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Heidari O, Winiker AK, Pollock S, Sodder S, Tsui JI, Tobin KE. A qualitative exploration of the use of telehealth for opioid treatment: Implications for nurse-managed care. J Clin Nurs 2024; 33:2707-2718. [PMID: 38500003 PMCID: PMC11176020 DOI: 10.1111/jocn.17125] [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: 08/23/2023] [Revised: 02/25/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
AIM To characterise experiences with telehealth for Medications for Opioid Use Disorder (MOUD) services among patients, prescribers, nurses and substance use counsellors to inform future best practices. DESIGN We engaged a qualitative descriptive study design. METHODS Semi-structured interviews were conducted with prescribers (nurse practitioners and physicians, n = 20), nurses and substance use counsellors (n = 7), and patients (n = 20) between June and September 2021. Interviews were verbatim transcribed. Thematic analysis was conducted using a qualitative descriptive method. RESULTS Among both providers and patients, four themes were identified: (1) Difficulties with telehealth connection (2) Flexibility in follow-up and retention, (3) Policy changes that enabled expanded care, (4) Path forward with telehealth. Two additional findings emerged from provider interviews: (1) Expansion of nurse-managed office-based opioid treatment, and (2) Novel methods to engage patients. CONCLUSIONS Patients and providers continued to view telehealth as an acceptable means for delivery and management of MOUD, particularly when utilised in a hybrid manner between in-person visits. Nurse-managed care for this service was evident as nurses extended the breadth of services offered and utilised novel methods such as text messages and management of 'call-in' lines to engage patients. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Use of telehealth for MOUD should be incorporated into practice settings to reach patients in a flexible manner. Nurses in particular can use this medium to extend office-based opioid treatment by conducting assessments and expanding capacity for other wrap-around services. IMPACT We identify recommendations for best practices in the use of telehealth for opioid use disorder management and highlight the value of nurse-managed care. REPORTING METHOD The consolidated criteria for reporting qualitative research. PATIENT OR PUBLIC CONTRIBUTION Patients with opioid use disorder and prescribers with experience using telehealth were interviewed for this study.
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Affiliation(s)
- Omeid Heidari
- School of Nursing, Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Abigail K Winiker
- Bloomberg School of Public Health, Department of Health, Behavior, and Society, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sarah Pollock
- Bloomberg School of Public Health, Department of Health, Behavior, and Society, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shereen Sodder
- Bloomberg School of Public Health, Department of Health, Behavior, and Society, Johns Hopkins University, Baltimore, Maryland, USA
| | - Judith I Tsui
- Harborview Medical Center, School of Medicine, Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Karin E Tobin
- Bloomberg School of Public Health, Department of Health, Behavior, and Society, Johns Hopkins University, Baltimore, Maryland, USA
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Geiger K, Patil A, Budhathoki C, Dooley KE, Lowensen K, Ndjeka N, Ngozo J, Farley JE. Relationship between HIV viral suppression and multidrug resistant tuberculosis treatment outcomes. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002714. [PMID: 38709764 PMCID: PMC11073678 DOI: 10.1371/journal.pgph.0002714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/05/2024] [Indexed: 05/08/2024]
Abstract
The impact of HIV viral suppression on multidrug resistant tuberculosis (MDR-TB) treatment outcomes among people with HIV (PWH) has not been clearly established. Using secondary data from a cluster-randomized clinical trial among people with MDR-TB in South Africa, we examined the effects of HIV viral suppression at MDR-TB treatment initiation and throughout treatment on MDR-TB outcomes among PWH using multinomial regression. This analysis included 1479 PWH. Viral suppression (457, 30.9%), detectable viral load (524, 35.4%), or unknown viral load (498, 33.7%) at MDR-TB treatment initiation were almost evenly distributed. Having a detectable HIV viral load at MDR-TB treatment initiation significantly increased risk of death compared to those virally suppressed (relative risk ratio [RRR] 2.12, 95% CI 1.11-4.07). Among 673 (45.5%) PWH with a known viral load at MDR-TB outcome, 194 (28.8%) maintained suppression, 267 (39.7%) became suppressed, 94 (14.0%) became detectable, and 118 (17.5%) were never suppressed. Those who became detectable (RRR 11.50, 95% CI 1.98-66.65) or were never suppressed (RRR 9.28, 95% CI 1.53-56.61) were at significantly increased risk of death (RRR 6.37, 95% CI 1.58-25.70), treatment failure (RRR 4.54, 95% CI 1.35-15.24), and loss to follow-up (RRR 7.00, 95% CI 2.83-17.31; RRR 2.97, 95% CI 1.02-8.61) compared to those who maintained viral suppression. Lack of viral suppression at MDR-TB treatment initiation and failure to achieve or maintain viral suppression during MDR-TB treatment drives differences in MDR-TB outcomes. Early intervention to support access and adherence to antiretroviral therapy among PWH should be prioritized to improve MDR-TB treatment outcomes.
