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Oyewusi L, Zeng C, Seung KJ, Mpinda S, Kunda M, Mitnick CD, Kanu M, Tamirat M, Makaka J, Mofolo M, Maime R, Maama L, Senyo N, Oguntoyinbo B, Mayombo L, Franke MF. Low body mass index as a predictor of sputum culture conversion and treatment outcomes among patients receiving treatment for multidrug-resistant tuberculosis in Lesotho. Glob Health Action 2024; 17:2305930. [PMID: 38305025 PMCID: PMC10840591 DOI: 10.1080/16549716.2024.2305930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 01/11/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND A low body mass index (BMI) at the start of treatment for rifampicin- or multidrug-resistant tuberculosis (MDR/RR-TB) is associated with poor treatment outcomes and may contribute to delayed sputum culture conversion, thereby prolonging the period of potential transmission to others. Whether the relative importance of low BMI in predicting treatment outcomes differs by HIV status is unclear. OBJECTIVES We evaluated the association between low BMI and two dependent variables, sputum culture conversion and end-of-treatment outcome, among patients receiving treatment for MDR/RR-TB in Lesotho, a setting with a high prevalence of HIV infection. METHODS Secondary data from a prospective cohort of patients initiating a longer (18-20 months) treatment containing bedaquiline and/or delamanid under routine programmatic conditions in Lesotho were analysed. Risk ratios and differences were adjusted for potential confounders using multivariable logistic regression, and estimates were stratified by HIV status. RESULTS Of 264 patients, 105 and 250 were eligible for culture conversion and end-of-treatment analyses, respectively. Seventy-one per cent of patients (74/105) experienced culture conversion within six months, while 74% (184/250) experienced a favourable end-of-treatment outcome. Low BMI was associated with a lower frequency of culture conversion at six months among those who were not living with HIV (relative risk [RR]: 0.50 [95% CI: 0.21, 0.79]); this association was attenuated among those living with HIV (RR: 0.88 [95% CI: 0.68, 1.23]). A low BMI was moderately associated with a lower frequency of treatment success (RR = 0.89 [95% CI: 0.77, 1.03]), regardless of HIV status. CONCLUSIONS Low BMI was common and associated with the frequency of six-month culture conversion and end-of-treatment outcomes. The association with culture conversion was more pronounced among those not living with HIV. Addressing the myriad factors that drive low BMI in this setting could hasten culture conversion and improve end-of-treatment outcomes. This will require a multipronged approach focused on alleviating food insecurity and enabling prompt diagnosis and treatment of HIV and TB.
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Affiliation(s)
- Lawrence Oyewusi
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | - Chengbo Zeng
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - KJ Seung
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA
| | - Stephanie Mpinda
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | - Mikanda Kunda
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | - Carole D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Makelele Kanu
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | - Meseret Tamirat
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | - Joalane Makaka
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | | | - Refiloe Maime
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | - Llang Maama
- National TB and Leprosy Programme, Lesotho Ministry of Health, Maseru, Lesotho
| | - Ninza Senyo
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | | | - Lwayi Mayombo
- Clinical department (MDRTB), Partners In Health, Maseru, Lesotho
| | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Koroma JA, Elduma AH, Sesay U, Gebru GN. Factors associated with unfavorable treatment outcomes among multidrug-resistant tuberculosis patients, Sierra Leone: a cross-sectional secondary data analysis. BMC Infect Dis 2024; 24:579. [PMID: 38862873 PMCID: PMC11167780 DOI: 10.1186/s12879-024-09370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 04/30/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Globally, multidrug-resistant tuberculosis (MDR-TB) is a major public health problem. The tuberculosis rate in Sierra Leone is 298 per 100,000 people, and Sierra Leone is considered a country with a high burden of tuberculosis. In Sierra Leone, there are few studies on the outcomes of MDR-TB treatment, especially those exacerbated by COVID-19. We identified factors associated with unfavorable treatment outcomes among people with MDR-TB in Sierra Leone. METHODS We conducted a cross-sectional study to analyze hospital-based MDR-TB data from 2017 to 2021. Demographic, clinical, and treatment outcome data were extracted from the main MDR-TB referral hospital database. We defined unfavorable outcomes as patients who died, were lost to follow-up, or defaulted. We calculated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) to identify predictors of the outcomes of MDR-TB treatment. RESULTS Between 2017 and 2021, 628 people with MDR-TB were reported at Lakka Hospital; 441 (71%) were male, with a median age of 25 years (interquartile ranges: 17-34). Clinically, 21% of the 628 MDR-TB patients were HIV positive, and 413 were underweight (66%). 70% (440) of MDR-TB patients received tuberculosis treatment. The majority of patients, 457 (73%), were treated with a short treatment regimen, and 126 (20%) experienced unfavorable outcomes. Age 45 years or younger (aOR = 5.08; CI:1.87-13.82), 21-45 years (aOR = 2.22; CI:140-3.54), tuberculosis retreatment (aOR = 3.23; CI:1.82-5.73), age group, HIV status (aOR = 2.16; CI:1.33-3.53), and malnourishment status (aOR = 1.79; CI:1.12-2.86) were significantly associated with unfavorable treatment outcomes for DR-TB patients. CONCLUSION This analysis revealed a high proportion of unfavorable treatment outcomes among MDR-TB patients in Sierra Leone. Malnourishment, TB retreatment, HIV coinfection, and age 45 years or younger were associated with unfavorable outcomes of MDR-TB treatment. Increasing patients' awareness, mainly among young people, heightens treatment adherence and HIV monitoring by measuring the amount of HIV in patient blood, which can reduce adverse treatment outcomes in Sierra Leone and other sub-Saharan African countries.
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Affiliation(s)
- Josephine Amie Koroma
- National Leprosy and Tuberculosis Control Program, Ministry of Health, Freetown, Sierra Leone
| | - Adel Hussein Elduma
- Sierra Leone Field Epidemiology Training Program, EOC Building, Wilkinson Road, Freetown, Sierra Leone.
- African Field Epidemiology Network (AFENET), EOC Building, Wilkinson Road, Freetown, Sierra Leone.
| | - Umaru Sesay
- Sierra Leone Field Epidemiology Training Program, EOC Building, Wilkinson Road, Freetown, Sierra Leone
| | - Gebrekrstos Negash Gebru
- Sierra Leone Field Epidemiology Training Program, EOC Building, Wilkinson Road, Freetown, Sierra Leone
- African Field Epidemiology Network (AFENET), EOC Building, Wilkinson Road, Freetown, Sierra Leone
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Campos Pacheco JE, Yalovenko T, Riaz A, Kotov N, Davids C, Persson A, Falkman P, Feiler A, Godaly G, Johnson CM, Ekström M, Pilkington GA, Valetti S. Inhalable porous particles as dual micro-nano carriers demonstrating efficient lung drug delivery for treatment of tuberculosis. J Control Release 2024; 369:231-250. [PMID: 38479444 DOI: 10.1016/j.jconrel.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 05/24/2024]
Abstract
