeholders across drug development and post-approval research, and organized around four themes: building capacity, supporting inclusion, achieving priority research and ensuring respect. The recommendations describe strategies towards ethically redressing the evidence gap for pregnant people around HIV and co-infections. The guidance has informed key efforts of leading organizations working to advance needed research, and identifies further opportunities for impact by a range of stakeholder groups. CONCLUSIONS There are clear pathways towards ethical inclusion of pregnant people in the biomedical research agenda, and strong agreement across the HIV research community about the need for - and the promise of - advancing them. Those who fund, conduct, oversee and advocate for research can use the PHASES guidance to facilitate more, better and earlier evidence to optimize the health and wellbeing of pregnant people and their children.
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Affiliation(s)
- Anne Drapkin Lyerly
- Department of Social Medicine and Center for BioethicsUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Richard Beigi
- Department of ObstetricsGynecology & Reproductive SciencesUPMC Magee‐Women's HospitalPittsburghPennsylvaniaUSA
| | - Linda‐Gail Bekker
- Desmond Tutu HIV Centre and Department of MedicineUniversity of Cape TownCape TownSouth Africa
| | - Benjamin H. Chi
- Department of Obstetrics and GynecologyUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Susan E. Cohn
- Department of MedicineFeinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | | | - Joseph Eron
- Department of Medicine and Center for AIDS ResearchUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Ruth Faden
- Johns Hopkins Berman Institute of BioethicsBaltimoreMarylandUSA
| | - Elana Jaffe
- Department of Social Medicine and Center for BioethicsUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Angela Kashuba
- Eshelman School of Pharmacy and Department of MedicineUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Mary Kasule
- Botswana‐Baylor Centre for Clinical ExcellenceGabaroneBotswana
| | | | - Maggie Little
- Kennedy Institute for Ethics and Department of PhilosophyGeorgetown UniversityWashingtonDCUSA
| | - Joseph Mfustso‐Bengo
- Center of Bioethics for Eastern & Southern Africa and Department of Health Systems and PolicyCollege of MedicineUniversity of MalawiZombaMalawi
| | - Lynne Mofenson
- Elizabeth Glaser Pediatric AIDS FoundationWashingtonDCUSA
| | | | - Lillian Mworeko
- International Community of Women Living with HIV Eastern AfricaKampalaUganda
| | - Landon Myer
- Division of Epidemiology and BiostatisticsSchool of Public Health and Family MedicineUniversity of Cape TownCape TownSouth Africa
| | | | - Annette Rid
- Department of BioethicsThe Clinical CenterNational Institutes of HealthBethesdaMarylandUSA
| | - Roger Shapiro
- Department of Immunology and Infectious DiseasesHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Jerome Amir Singh
- Howard College School of LawUniversity of KwaZulu‐NatalKwaZulu‐NatalSouth Africa
- Dalla Lana School of Public Health Sciences, University of TorontoTorontoOntarioCanada
| | - Kristen Sullivan
- Department of Social Medicine and Center for BioethicsUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | | | - Jacque Wambui
- National Empowerment Network of People Living with HIV and AIDS in Kenya (NEPHAK)African Communities Advisory Board (AfroCAB)LusakaZambia
| | - Amina White
- Department of Obstetrics and GynecologyUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Marisha Wickremsinhe
- Ethox Centre and Wellcome Centre for Ethics and HumanitiesUniversity of OxfordOxfordUK
| | - Leslie Wolf
- Center for LawHealth & Society and College of Law and School of Public HealthGeorgia State UniversityAtlantaGeorgiaUSA
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Loveday M, Hughes J, Sunkari B, Master I, Hlangu S, Reddy T, Chotoo S, Green N, Seddon JA. Maternal and Infant Outcomes Among Pregnant Women Treated for Multidrug/Rifampicin-Resistant Tuberculosis in South Africa. Clin Infect Dis 2021; 72:1158-1168. [PMID: 32141495 PMCID: PMC8028100 DOI: 10.1093/cid/ciaa189] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/27/2020] [Indexed: 11/16/2022] Open
Abstract
Background Data on safety and efficacy of second-line tuberculosis drugs in pregnant women and their infants are severely limited due to exclusion from clinical trials and expanded access programs. Methods Pregnant women starting treatment for multidrug/rifampicin-resistant (MDR/RR)-tuberculosis at King Dinuzulu Hospital in KwaZulu-Natal, South Africa, from 1 January 2013 to 31 December 2017, were included. We conducted a record review to describe maternal treatment and pregnancy outcomes, and a clinical assessment to describe infant outcomes. Results Of 108 pregnant women treated for MDR/RR-tuberculosis, 88 (81%) were living with human immunodeficiency virus.. Favorable MDR/RR-tuberculosis treatment outcomes were reported in 72 (67%) women. Ninety-nine (91%) of the 109 babies were born alive, but overall, 52 (48%) women had unfavorable pregnancy outcomes. Fifty-eight (54%) women received bedaquiline, and 49 (45%) babies were exposed to bedaquiline in utero. Low birth weight was reported in more babies exposed to bedaquiline compared to babies not exposed (45% vs 26%; P = .034). In multivariate analyses, bedaquiline and levofloxacin, drugs often used in combination, were both independently associated with increased risk of low birth weight. Of the 86 children evaluated at 12 months, 72 (84%) had favorable outcomes; 88% of babies exposed to bedaquiline were thriving and developing normally compared to 82% of the babies not exposed. Conclusions MDR/RR-tuberculosis treatment outcomes among pregnant women were comparable to nonpregnant women. Although more babies exposed to bedaquiline were of low birth weight, over 80% had gained weight and were developing normally at 1 year.