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Affiliation(s)
- Keri Geiger
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Amita Patil
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Chakra Budhathoki
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kelly E. Dooley
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Kelly Lowensen
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Norbert Ndjeka
- National Department of Health, Tuberculosis Control and Management, Pretoria, Gauteng, South Africa
| | - Jacqueline Ngozo
- KwaZulu-Natal Department of Health, Tuberculosis Programme, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Jason E. Farley
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, Baltimore, Maryland, United States of America
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McNabb KC, Bergman AJ, Patil A, Lowensen K, Mthimkhulu N, Budhathoki C, Perrin N, Farley JE. Travel distance to rifampicin-resistant tuberculosis treatment and its impact on loss to follow-up: the importance of continued RR-TB treatment decentralization in South Africa. BMC Public Health 2024; 24:578. [PMID: 38389038 PMCID: PMC10885440 DOI: 10.1186/s12889-024-17924-0] [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: 11/04/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Understanding why patients experience loss to follow-up (LTFU) is essential for TB control. This analysis examines the impact of travel distance to RR-TB treatment on LTFU, which has yet to be analyzed within South Africa. METHODS We retrospectively analyzed 1436 patients treated for RR-TB at ten South African public hospitals. We linked patients to their residential ward using data reported to NHLS and maps available from the Municipal Demarcation Board. Travel distance was calculated from each patient's ward centroid to their RR-TB treatment site using the georoute command in Stata. The relationship between LTFU and travel distance was modeled using multivariable logistic regression. RESULTS Among 1436 participants, 75.6% successfully completed treatment and 24.4% were LTFU. The median travel distance was 40.96 km (IQR: 17.12, 63.49). A travel distance > 60 km increased odds of LTFU by 91% (p = 0.001) when adjusting for HIV status, age, sex, education level, employment status, residential locale, treatment regimen, and treatment site. CONCLUSION People living in KwaZulu-Natal and Eastern Cape travel long distances to receive RR-TB care, placing them at increased risk for LTFU. Policies that bring RR-TB treatment closer to patients, such as further decentralization to PHCs, are necessary to improve RR-TB outcomes.
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Affiliation(s)
- Katherine C McNabb
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA.
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA.
| | - Alanna J Bergman
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Amita Patil
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Kelly Lowensen
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Nomusa Mthimkhulu
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Port Shepstone, Republic of South Africa
| | - Chakra Budhathoki
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Nancy Perrin
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA
| | - Jason E Farley
- Johns Hopkins University School of Nursing, 525 N Wolfe St, Baltimore, MD, 21205, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
- Johns Hopkins TB Research Advancement Center, Baltimore, MD, USA
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Geiger K, Patil A, Bergman A, Budhathoki C, Heidari O, Lowensen K, Mthimkhulu N, McNabb KC, Ndjeka N, Ngozo J, Reynolds N, Farley JE. Exploring HIV disease indicators at MDR-TB treatment initiation in South Africa. Int J Tuberc Lung Dis 2024; 28:42-50. [PMID: 38178293 PMCID: PMC10915896 DOI: 10.5588/ijtld.23.0242] [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] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND: Understanding relationships between HIV and multidrug-resistant TB (MDR-TB) is crucial for ensuring successful MDR-TB outcomes.METHODS: We used a cross-sectional analysis to evaluate sociodemographic and clinical characteristics as correlates of antiretroviral therapy (ART) use, having an HIV viral load (VL) result, and HIV viral suppression in a cross-sectional sample of people with HIV (PWH) and MDR-TB enrolled in a cluster-randomized trial of nurse case management to improve MDR-TB outcomes.RESULTS: Among 1,479 PWH, the mean age was 37.1 years; 809 (54.7%) were male, and 881 (59.6%) were taking ART. Housing location, employment status, and CD4 count differed significantly between those taking vs. those not taking ART. Among the 881 taking ART, 681 (77.3%) had available HIV VL results. Housing location, CD4 count, and prior history of TB differed significantly between those with and without a VL result. Among the 681 with a VL result, 418 (61.4%) were virally suppressed. Age, education level, CD4 count, TB history, housing location, and ART type differed significantly between those with and without viral suppression.CONCLUSION: PWH presenting for MDR-TB treatment with a history of TB, taking a protease inhibitor, or living in a township may risk poor MDR-TB outcomes.
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Affiliation(s)
- Keri Geiger
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Amita Patil
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Durban, Republic of South Africa
| | - Alanna Bergman
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | | | - Omeid Heidari
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
- University of Washington School of Nursing, Seattle, WA, USA
| | - Kelly Lowensen
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Durban, Republic of South Africa
| | - Nomusa Mthimkhulu
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Durban, Republic of South Africa
| | - Katherine C. McNabb
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
| | - Norbert Ndjeka
- National Department of Health, Republic of South Africa, TB Control and Management
| | - Jaqueline Ngozo
- KwaZulu Natal Department of Health, Republic of South Africa
| | - Nancy Reynolds
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Jason E. Farley
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Baltimore, MD, USA
- Johns Hopkins Center for Infectious Disease and Nursing Innovation, Durban, Republic of South Africa
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Geiger K, Patil A, Budhathoki C, Dooley KE, Lowensen K, Ndjeka N, Ngozo J, Farley JE. Successful Multidrug-Resistant Tuberculosis Treatment Without HIV Viral Suppression: A Missed Opportunity. J Acquir Immune Defic Syndr 2023; 94:253-261. [PMID: 37757847 PMCID: PMC10592374 DOI: 10.1097/qai.0000000000003268] [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: 05/11/2023] [Accepted: 06/26/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Coinfection with multidrug-resistant tuberculosis (MDR-TB) and HIV is common, but few published studies examine how undergoing MDR-TB treatment affects HIV disease indicators. METHODS Using data from a nested, retrospective cohort of people with HIV (PWH) and successful MDR-TB treatment outcomes, we built multivariable regression models to explore correlates of HIV viral suppression at MDR-TB treatment completion. RESULTS Among 531 PWH successfully treated for MDR-TB, mean age was 37.4 years (SD 10.2, interquartile range 30-43), 270 (50.8%) were male, 395 (74.4%) were virally suppressed at MDR-TB outcome, and 259 (48.8%) took bedaquiline. Older age (adjusted odds ratio [aOR] 1.04, 95% confidence interval [CI]: 1.01 to 1.06) increased odds of viral suppression, while having a prior TB episode (aOR 0.45, 95% CI: 0.31 to 0.64), having a detectable viral load at MDR-TB treatment initiation (aOR 0.17, 95% CI: 0.09 to 0.30), living in a township (aOR 0.49, 95% CI: 0.28 to 0.87), and being changed from efavirenz-based antiretroviral therapy (ART) to a protease inhibitor due to bedaquiline usage (aOR 0.19, 95% CI: 0.04 to 0.82) or not having an ART change while on bedaquiline (aOR 0.29, 95% CI: 0.11 to 0.75) lowered odds of viral suppression. Changing from efavirenz to nevirapine due to bedaquiline usage did not significantly affect odds of viral suppression (aOR 0.41, 95% CI: 0.16 to 1.04). CONCLUSIONS Increased pill burden and adverse treatment effects did not significantly affect HIV viral suppression while switching ART to a protease inhibitor to accommodate bedaquiline or not changing ART while taking bedaquiline did, suggesting that PWH and MDR-TB may benefit from additional support if they must switch ART.
