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Hongprasit P, Sonthisombat P. Assessment of TB treatment adherence using computer-assisted self-interviewing. Int J Tuberc Lung Dis 2023; 27:626-631. [PMID: 37491749 PMCID: PMC10365558 DOI: 10.5588/ijtld.22.0696] [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: 12/31/2022] [Accepted: 03/07/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVES: To evaluate the correlation and agreement between computer-assisted self-interviewing (CASI) and home-based unannounced pill counts (HUPC) for assessing anti-TB medication adherence (MA) and to examine the relationship between MA and treatment success.METHODS: Individual CASI-evaluated MA was compared three times with HUPC MA over the treatment course. The relationship between the two methodologies was determined using correlation coefficients (r) and intraclass correlation coefficients (ICC). The association between MA and efficacy was evaluated using odds ratios (ORs).RESULTS: According to CASI assessments, MA rates of 52 TB patients were 92.2%, 90.6%, and 87.5% at Week 4, 8 and 16-24, respectively, with a strong correlation (r > 0.76) and agreement (ICC > 0.88) with HUPC evaluations. CASI missed one-third of the non-adherent cases reported by HUPC based on patient adherence status. The treatment success rates of patients with >90% adherence, as measured by CASI and HUPC, did not differ significantly; however, >85% adherence was associated with higher treatment success (OR 45.1) than 90% adherence (OR 21.9).CONCLUSION: CASI results were comparable to those of HUPC. As it increased the likelihood of successful treatment, a threshold of >85% may be more appropriate than >90% for defining medication-adherent patients.
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Affiliation(s)
- P Hongprasit
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - P Sonthisombat
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
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Kashyap B, Jhanjharia S, Saha R, Gomber S. Missed phenotypic drug resistance in pediatric tuberculosis: A cause of concern in a resource-limited setting. Indian J Tuberc 2023; 70 Suppl 1:S59-S64. [PMID: 38110261 DOI: 10.1016/j.ijtb.2023.04.004] [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: 11/29/2022] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Multi-drug resistance (MDR) in pediatric tuberculosis (TB) is a growing global threat. Unavailability of conventional or molecular drug susceptibility test (DST) in resource-limited settings often impede the determination of the extent of first line anti-tubercular drugs deployed in national programs. MATERIALS AND METHOD Pulmonary and extra pulmonary specimens were collected from clinically suspected pediatric TB cases, who were microbiologically confirmed. Resistance to first-line anti-TB was detected by 1% proportion method. KatG315 and inhA-15 genes were amplified by PCR and detection of mutations were done by sequencing. Genotypic resistance for rifampicin was detected by Xpert MTB/RIF assay (Cepheid Inc., Sunnyvale, California). RESULTS Fifty-one cases of pediatric tuberculosis were confirmed microbiologically. Resistance to isoniazid, streptomycin, rifampicin and ethambutol were 5 (14%), 4 (11%), 2 (5.5%) and 2 (5.5%) respectively by 1% proportion method. Genotypic Rifampicin and isoniazid resistance was found in 2 (5.5%) and 7 (14%) samples respectively. CONCLUSION Existing genotypic methods, detect targeted mutations conferring rifampicin resistance, however isoniazid (INH) resistance often go undetected. Since the resistance to pivotal anti-TB drugs are often encoded by multiple genes which may not be targeted by widely available molecular tests, discrepancies in molecular and culture-based DST reports should be interpreted with caution.
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Affiliation(s)
- Bineeta Kashyap
- Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India.
| | - Sapna Jhanjharia
- Department of Microbiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India
| | - Rituparna Saha
- Department of Microbiology, Faculty of Medicine & Health Sciences, Shree Guru Gobind Singh Tricentenary University, Gurugram, Haryana, India
| | - Sunil Gomber
- Department of Pediatrics, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India
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Jaiswal S, Sharma H, Joshi U, Agrawal M, Sheohare R. Non-adherence to anti-tubercular treatment during COVID-19 pandemic in Raipur district Central India. Indian J Tuberc 2022; 69:558-564. [PMID: 36460389 PMCID: PMC8426138 DOI: 10.1016/j.ijtb.2021.08.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/25/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Non-adherence is major factor in failure of any drug regimen. The significance of non-adherence is so much that WHO states that increasing the effectiveness of Adherence Interventions may have far greater impact on health of population than any improvement in specific medical treatments. Incidence of non-adherence to Anti Tubercular Treatment (ATT) usually ranges from 8.4% to 55.8%. This study aims to find out the reasons of Non-adherence to ATT in patients receiving anti-tubercular treatment at DIRECTLY OBSERVED TREATMENT SHORTCOURSE (DOTS) Centre at District Tuberculosis Centre (DTC), Kalibadi, Raipur during COVID-19 pandemic. METHODS A cross sectional study was conducted at Department of Pharmacology, Pt. JNM Medical College and DTC Kalibadi Raipur. 55 Patients taking ATT fulfilling inclusion and exclusion criteria were interviewed using structured questionnaire. The data obtained was analysed to know causes of non-adherence. RESULTS Study was carried out between March & April 2020. In our study, 80% subjects were male and 20% were female. The main reasons for Non-adherence were Side-effects of drug in 36% cases, missing medication intentionally in 34% cases, lack of encouragement by family members in 32% cases, patient's unawareness of consequences of skipping medication in 25% cases, unaware of treatment duration in 22%, not feeling any change, forgetting to take medication, and burden of concomitant medication besides ATT, each in 20% cases, 13% cases had difficulty in procuring medication due to lockdown, 5% cases did not go to collect their medicine due to fear of contracting COVID-19 infection. CONCLUSIONS Our study shows reasons for Non-adherence are multi-factorial with drug side -effects & intentionally skipping medication being major factors.
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Affiliation(s)
- Shikha Jaiswal
- Department of Pharmacology, Pt. J.N.M. Medical College, Raipur, India.
| | - Himanshu Sharma
- Department of Pharmacology, Pt. J.N.M. Medical College, Raipur, India
| | - Usha Joshi
- Department of Pharmacology, Pt. J.N.M. Medical College, Raipur, India
| | - Manju Agrawal
- Department of Pharmacology, Pt. J.N.M. Medical College, Raipur, India
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Alcohol drinking delays the rate of sputum smear conversion among DR-TB patients in northwest Ethiopia; A retrospective follow-up study. PLoS One 2022; 17:e0264852. [PMID: 35263367 PMCID: PMC8906643 DOI: 10.1371/journal.pone.0264852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/17/2022] [Indexed: 01/22/2023] Open
Abstract
Background Sputum smear microscopy is simple and feasible technique to assess the presence of acid-fast bacilli (AFB) in the respiratory tract of patients with Drug Resistance Tuberculosis (DR-TB). Conversion of sputum smear from positive to negative is considered as an interim indicator of efficacy of anti-tubercular treatment and the program effectiveness. Although evidences regarding the factors affecting the sputum smear conversion are available on drug susceptible TB patients, there is dearth of literature about smear conversion and its predictors among DR-TB patients in the study setting. Hence, shortening the time to sputum smear conversion is desirable to reduce the likelihood of mycobacterial transmission. This study has therefore aimed at estimating the median time of sputum smear conversion and to determine its predictors. Methods This was a retrospective follow-up study conducted among DR-TB patients registered for second-line anti-TB treatment in the four hospitals of Amhara regional state, Northwest Ethiopia. Of all patients enrolled to DR-TB treatment in the study setting from 2010 to 2017, 436 patients have been include for this study who fulfilled the eligibility criteria. The cox proportional hazard model was fitted and the adjusted hazard ratio (AHR) with 95% confidence interval (CI) and p <0.05 was used to declare statistical significance of the variables associated with the smear conversion. Results From the 436 patients with sputum smear positive at baseline, 351 (80.5%) converted sputum smear at a median time of 48 (IQR: 30–78) days. The median time of smear conversion was 59 (95% CI: 42, 74) and 44 (95% CI: 37, 54) days among patients who had and had no history of alcohol drinking, respectively. Similarly, the median time to smear conversion was 61 (95% CI: 36, 73) days among patients with comorbid conditions and 44 (95% CI: 38, 54) days among patients with no comorbid conditions. In the multi-variable analysis, only history of alcohol consumption [AHR = 0.66 (0.50, 0.87)] was found to delay significantly the rate of sputum smear conversion. Conclusion In our study, the median time of sputum smear conversion was with in the expected time frame of conversion. History of alcohol consumption was found to delay significantly the rate of sputum smear conversion. The DR-TB patients are strongly advised to avoid alcohol consumption.
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Reuter A, Beko B, Memani B, Furin J, Daniels J, Rodriguez E, Reuter H, Weich L, Isaakidis P, von der Heyden E, Kock Y, Mohr-Holland E. Implementing a Substance-Use Screening and Intervention Program for People Living with Rifampicin-Resistant Tuberculosis: Pragmatic Experience from Khayelitsha, South Africa. Trop Med Infect Dis 2022; 7:tropicalmed7020021. [PMID: 35202216 PMCID: PMC8879094 DOI: 10.3390/tropicalmed7020021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 02/01/2023] Open
Abstract
Substance use (SU) is associated with poor rifampicin-resistant tuberculosis (RR-TB) treatment outcomes. In 2017, a SBIRT (SU screening-brief intervention-referral to treatment) was integrated into routine RR-TB care in Khayelitsha, South Africa. This was a retrospective study of persons with RR-TB who were screened for SU between 1 July 2018 and 30 September 2020 using the ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). Here we describe outcomes from this program. Persons scoring moderate/high risk received a brief intervention and referral to treatment. Overall, 333 persons were initiated on RR-TB treatment; 38% (n = 128) were screened for SU. Of those, 88% (n = 113/128) reported SU; 65% (n = 83/128) had moderate/high risk SU. Eighty percent (n = 103/128) reported alcohol use, of whom 52% (n = 54/103) reported moderate/high risk alcohol use. Seventy-seven persons were screened for SU within ≤2 months of RR-TB treatment initiation, of whom 69%, 12%, and 12% had outcomes of treatment success, loss to follow-up and death, respectively. Outcomes did not differ between persons with no/low risk and moderate/high risk SU or based on the receipt of naltrexone (p > 0.05). SU was common among persons with RR-TB; there is a need for interventions to address this co-morbidity as part of “person-centered care”. Integrated, holistic care is needed at the community level to address unique challenges of persons with RR-TB and SU.
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Affiliation(s)
- Anja Reuter
- Médecins Sans Frontières, Khayelitsha 7784, South Africa; (B.B.); (B.M.); (J.D.); (E.R.); or (E.M.-H.)
- Correspondence:
| | - Buci Beko
- Médecins Sans Frontières, Khayelitsha 7784, South Africa; (B.B.); (B.M.); (J.D.); (E.R.); or (E.M.-H.)
| | - Boniwe Memani
- Médecins Sans Frontières, Khayelitsha 7784, South Africa; (B.B.); (B.M.); (J.D.); (E.R.); or (E.M.-H.)