Inhalation therapy treating severe infectious disease is among the more complex and emerging topics in controlled drug release. Micron-sized carriers are needed to deposit drugs into the lower airways, while nano-sized carriers are of preference for cell targeting. Here, we present a novel and versatile strategy using micron-sized spherical particles with an excellent aerodynamic profile that dissolve in the lung fluid to ultimately generate nanoparticles enabling to enhance both extra- and intra-cellular drug delivery (i.e., dual micro-nano inhalation strategy). The spherical particles are synthesised through the condensation of nano-sized amorphous silicon dioxide resulting in high surface area, disordered mesoporous silica particles (MSPs) with monodispersed size of 2.43 μm. Clofazimine (CLZ), a drug shown to be effective against multidrug-resistant tuberculosis, was encapsulated in the MSPs obtaining a dry powder formulation with high respirable fraction (F.P.F. <5 μm of 50%) without the need of additional excipients. DSC, XRPD, and Nitrogen adsorption-desorption indicate that the drug was fully amorphous when confined in the nano-sized pores (9-10 nm) of the MSPs (shelf-life of 20 months at 4 °C). Once deposited in the lung, the CLZ-MSPs exhibited a dual action. Firstly, the nanoconfinement within the MSPs enabled a drastic dissolution enhancement of CLZ in simulated lung fluid (i.e., 16-fold higher than the free drug), increasing mycobacterial killing than CLZ alone (p = 0.0262) and reaching concentrations above the minimum bactericidal concentration (MBC) against biofilms of M. tuberculosis (i.e., targeting extracellular bacteria). The released CLZ permeated but was highly retained in a Calu-3 respiratory epithelium model, suggesting a high local drug concentration within the lung tissue minimizing risk for systemic side effects. Secondly, the micron-sized drug carriers spontaneously dissolve in simulated lung fluid into nano-sized drug carriers (shown by Nano-FTIR), delivering high CLZ cargo inside macrophages and drastically decreasing the mycobacterial burden inside macrophages (i.e., targeting intracellular bacteria). Safety studies showed neither measurable toxicity on macrophages nor Calu-3 cells, nor impaired epithelial integrity. The dissolved MSPs also did not show haemolytic effect on human erythrocytes. In a nutshell, this study presents a low-cost, stable and non-invasive dried powder formulation based on a dual micro-nano carrier to efficiently deliver drug to the lungs overcoming technological and practical challenges for global healthcare.
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Affiliation(s)
- Jesús E Campos Pacheco
- Biomedical Science, Faculty of Health and Society, Malmö University, 205 06 Malmö, Sweden; Biofilms - Research Center for Biointerfaces (BRCB), Malmö University, 205 06 Malmö, Sweden
| | - Tetiana Yalovenko
- Biomedical Science, Faculty of Health and Society, Malmö University, 205 06 Malmö, Sweden; Biofilms - Research Center for Biointerfaces (BRCB), Malmö University, 205 06 Malmö, Sweden
| | - Azra Riaz
- Biomedical Science, Faculty of Health and Society, Malmö University, 205 06 Malmö, Sweden; Biofilms - Research Center for Biointerfaces (BRCB), Malmö University, 205 06 Malmö, Sweden
| | - Nikolay Kotov
- Department of Chemistry, KTH Royal Institute of Technology, SE-100 44 Stockholm, Sweden
| | - Camilla Davids
- Department of Microbiology, Immunology and Glycobiology, Institution of Laboratory Medicine, Lund University, Lund, Sweden
| | - Alva Persson
- Biomedical Science, Faculty of Health and Society, Malmö University, 205 06 Malmö, Sweden; Biofilms - Research Center for Biointerfaces (BRCB), Malmö University, 205 06 Malmö, Sweden
| | - Peter Falkman
- Biomedical Science, Faculty of Health and Society, Malmö University, 205 06 Malmö, Sweden; Biofilms - Research Center for Biointerfaces (BRCB), Malmö University, 205 06 Malmö, Sweden
| | - Adam Feiler
- Department of Chemistry, KTH Royal Institute of Technology, SE-100 44 Stockholm, Sweden; Nanologica AB (publ), Forskargatan 20G, 151 36 Södertälje, Sweden
| | - Gabriela Godaly
- Department of Microbiology, Immunology and Glycobiology, Institution of Laboratory Medicine, Lund University, Lund, Sweden
| | - C Magnus Johnson
- Department of Chemistry, KTH Royal Institute of Technology, SE-100 44 Stockholm, Sweden
| | | | - Georgia A Pilkington
- Department of Chemistry, KTH Royal Institute of Technology, SE-100 44 Stockholm, Sweden; Nanologica AB (publ), Forskargatan 20G, 151 36 Södertälje, Sweden.
| | - Sabrina Valetti
- Biomedical Science, Faculty of Health and Society, Malmö University, 205 06 Malmö, Sweden; Biofilms - Research Center for Biointerfaces (BRCB), Malmö University, 205 06 Malmö, Sweden.