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Affiliation(s)
- Keri Geiger
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, Baltimore, MD, USA
| | - Amita Patil
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, Baltimore, MD, USA
| | | | - Kelly E. Dooley
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kelly Lowensen
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, Baltimore, MD, USA
| | - Norbert Ndjeka
- National Department of Health, Republic of South Africa, TB Control and Management
- University of Cape Town, Republic of South Africa
| | - Jaqueline Ngozo
- KwaZulu Natal Department of Health, Republic of South Africa
| | - Jason E. Farley
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
- Center for Infectious Disease and Nursing Innovation, Johns Hopkins University, Baltimore, MD, USA
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Arcêncio RA, Palha PF, Maciel ELN. O diagnóstico e o tratamento da tuberculose latente por enfermeiros no Brasil: estratégia necessária. Rev Bras Enferm 2023. [DOI: 10.1590/0034-7167.2023760101pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Arcêncio RA, Palha PF, Maciel ELN. El diagnóstico y tratamiento de la tuberculosis latente por enfermeros en Brasil: una estrategia necesaria. Rev Bras Enferm 2023. [DOI: 10.1590/0034-7167.2023760101esp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Arcêncio RA, Palha PF, Maciel ELN. The diagnosis and treatment of latent tuberculosis by nurses in Brazil: a necessary strategy. Rev Bras Enferm 2022; 76:e760101. [PMID: 36449979 PMCID: PMC9728814 DOI: 10.1590/0034-7167.2023760101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Ricardo Alexandre Arcêncio
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Department of Maternal-Child Nursing and Public Health. Ribeirão Preto, São Paulo, Brazil
| | - Pedro Fredemir Palha
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Department of Maternal-Child Nursing and Public Health. Ribeirão Preto, São Paulo, Brazil
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Geiger K, Bergman A, Farley JE. Evaluating Integrated Care for People Living With HIV and Multidrug-Resistant Tuberculosis in South Africa: A Case-Based Approach Using the Chronic Care Model. J Assoc Nurses AIDS Care 2021; 32:e91-e102. [PMID: 33595985 DOI: 10.1097/jnc.0000000000000242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT In South Africa, tuberculosis (TB) and multidrug-resistant TB (MDR-TB) frequently occur in people living with HIV. World Health Organization guidelines recommend the integration of MDR-TB and HIV care but, in practice, fully integrated care is difficult to achieve. In this article, we use five elements of the Chronic Care Model as a framework for evaluating a case of integrated MDR-TB/HIV care and to highlight opportunities for nurses to improve care delivery and patient outcomes. We apply the Chronic Care Model framework to a concrete example by examining the case of a 33-year-old man who developed MDR-TB treatment failure while concurrently taking a powerful new MDR-TB antiretroviral therapy regimen for his HIV.
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Affiliation(s)
- Keri Geiger
- Keri Geiger, RN, BSN, ACRN, and Alanna Bergman, MSN, RN, AAHIVS, are PhD Students, Johns Hopkins School of Nursing, Baltimore, Maryland, USA. Jason E. Farley, PhD, MPH, ANP-BC, FAAN, FAANP, AACRN, is a Professor, Johns Hopkins School of Nursing, and is a Director of the REACH Initiative, Baltimore, Maryland, USA
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Wei H, Duan X. Application of KTH-integrated nursing model in care of patients with multi-drug resistant tuberculosis. Am J Transl Res 2021; 13:6855-6863. [PMID: 34306436 PMCID: PMC8290726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the effect of the KTH-integrated nursing model of the knowledge-attitude-belief-practice model (KABP)-transtheoretical model (TTM)-as a health belief model (HBM) in nursing care of patients with multi-drug resistant tuberculosis (MDR-TB). METHODS Using a prospective study method, 102 patients with MDR-TB were randomly divided into two groups according to a random number table. The control group (n=51) received conventional nursing care, and the study group (n=51) received a KTH-integrated nursing model. The sputum negative conversion rate, effective rate of lesion absorption, level of disease cognition, compliance, self-efficacy (general self-efficacy scale, GSES score), healthy behavior (health-promoting lifestyle profile, HPLP), and quality of life (GQOL-74 scale score) were compared between the two groups. RESULTS Six months after enrollment, the sputum-negative conversion rate, total effective rate of lesion absorption, and total compliance rate of the study group were significantly higher than those of the control group (80.39% vs. 62.75%, 84.31% vs. 66.67%, 96.08% vs. 78.43%, P<0.05). 6 months after enrollment, the treatment plan, etiopathogenesis and harm, precautions, importance of treatment compliance, observation and follow-up, and total score of the study were all significantly higher than those of the control group (P<0.05). Six months after enrollment, the scores of GSES, HPLP and GQOL-74 in the study group were significantly higher than those of the control group (P<0.05). CONCLUSION The implementation of a KTH integrated nursing model for patients with MDR-TB was beneficial to promote sputum-negative conversion and lesion absorption, and improved disease awareness, medication compliance, self-efficacy, healthy behavior, and quality of life.