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA;
| | - Johnny Daniels
- Médecins Sans Frontières, Khayelitsha 7784, South Africa; (B.B.); (B.M.); (J.D.); (E.R.); or (E.M.-H.)
| | - Erickmar Rodriguez
- Médecins Sans Frontières, Khayelitsha 7784, South Africa; (B.B.); (B.M.); (J.D.); (E.R.); or (E.M.-H.)
| | - Hermann Reuter
- Faculty of Health Sciences, University of Cape Town, Cape Town 7701, South Africa;
| | - Lize Weich
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7701, South Africa;
| | - Petros Isaakidis
- Médecins Sans Frontières Southern Africa Medical Unit, Cape Town 7925, South Africa;
| | | | - Yulene Kock
- National Department of Health Tuberculosis Program, Pretoria 0187, South Africa;
| | - Erika Mohr-Holland
- Médecins Sans Frontières, Khayelitsha 7784, South Africa; (B.B.); (B.M.); (J.D.); (E.R.); or (E.M.-H.)
- Médecins Sans Frontières Southern Africa Medical Unit, Cape Town 7925, South Africa;
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Suliman Q, Lim PY, Md Said S, Tan KA, Mohd Zulkefli NA. Risk factors for early TB treatment interruption among newly diagnosed patients in Malaysia. Sci Rep 2022; 12:745. [PMID: 35031658 PMCID: PMC8760252 DOI: 10.1038/s41598-021-04742-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/29/2021] [Indexed: 12/01/2022] Open
Abstract
TB treatment interruption has resulted in delayed sputum conversion, drug resistance, and a high mortality rate and a prolonged treatment course, hence leading to economic and psychosocial affliction. To date, there are limited studies investigating the physico-social risk factors for early treatment interruptions. This prospective multicenter cohort study aimed to investigate the risk factors for early treatment interruption among new pulmonary tuberculosis (TB) smear-positive patients in Selangor, Malaysia. A total of 439 participants were recruited from 39 public treatment centres, 2018–2019. Multivariate Cox proportional hazard analyses were performed to analyse the risk factors for early treatment interruption. Of 439 participants, 104 (23.7%) had early treatment interruption, with 67.3% of early treatment interruption occurring in the first month of treatment. Being a current smoker and having a history of hospitalization, internalized stigma, low TB symptoms score, and waiting time spent at Directly Observed Treatment, Short-course centre were risk factors for early treatment interruption. An appropriate treatment adherence strategy is suggested to prioritize the high-risk group with high early treatment interruption. Efforts to quit smoking cessation programs and to promote stigma reduction interventions are crucial to reduce the probability of early treatment interruption.
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Affiliation(s)
- Qudsiah Suliman
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia.,Ministry of Health, Putrajaya, Wilayah Persekutuan Putrajaya, Malaysia
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia.
| | - Salmiah Md Said
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia
| | - Kit-Aun Tan
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia
| | - Nor Afiah Mohd Zulkefli
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM, 43400, Serdang, Selangor, Malaysia
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Gilmour B, Xu Z, Bai L, Addis Alene K, Clements ACA. Risk factors associated with unsuccessful tuberculosis treatment outcomes in Hunan Province, China. Trop Med Int Health 2022; 27:290-299. [PMID: 35014123 PMCID: PMC9305245 DOI: 10.1111/tmi.13720] [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: 11/29/2022]
Abstract
OBJECTIVES Globally, China has the third highest number of tuberculosis (TB) cases despite high rates (85.6%) of effective treatment coverage. Identifying risk factors associated with unsuccessful treatment outcomes is an important component of maximizing the efficacy of TB control programs. METHODS Retrospective cohort study to evaluate the outcomes of 306,860 drug-susceptible TB patients who underwent treatment in Hunan Province, China between 2013 and 2018. Univariable and multivariable logistic regression models were used to identify factors associated with unsuccessful TB treatment outcomes. RESULTS A successful treatment outcome was recorded for 98.6% of patients, defined as the sum of patients who were cured (36.2%) and completed treatment (62.4%). An unsuccessful treatment outcome was recorded for 1.8% of patients, defined as the sum of treatment failure (1.1%), deaths (0.5%) and lost to follow up (0.2%). The odds of an unsuccessful treatment outcome showed an increasing trend in more recent years of registration (2018 Adjusted Odds Ratio (AOR): 1.43; 95% Confidence Interval (CI) 1.31, 1.57 relative to 2013). Other significant risk factors were male sex (AOR: 1.17; 95% CI 1.10, 1.25); increasing age (AOR:1.02 per year increase; 95% CI 1.02,1.02); being severely ill (AOR: 1.50; 95% CI 1.33, 1.70); having a history of TB treatment (AOR: 2.93; 95% CI 2.69, 3.20); not being under systematic management (AOR: 16.10 (14.49, 17.88) and treatment regimens that differed from full course management. CONCLUSIONS The increasing likelihood of an unsuccessful treatment outcome over time necessitates the need for further research.
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Affiliation(s)
- Beth Gilmour
- Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - Zuhui Xu
- Xiangya School of Public Health, Central South University, Changsha, China.,TB Control Institute of Hunan Province, Changsha, China
| | - Liqiong Bai
- TB Control Institute of Hunan Province, Changsha, China
| | - Kefyalew Addis Alene
- Faculty of Health Sciences, Curtin University, Bentley, Australia.,Telethon Kids Institute, Nedlands, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Bentley, Australia.,Telethon Kids Institute, Nedlands, Australia
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Nidoi J, Muttamba W, Walusimbi S, Imoko JF, Lochoro P, Ictho J, Mugenyi L, Sekibira R, Turyahabwe S, Byaruhanga R, Putoto G, Villa S, Raviglione MC, Kirenga B. Impact of socio-economic factors on Tuberculosis treatment outcomes in north-eastern Uganda: a mixed methods study. BMC Public Health 2021; 21:2167. [PMID: 34836521 PMCID: PMC8620143 DOI: 10.1186/s12889-021-12056-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a major public health problem and at 48%, Karamoja in North-Eastern Uganda has the lowest treatment success rate nationally. Addressing the social determinants of TB is crucial to ending TB. This study sought to understand the extent and ways in which socio-economic factors affect TB treatment outcomes in Karamoja. METHODS We conducted a convergent parallel mixed methods study in 10 TB Diagnostic and Treatment Units. The study enrolled former TB patients diagnosed with drug-susceptible TB between April 2018 and March 2019. Unit TB and laboratory registers were reviewed to identify pre-treatment losses to follow-up. Four focus group discussions with former TB patients and 18 key informant interviews with healthcare workers were conducted. Principle component analysis was used to generate wealth quintiles that were compared to treatment outcomes using the proportion test. The association between sociodemographic characteristics and TB treatment outcomes was evaluated using the chi-square test and multiple logistic regression. RESULTS A total of 313 participants were randomly selected from 1184 former TB patients recorded in the unit TB registers. Of these, 264 were contacted in the community and consented to join the study: 57% were male and 156 (59.1%) participants had unsuccessful treatment outcomes. The wealthiest quintile had a 58% reduction in the risk of having an unsuccessful treatment outcome (adj OR = 0.42, 95% CI 0.18-0.99, p = 0.047). People who were employed in the informal sector (adj OR = 4.71, 95% CI 1.18-18.89, p = 0.029) and children under the age of 15 years who were not in school or employed (adj OR = 2.71, 95% CI 1.11-6.62, p = 0.029) had significantly higher odds of unsuccessful treatment outcome. Analysis of the pre-treatment loss to follow-up showed that 17.2% of patients with pulmonary bacteriologically confirmed TB did not initiate treatment with a higher proportion among females (21.7%) than males (13.5%). Inadequate food, belonging to migratory communities, stigma, lack of social protection, drug stock-outs and transport challenges affected TB treatment outcomes. CONCLUSIONS This study confirmed that low socio-economic status is associated with poor TB treatment outcomes emphasizing the need for multi- and cross-sectoral approaches and socio-economic enablers to optimise TB care.
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Affiliation(s)
- Jasper Nidoi
- Makerere University Lung Institute (MLI), Kampala, Uganda.
| | | | | | - Joseph F Imoko
- Makerere University Lung Institute (MLI), Kampala, Uganda
| | | | | | | | | | - Stavia Turyahabwe
- National Tuberculosis and Leprosy Control Program (NTLP), Kampala, Uganda
| | - Raymond Byaruhanga
- National Tuberculosis and Leprosy Control Program (NTLP), Kampala, Uganda
| | | | - Simone Villa
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Mario C Raviglione
- Centre for Multidisciplinary Research in Health Science, University of Milan, Milan, Italy
| | - Bruce Kirenga
- Makerere University Lung Institute (MLI), Kampala, Uganda
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Ausi Y, Santoso P, Sunjaya DK, Barliana MI. Between Curing and Torturing: Burden of Adverse Reaction in Drug-Resistant Tuberculosis Therapy. Patient Prefer Adherence 2021; 15:2597-2607. [PMID: 34848950 PMCID: PMC8627322 DOI: 10.2147/ppa.s333111] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/09/2021] [Indexed: 01/07/2023] Open
Abstract
Drug-resistant tuberculosis (DR-TB) requires prolonged and complex therapy which is associated with several adverse drug reactions (ADR). The burden of ADR can affect the quality of life (QoL) of patients that consists of physical, mental, and social well-being, and influences the beliefs and behaviors of patient related to treatment. This article reviews the burden of ADR and its association with QoL and adherence. We used PubMed to retrieve the relevant original research articles written in English from 2011 to 2021. We combined the following keywords: "tuberculosis," "Drug-resistant tuberculosis," "Side Effect," "Adverse Drug Reactions," "Adverse Event," "Quality of Life," "Adherence," "Non-adherence," "Default," and "Loss to follow-up." Article selection process was unsystematic. We included 12 relevant main articles and summarized into two main topics, namely, 1) ADR and QoL (3 articles), and 2) ADR and therapy adherence (9 articles). The result showed that patients with ADR tend to have low QoL, even in the end of treatment. Although it was torturing, the presence of ADR does not always result in non-adherence. It is probably because the perception about the benefit of the treatment dominates the perceived barrier. In conclusion, burden of ADR generally tends to degrade QoL of patients and potentially influence the adherence. A comprehensive support from family, community, and healthcare provider is required to help patients in coping with the burden of ADR. Nevertheless, the regimen safety and efficacy improvement are highly needed.