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Fan L, Yang M, Han YT, Ren F, Wang H, Ma JB, Zhu GH, Xiong YJ, Fan XX, Chen SX, Wu HY, Sun WW, Zhang SJ, Ke H, Cheng XH, Xu B, Chen Y, Chen C. Drug recommendation for optimization on treatment outcome for MDR/RR-TB based on a multi-center, large scale, retrospective cohort study in China. Expert Rev Anti Infect Ther 2024; 22:353-363. [PMID: 38251634 DOI: 10.1080/14787210.2024.2303032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE With the change in drug-resistant pattern, MDR/RR-TB was faced with underlying changes in regimens. A multi-center, large-scale, retrospective study performed aims to provide a recommendation of drug selection on optimization of outcome for the patients. METHOD The study was conducted in six TB-specialized hospitals in China. Patients were included from 2018-2021 and followed up throughout the treatment. Using a multivarariable and propensity score-matched logistic regression analysis, we evaluated associations between outcomes and drug use, as well as clinical characteritics. RESULTS Of 3112 patients, 74.29% had treatment sucess, 14.52% lost to follow-up, 9.67% failure, and 1.51% died. Treatment success was positively associated with Bedaquiline(Bdq), Linezolid(Lzd), and Cycloserin(Cs). Capreomycin(Cm) increased the risk of unfavorable outcomes. other drugs such as Amikacin(Amk) and clofazimine had no significant effect on outcomes. If isolates were susceptible to fluoroquinolones(FQs), FQs could decrease the risk of unfavorable outcomes. CONCLUSIONS The recommendation order for the treatment of MDR/RR-TB is Bdq, Lzd, and Cs. FQs were decreased in use intensity. Injection drugs, whether Amk or Cm, are not recommended.
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Affiliation(s)
- Lin Fan
- Department of Tuberculosis, Shanghai Clinical Research Center for Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai Clinical Research Center for Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai, China
| | - Ming Yang
- Department of Tuberculosis, Public Health Clinical Center of Cheng Du, Chengdu, China
| | - Yu-Tong Han
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), Shanghai, China
| | - Fei Ren
- Department of Tuberculosis, West Section of HangTian Avenue, Xi'an Chest Hospital, Xi'an, Shanxi Province, China
| | - Hua Wang
- Department of Tuberculosis, Anhui Chest Hospital, Hefei, Anhui, China
| | - Jin-Bao Ma
- Department of Tuberculosis, West Section of HangTian Avenue, Xi'an Chest Hospital, Xi'an, Shanxi Province, China
| | - Guo-Hui Zhu
- Department of Tuberculosis, Public Health Clinical Center of Cheng Du, Chengdu, China
| | - Yan-Jun Xiong
- Department of Tuberculosis, Anhui Chest Hospital, Hefei, Anhui, China
| | - Xin-Xin Fan
- Department of Tuberculosis, The Pulmonary Hospital of Fuzhou, Fu Zhou, Fujian Province, China
| | - Su-Xia Chen
- Department of Tuberculosis, The Pulmonary Hospital of Fuzhou, Fu Zhou, Fujian Province, China
| | - Hao-Yu Wu
- Department of Tuberculosis, Shenyang Tenth People's Hospital (Shenyang Chest Hospital), Shenyang, China
| | - Wen-Wen Sun
- Department of Tuberculosis, Shanghai Clinical Research Center for Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai Clinical Research Center for Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai, China
| | - Shao-Jun Zhang
- Department of Tuberculosis, Shanghai Clinical Research Center for Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai Clinical Research Center for Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai, China
| | - Hui Ke
- Department of Tuberculosis, Shanghai Clinical Research Center for Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai Clinical Research Center for Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai, China
| | - Xiao-Hong Cheng
- Department of Tuberculosis, The Pulmonary Hospital of Fuzhou, Fu Zhou, Fujian Province, China
| | - Biao Xu
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), Shanghai, China
| | - Yu Chen
- Department of Tuberculosis, Shenyang Tenth People's Hospital (Shenyang Chest Hospital), Shenyang, China
| | - Chang Chen
- Department of Tuberculosis, Shanghai Clinical Research Center for Tuberculosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai Clinical Research Center for Tuberculosis, Shanghai Key Lab of Tuberculosis, Shanghai, China