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Affiliation(s)
- Hanfen Wei
- The Five Tuberculosis Endemic Areas, The Public Health Clinical Center of ChengduChengdu, Sichuan Province, China
| | - Xiaoqian Duan
- Department of Psychosomatic Medicine, Xijing Hospital, Air Force Military Medical UniversityXi’an, Shaanxi Province, China
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Hong H, Dowdy DW, Dooley KE, Francis HW, Budhathoki C, Han HR, Farley JE. Risk of hearing loss among multidrug-resistant tuberculosis patients according to cumulative aminoglycoside dose. Int J Tuberc Lung Dis 2021; 24:65-72. [PMID: 32005308 DOI: 10.5588/ijtld.19.0062] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: The ototoxic effects of aminoglycosides (AGs) lead to permanent hearing loss, which is one of the devastating consequences of multidrug-resistant tuberculosis (MDR-TB) treatment. As AG ototoxicity is dose-dependent, the impact of a surrogate measure of AG exposure on AG-induced hearing loss warrants close attention for settings with limited therapeutic drug monitoring.OBJECTIVE: To explore the prognostic impact of cumulative AG dose on AG ototoxicity in patients following initiation of AG-containing treatment for MDR-TB.DESIGN: This prospective cohort study was nested within an ongoing cluster-randomized trial of nurse case management intervention across 10 MDR-TB hospitals in South Africa.RESULTS: The adjusted hazard of AG regimen modification due to ototoxicity in the high-dose group (≥75 mg/kg/week) was 1.33 times higher than in the low-dose group (<75 mg/kg/week, 95%CI 1.09-1.64). The adjusted hazard of developing audiometric hearing loss was 1.34 times higher than in the low-dose group (95%CI 1.01-1.77). Pre-existing hearing loss (adjusted hazard ratio [aHR] 1.71, 95%CI 1.29-2.26) and age (aHR 1.16 per 10 years of age, 95%CI 1.01-1.33) were also associated with an increased risk of hearing loss.CONCLUSION: MDR-TB patients with high AG dose, advanced age and pre-existing hearing loss have a significantly higher risk of AG-induced hearing loss. Those at high risk may be candidates for more frequent monitoring or AG-sparing regimens.
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Affiliation(s)
- H Hong
- Johns Hopkins University School of Nursing, Baltimore, MD, The REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD
| | - D W Dowdy
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - K E Dooley
- Divisions of Clinical Pharmacology and Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - H W Francis
- Division of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC
| | - C Budhathoki
- Johns Hopkins University School of Nursing, Baltimore, MD
| | - H-R Han
- Johns Hopkins University School of Nursing, Baltimore, MD, Center for Cardiovascular and Chronic Care, Johns Hopkins University, Baltimore, MD, USA
| | - J E Farley
- Johns Hopkins University School of Nursing, Baltimore, MD, The REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD
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Hong H, Dowdy DW, Dooley KE, Francis HW, Budhathoki C, Han HR, Farley JE. Aminoglycoside-induced Hearing Loss Among Patients Being Treated for Drug-resistant Tuberculosis in South Africa: A Prediction Model. Clin Infect Dis 2021; 70:917-924. [PMID: 30963176 DOI: 10.1093/cid/ciz289] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/04/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Individuals treated for drug-resistant tuberculosis (DR-TB) with aminoglycosides (AGs) in resource-limited settings often experience permanent hearing loss, yet there is no practical method to identify those at higher risk. We sought to develop a clinical prediction model of AG-induced hearing loss among patients initiating DR-TB treatment in South Africa. METHODS Using nested, prospective data from a cohort of 379 South African adults being treated for confirmed DR-TB with AG-based regimens we developed the prediction model using multiple logistic regression. Predictors were collected from clinical, audiological, and laboratory evaluations conducted at the initiation of DR-TB treatment. The outcome of AG-induced hearing loss was identified from audiometric and clinical evaluation by a worsened hearing threshold compared with baseline during the 6-month intensive phase. RESULTS Sixty-three percent of participants (n = 238) developed any level of hearing loss. The model predicting hearing loss at frequencies from 250 to 8000 Hz included weekly AG dose, human immunodeficiency virus status with CD4 count, age, serum albumin, body mass index, and pre-existing hearing loss. This model demonstrated reasonable discrimination (area under the receiver operating characteristic curve [AUC] = 0.71) and calibration (χ2[8] = 6.10, P = .636). Using a cutoff of 80% predicted probability of hearing loss, the positive predictive value of this model was 83% and negative predictive value was 40%. Model discrimination was similar for ultrahigh-frequency hearing loss (frequencies >9000 Hz; AUC = 0.81) but weaker for clinically determined hearing loss (AUC = 0.60). CONCLUSIONS This model may identify patients with DR-TB who are at highest risk of developing AG-induced ototoxicity and may help prioritize patients for AG-sparing regimens in clinical settings where access is limited.