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Affiliation(s)
- Yudisia Ausi
- Department of Biological Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Master Program in Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
| | - Prayudi Santoso
- Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Deni Kurniadi Sunjaya
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Melisa Intan Barliana
- Department of Biological Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
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FAST tuberculosis transmission control strategy speeds the start of tuberculosis treatment at a general hospital in Lima, Peru. Infect Control Hosp Epidemiol 2021; 43:1459-1465. [PMID: 34612182 PMCID: PMC8983787 DOI: 10.1017/ice.2021.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To evaluate the effect of the FAST (Find cases Actively, Separate safely, Treat effectively) strategy on time to tuberculosis diagnosis and treatment for patients at a general hospital in a tuberculosis-endemic setting. Design: Prospective cohort study with historical controls. Participants: Patients diagnosed with pulmonary tuberculosis during hospitalization at Hospital Nacional Hipolito Unanue in Lima, Peru. Methods: The FAST strategy was implemented from July 24, 2016, to December 31, 2019. We compared the proportion of patients with drug susceptibility testing and tuberculosis treatment during FAST to the 6-month period prior to FAST. Times to diagnosis and tuberculosis treatment were also compared using Kaplan-Meier plots and Cox regressions. Results: We analyzed 75 patients diagnosed with pulmonary tuberculosis through FAST. The historical cohort comprised 76 patients. More FAST patients underwent drug susceptibility testing (98.7% vs 57.8%; OR, 53.8; P < .001), which led to the diagnosis of drug-resistant tuberculosis in 18 (24.3%) of 74 of the prospective cohort and 4 (9%) of 44 of the historical cohort (OR, 3.2; P = .03). Overall, 55 FAST patients (73.3%) started tuberculosis treatment during hospitalization compared to 39 (51.3%) controls (OR, 2.44; P = .012). FAST reduced the time from hospital admission to the start of TB treatment (HR, 2.11; 95% CI, 1.39–3.21; P < .001). Conclusions: Using the FAST strategy improved the diagnosis of drug-resistant tuberculosis and the likelihood and speed of starting treatment among patients with pulmonary tuberculosis at a general hospital in a tuberculosis-endemic setting. In these settings, the FAST strategy should be considered to reduce tuberculosis transmission while simultaneously improving the quality of care.
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Soboka M, Tesfaye M, Adorjan K, Krahl W, Tesfaye E, Yitayih Y, Strobl R, Grill E. Substance use disorders and adherence to antituberculosis medications in Southwest Ethiopia: a prospective cohort study. BMJ Open 2021; 11:e043050. [PMID: 34226210 PMCID: PMC8258551 DOI: 10.1136/bmjopen-2020-043050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES In Ethiopia, little is known about the association between substance use disorders and adherence to antituberculosis (anti-TB) medications. Therefore, the objective of this study was to assess the effect of substance use disorders on adherence to anti-TB medications in Southwest Ethiopia. DESIGN Prospective cohort study. SETTINGS Patients were recruited from 22 health centres and four hospitals in Southwest Ethiopia. PARTICIPANTS This study was conducted among 268 patients with TB, aged 18-80 in Southwest Ethiopia between October 2017 and October 2018. At baseline, patients who were exposed substance use disorders (134 patients) and unexposed to substance use disorders (134 patients) were recruited. Patients were followed for 6 months, and data were collected on three occasions. MAIN OUTCOME MEASURE Adherence to anti-TB medications. RESULTS Patients with substance use disorders had consistently higher prevalence of non-adherence than those without, 16.4% versus 3.0% at baseline, 41.7% versus 14.4% at 2-month follow-up and 45.7% versus 10.8% at 6-month follow-up assessments. Patients with khat use disorder were 3.8 times more likely to be non-adherent to anti-TB medications than patients without khat use disorder (Adjusted odds ratio (aOR)=3.8, 95% CI 1.8 to 8.0). Patients who had alcohol use disorder (AUD) were also 3.2 times likely to have poor adherence compared with their counterparts (aOR=3.2, 95% CI 1.6 to 6.6). In addition, being educated (aOR=4.4, 95% CI 1.7 to 11.3), and being merchant (aOR=6.1, 95% CI 1.2 to 30.8) were associated with non-adherence to anti-TB medications. CONCLUSION Khat and AUDs predict greater likelihood of non-adherence to anti-TB medication. This implies the need to integrate the management for substance use disorders into the existing TB treatment services.
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Affiliation(s)
- Matiwos Soboka
- Department of Psychiatry, Medical Faculty, Jimma University, Jimma, Ethiopia
- Center for International Health, Ludwig Maxmilians University, Munich, Germany
| | - Markos Tesfaye
- Center for International Health, Ludwig Maxmilians University, Munich, Germany
- Department of Psychiatry, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Kristina Adorjan
- Center for International Health, Ludwig Maxmilians University, Munich, Germany
- Department of Psychiatry and Psychotherapy, LMU Munich, Munich, Germany
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Krahl
- Center for International Health, Ludwig Maxmilians University, Munich, Germany
- Department of Forensic Psychiatry, Isar Amper Klinikum, Munich, Germany
| | - Elias Tesfaye
- Department of Psychiatry, Medical Faculty, Jimma University, Jimma, Ethiopia
| | - Yimenu Yitayih
- Department of Psychiatry, Medical Faculty, Jimma University, Jimma, Ethiopia
| | - Ralf Strobl
- Institute for Medical Information Processing, Biometry and Epidemiology,Ludwig Maximilians University Muenchen, Munich, Germany
- German Center for Vertigo and Balance Disorders, University Hospital LMU Muenchen, Munich, Germany
| | - Eva Grill
- Center for International Health, Ludwig Maxmilians University, Munich, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology,Ludwig Maximilians University Muenchen, Munich, Germany
- German Center for Vertigo and Balance Disorders, University Hospital LMU Muenchen, Munich, Germany
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12
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Deol AK, Scarponi D, Beckwith P, Yates TA, Karat AS, Yan AWC, Baisley KS, Grant AD, White RG, McCreesh N. Estimating ventilation rates in rooms with varying occupancy levels: Relevance for reducing transmission risk of airborne pathogens. PLoS One 2021; 16:e0253096. [PMID: 34166388 PMCID: PMC8224849 DOI: 10.1371/journal.pone.0253096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/27/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In light of the role that airborne transmission plays in the spread of SARS-CoV-2, as well as the ongoing high global mortality from well-known airborne diseases such as tuberculosis and measles, there is an urgent need for practical ways of identifying congregate spaces where low ventilation levels contribute to high transmission risk. Poorly ventilated clinic spaces in particular may be high risk, due to the presence of both infectious and susceptible people. While relatively simple approaches to estimating ventilation rates exist, the approaches most frequently used in epidemiology cannot be used where occupancy varies, and so cannot be reliably applied in many of the types of spaces where they are most needed. METHODS The aim of this study was to demonstrate the use of a non-steady state method to estimate the absolute ventilation rate, which can be applied in rooms where occupancy levels vary. We used data from a room in a primary healthcare clinic in a high TB and HIV prevalence setting, comprising indoor and outdoor carbon dioxide measurements and head counts (by age), taken over time. Two approaches were compared: approach 1 using a simple linear regression model and approach 2 using an ordinary differential equation model. RESULTS The absolute ventilation rate, Q, using approach 1 was 2407 l/s [95% CI: 1632-3181] and Q from approach 2 was 2743 l/s [95% CI: 2139-4429]. CONCLUSIONS We demonstrate two methods that can be used to estimate ventilation rate in busy congregate settings, such as clinic waiting rooms. Both approaches produced comparable results, however the simple linear regression method has the advantage of not requiring room volume measurements. These methods can be used to identify poorly-ventilated spaces, allowing measures to be taken to reduce the airborne transmission of pathogens such as Mycobacterium tuberculosis, measles, and SARS-CoV-2.
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Affiliation(s)
- Arminder K. Deol
- Department of Infectious Disease Epidemiology, TB Centre, The London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Danny Scarponi
- Department of Infectious Disease Epidemiology, TB Centre, The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Peter Beckwith
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- The Institute for Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
| | - Tom A. Yates
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Aaron S. Karat
- Department of Infectious Disease Epidemiology, TB Centre, The London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Institute for Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
| | - Ada W. C. Yan
- Section of Immunology of Infection, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Kathy S. Baisley
- Department of Infectious Disease Epidemiology, The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alison D. Grant
- Department of Infectious Disease Epidemiology, TB Centre, The London School of Hygiene & Tropical Medicine, London, United Kingdom
- Africa Health Research Institute, School of Laboratory Medicine & Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard G. White
- Department of Infectious Disease Epidemiology, TB Centre, The London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nicky McCreesh
- Department of Infectious Disease Epidemiology, TB Centre, The London School of Hygiene & Tropical Medicine, London, United Kingdom
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Patients' perceptions regarding multidrug-resistant tuberculosis and barriers to seeking care in a priority city in Brazil during COVID-19 pandemic: A qualitative study. PLoS One 2021; 16:e0249822. [PMID: 33836024 PMCID: PMC8034748 DOI: 10.1371/journal.pone.0249822] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/26/2021] [Indexed: 12/29/2022] Open
Abstract
This study aimed to analyze the discourses of patients who were diagnosed with multidrug-resistant tuberculosis, the perception of why they acquired this health condition and barriers to seeking care in a priority city in Brazil during the COVID-19 pandemic. This was an exploratory qualitative study, which used the theoretical-methodological framework of the Discourse Analysis of French matrix, guided by the Consolidated Criteria for Reporting Qualitative Research. The study was conducted in Ribeirão Preto, São Paulo, Brazil. Seven participants were interviewed who were undergoing treatment at the time of the interview. The analysis of the participants' discourses allowed the emergence of four discursive blocks: (1) impact of the social determinants in the development of multidrug-resistant tuberculosis, (2) barriers to seeking care and difficulties accessing health services, (3) perceptions of the side effects and their impact on multidrug-resistant tuberculosis treatment, and (4) tuberculosis and COVID-19: a necessary dialogue. Through discursive formations, these revealed the determinants of multidrug-resistant tuberculosis. Considering the complexity involved in the dynamics of multidrug-resistant tuberculosis, advancing in terms of equity in health, that is, in reducing unjust differences, is a challenge for public policies, especially at the current moment in Brazil, which is of accentuated economic, political and social crisis. The importance of psychosocial stressors and the lack of social support should also be highlighted as intermediary determinants of health. The study has also shown the situation of COVID-19, which consists of an important barrier for patients seeking care. Many patients reported fear, insecurity and worry with regard to returning to medical appointments, which might contribute to the worsening of tuberculosis in the scenario under study.