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Affiliation(s)
- Marian Loveday
- Health Systems Research Unit, South African Medical Research Council, KwaZulu-Natal, South Africa.,South African Medical Research Council HIV-TB Pathogenesis and Treatment Research Unit, CAPRISA, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa
| | - Jennifer Hughes
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, South Africa
| | - Babu Sunkari
- MDR-TB unit, King Dinuzulu Hospital, Durban, South Africa
| | - Iqbal Master
- MDR-TB unit, King Dinuzulu Hospital, Durban, South Africa
| | - Sindisiwe Hlangu
- Health Systems Research Unit, South African Medical Research Council, KwaZulu-Natal, South Africa
| | - Tarylee Reddy
- Department of Biostatistics, South African Medical Research Council, KwaZulu-Natal, South Africa
| | - Sunitha Chotoo
- MDR-TB unit, King Dinuzulu Hospital, Durban, South Africa
| | - Nathan Green
- MDR-TB unit, King Dinuzulu Hospital, Durban, South Africa.,Department of Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - James A Seddon
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, South Africa.,Department of Infectious Diseases, Imperial College London, United Kingdom
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19
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Marais BJ. Good Outcomes in Babies With In Utero Bedaquiline Exposure. Clin Infect Dis 2021; 72:1169-1170. [PMID: 32141498 DOI: 10.1093/cid/ciaa174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/01/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ben J Marais
- University of Sydney and Children's Hospital at Westmead, Sydney, Australia
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20
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Alene KA, Jegnie A, Adane AA. Multidrug-resistant tuberculosis during pregnancy and adverse birth outcomes: a systematic review and meta-analysis. BJOG 2020; 128:1125-1133. [PMID: 33068306 DOI: 10.1111/1471-0528.16573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) is a major global public health concern. However, there is a dearth of literature on whether MDR-TB and its medications impact maternal and perinatal outcomes, and when such evidence exists the findings are conflicting. OBJECTIVES This systematic review and meta-analysis aimed to examine the impact of MDR-TB and its medications during pregnancy on maternal and perinatal outcomes. SEARCH STRATEGY PubMed, Scopus and Web of Science databases were searched from earliest to February 2020. SELECTION CRITERIA Records were screened based on pre-defined selection criteria and assessed for quality by two independent reviewers. DATA COLLECTION AND ANALYSIS A meta-analysis was performed using the random effects model to calculate pooled prevalence for each outcome. MAIN RESULTS Of the 72 records identified, 12 were included in the systematic review and meta-analysis, consisting of 174 pregnant women with MDR-TB and 110 adverse outcomes. Maternal death, pregnancy loss, preterm birth and low birthweight were the most common maternal and perinatal adverse outcomes reported in the studies. The overall pooled prevalence was 7.5% (95% CI 3.2-12.8) for maternal death, 10.6% (95% CI 6.0-16.3) for pregnancy loss, 12.9% (95% CI 0.0-38.0) for preterm birth and 23.7% (95% CI 17.0-31.0) for low birthweight. CONCLUSIONS The findings suggest that MDR-TB is associated with a high risk of adverse maternal and perinatal outcomes, but these should be interpreted cautiously because the evidence is largely preliminary. Adequately powered prospective cohort studies are urgently required to corroborate these findings. TWEETABLE ABSTRACT Multidrug-resistant tuberculosis may increase the risk of adverse maternal and perinatal outcomes.