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Affiliation(s)
- Hyejeong Hong
- Johns Hopkins University School of Nursing, Baltimore, Maryland.,The Research Education Advocacy Community Health Initiative, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - David W Dowdy
- Departments of Epidemiology, and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kelly E Dooley
- Divisions of Clinical Pharmacology and Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Howard W Francis
- Division of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | | | - Hae-Ra Han
- Johns Hopkins University School of Nursing, Baltimore, Maryland.,Center for Cardiovascular and Chronic Care, Johns Hopkins University, Baltimore, Maryland
| | - Jason E Farley
- Johns Hopkins University School of Nursing, Baltimore, Maryland.,The Research Education Advocacy Community Health Initiative, Johns Hopkins University School of Nursing, Baltimore, Maryland
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Hong H, Dowdy DW, Dooley KE, Francis HW, Budhathoki C, Han HR, Farley JE. Prevalence of Pre-Existing Hearing Loss Among Patients With Drug-Resistant Tuberculosis in South Africa. Am J Audiol 2020; 29:199-205. [PMID: 32320639 DOI: 10.1044/2020_aja-19-00103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Hearing loss, resulting from aminoglycoside ototoxicity, is common among patients with drug-resistant tuberculosis (DR-TB). Those with pre-existing hearing loss are at particular risk of clinically important hearing loss with aminoglycoside-containing treatment than those with normal hearing at baseline. This study aimed to identify factors associated with pre-existing hearing loss among patients being treated for DR-TB in South Africa. Method Cross-sectional analysis nested within a cluster-randomized trial data across 10 South African TB hospitals. Patients ≥ 13 years old received clinical and audiological evaluations before DR-TB treatment initiation. Results Of 936 patients, average age was 35 years. One hundred forty-two (15%) reported pre-existing auditory symptoms. Of 482 patients tested by audiometry, 290 (60%) had pre-existing hearing loss. The prevalence of pre-existing hearing loss was highest among patients ≥ 50 years (adjusted prevalence ratio [aPrR] for symptoms 5.53, 95% confidence interval (CI) [3.63, 8.42]; aPrR for audiometric hearing loss 1.63, 95% CI [1.31, 2.03] compared to age 13-18 years) and among those with a prior history of second-line TB treatment (aPrR for symptoms 1.73, 95% CI [1.66, 1.80]; PrR for audiometric hearing loss 1.33, 95% CI [1.03, 1.73]). Having HIV with cluster of differentiation 4 cell count < 200 cells/mm3 and malnutrition were risk factors but did not reach statistical significance in adjusted analyses. Conclusion Pre-existing hearing loss is common among patients presenting for DR-TB treatment in South Africa, and those older than the age of 50 years or who had prior second-line TB treatment history were at highest risk.
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Affiliation(s)
- Hyejeong Hong
- The REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD
- Johns Hopkins University School of Nursing, Baltimore, MD
| | - David W. Dowdy
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Kelly E. Dooley
- Divisions of Clinical Pharmacology and Infectious Disease, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Howard W. Francis
- Division of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC
| | - Chakra Budhathoki
- The REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD
| | - Hae-Ra Han
- The REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD
- Center for Cardiovascular and Chronic Care, The Johns Hopkins University, Baltimore, MD
| | - Jason E. Farley
- The REACH Initiative, Johns Hopkins University School of Nursing, Baltimore, MD
- Johns Hopkins University School of Nursing, Baltimore, MD
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14
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Barrera-Cancedda AE, Riman KA, Shinnick JE, Buttenheim AM. Implementation strategies for infection prevention and control promotion for nurses in Sub-Saharan Africa: a systematic review. Implement Sci 2019; 14:111. [PMID: 31888673 PMCID: PMC6937686 DOI: 10.1186/s13012-019-0958-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 12/02/2019] [Indexed: 12/13/2022] Open
Abstract
Background Despite impressive reductions in infectious disease burden within Sub-Saharan Africa (SSA), half of the top ten causes of poor health or death in SSA are communicable illnesses. With emerging and re-emerging infections affecting the region, the possibility of healthcare-acquired infections (HAIs) being transmitted to patients and healthcare workers, especially nurses, is a critical concern. Despite infection prevention and control (IPC) evidence-based practices (EBP) to minimize the transmission of HAIs, many healthcare systems in SSA are challenged to implement them. The purpose of this review is to synthesize and critique what is known about implementation strategies to promote IPC for nurses in SSA. Methods The databases, PubMed, Ovid/Medline, Embase, Cochrane, and CINHAL, were searched for articles with the following criteria: English language, peer-reviewed, published between 1998 and 2018, implemented in SSA, targeted nurses, and promoted IPC EBPs. Further, 6241 search results were produced and screened for eligibility to identify implementation strategies used to promote IPC for nurses in SSA. A total of 61 articles met the inclusion criteria for the final review. The articles were evaluated using the Joanna Briggs Institute’s (JBI) quality appraisal tools. Results were reported using PRISMA guidelines. Results Most studies were conducted in South Africa (n = 18, 30%), within the last 18 years (n = 41, 67%), and utilized a quasi-experimental design (n = 22, 36%). Few studies (n = 14, 23%) had sample populations comprising nurses only. The majority of studies focused on administrative precautions (n = 36, 59%). The most frequent implementation strategies reported were education (n = 59, 97%), quality management (n = 39, 64%), planning (n = 33, 54%), and restructure (n = 32, 53%). Penetration and feasibility were the most common outcomes measured for both EBPs and implementation strategies used to implement the EBPs. The most common MAStARI and MMAT scores were 5 (n = 19, 31%) and 50% (n = 3, 4.9%) respectively. Conclusions As infectious diseases, especially emerging and re-emerging infectious diseases, continue to challenge healthcare systems in SSA, nurses, the keystones to IPC practice, need to have a better understanding of which, in what combination, and in what context implementation strategies should be best utilized to ensure their safety and that of their patients. Based on the results of this review, it is clear that implementation of IPC EBPs in SSA requires additional research from an implementation science-specific perspective to promote IPC protocols for nurses in SSA.