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Xing W, Zhang R, Jiang W, Zhang T, Pender M, Zhou J, Pu J, Liu S, Wang G, Chen Y, Li J, Hu D, Tang S, Li Y. Adherence to Multidrug Resistant Tuberculosis Treatment and Case Management in Chongqing, China - A Mixed Method Research Study. Infect Drug Resist 2021; 14:999-1012. [PMID: 33758516 PMCID: PMC7979342 DOI: 10.2147/idr.s293583] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Abstract
Aim This paper evaluated the treatment adherence for multidrug-resistant tuberculosis (MDR-TB) and MDR-TB case management (MTCM) in Chongqing, China in order to identify factors associated with poor treatment adherence and case management. Methods Surveys with 132 MDR-TB patients and six in-depth interviews with health care workers (HCWs) from primary health centers (PHC), doctors from MDR-TB designated hospitals and MDR-TB patients were conducted. Surveys collected demographic and socio-economic characteristics, as well as factors associated with treatment and case management. In-depth interviews gathered information on treatment and case management experience and adherence behaviors. Results Patient surveys found the two main reasons for poor adherence were negative side-effects from the treatment and busy work schedules. In-depth interviews with key stakeholders found that self-perceived symptom improvement, negative side-effects from treatment and financial difficulties were the main reasons for poor adherence. MDR-TB patients from urban areas, who were unmarried, were female, had migrant status, and whose treatments were supervised by health care workers from primary health clinics, had poorer treatment adherence (P<0.05). Among the MDR-TB patients surveyed, 86.7% received any type of MTCM in general (received any kind of MTCM from HCWs in PHC, MDR-TB designated hospital and centers of disease control/TB dispensaries and 62.50% received MTCM from HCWs in PHC sectors). Patients from suburban areas were more likely to receive both MTCM in general (OR=6.70) and MTCM from HCWs in MDR-TB designated hospitals (OR=2.77), but female patients (OR=0.26) were less likely to receive MTCM from HCWs in PHC sectors, and patients who were not educated about MTCM by TB doctors in designated hospitals were less likely to receive MTCM in general (OR=0.14). Patients who had not been hospitalized were less likely to receive MTCM from HCWs in MDR-TB designated hospitals (OR=0.21). Conclusion Stronger MTCM by HCWs in PHC sectors would improve treatment adherence among MDR-TB patients. Community-based patient-centered models of MTCM in PHC sectors and the use of digital health technology could help to improve case management and thereby improve adherence.
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Affiliation(s)
- Wei Xing
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Rui Zhang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Weixi Jiang
- Duke Kunshan University, Kunshan, Jiangsu, People's Republic of China
| | - Ting Zhang
- Department of Districts and Counties, Chongqing Institute of TB Prevention and Treatment, Chongqing, People's Republic of China
| | - Michelle Pender
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jiani Zhou
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Jie Pu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Shili Liu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Geng Wang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Yong Chen
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Jin Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
| | - Daiyu Hu
- Chongqing Institute of TB Prevention and Treatment, Chongqing, People's Republic of China
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Ying Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China
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15
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Necho M, Tsehay M, Seid M, Zenebe Y, Belete A, Gelaye H, Muche A. Prevalence and associated factors for alcohol use disorder among tuberculosis patients: a systematic review and meta-analysis study. Subst Abuse Treat Prev Policy 2021; 16:2. [PMID: 33388060 PMCID: PMC7778806 DOI: 10.1186/s13011-020-00335-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Alcohol use disorders (AUD) in tuberculosis patients are complicated with poor compliance to anti-tuberculosis treatment and poor tuberculosis treatment outcomes. However, aggregate data concerning this problem is not available. Therefore, this review aimed to fill the above gap by generating an average prevalence of AUD in tuberculosis patients. METHOD Our electronic search for original articles was conducted in the databases of Scopus, PubMed, and EMBASE, African Index Medicus, and psych-info. Besides, the reference list of selected articles was looked at manually to have further eligible articles for the prevalence and associated factors of AUD in tuberculosis patients. The random-effects model was employed during the analysis. MS-Excel was used to extract data and stata-11 to determine the average prevalence of AUD among tuberculosis patients. A sub-group analysis and sensitivity analysis were also run. A visual inspection of the funnel plots and an Eggers publication bias plot test were checked for the presence of publication bias. RESULT A search of the electronic and manual system resulted in 1970 articles. After removing duplicates and unoriginal articles, only 28 articles that studied 30,854 tuberculosis patients met the inclusion criteria. The average estimated prevalence of AUD in tuberculosis patients was 30% (95% CI: 24.00, 35.00). This was with a slight heterogeneity (I2 = 57%, p-value < 0.001). The prevalence of AUD in tuberculosis patients was higher in Asia and Europe; 37% than the prevalence in the US and Africa; 24%. Besides, the average prevalence of AUD was 39, 30, 30, and 20% in studies with case-control, cohort, cross-sectional and experimental in design respectively. Also, the prevalence of AUD was higher in studies with the assessment tool not reported (36%) than studies assessed with AUDIT. AUD was also relatively higher in studies with a mean age of ≥40 years (42%) than studies with a mean age < 40 years (24%) and mean age not reported (27%). Based on a qualitative review; the male gender, older age, being single, unemployment, low level of education and income from socio-demographic variables, retreatment and treatment failure patients, stigma, and medication non-adherence from clinical variables were among the associated factors for AUD. CONCLUSION This review obtained a high average prevalence of AUD in tuberculosis patients and this varies across continents, design of studies, mean age of the participants, and assessment tool used. This implied the need for early screening and management of AUD in tuberculosis patients.
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Affiliation(s)
- Mogesie Necho
- College of Medicine and Health Sciences, Department of Psychiatry, Wollo University, Dessie, Ethiopia
| | - Mekonnen Tsehay
- College of Medicine and Health Sciences, Department of Psychiatry, Wollo University, Dessie, Ethiopia
| | - Muhammed Seid
- College of Medicine and Health Sciences, Department of Psychiatry, Wollo University, Dessie, Ethiopia
| | - Yosef Zenebe
- College of Medicine and Health Sciences, Department of Psychiatry, Wollo University, Dessie, Ethiopia
| | - Asmare Belete
- College of Medicine and Health Sciences, Department of Psychiatry, Wollo University, Dessie, Ethiopia
| | - Habitam Gelaye
- College of Medicine and Health Sciences, Department of Psychiatry, Wollo University, Dessie, Ethiopia
| | - Amare Muche
- College of Medicine and Health Sciences, Department of Public Health, Wollo University, Dessie, Ethiopia
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16
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Zheng Z, Nehl EJ, Zhou C, Li J, Xie Z, Zhou Z, Liang H. Insufficient tuberculosis treatment leads to earlier and higher mortality in individuals co-infected with HIV in southern China: a cohort study. BMC Infect Dis 2020; 20:873. [PMID: 33225919 PMCID: PMC7682080 DOI: 10.1186/s12879-020-05527-0] [Citation(s) in RCA: 2] [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: 04/29/2020] [Accepted: 10/19/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) and Acquired Immune Deficiency Syndrome (AIDS) are leading causes of death globally. However, little is known about the long-term mortality risk and the timeline of death in those co-infected with human immunodeficiency virus (HIV) and Mycobacterium tuberculosis (MTB). This study sought to understand the long-term mortality risk, factors, and the timeline of death in those with HIV-Mycobacterium tuberculosis (MTB) coinfection, particularly in those with insufficient TB treatment. METHODS TB-cause specific deaths were classified using a modified 'Coding of Cause of Death in HIV' protocol. A longitudinal cross-registration-system checking approach was used to confirm HIV/MTB co-infection between two observational cohorts. Mortality from the end of TB treatment (6 months) to post-treatment year (PTY) 5 (60 months) was investigated by different TB treatment outcomes. General linear models were used to estimate the mean mortality at each time-point and change between time-points. Cox's proportional hazard regressions measured the mortality hazard risk (HR) at each time-point. The Mantel-Haenszel stratification was used to identify mortality risk factors. Mortality density was calculated by person year of follow-up. RESULTS At the end point, mortality among patients with HIV/MTB coinfection was 34.7%. From the end of TB treatment to PTY5, mortality and loss of person years among individuals with TB treatment failure, missing, and adverse events (TBFMA) were significantly higher than those who had TB cure (TBC) and TB complete regimen (TBCR). Compared to individuals with TBC and with TBCR, individuals with TBFMA tended to die earlier and their mortality was significantly higher (HRTBFMA-TBC = 3.0, 95% confidence interval: 2.5-3.6, HRTBFMA-TBCR = 2.9, 95% CI: 2.5-3.4, P < 0.0001). Those who were naïve to antiretroviral therapy, were farmers, had lower CD4 counts (≤200 cells/μL) and were ≥ 50 years of age were at the highest risk of mortality. Mortality risk for participants with TBFMA was significantly higher across all stratifications except those with a CD4 count of ≤200 cells/μL. CONCLUSIONS Earlier and long-term mortality among those with HIV/MTB co-infection is a significant problem when TB treatment fails or is inadequate.
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Affiliation(s)
- Zhigang Zheng
- Department of Epidemiology and Statistic, School of Public Health, Guangxi Medical University, Nanning, 530021 Guangxi China
- AIDS Program, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, 18 Jin Zhou Road, Nanning, 530028 China
| | - Eric J. Nehl
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, 30322 GA U.S.A
| | - Chongxing Zhou
- AIDS Program, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, 18 Jin Zhou Road, Nanning, 530028 China
| | - Jianjun Li
- AIDS Program, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, 18 Jin Zhou Road, Nanning, 530028 China
| | - Zhouhua Xie
- HIV/TB Treatment Department, the Fourth Hospital of Nanning City, Nanning, 530023 China
| | - Zijun Zhou
- HIV/TB Treatment Department, the Fourth Hospital of Nanning City, Nanning, 530023 China
| | - Hao Liang
- Guangxi Key Laboratory of AIDS Prevention and Treatment, School of Public Health, Guangxi Medical University, Nanning, 530021 Guangxi China
- Guangxi Collaborative Innovation Center for Biomedicine, Life Sciences Institute, Guangxi Medical University, No.22, Shuangyong Road, Qingxiu District, Nanning, 530021 Guangxi China
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Nardell E, Lederer P, Mishra H, Nathavitharana R, Theron G. Cool but dangerous: How climate change is increasing the risk of airborne infections. INDOOR AIR 2020; 30:195-197. [PMID: 32100390 PMCID: PMC7831375 DOI: 10.1111/ina.12608] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/29/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Edward Nardell
- Division of Global Health Equity, Brigham & Women's Hospital, Boston, MA, USA
| | - Philip Lederer
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
| | - Hridesh Mishra
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, and South African Medical Research Council Centre for Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
| | | | - Grant Theron
- Division of Global Health Equity, Brigham & Women's Hospital, Boston, MA, USA
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18
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Nathavitharana RR, Lederer P, Tierney DB, Nardell E. Treatment as prevention and other interventions to reduce transmission of multidrug-resistant tuberculosis. Int J Tuberc Lung Dis 2020; 23:396-404. [PMID: 31064617 DOI: 10.5588/ijtld.18.0276] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Drug-resistant tuberculosis (DR-TB) represents a major programmatic challenge at the national and global levels. Only ∼30% of patients with multidrug-resistant TB (MDR-TB) were diagnosed, and ∼25% were initiated on treatment for MDR-TB in 2016. Increasing evidence now points towards primary transmission of DR-TB, rather than inadequate treatment, as the main driver of the DR-TB epidemic. The cornerstone of DR-TB transmission prevention should be earlier diagnosis and prompt initiation of effective treatment for all patients with DR-TB. Despite the extensive scale-up of Xpert® MTB/RIF testing, major implementation barriers continue to limit its impact. Although there is longstanding evidence in support of the rapid impact of treatment on patient infectiousness, delays in the initiation of effective DR-TB treatment persist, resulting in ongoing transmission. However, it is also imperative to address the burden of latent drug-resistant tuberculous infection because it is estimated that many DR-TB patients will become infectious before seeking care and encounter various diagnostic delays before treatment. Addressing latent DR-TB primarily consists of identifying, treating and following the contacts of patients with MDR-TB, typically through household contact evaluation. Adjunctive measures, such as improved ventilation and use of germicidal ultraviolet technology can further reduce TB transmission in high-risk congregate settings. Although many gaps remain in our biological understanding of TB transmission, implementation barriers to early diagnosis and rapid initiation of effective DR-TB treatment can and must be overcome if we are to impact DR-TB incidence in the short and long term.