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Cheng Q, Dang T, Nguyen TA, Velen K, Nguyen VN, Nguyen BH, Vu DH, Long CH, Do TT, Vu TM, Marks GB, Yapa M, Fox GJ, Wiseman V. mHealth application for improving treatment outcomes for patients with multidrug-resistant tuberculosis in Vietnam: an economic evaluation protocol for the V-SMART trial. BMJ Open 2023; 13:e076778. [PMID: 38081668 PMCID: PMC10729151 DOI: 10.1136/bmjopen-2023-076778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION The Strengthen the Management of Multidrug-Resistant Tuberculosis in Vietnam (V-SMART) trial is a randomised controlled trial of using mobile health (mHealth) technologies to improve adherence to medications and management of adverse events (AEs) in people with multidrug-resistant tuberculosis (MDR-TB) undergoing treatment in Vietnam. This economic evaluation seeks to quantify the cost-effectiveness of this mHealth intervention from a healthcare provider and societal perspective. METHODS AND ANALYSIS The V-SMART trial will recruit 902 patients treated for MDR-TB across seven participating provinces in Vietnam. Participants in both intervention and control groups will receive standard community-based therapy for MDR-TB. Participants in the intervention group will also have a purpose-designed App installed on their smartphones to report AEs to health workers and to facilitate timely management of AEs. This economic evaluation will compare the costs and health outcomes between the intervention group (mHealth) and the control group (standard of care). Costs associated with delivering the intervention and health service utilisation will be recorded, as well as patient out-of-pocket costs. The health-related quality of life (HRQoL) of study participants will be captured using the 36-Item Short Form Survey (SF-36) questionnaire and used to calculate quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratios (ICERs) will be based on the primary outcome (proportion of patients with treatment success after 24 months) and QALYs gained. Sensitivity analysis will be conducted to test the robustness of the ICERs. A budget impact analysis will be conducted from a payer perspective to provide an estimate of the total budget required to scale-up delivery of the intervention. ETHICS AND DISSEMINATION Ethical approval for the study was granted by the University of Sydney Human Research Ethics Committee (2019/676), the Scientific Committee of the Ministry of Science and Technology, Vietnam (08/QD-HDQL-NAFOSTED) and the Institutional Review Board of the National Lung Hospital, Vietnam (13/19/CT-HDDD). Study findings will be published in peer-reviewed journals and conference proceedings. TRIAL REGISTRATION NUMBER ACTRN12620000681954.
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Affiliation(s)
- Qinglu Cheng
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Tho Dang
- Woolcock Institute of Medical Research, Hanoi, Vietnam
| | - Thu-Anh Nguyen
- Woolcock Institute of Medical Research, Hanoi, Vietnam
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kavindhran Velen
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Binh Hoa Nguyen
- Vietnam National Tuberculosis Control Program, Hanoi, Vietnam
| | - Dinh Hoa Vu
- Hanoi University of Pharmacy, Hanoi, Vietnam
| | | | - Thu Thuong Do
- Vietnam National Tuberculosis Control Program, Hanoi, Vietnam
| | - Truong-Minh Vu
- Ho Chi Minh City Institute for Development Studies, Ho Chi Minh City, Vietnam
| | - Guy B Marks
- Woolcock Institute of Medical Research, Hanoi, Vietnam
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Manisha Yapa
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gregory J Fox
- Woolcock Institute of Medical Research, Hanoi, Vietnam
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Virginia Wiseman
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
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Getahun GK, Gezahegn E, Endazenawe G, Shitemaw T, Negash Z, Dessu S. Survival status and risk factors for mortality among multidrug-resistant tuberculosis patients in Addis Ababa, Ethiopia: A retrospective follow-up study. J Clin Tuberc Other Mycobact Dis 2023; 33:100398. [PMID: 37767135 PMCID: PMC10520522 DOI: 10.1016/j.jctube.2023.100398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
Background Tuberculosis continues to be a major health concern around the world. It kills an estimated 1.6 million people each year. The World Health Organization (WHO) removed Ethiopia from its list of thirty countries having a high prevalence of MDR/RR-TB in 2021. As a result, the aim of this study was to assess the current context of survival status and risk factors of multidrug-resistant tuberculosis patients in Addis Ababa, Ethiopia, in 2022. Methods An institutional-based retrospective cohort study with 245 patients was undertaken using multidrug-resistant tuberculosis patients who were recruited from January 1st, 2018 to December 30th, 2021, in St. Peter's specialized hospital. To find independent predictors of survival status, Cox regression analysis was used. An adjusted hazard ratio with a 95% confidence interval and a p-value of < 0.05 was used to establish association and statistical significance. Results The result of the study revealed that the incidence of mortality in this study was 13.1% (95% CI: 10.3-16.5). Moreover, being male (AOR = 3.7: 95% CI = 1.2, 11.4), old age (AOR = 14: 95% CI = 3.0, 60.4), site of TB (AOR = 0.2: 95% CI = 0.03, 0.6), and presence of comorbidity (AOR = 9.2: 95% CI = 2.4, 35.3), were independent predictors of time to death. Conclusion Generally, the death rate among research participants was high. Moreover, male gender, old age, site of tuberculosis, and presence of other comorbidity were predictors of mortality among MDR-TB patients.