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Affiliation(s)
| | - Kathryn A Riman
- School of Nursing, University of Pennsylvania, Philadelphia, PA, 19104, USA
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15
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Migliori GB, Nardell E, Yedilbayev A, D'Ambrosio L, Centis R, Tadolini M, van den Boom M, Ehsani S, Sotgiu G, Dara M. Reducing tuberculosis transmission: a consensus document from the World Health Organization Regional Office for Europe. Eur Respir J 2019; 53:13993003.00391-2019. [PMID: 31023852 DOI: 10.1183/13993003.00391-2019] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/18/2019] [Indexed: 12/11/2022]
Abstract
Evidence-based guidance is needed on 1) how tuberculosis (TB) infectiousness evolves in response to effective treatment and 2) how the TB infection risk can be minimised to help countries to implement community-based, outpatient-based care.This document aims to 1) review the available evidence on how quickly TB infectiousness responds to effective treatment (and which factors can lower or boost infectiousness), 2) review policy options on the infectiousness of TB patients relevant to the World Health Organization European Region, 3) define limitations of the available evidence and 4) provide recommendations for further research.The consensus document aims to target all professionals dealing with TB (e.g TB specialists, pulmonologists, infectious disease specialists, primary healthcare professionals, and other clinical and public health professionals), as well as health staff working in settings where TB infection is prevalent.
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Affiliation(s)
- Giovanni Battista Migliori
- Respiratory Diseases Clinical Epidemiology Unit, Clinical Scientific Institutes Maugeri, IRCCS, Tradate, Italy.,These authors contributed equally to this work
| | - Edward Nardell
- Division of Global Health Equity, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.,These authors contributed equally to this work
| | | | | | - Rosella Centis
- Respiratory Diseases Clinical Epidemiology Unit, Clinical Scientific Institutes Maugeri, IRCCS, Tradate, Italy
| | - Marina Tadolini
- Dept of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Martin van den Boom
- Joint Tuberculosis, HIV and Viral Hepatitis Programme, WHO Regional Office for Europe, Copenhagen, Denmark.,These authors contributed equally to this work
| | - Soudeh Ehsani
- Joint Tuberculosis, HIV and Viral Hepatitis Programme, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Dept of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.,These authors contributed equally to this work
| | - Masoud Dara
- Joint Tuberculosis, HIV and Viral Hepatitis Programme, WHO Regional Office for Europe, Copenhagen, Denmark
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16
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Wise JM, Ott C, Azuero A, Lanzi RG, Davies S, Gardner A, Vance DE, Kempf MC. Barriers to HIV Testing: Patient and Provider Perspectives in the Deep South. AIDS Behav 2019; 23:1062-1072. [PMID: 30607759 DOI: 10.1007/s10461-018-02385-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although CDC guidelines call for universal, "opt-out" HIV testing, barriers to testing continue to exist throughout the United States, with the rural South particularly vulnerable to both HIV infection and decreased awareness of status. Therefore, the objectives of this study were to evaluate uptake of "opt-out" HIV testing and barriers to testing within the primary care setting in the South. A concurrent triangulation design guided the collection of quantitative data from patients (N = 250) and qualitative data from providers (N = 10) across three primary health clinics in Alabama. We found that 30% of patients had never been tested for HIV, with the highest ranked barrier among patients being perceived costs, access to specialty care, and not feeling at risk. Significant differences existed in perceived barriers between patients and providers. Increased provider-patient engagement and the routine implementation of "opt-out" HIV testing would effectively reveal and mitigate barriers to testing, thus, increasing awareness of status.
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17
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Comins CA, Schwartz SR, Phetlhu DR, Guddera V, Young K, Farley JE, West N, Parmley L, Geng E, Beyrer C, Dowdy D, Mishra S, Hausler H, Baral S. Siyaphambili protocol: An evaluation of randomized, nurse-led adaptive HIV treatment interventions for cisgender female sex workers living with HIV in Durban, South Africa. Res Nurs Health 2019; 42:107-118. [PMID: 30644999 DOI: 10.1002/nur.21928] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/25/2018] [Indexed: 01/05/2023]
Abstract
In South Africa, 60% of female sex workers are estimated to be living with human immunodeficiency virus (HIV). Many of these women face structural and individual-level barriers to initiating, accessing, and adhering to antiretroviral therapy (ART). While data are limited, it is estimated that less than 40% of sex workers living with HIV achieve viral suppression, leading to suboptimal clinical outcomes and sustained risks of onward sexual and vertical HIV transmission. Siyaphambili, a NINR/NIH-funded study, focuses on studying optimal implementation strategies for meeting HIV treatment needs among cisgender female sex workers living with HIV who are not virally suppressed. Here, we present the study protocol of this sequential multiple assignment randomized trial. In total, 800 viremic female sex workers will be enrolled into an 18-month adaptive implementation study to 1) compare the effectiveness and durability of a nurse-led decentralized ART treatment program versus an individualized case management approach, in isolation or in combination to achieve viral suppression and 2) estimate incremental cost-effectiveness of interventions and combinations of interventions. The primary outcome is a combined intention-to-treat outcome of retention in ART care and viral suppression at 18 months with secondary implementation outcomes. Siyaphambili aims to inform the implementation of and scale-up of HIV treatment services for female sex workers by determining the minimal package of services needed to achieve viral suppression and by characterizing individuals in need of more intensive HIV treatment approaches.