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Affiliation(s)
- R R Nathavitharana
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - P Lederer
- Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts
| | - D B Tierney
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - E Nardell
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Janse Van Rensburg A, Dube A, Curran R, Ambaw F, Murdoch J, Bachmann M, Petersen I, Fairall L. Comorbidities between tuberculosis and common mental disorders: a scoping review of epidemiological patterns and person-centred care interventions from low-to-middle income and BRICS countries. Infect Dis Poverty 2020; 9:4. [PMID: 31941551 PMCID: PMC6964032 DOI: 10.1186/s40249-019-0619-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/23/2019] [Indexed: 12/22/2022] Open
Abstract
Background There is increasing evidence that the substantial global burden of disease for tuberculosis unfolds in concert with dimensions of common mental disorders. Person-centred care holds much promise to ameliorate these comorbidities in low-to-middle income countries (LMICs) and emerging economies. Towards this end, this paper aims to review 1) the nature and extent of tuberculosis and common mental disorder comorbidity and 2) person-centred tuberculosis care in low-to-middle income countries and emerging economies. Main text A scoping review of 100 articles was conducted of English-language studies published from 2000 to 2019 in peer-reviewed and grey literature, using established guidelines, for each of the study objectives. Four broad tuberculosis/mental disorder comorbidities were described in the literature, namely alcohol use and tuberculosis, depression and tuberculosis, anxiety and tuberculosis, and general mental health and tuberculosis. Rates of comorbidity varied widely across countries for depression, anxiety, alcohol use and general mental health. Alcohol use and tuberculosis were significantly related, especially in the context of poverty. The initial tuberculosis diagnostic episode had substantial socio-psychological effects on service users. While men tended to report higher rates of alcohol use and treatment default, women in general had worse mental health outcomes. Older age and a history of mental illness were also associated with pronounced tuberculosis and mental disorder comorbidity. Person-centred tuberculosis care interventions were almost absent, with only one study from Nepal identified. Conclusions There is an emerging body of evidence describing the nature and extent of tuberculosis and mental disorders comorbidity in low-to-middle income countries. Despite the potential of person-centred interventions, evidence is limited. This review highlights a pronounced need to address psychosocial comorbidities with tuberculosis in LMICs, where models of person-centred tuberculosis care in routine care platforms may yield promising outcomes.
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Affiliation(s)
- André Janse Van Rensburg
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal Howard College, Berea, Durban, South Africa.
| | - Audry Dube
- Knowledge Translation Unit, University of Cape Town Lung Institute, George Street, Mowbray, Cape Town, South Africa
| | - Robyn Curran
- Knowledge Translation Unit, University of Cape Town Lung Institute, George Street, Mowbray, Cape Town, South Africa
| | - Fentie Ambaw
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Jamie Murdoch
- University of East Anglia School of Health Sciences, Norwich Research Park, Norwich, Norfolk, UK
| | - Max Bachmann
- University of East Anglia School of Health Sciences, Norwich Research Park, Norwich, Norfolk, UK
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal Howard College, Berea, Durban, South Africa
| | - Lara Fairall
- Knowledge Translation Unit, University of Cape Town Lung Institute, George Street, Mowbray, Cape Town, South Africa.,King's Global Health Institute, King's College London, Stamford Street, London, UK
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20
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Ragan EJ, Kleinman MB, Sweigart B, Gnatienko N, Parry CD, Horsburgh CR, LaValley MP, Myers B, Jacobson KR. The impact of alcohol use on tuberculosis treatment outcomes: a systematic review and meta-analysis. Int J Tuberc Lung Dis 2020; 24:73-82. [PMID: 32005309 PMCID: PMC7491444 DOI: 10.5588/ijtld.19.0080] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Alcohol use is associated with increased risk of developing tuberculosis (TB) disease, yet the impact of alcohol use on TB treatment outcomes has not been summarized. We aimed to quantitatively review evidence of the relationship between alcohol use and poor TB treatment outcomes. We conducted a systematic review of PubMed, EMBASE, and Web of Science (January 1980-May 2018). We categorized studies as having a high- or low-quality alcohol use definition and examined poor treatment outcomes individually and as two aggregated definitions (i.e., including or excluding loss to follow-up [LTFU]). We analyzed drug-susceptible (DS-) and multidrug-resistant (MDR-) TB studies separately. Our systematic review yielded 111 studies reporting alcohol use as a predictor of DS- and MDR-TB treatment outcomes. Alcohol use was associated with increased odds of poor treatment outcomes (i.e., death, treatment failure, and LTFU) in DS (OR 1.99, 95% CI 1.57-2.51) and MDR-TB studies (OR 2.00, 95% CI 1.73-2.32). This association persisted for aggregated poor treatment outcomes excluding LTFU, each individual poor outcome, and across sub-group and sensitivity analyses. Only 19% of studies used high-quality alcohol definitions. Alcohol use significantly increased the risk of poor treatment outcomes in both DS- and MDR-TB patients. This study highlights the need for improved assessment of alcohol use in TB outcomes research and potentially modified treatment guidelines for TB patients who consume alcohol.
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Affiliation(s)
- E J Ragan
- Section of Infectious Diseases, Boston Medical Center, Boston, MA
| | - M B Kleinman
- Department of Psychology, University of Maryland, College Park, MD
| | - B Sweigart
- Department of Biostatistics, Boston University, Boston, MA
| | - N Gnatienko
- Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - C D Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - C R Horsburgh
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, Department of Biostatistics, Boston University, Boston, MA, Department of Global Health, Department of Epidemiology, Boston University, Boston, MA, USA
| | - M P LaValley
- Department of Biostatistics, Boston University, Boston, MA
| | - B Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - K R Jacobson
- Section of Infectious Diseases, Boston Medical Center, Boston, MA
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Intermittent treatment interruption and its effect on multidrug resistant tuberculosis treatment outcome in Ethiopia. Sci Rep 2019; 9:20030. [PMID: 31882784 PMCID: PMC6934462 DOI: 10.1038/s41598-019-56553-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/12/2019] [Indexed: 11/21/2022] Open
Abstract
Treatment interruption is one of the main risk factors of poor treatment outcome and occurrence of additional drug resistant tuberculosis. This study is a national retrospective cohort study with 10 years follow up period in MDR-TB patients in Ethiopia. We included 204 patients who had missed the treatment at least for one day over the course of the treatment (exposed group) and 203 patients who had never interrupted the treatment (unexposed group). We categorized treatment outcome into successful (cured or completed) and unsuccessful (lost to follow up, failed or died). We described treatment interruption by the length of time between interruptions, time to first interruption, total number of interruption episodes and percent of missed doses. We used Poisson regression model with robust standard error to determine the association between treatment interruption and outcome. 82% of the patients interrupted the treatment in the first six month of treatment period, and considerable proportion of patients demonstrated long intervals between two consecutive interruptions. Treatment interruption was significantly associated with unsuccessful treatment outcome (Adjusted Risk Ratio (ARR) = 1.9; 95% CI (1.4–2.6)). Early identification of patients at high risk of interruption is vital in improving successful treatment outcome.
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Miller AC, Livchits V, Ahmad Khan F, Atwood S, Kornienko S, Kononenko Y, Vasilyeva I, Keshavjee S. Turning Off the Tap: Using the FAST Approach to Stop the Spread of Drug-Resistant Tuberculosis in the Russian Federation. J Infect Dis 2019; 218:654-658. [PMID: 29659912 PMCID: PMC6047444 DOI: 10.1093/infdis/jiy190] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 04/04/2018] [Indexed: 11/25/2022] Open
Abstract
Background We report the association of the FAST strategy (find cases actively, separate safely, and treat effectively) with reduction of hospital-based acquisition of multidrug-resistant tuberculosis in the Russian Federation. Methods We used preintervention and postintervention cohorts in 2 Russian hospitals to determine whether the FAST strategy was associated with a reduced odds of converting MDR tuberculosis within 12 months among patients with tuberculosis susceptible to isoniazid and rifampin at baseline. Results Sixty-three of 709 patients (8.9%) with isoniazid and rifampin–susceptible tuberculosis acquired MDR tuberculosis; 55 (12.2%) were in the early cohort, and 8 (3.1%) were in the FAST cohort. The FAST strategy was associated with a reduced odds (adjusted odds ratio, 0.16; 95% confidence interval, .07–.39) and 9.2% absolute reduction in the risk of MDR tuberculosis acquisition. Conclusion Use of the FAST strategy in 2 Russian hospitals was associated with significantly less MDR tuberculosis 12 months after implementation.
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Affiliation(s)
- Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Faiz Ahmad Khan
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Yulia Kononenko
- Republic of Karelia Clinical Tuberculosis Hospital, Petrozavodsk, Russian Federation
| | - Irina Vasilyeva
- Ministry of Health of the Russian Federation.,Research Institute of Phthisiopulmonology, I. M. Sechenov First Moscow State Medical University, Moscow
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.,Partners in Health, Boston, Massachusetts
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Abandonment of therapy in multidrug-resistant tuberculosis: Associated factors in a region with a high burden of the disease in Perú. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2019; 39:44-57. [PMID: 31529833 DOI: 10.7705/biomedica.v39i3.4564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Indexed: 11/21/2022]
Abstract
Introduction: In the context of multidrug-resistant tuberculosis, abandonment of therapy represents a serious public health problem that affects the quality of life of patients, families, and communities. Managing this phenomenon places a burden on health systems since it causes free sources of transmission in the community, thereby increasing prevalence and mortality. Thus, there is a need to study factors associated with this problem.
Objective: This study sought to identify risk factors associated with the abandonment of therapy by patients with multidrug-resistant tuberculosis in the Peruvian region of Callao.
Materials and methods: We conducted an analytical case-control study (cases=80; controls=180) in patients under treatment from January 1st, 2010, to December 31, 2012. Risk factors were identified using logistic regression; odds ratios (OR) and 95% confidence intervals (CI) were calculated.