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Affiliation(s)
| | | | | | | | | | - Samuel Dessu
- College of Medicine and Health Sciences, Wolkite University, Ethiopia
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Mohamed MA, Ali OA, Osman AM, Abatcha MG, Ahmed AA, Ali AM, Dirie AA, de Oliveira CJB, Osman AY, Wang SH, Vieira RFC. Assessment of drug-susceptible and multidrug-resistant tuberculosis (MDR-TB) in the Central Region of Somalia: A 3-year retrospective study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002319. [PMID: 37676848 PMCID: PMC10484424 DOI: 10.1371/journal.pgph.0002319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) remains a public health emergency and a threat globally. Although increasing MDR-TB cases have been recently reported in Somalia, limited information is known. This study aims to determine the prevalence of drug-susceptible and MDR-TB in suspected patients referred to the TB Department in Mudug Hospital, Galkayo, Somalia, and identify potential factors associated with MDR-TB. METHODS A 3-year hospital laboratory-based retrospective study was conducted by manually reviewing laboratory records of Mycobacterium tuberculosis specimens and GeneXpert MTB/RIF results from January 2019 to December 2021 at the reference mycobacteria laboratory department in Mudug Hospital. RESULTS A total of 714 positive GeneXpert-MTB results were identified: 619 (86.7%) were drug susceptible (no Rifampin resistance [RR] detected) and 95 (13.3%) with RR detected or defined as MDR-TB. Most of the MDR-TB patients were males (71.6%, 68/95) and between the ages of 15 to 24 (31.6%, 30/95). Most isolates were collected in 2021 (43.2%, 41/95). Multivariate analyses show no significant difference between patients having MDR-TB and/or drug-susceptible TB for all variables. CONCLUSION This study showed an alarming frequency of MDR-TB cases among M. tuberculosis-positive patients at a regional TB reference laboratory in central Somalia.
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Affiliation(s)
- Mohamed Abdelrahman Mohamed
- Somali National Institutes of Health, Ministry of Health, Mogadishu, Somalia
- Faculty of Veterinary Medicine and Animal Husbandry, Somali National University, Mogadishu, Somalia
| | | | - Aamir Muse Osman
- Somali One Health Centre, Abrar University, Mogadishu, Somalia
- Vector-Borne Diseases Laboratory, Department of Veterinary Medicine, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
- College of Veterinary Medicine, Abrar University, Mogadishu, Somalia
| | - Mustapha Goni Abatcha
- Veterinary Service Department, Ministry of Agriculture and Natural Resources, Damaturu, Yobe State, Nigeria
| | | | - Ali Mohamed Ali
- Food and Agriculture Organization of the United Nations, Mogadishu, Somalia
| | | | - Celso José Bruno de Oliveira
- Department of Animal Science, College of Agricultural Sciences, Federal University of Paraíba, Areia, Paraiba, Brazil
- Global One Health Initiative, The Ohio State University, Columbus, Ohio, United States of America
| | - Abdinasir Yusuf Osman
- Somali National Institutes of Health, Ministry of Health, Mogadishu, Somalia
- The Royal Veterinary College, University of London, Hatfield, United Kingdom
| | - Shu-Hua Wang
- Global One Health Initiative, The Ohio State University, Columbus, Ohio, United States of America
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Rafael F. C. Vieira
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
- Center for Computational Intelligence to Predict Health and Environmental Risks, University of North Carolina at Charlotte, Charlotte, North Carolina, United States of America