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Affiliation(s)
- K A Alene
- Faculty of Health Sciences, Curtin University, Bentley, WA, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia.,Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - A Jegnie
- UWA School of Agriculture and Environment, The University of Western Australia, Crawley, WA, Australia
| | - A A Adane
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
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21
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Marais BJ, Nicol M, Zar HJ. Key advances and remaining challenges in childhood and adolescent tuberculosis. Paediatr Respir Rev 2020; 36:25-26. [PMID: 32830068 DOI: 10.1016/j.prrv.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/28/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Ben J Marais
- The Children's Hospital at Westmead, University of Sydney, Sydney, Australia.
| | - Mark Nicol
- The School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - Heather J Zar
- Department of Paediatrics & Child Health and SA-MRC Unit on Child & Adolescent Health, University of Cape Town, South Africa
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22
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K J S, A B, G K H, S M G. Tuberculosis in pregnant women and neonates: A meta-review of current evidence. Paediatr Respir Rev 2020; 36:27-32. [PMID: 32144052 DOI: 10.1016/j.prrv.2020.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/07/2020] [Indexed: 01/08/2023]
Abstract
Pregnant women and their infants are a vulnerable but neglected population in tuberculosis (TB) control efforts. Recent advances in TB prevention, diagnosis and treatment have implications for their care, despite their frequent exclusion from research. We have conducted a meta-review of current evidence and clinical guidelines for TB prevention, diagnosis and management in pregnant women and neonates, focusing on review articles published since 2010. The actual burden of TB in pregnancy is unmeasured, but has been estimated at 216,500 cases per year. Although the effect of pregnancy on TB risk is uncertain and controversial, two large whole-of-population studies found that pregnancy was associated with a two- to three-fold increase in risk of TB. Congenital TB is rare but extremely serious. Neonates exposed to TB after delivery will be at high risk of disease, and preventive therapy is recommended once disease has been ruled out. At present, there is limited evidence regarding the performance of different screening strategies for pregnant women, appropriate drug dosing for either pregnant women or neonates, and the safety of most second-line drugs in pregnancy. High quality evidence on these topics is needed, as are detailed guidelines to inform efforts by TB control programs and clinicians working with pregnant women and their infants.
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Affiliation(s)
- Snow K J
- Centre for International Child Health, University of Melbourne, Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Bekker A
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Huang G K
- The Burnet Institute, Melbourne, Australia
| | - Graham S M
- Centre for International Child Health, University of Melbourne, Department of Paediatrics and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia; The Burnet Institute, Melbourne, Australia; International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
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24
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Mathad JS, LaCourse SM, Gupta A. TB prevention strategies and unanswered questions for pregnant and postpartum women living with HIV: the need for improved evidence. J Int AIDS Soc 2020; 23:e25481. [PMID: 32202066 PMCID: PMC7086302 DOI: 10.1002/jia2.25481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Jyoti S Mathad
- Department of Medicine and Obstetrics & GynecologyCenter for Global HealthWeill Cornell MedicineNew YorkNYUSA
| | - Sylvia M LaCourse
- Department of MedicineDivision of Allergy and Infectious DiseasesUniversity of WashingtonSeattleWAUSA
| | - Amita Gupta
- Department of Medicine and International HealthJohns Hopkins UniversityBaltimoreMDUSA
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25
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Tuberculosis in children, adolescents, and women. THE LANCET RESPIRATORY MEDICINE 2020; 8:335-337. [PMID: 32113571 DOI: 10.1016/s2213-2600(20)30077-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 12/16/2022]
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26
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Lienhardt C, Nunn A, Chaisson R, Vernon AA, Zignol M, Nahid P, Delaporte E, Kasaeva T. Advances in clinical trial design: Weaving tomorrow's TB treatments. PLoS Med 2020; 17:e1003059. [PMID: 32106220 PMCID: PMC7046183 DOI: 10.1371/journal.pmed.1003059] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Christian Lienhardt and co-authors discuss the conclusions of the PLOS Medicine Collection on advances in clinical trial design for development of new tuberculosis treatments.
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Affiliation(s)
- Christian Lienhardt
- Unité Mixte Internationale TransVIHMI, UMI 233 IRD–U1175 INSERM—Université de Montpellier, Institut de Recherche pour le Développement (IRD), Montpellier, France
- * E-mail:
| | - Andrew Nunn
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Richard Chaisson
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, United States of America
| | - Andrew A. Vernon
- Division of TB Elimination, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Matteo Zignol
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | - Payam Nahid
- UCSF Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Eric Delaporte
- Unité Mixte Internationale TransVIHMI, UMI 233 IRD–U1175 INSERM—Université de Montpellier, Institut de Recherche pour le Développement (IRD), Montpellier, France
| | - Tereza Kasaeva
- Global TB Programme, World Health Organization, Geneva, Switzerland
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