Results: The multivariate analysis identified the following risk factors: Being unaware of the disease (OR=23.10; 95% CI 3.6-36.79; p=0.002); not believing in healing (OR=117.34; 95% CI 13.57-124.6; p=0.000); not having social support (OR=19.16; 95% CI 1.32-27.77; p=0.030); considering the hours of attention to be inadequate (OR=78.13; 95% CI 4.84-125.97; p=0.002), and not receiving laboratory reports (OR=46.13; 95% CI 2.85-74.77; p=0.007).
Conclusion: Health services must focus on the early detection of conditions that may represent risk factors to proactively implement effective, rapid and high-impact interventions.
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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: 57] [Impact Index Per Article: 11.4] [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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Koomen LEM, Burger R, van Doorslaer EKA. Effects and determinants of tuberculosis drug stockouts in South Africa. BMC Health Serv Res 2019; 19:213. [PMID: 30943967 PMCID: PMC6448237 DOI: 10.1186/s12913-019-3972-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 02/25/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The frequent occurrence of medicine stockouts represents a significant obstacle to tuberculosis control in South Africa. Stockouts can lead to treatment alterations or interruptions, which can impact treatment outcomes. This study investigates the determinants and effects of TB drug stockouts and whether poorer districts are disproportionately affected. METHODS TB stockout data, health system indicators and TB treatment outcomes at the district level were extracted from the District Health Barometer for the years 2011, 2012 and 2013. Poverty terciles were constructed using the Census 2011 data to investigate whether stockouts and poor treatment outcomes were more prevalent in more impoverished districts. Fixed-effects regressions were used to estimate the effects of TB stockouts on TB treatment outcomes. RESULTS TB stockouts occurred in all provinces but varied across provinces and years. Regression analysis showed a significant association between district per capita income and stockouts: a 10% rise in income was associated with an 8.50% decline in stockout proportions. In terms of consequences, after controlling for unobserved time invariant heterogeneity between districts, a 10% rise in TB drug stockouts was found to lower the cure rate by 2.10% (p < 0.01) and the success rate by 1.42% (p < 0.01). These effects were found to be larger in poorer districts. CONCLUSIONS The unequal spread of TB drug stockouts adds to the socioeconomic inequality in TB outcomes. Not only are stockouts more prevalent in poorer parts of South Africa, they also have a more severe impact on TB treatment outcomes in poorer districts. This suggests that efforts to cut back TB drug stockouts would not only improve TB treatment outcomes on average, they are also likely to improve equity because a disproportionate share of this burden is currently borne by the poorer districts.
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Affiliation(s)
- L. E. M. Koomen
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, PA 3062 The Netherlands
| | - R. Burger
- Department of Economics, Stellenbosch University, Stellenbosch, South Africa
| | - E. K. A. van Doorslaer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, PA 3062 The Netherlands
- Department of Economics, Stellenbosch University, Stellenbosch, South Africa
- Erasmus School of Economics, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, PA 3062 The Netherlands
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Zegeye A, Dessie G, Wagnew F, Gebrie A, Islam SMS, Tesfaye B, Kiross D. Prevalence and determinants of anti-tuberculosis treatment non-adherence in Ethiopia: A systematic review and meta-analysis. PLoS One 2019; 14:e0210422. [PMID: 30629684 PMCID: PMC6328265 DOI: 10.1371/journal.pone.0210422] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 12/22/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tuberculosis is a global public health problem. One of the overarching dilemmas and challenges facing most tuberculosis program is non-adherence to treatment. However, in Ethiopia there are few studies with variable and inconsistent findings regarding non-adherence to treatment for tuberculosis. METHODS This systematic review and meta-analysis was conducted to determine the prevalence of non-adherence to tuberculosis treatment and its determinants in Ethiopia. Biomedical databases including PubMed, Google Scholar, Science Direct, HINARI, EMBASE and Cochrane Library were systematically and comprehensively searched. To estimate the pooled prevalence, studies reporting the prevalence of adherence or non-adherence to tuberculosis treatment and its determinants were included. Data were extracted using a standardized data extraction tool prepared in Microsoft Excel and transferred to STATA/se version-14 statistical software for further analyses. To assess heterogeneity, the Cochrane Q test statistics and I2 test were performed. Since the included studies exhibited high heterogeneity, a random effects model meta- analysis was used to estimate the pooled prevalence of non-adherence to tuberculosis treatment. Finally, the association between determinant factors and non-adherence to tuberculosis treatment was assessed. RESULTS The result of 13 studies revealed that the pooled prevalence of non-adherence to tuberculosis treatment in Ethiopia was found to be 21.29% (95% CI: 15.75, 26.68). In the subgroup analysis, the highest prevalence was observed in Southern Nations and Nationalities of Ethiopia, 23.61% (95% CI: 21.05, 26.17) whereas the lowest prevalence was observed in Amhara region, 10.0% (95% CI: 6.48, 13.17.0;). Forgetfulness (OR = 3.22, 95% CI = 2.28, 4.53), fear side effect of the drugs (OR = 1.93, 95% CI = 1.37, 2.74), waiting time ≥ 1 hour during service (OR = 4.88, 95% CI = 3.44, 6.91) and feeling distance to health institution is long (OR = 5.35, 95% CI = 4.00, 7.16) were found to be determinants of non-adherence to tuberculosis treatment. CONCLUSION In this meta-analysis, the pooled prevalence of non-adherence to tuberculosis treatment in Ethiopia was high. Forgetfulness, fear of side effect of the drugs, long waiting time (≥1 hour) during service and feeling distance to health institution is long were the main risk factors for non-adherence to tuberculosis treatment in Ethiopia. Early monitoring of the side effects and other reasons which account for missing medication may increase medication adherence in patients with tuberculosis in Ethiopia.
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Affiliation(s)
- Abriham Zegeye
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Getnet Dessie
- Lecturer of Nursing, Department of Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Fasil Wagnew
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Alemu Gebrie
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geeland, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Bekele Tesfaye
- Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Dessalegn Kiross
- Department of Psychiatry, College of Medicine and Health Science, Adigrat University, Ethiopia
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27
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Abstract
We report GSK3011724A (DG167) as a binary inhibitor of β-ketoacyl-ACP synthase (KasA) in Mycobacterium tuberculosis Genetic and biochemical studies established KasA as the primary target. The X-ray crystal structure of the KasA-DG167 complex refined to 2.0-Å resolution revealed two interacting DG167 molecules occupying nonidentical sites in the substrate-binding channel of KasA. The binding affinities of KasA to DG167 and its analog, 5g, which binds only once in the substrate-binding channel, were determined, along with the KasA-5g X-ray crystal structure. DG167 strongly augmented the in vitro activity of isoniazid (INH), leading to synergistic lethality, and also synergized in an acute mouse model of M. tuberculosis infection. Synergistic lethality correlated with a unique transcriptional signature, including upregulation of oxidoreductases and downregulation of molecular chaperones. The lead structure-activity relationships (SAR), pharmacokinetic profile, and detailed interactions with the KasA protein that we describe may be applied to evolve a next-generation therapeutic strategy for tuberculosis (TB).IMPORTANCE Cell wall biosynthesis inhibitors have proven highly effective for treating tuberculosis (TB). We discovered and validated members of the indazole sulfonamide class of small molecules as inhibitors of Mycobacterium tuberculosis KasA-a key component for biosynthesis of the mycolic acid layer of the bacterium's cell wall and the same pathway as that inhibited by the first-line antitubercular drug isoniazid (INH). One lead compound, DG167, demonstrated synergistic lethality in combination with INH and a transcriptional pattern consistent with bactericidality and loss of persisters. Our results also detail a novel dual-binding mechanism for this compound as well as substantial structure-activity relationships (SAR) that may help in lead optimization activities. Together, these results suggest that KasA inhibition, specifically, that shown by the DG167 series, may be developed into a potent therapy that can synergize with existing antituberculars.
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29
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Abstract
Tuberculosis kills more people worldwide than any other single infectious disease agent, a threat made more dire by the spread of drug-resistant strains of Mycobacterium tuberculosis (Mtb). Development of new vaccines capable of preventing TB disease and new Mtb infection are an essential component of the strategy to combat the TB epidemic. Accordingly, the WHO considers the development of new TB vaccines a major public health priority. In October 2017, the WHO convened a consultation with global leaders in the TB vaccine development field to emphasize the WHO commitment to this effort and to facilitate creative approaches to the discovery and development of TB vaccine candidates. This review summarizes the presentations at this consultation, updated with scientific literature references, and includes discussions of the public health need for a TB vaccine; the status of efforts to develop vaccines to replace or potentiate BCG in infants and develop new TB vaccines for adolescents and adults; strategies being employed to diversify vaccine platforms; and new animal models being developed to facilitate TB vaccine development. A perspective on the status of these efforts from the major funders and organizational contributors also is included. This presentation highlights the extraordinary progress being made to develop new TB vaccines and provided a clear picture of the exciting development pathways that are being explored.
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Affiliation(s)
| | | | - Johan Vekemans
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
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30
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Abstract
Tuberculosis kills more people worldwide than any other single infectious disease agent, a threat made more dire by the spread of drug-resistant strains of Mycobacterium tuberculosis (Mtb). Development of new vaccines capable of preventing TB disease and new Mtb infection are an essential component of the strategy to combat the TB epidemic. Accordingly, the WHO considers the development of new TB vaccines a major public health priority. In October 2017, the WHO convened a consultation with global leaders in the TB vaccine development field to emphasize the WHO commitment to this effort and to facilitate creative approaches to the discovery and development of TB vaccine candidates. This review summarizes the presentations at this consultation, updated with scientific literature references, and includes discussions of the public health need for a TB vaccine; the status of efforts to develop vaccines to replace or potentiate BCG in infants and develop new TB vaccines for adolescents and adults; strategies being employed to diversify vaccine platforms; and new animal models being developed to facilitate TB vaccine development. A perspective on the status of these efforts from the major funders and organizational contributors also is included. This presentation highlights the extraordinary progress being made to develop new TB vaccines and provided a clear picture of the exciting development pathways that are being explored.