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Affiliation(s)
- Carly A Comins
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Sheree R Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | | | | | - Jason E Farley
- Johns Hopkins University, School of Nursing, The REACH Initiative, Baltimore, Maryland
| | - Nora West
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Lauren Parmley
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Elvin Geng
- University of California, San Francisco, California
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Sharmistha Mishra
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Harry Hausler
- Johns Hopkins University, School of Nursing, The REACH Initiative, Baltimore, Maryland
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
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18
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van de Water BJ, Silva SG, Prvu Bettger J, Humphreys J, Cunningham CK, Farley JE. Provision of guideline-based care for drug-resistant tuberculosis in South Africa: Level of concordance between prescribing practices and guidelines. PLoS One 2018; 13:e0203749. [PMID: 30395565 PMCID: PMC6218024 DOI: 10.1371/journal.pone.0203749] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/27/2018] [Indexed: 11/19/2022] Open
Abstract
TITLE Provision of guideline-based care for drug-resistant tuberculosis in South Africa: Level of concordance between prescribing practices and guidelines. OBJECTIVE We examined the influence of individual and site characteristics on the concordance between prescribed treatment regimens and recommended standardized regimen according to national guidelines for patients with drug-resistant tuberculosis (DR-TB) in South Africa. METHODS Participants were 337 youth and adults treated for DR-TB between November 2014 and August 2016 at ten DR-TB treatment sites in Eastern Cape and KwaZulu Natal provinces, South Africa. Logistic regression was used to determine individual and system characteristics related to concordance at treatment initiation between the prescribed treatment regimens in terms of medication composition, dosage, and frequency and guideline-based standardized regimen that included four oral and one injectable medications. RESULTS The sample was 19% (n = 64) youth (15-24 years), 53% (n = 179) male, 73% (n = 243) HIV coinfected, and 51% (n = 169) with prior history of TB treatment. Guideline medications were correctly prescribed for 88% (n = 295) of patients, but only 33% (n = 103) received the correct medications and doses. Complete guideline adherence to medications, doses, and frequency was achieved for 30% (n = 95) of patients. Younger age, HIV coinfection, and rural treatment setting were associated with the prescription of correct medications. CONCLUSION Most individuals are prescribed the correct DR-TB medications, yet few individuals receive correct medications, dosages, and frequencies. Further study is needed to examine the root causes for treatment guideline deviations and opportunities for improvement.
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Affiliation(s)
- Brittney J. van de Water
- Duke University School of Nursing, Duke University, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Susan G. Silva
- Duke University School of Nursing, Duke University, Durham, NC, United States of America
| | - Janet Prvu Bettger
- Duke University School of Nursing, Duke University, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United States of America
| | - Janice Humphreys
- Duke University School of Nursing, Duke University, Durham, NC, United States of America
| | - Coleen K. Cunningham
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, United States of America
| | - Jason E. Farley
- Department of Community Public Health, Johns Hopkins University School of Nursing, Baltimore, MD, United States of America
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19
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Farley JE, Ndjeka N, Kelly AM, Whitehouse E, Lachman S, Budhathoki C, Lowensen K, Bergren E, Mabuza H, Mlandu N, van der Walt M. Evaluation of a nurse practitioner-physician task-sharing model for multidrug-resistant tuberculosis in South Africa. PLoS One 2017; 12:e0182780. [PMID: 28783758 PMCID: PMC5544244 DOI: 10.1371/journal.pone.0182780] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/24/2017] [Indexed: 11/18/2022] Open
Abstract
Background Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) in South Africa remain close to 50%. Lack of access to timely, decentralized care is a contributing factor. We evaluated MDR-TB treatment outcomes from a clinical cohort with task-sharing between a clinical nurse practitioner (CNP) and a medical officer (MO). Methods We completed a retrospective evaluation of outcomes from a prospective, programmatically-based MDR-TB cohort who were enrolled and received care between 2012 and 2015 at a peri-urban hospital in KwaZulu-Natal, South Africa. Treatment was provided by either by a CNP or MO. Findings The cohort included 197 participants with a median age of 33 years, 51% female, and 74% co-infected with HIV. The CNP initiated 123 participants on treatment. Overall MDR-TB treatment success rate in this cohort was 57.9%, significantly higher than the South African national average of 45% in 2012 (p<0·0001) and similar to the provincal average of 60% (p = NS). There were no significant differences by provider type: treatment success was 61% for patients initiated by the CNP and 52.7% for those initiated by the MO. Interpretation Clinics that adopted a task sharing approach for MDR-TB demonstrated greater treatment success rates than the national average. Task-sharing between the CNP and MO did not adversely impact treatment outcome with similar success rates noted. Task-sharing is a feasible option for South Africa to support decentralization without compromising patient outcomes. Models that allow sharing of responsibility for MDR-TB may optimize the use of human resources and improve access to care.