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The effect of undernutrition on sputum culture conversion and treatment outcomes among people with multidrug-resistant tuberculosis: a systematic review and meta-analysis. Int J Infect Dis 2023; 127:93-105. [PMID: 36481489 DOI: 10.1016/j.ijid.2022.11.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES We aimed to evaluate the effect of undernutrition on sputum culture conversion and treatment outcomes among people with multidrug-resistant tuberculosis (MDR-TB). METHODS We searched for publications in the Medline, Embase, Scopus, and Web of Science databases. We conducted a random-effect meta-analysis to estimate the effects of undernutrition on sputum culture conversion and treatment outcomes. Hazard ratio (HR) for sputum culture conversion and odds ratio (OR) for end-of-treatment outcomes, with 95% CI, were used to summarize the effect estimates. Potential publication bias was checked using funnel plots and Egger's tests. RESULTS Of the 2358 records screened, 63 studies comprising a total of 31,583 people with MDR-TB were included. Undernutrition was significantly associated with a longer time to sputum culture conversion (HR 0.7, 95% CI 0.6-0.9, I2 = 67·1%), and a higher rate of mortality (OR 2.8, 95% CI 2.1-3.6, I2 = 21%) and unsuccessful treatment outcomes (OR 1.8, 95% CI 1.5-2.1, I2 = 70%). There was no significant publication bias in the included studies. CONCLUSION Undernutrition was significantly associated with unsuccessful treatment outcomes, including mortality and longer time to sputum culture conversion among people with MDR-TB. These findings have implications for supporting targeted nutritional interventions alongside standardized TB drugs.
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Attitudes of Healthcare Workers about Prevention and Control of Nosocomial Multidrug-Resistant Tuberculosis Infection in Two Top-Ranked Tuberculosis Specialized Public Hospitals of Ethiopia. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2022; 2022:5266347. [PMID: 36570677 PMCID: PMC9771643 DOI: 10.1155/2022/5266347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
Background Tuberculosis (TB) exists as a human curse since antiquity. Around 9.5 million cases and 1.5 million deaths were reported due to TB in 2021. Ethiopia is one of the high-burdenmultidrug-resistant (MDR) TB countries. MDR-TB is acquired either by poor adherence to treatment or by primary infection with a drug-resistant strain, which has a high transmission rate from patients to healthcare workers (HCWs). Hospital outbreaks of MDR-TB are common in Africa. Hence, this study aimed to score the attitude of HCWs working in the two nationally top-rankedTB-specialized hospitals in Ethiopia, Saint Peter's and ALERT TB-specialized public hospitals about the infection prevention and control (IPC) of nosocomial MDR-TB. Methods A cross-sectional study was conducted from December 1, 2020, to March 31, 2021. A simple random sampling method was applied to select 384 HCWs. The data collection tool was a self-administered interview structured questionnaire. The data were analyzed using SPSS software. Descriptive statistics were applied to score attitude. Bivariate and multivariable logistic regression models were performed to identify the independent determinants of attitude. The odds ratio was used to test the degree of association between variables at a 95% confidence interval (CI). The level of statistical significance was fixed at p value < 0.05. Results Among the respondents, 87% of the HCWs held favourable attitudes about the nosocomial MDR-TB-IPC. The favourable attitude score had a significant association with the monthly salary earned between 7001 and 9000 ETB (Ethiopian Birr) (AOR = 3.34, 95% CI: 1.11, 10.05) and the previous training obtained on TB/MDR-TB (AOR = 2.96, 95% CI: 1.32, 6.62). Conclusions Almost one in seven HCWs has an unfavourable attitude. Prior training received and earning monthly income above 7000 ETB are independent determinants of a favourable attitude score. Refreshment training and a reasonable increment in monthly income should be strengthened in TB-specialized hospitals in Ethiopia.
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