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Affiliation(s)
| | | | - Johan Vekemans
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
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31
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Time to sputum culture conversion and its determinants among Multi-drug resistant Tuberculosis patients at public hospitals of the Amhara Regional State: A multicenter retrospective follow up study. PLoS One 2018; 13:e0199320. [PMID: 29927980 PMCID: PMC6013102 DOI: 10.1371/journal.pone.0199320] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 05/09/2018] [Indexed: 12/01/2022] Open
Abstract
Background In Ethiopia, Multi-drug resistant Tuberculosis (MDR-TB) is one of the major public health problems that need great attention. Time to sputum culture conversion is often used as an early predictive value for the final treatment outcome. Although guidelines for MDR-TB are frequently designed, medication freely provided, and centers for treatment duly expanded, studies on time to sputum culture conversion have been very limited in Ethiopia. This study was aimed at determining the time to sputum culture conversion and the determinants among MDR-TB patients at public Hospitals of the Amhara Regional State. Methods A retrospective follow up study was conducted between September 2010 and December 2016. Three hundred ninety two MDR-TB patients were included in the study. Parametric frailty models were fitted and Cox Snell residual was used for goodness of fit, which the Akaike’s information criteria was used for model selection. Adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was reported to show the strength of association. Result Out of the 392 participants, sputum culture changed for 340(86.7%) during the follow up period. The median culture conversion time in this study was 65 (60–70 days). Alcohol drinking (AHR = 3.79, 95%CI = 1.65–8.68), sputum smear grading +2 (AHR = 0.39, 95%CI 0.19–0.79), smear grading +3 (AHR = 0.30, CI = 0.14–064), cavitations (AHR = 0.36, 95%CI = 0.19–0.68), and consolidation (AHR = 0.29, CI = 0.13–0.69) were the determinants of time to sputum culture conversion. Conclusion In this study, time to sputum culture was rapid as compared to 4 months WHO recommendation. Alcohol drinking, sputum smear grading, cavitations and consolidations were found to be the determinants of time to sputum culture conversion. Therefore, providing a special attention to patients who had baseline radiological finding is recommended, high bacillary load and patients with a history of alcohol intake at baseline should be given priority.
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Comorbidities and treatment outcomes in multidrug resistant tuberculosis: a systematic review and meta-analysis. Sci Rep 2018; 8:4980. [PMID: 29563561 PMCID: PMC5862834 DOI: 10.1038/s41598-018-23344-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/09/2018] [Indexed: 01/14/2023] Open
Abstract
Little is known about the impact of comorbidities on multidrug resistant (MDR) and extensively drug resistant (XDR) tuberculosis (TB) treatment outcomes. We aimed to examine the effect of human immunodeficiency virus (HIV), diabetes, chronic kidney disease (CKD), alcohol misuse, and smoking on MDR/XDRTB treatment outcomes. We searched MEDLINE, EMBASE, Cochrane Central Registrar and Cochrane Database of Systematic Reviews as per PRISMA guidelines. Eligible studies were identified and treatment outcome data were extracted. We performed a meta-analysis to generate a pooled relative risk (RR) for unsuccessful outcome in MDR/XDRTB treatment by co-morbidity. From 2457 studies identified, 48 reported on 18,257 participants, which were included in the final analysis. Median study population was 235 (range 60-1768). Pooled RR of unsuccessful outcome was higher in people living with HIV (RR = 1.41 [95%CI: 1.15-1.73]) and in people with alcohol misuse (RR = 1.45 [95%CI: 1.21-1.74]). Outcomes were similar in people with diabetes or in people that smoked. Data was insufficient to examine outcomes in exclusive XDRTB or CKD cohorts. In this systematic review and meta-analysis, alcohol misuse and HIV were associated with higher pooled OR of an unsuccessful outcome in MDR/XDRTB treatment. Further research is required to understand the role of comorbidities in driving unsuccessful treatment outcomes.
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Ambaw F, Mayston R, Hanlon C, Medhin G, Alem A. Untreated depression and tuberculosis treatment outcomes, quality of life and disability, Ethiopia. Bull World Health Organ 2018; 96:243-255. [PMID: 29695881 PMCID: PMC5872008 DOI: 10.2471/blt.17.192658] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 12/21/2022] Open
Abstract
Objective To investigate the association between comorbid depression and tuberculosis treatment outcomes, quality of life and disability in Ethiopia. Methods The study involved 648 consecutive adults treated for tuberculosis at 14 primary health-care facilities. All were assessed at treatment initiation (i.e. baseline) and after 2 and 6 months. We defined probable depression as a score of 10 or above on the nine-item Patient Health Questionnaire. Data on treatment default, failure and success and on death were obtained from tuberculosis registers. Quality of life was assessed using a visual analogue scale and we calculated disability scores using the World Health Organization’s Disability Assessment Scale. Using multivariate Poisson regression analysis, we estimated the association between probable depression at baseline and treatment outcomes and death. Results Untreated depression at baseline was independently associated with tuberculosis treatment default (adjusted risk ratio, aRR: 9.09; 95% confidence interval, CI: 6.72 to 12.30), death (aRR: 2.99; 95% CI: 1.54 to 5.78), greater disability (β: 0.83; 95% CI: 0.67 to 0.99) and poorer quality of life (β: −0.07; 95% CI: −0.07 to −0.06) at 6 months. Participants with probable depression had a lower mean quality-of-life score than those without (5.0 versus 6.0, respectively; P < 0.001) and a higher median disability score (22.0 versus 14.0, respectively; P < 0.001) at 6 months. Conclusion Untreated depression in people with tuberculosis was associated with worse treatment outcomes, poorer quality of life and greater disability. Health workers should be given the support needed to provide depression care for people with tuberculosis.
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Affiliation(s)
- Fentie Ambaw
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, PO Box 1985, Bahir Dar, Ethiopia
| | - Rosie Mayston
- Centre for Global Mental Health, King's College London, London, England
| | - Charlotte Hanlon
- Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Girmay Medhin
- Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atalay Alem
- Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
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Choi H, Chung H, Muntaner C, Lee M, Kim Y, Barry CE, Cho SN. The impact of social conditions on patient adherence to pulmonary tuberculosis treatment. Int J Tuberc Lung Dis 2018; 20:948-54. [PMID: 27287649 DOI: 10.5588/ijtld.15.0759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Tuberculosis (TB) remains one of the main concerns in global health. One of the main threats to treatment success is patient non-adherence to anti-tuberculosis treatment. OBJECTIVE To identify the relation between social conditions and treatment adherence in a prospective cohort setting in an intermediate TB burden country. DESIGN To identify associations between poor adherence and social conditions, including educational level, type of residence and occupation, we constructed hierarchical logistic regression models. RESULTS A total of 551 participants were included in the study. Low educational levels, poor housing and occupations in the construction and manufacturing industries and service sectors were associated with poor adherence; this association was likely to be differentiated by previous history of anti-tuberculosis treatment. CONCLUSION Policy making should focus on improving the social conditions of patients by working towards better housing conditions and providing health promoting working conditions to enable treatment adherence.
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Affiliation(s)
- H Choi
- Clinical Research Section, International Tuberculosis Research Center, Changwon, Department of Research and Development, The Korean Institute of Tuberculosis, Cheongju, Seoul, Republic of Korea
| | - H Chung
- BK21PLUS Program in Embodiment: Health-Society Interaction, Department of Public Health Sciences, Graduate School, Korea University, Seoul, Republic of Korea; School of Health Policy & Management, College of Health Science, Korea University, Seoul, Republic of Korea
| | - C Muntaner
- Bloomberg Faculty of Nursing, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - M Lee
- Clinical Research Section, International Tuberculosis Research Center, Changwon, Republic of Korea
| | - Y Kim
- Clinical Research Section, International Tuberculosis Research Center, Changwon, Republic of Korea
| | - C E Barry
- Tuberculosis Research Section, Laboratory of Clinical Infectious Disease, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - S-N Cho
- Clinical Research Section, International Tuberculosis Research Center, Changwon, Seoul, Republic of Korea
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Social support a key factor for adherence to multidrug-resistant tuberculosis treatment. ACTA ACUST UNITED AC 2018; 65:41-47. [DOI: 10.1016/j.ijtb.2017.05.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 03/29/2017] [Accepted: 05/11/2017] [Indexed: 11/21/2022]
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36
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Tola HH, Karimi M, Yekaninejad MS. Effects of sociodemographic characteristics and patients' health beliefs on tuberculosis treatment adherence in Ethiopia: a structural equation modelling approach. Infect Dis Poverty 2017; 6:167. [PMID: 29241454 PMCID: PMC5731079 DOI: 10.1186/s40249-017-0380-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 11/30/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Patients' beliefs are a major factor affecting tuberculosis (TB) treatment adherence. However, there has been little use of Health Belief Model (HBM) in determining the pathway effect of patients' sociodemographic characteristics and beliefs on TB treatment adherence. Therefore, this study was aimed at determining the effect of sociodemographic characteristics and patients' health beliefs on TB treatment adherence based on the HBM concept in Ethiopia. METHODS A cross-sectional study was conducted in Addis Ababa, Ethiopia among TB patients undertaking treatment. Thirty health centres were randomly selected and one hospital was purposely chosen. Six hundred and ninety-eight TB patients who had been on treatment for 1-2 month, were aged 18 years or above, and had the mental capability to provide consent were enrolled consecutively with non-probability sampling technique from the TB registration book until required sample size achieved. Structured questionnaires were used to collect data. Structural equation modelling was employed to assess the pathway relationship between sociodemographic characteristics, patients' beliefs, and treatment adherence. RESULTS Of the 698 enrolled participants, 401 (57.4%) were male and 490 (70.2%) were aged 35 years and below. The mean age of participants was 32 (± 11.7) and the age range was 18-90 years. Perceived barrier/benefit was shown to be a significant direct negative effect on TB treatment adherence (ß = -0.124, P = 0.032). In addition, cue to action (ß = -0.68, P ≤ 0.001) and psychological distress (ß = 0.08, P < 0.001) were shown significant indirect effects on TB treatment adherence through perceived barrier/benefit. CONCLUSIONS Interventions intended to decrease perceived barriers and maximize perceived benefits should be implemented to enhance TB treatment adherence. In addition, it is crucial that counselling is incorporated with the regular directly observed therapy program. Motivators (cue to actions) such as friends, family, healthcare workers, and the media could be used to promote TB treatment adherence.
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Affiliation(s)
- Habteyes Hailu Tola
- Department of Epidemiology and Biostatics, School of Public Health, Tehran University of Medical Sciences, International Campus, Tehran, Iran
- Tuberculosis/HIV Research Directorate, Ethiopian Public Health Institute, P.O. Box 1242, /5654 Addis Ababa, Ethiopia
| | - Mehrdad Karimi
- Department of Epidemiology and Biostatics, School of Public Health, Tehran University of Medical Sciences, International Campus, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatics, School of Public Health, Tehran University of Medical Sciences, International Campus, Tehran, Iran
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Drug addiction and alcoholism as predictors for tuberculosis treatment default in Brazil: a prospective cohort study. Epidemiol Infect 2017; 145:3516-3524. [PMID: 29173226 DOI: 10.1017/s0950268817002631] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This study aimed to evaluate the risk factors for tuberculosis (TB) treatment default in a priority city for disease control in Brazil. A cohort of TB cases diagnosed from 2008 to 2009 was followed up from patients' entry into three outpatient sites, in Juiz de Fora, Minas Gerais (Brazil), until the recording of the outcomes. Drug addiction, alcoholism and treatment site appeared to be independently associated with default. Current users of crack as the hardest drug (odds ratio (OR) 12·25, 95% confidence interval (CI) 3·04-49·26) were more likely to default than other hard drug users (OR 5·67, 95% CI 1·34-24·03), former users (OR 4·12, 95% CI 1·11-15·20) and those not known to use drugs (reference group). Consumers at high risk of alcoholism (OR 2·94, 95% CI 1·08-7·99) and those treated in an outpatient hospital unit (OR 8·22, 95% CI 2·79-24·21%) also were more likely to default. Our results establish that substance abuse was independently associated with default. National TB programmes might be more likely to achieve their control targets if they include interventions aimed at improving adherence and cure rates, by diagnosing and treating substance abuse concurrently with standard TB therapy.