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Affiliation(s)
- Jason E. Farley
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
| | - Norbert Ndjeka
- Republic of South Africa Department of Health, Pretoria, South Africa
| | - Ana M. Kelly
- School of Nursing, Columbia University, New York, New York, United States of America
| | - Erin Whitehouse
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Simmi Lachman
- Murchison District Hospital, Port Shepstone, South Africa
| | - Chakra Budhathoki
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kelly Lowensen
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ellie Bergren
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Hloniphile Mabuza
- Center for Disease Control and Prevention, Atlanta, Georgia, United States of America
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20
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Kelly AM, Smith B, Luo Z, Given B, Wehrwein T, Master I, Farley JE. Discordance between patient and clinician reports of adverse reactions to MDR-TB treatment. Int J Tuberc Lung Dis 2017; 20:442-7. [PMID: 26970151 DOI: 10.5588/ijtld.15.0318] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING An urban out-patient clinic in Durban, South Africa, providing community-based treatment for drug-resistant tuberculosis (TB). OBJECTIVE To describe concordance between patient report and clinician documentation of adverse drug reactions (ADRs) to treatment for multidrug-resistant TB (MDR-TB). DESIGN ADRs were documented by interview using an 18-item symptom checklist and medical record data abstraction during a cross-sectional parent study with 121 MDR-TB patients, 75% of whom were co-infected with the human immunodeficiency virus. Concordance was analyzed using Cohen's κ statistic, Gwet's agreement coefficient (AC) 1, and McNemar's test. RESULTS ADRs were reported much more frequently in patient interviews (μ = 8.6) than in medical records (μ = 1.4). Insomnia was most common (67% vs. 2%), followed by peripheral neuropathy (65% vs. 18%), and confusion (61 vs. 4%). κ scores were very low, with the highest degree of concordance found in hearing loss (κ = 0.23), which was the only ADR not found to be significantly different between the two data sources (P = 0.34). CONCLUSIONS Our study showed a lack of concordance between patient report and clinician documentation of ADRs. These findings indicate the need for improved documentation of ADRs to better reflect patients' experiences during MDR-TB treatment. These data have important implications for country-level pharmacovigilance programs that rely on clinician documentation of ADRs for MDR-TB policy formation.
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Affiliation(s)
- A M Kelly
- Columbia University School of Nursing, New York, New York, USA
| | - B Smith
- Michigan State University College of Nursing, East Lansing, Michigan, USA
| | - Z Luo
- Michigan State University Department of Epidemiology and Biostatistics, East Lansing, Michigan, USA
| | - B Given
- Michigan State University College of NursingEast Lansing, Michigan, USA
| | - T Wehrwein
- Michigan State University College of NursingEast Lansing, Michigan, USA
| | - I Master
- King Dinuzulu Hospital Complex, Durban, South Africa
| | - J E Farley
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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21
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van Cutsem G, Isaakidis P, Farley J, Nardell E, Volchenkov G, Cox H. Infection Control for Drug-Resistant Tuberculosis: Early Diagnosis and Treatment Is the Key. Clin Infect Dis 2016; 62 Suppl 3:S238-43. [PMID: 27118853 PMCID: PMC4845888 DOI: 10.1093/cid/ciw012] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Multidrug-resistant (MDR) tuberculosis, "Ebola with wings," is a significant threat to tuberculosis control efforts. Previous prevailing views that resistance was mainly acquired through poor treatment led to decades of focus on drug-sensitive rather than drug-resistant (DR) tuberculosis, driven by the World Health Organization's directly observed therapy, short course strategy. The paradigm has shifted toward recognition that most DR tuberculosis is transmitted and that there is a need for increased efforts to control DR tuberculosis. Yet most people with DR tuberculosis are untested and untreated, driving transmission in the community and in health systems in high-burden settings. The risk of nosocomial transmission is high for patients and staff alike. Lowering transmission risk for MDR tuberculosis requires a combination approach centered on rapid identification of active tuberculosis disease and tuberculosis drug resistance, followed by rapid initiation of appropriate treatment and adherence support, complemented by universal tuberculosis infection control measures in healthcare facilities. It also requires a second paradigm shift, from the classic infection control hierarchy to a novel, decentralized approach across the continuum from early diagnosis and treatment to community awareness and support. A massive scale-up of rapid diagnosis and treatment is necessary to control the MDR tuberculosis epidemic. This will not be possible without intense efforts toward the implementation of decentralized, ambulatory models of care. Increasing political will and resources need to be accompanied by a paradigm shift. Instead of focusing on diagnosed cases, recognition that transmission is driven largely by undiagnosed, untreated cases, both in the community and in healthcare settings, is necessary. This article discusses this comprehensive approach, strategies available, and associated challenges.
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Affiliation(s)
- Gilles van Cutsem
- Médecins Sans Frontières Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | | | - Jason Farley
- School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Ed Nardell
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Grigory Volchenkov
- Department of Tuberculosis Control, Vladimir Oblast Tuberculosis Dispensary, Russian Federation
| | - Helen Cox
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa Division of Medical Microbiology and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
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22
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Luo W, Qu ZL, Xie Y, Xiang J, Zhang XL. Identification of a novel immunodominant antigen Rv2645 from RD13 with potential as a cell-mediated immunity-based TB diagnostic agent. J Infect 2015; 71:534-43. [DOI: 10.1016/j.jinf.2015.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 12/31/2022]
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