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Aibana O, Slavuckij A, Bachmaha M, Krasiuk V, Rybak N, Flanigan TP, Petrenko V, Murray MB. Patient predictors of poor drug sensitive tuberculosis treatment outcomes in Kyiv Oblast, Ukraine. F1000Res 2017; 6:1873. [PMID: 31839924 PMCID: PMC6859782 DOI: 10.12688/f1000research.12687.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2019] [Indexed: 10/05/2023] Open
Abstract
Background: Ukraine has high rates of poor treatment outcomes among drug sensitive tuberculosis (DSTB) patients, while global treatment success rates for DSTB remain high. We evaluated baseline patient factors as predictors of poor DSTB treatment outcomes. Methods: We conducted a retrospective analysis of new drug sensitive pulmonary TB patients treated in Kyiv Oblast, Ukraine between November 2012 and October 2014. We defined good treatment outcomes as cure or completion and poor outcomes as death, default or treatment failure. We performed logistic regression analyses, using routine program data, to identify baseline patient factors associated with poor outcomes. Results: Among 302 patients, 193 (63.9%) experienced good treatment outcomes while 39 (12.9%) failed treatment, 34 (11.3%) died, and 30 (9.9%) defaulted. In the multivariate analysis, HIV positive patients on anti-retroviral therapy (ART) [OR 3.50; 95% CI 1.46 - 8.42; p 0.005] or without ART (OR 4.12; 95% CI 1.36 - 12.43; p 0.01) were at increased risk of poor outcomes. Alcohol abuse (OR 1.81; 95% CI 0.93 - 3.55; p 0.08) and smear positivity (OR 1.75; 95% CI 1.03 - 2.97; p 0.04) were also associated with poor treatment outcomes. Conclusions: High rates of poor outcomes among patients with newly diagnosed drug sensitive TB in Kyiv Oblast, Ukraine highlight the urgent need for programmatic interventions, especially aimed at patients with the highest risk of poor outcomes.
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Affiliation(s)
- Omowunmi Aibana
- Division of General Internal Medicine, The University of Texas Health Science Center at Houston - McGovern Medical School, Houston, TX, USA
| | | | - Mariya Bachmaha
- Brown University School of Public Health, Providence, RI, USA
| | - Viatcheslav Krasiuk
- Department of Pulmonology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Natasha Rybak
- Division of Infectious Diseases, The Miriam Hospital, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Timothy P. Flanigan
- Division of Infectious Diseases, The Miriam Hospital, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Vasyl Petrenko
- Department of Pulmonology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Megan B. Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Aibana O, Slavuckij A, Bachmaha M, Krasiuk V, Rybak N, Flanigan TP, Petrenko V, Murray MB. Patient predictors of poor drug sensitive tuberculosis treatment outcomes in Kyiv Oblast, Ukraine. F1000Res 2017; 6:1873. [PMID: 31839924 PMCID: PMC6859782 DOI: 10.12688/f1000research.12687.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2019] [Indexed: 01/01/2023] Open
Abstract
Background: Ukraine has high rates of poor treatment outcomes among drug sensitive tuberculosis (DSTB) patients, while global treatment success rates for DSTB remain high. We evaluated baseline patient factors as predictors of poor DSTB treatment outcomes. Methods: We conducted a retrospective analysis of new drug sensitive pulmonary TB patients treated in Kyiv Oblast, Ukraine between November 2012 and October 2014. We defined good treatment outcomes as cure or completion and poor outcomes as death, default or treatment failure. We performed logistic regression analyses, using routine program data, to identify baseline patient factors associated with poor outcomes. Results: Among 302 patients, 193 (63.9%) experienced good treatment outcomes while 39 (12.9%) failed treatment, 34 (11.3%) died, and 30 (9.9%) defaulted. In the multivariate analysis, HIV positive patients on anti-retroviral therapy (ART) [OR 3.50; 95% CI 1.46 - 8.42; p 0.005] or without ART (OR 4.12; 95% CI 1.36 - 12.43; p 0.01) were at increased risk of poor outcomes. Alcohol abuse (OR 1.81; 95% CI 0.93 - 3.55; p 0.08) and smear positivity (OR 1.75; 95% CI 1.03 - 2.97; p 0.04) were also associated with poor treatment outcomes. Conclusions: High rates of poor outcomes among patients with newly diagnosed drug sensitive TB in Kyiv Oblast, Ukraine highlight the urgent need for programmatic interventions, especially aimed at patients with the highest risk of poor outcomes.
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Affiliation(s)
- Omowunmi Aibana
- Division of General Internal Medicine, The University of Texas Health Science Center at Houston - McGovern Medical School, Houston, TX, USA
| | | | - Mariya Bachmaha
- Brown University School of Public Health, Providence, RI, USA
| | - Viatcheslav Krasiuk
- Department of Pulmonology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Natasha Rybak
- Division of Infectious Diseases, The Miriam Hospital, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Timothy P. Flanigan
- Division of Infectious Diseases, The Miriam Hospital, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Vasyl Petrenko
- Department of Pulmonology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Megan B. Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Wohlleben J, Makhmudova M, Saidova F, Azamova S, Mergenthaler C, Verver S. Risk factors associated with loss to follow-up from tuberculosis treatment in Tajikistan: a case-control study. BMC Infect Dis 2017; 17:543. [PMID: 28778187 PMCID: PMC5545046 DOI: 10.1186/s12879-017-2655-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 07/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are very few studies on reasons for loss to follow-up from TB treatment in Central Asia. This study assessed risk factors for LTFU and compared their occurrence with successfully treated (ST) patients in Tajikistan. METHODS This study took place in all TB facilities in the 19 districts with at least 5 TB patients registered as loss to follow-up (LTFU) from treatment. With a matched case control design we included all LTFU patients registered in the selected districts in 2011 and 2012 as cases, with ST patients from the same districts being controls. Data were copied from patient records and registers. Conditional logistic regressions were run to analyse associations between collected variables and LTFU as dependent variable. RESULTS Three hundred cases were compared to 592 controls. Half of the cases had migrated or moved. In multivariate analysis, risk factors associated with increased LTFU were migration to another country (OR 10.6, 95% CI 6.12-18.4), moving within country (OR 11.0, 95% CI 3.50-34.9), having side effects of treatment (OR 3.67, 95% CI 1.68-8.00) and being previously treated for TB (OR 2.03, 95% CI 1.05-3.93). Medical staff also mentioned patient refusal, stigma and family problems as risk factors. CONCLUSIONS LTFU of TB patients in Tajikistan is largely a result of migration, and to a lesser extent associated with side-effects and previous treatment. There is a need to strengthen referral between health facilities within Tajikistan and with neighbouring countries and support patients with side effects and/or previous TB to prevent loss to follow-up from treatment.
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Affiliation(s)
- Jessica Wohlleben
- KNCV Tuberculosis Foundation, Evidence team, The Hague, The Netherlands.,Department of International Health, University Maastricht, Maastricht, The Netherlands
| | | | - Firuza Saidova
- KNCV TB Foundation, country office Tajikistan, Dushanbe, Tajikistan
| | - Shahnoza Azamova
- Republican Center for protection of population from TB, Dushanbe, Tajikistan
| | - Christina Mergenthaler
- KNCV Tuberculosis Foundation, Evidence team, The Hague, The Netherlands.,Present address: Royal Tropical Institute (KIT), Amsterdam, The Netherlands
| | - Suzanne Verver
- KNCV Tuberculosis Foundation, Evidence team, The Hague, The Netherlands. .,Academic Medical Centre, AIGHD, Amsterdam, the Netherlands. .,Present address: Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
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Shelby PW, Lia MP, Israel A. Collaborative public-private initiatives targeting multidrug-resistant tuberculosis (MDR-TB) supported by the Lilly MDR-TB Partnership: experiences in 2012-2016. J Healthc Leadersh 2017; 9:47-57. [PMID: 29355239 PMCID: PMC5774453 DOI: 10.2147/jhl.s130207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Since 2003, the Lilly Foundation has supported the noncommercial Lilly MDR-TB Partnership, which involves more than 45 local, national, global, and nongovernmental organizations and governments. The aim of the Lilly MDR-TB Partnership is to achieve significant global impact on multidrug-resistant tuberculosis (MDR-TB) by addressing a series of important local health care needs in highly affected countries: China, India, Russia, and South Africa. The main focus of activities during 2012–2016 was on community needs in primary care. Supported projects seek to make meaningful and measurable progress toward global and national TB objectives. The partnership programs share an overall conceptual approach known as “research, report, advocate”, based on the piloting of novel approaches on a small scale, with outcomes assessed at early stages. The results are analyzed and communicated to governments, health-policy experts, and local and national stakeholders, including those in other countries facing similar MDR-TB challenges. For successful, cost-effective initiatives, the analysis is used as support when advocating for the scaling up of initiatives to regional or national levels. This article discusses representative examples of projects supported by the Lilly MDR-TB Partnership in the time period 2012–2016. The examples illustrate the potential for globally informed, locally designed primary-care collaborations to strengthen health care systems and support TB policies and offer observations to inform future health care public–private partnerships.
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Affiliation(s)
| | | | - Amy Israel
- Lilly Global Health Programs, Geneva, Switzerland
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42
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Bemba ELP, Bopaka RG, Ossibi-Ibara R, Toungou SN, Ossale-Abacka BK, Okemba-Okombi FH, Mboussa J. [Predictive factors of lost to follow-up status during tuberculosis treatment in Brazzaville]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:81-89. [PMID: 28041659 DOI: 10.1016/j.pneumo.2016.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 10/04/2016] [Accepted: 11/10/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The abandonment of TB treatment has consequences both individual by increasing the risk of drug resistance and collective seeding entourage. The aim of this study is to determine the risk factors to be lost sight of during TB treatment. PATIENTS AND METHODS He acted in a prospective cohort study of patients with microbiologically confirmed tuberculosis, beginning TB treatment and followed for six months. The comparative study between 75 patients lost (PL) and 108 no-patients lost (NPL). RESULTS The presence of a large distance between the home center [OR=3.73 (1.21-11.05), P=0.022], to alcohol poisoning [OR=3.80 (3.80-11.3), P=0.031], the number of compressed high (depending on the patient) [OR=7.64 (1.96-29.8), P=0.007], stigma [OR=7.85 (1.87-33), P=0.004] were related to PL status. For against the implementation of the directly observed treatment by the community [OR=0.2 (0.03-0.92), P=0.04], be [OR=0.18 (0.05-0.63), P=0.07] were linked to reduced risk of being lost. CONCLUSION Reducing the rate of PL requires patient compliance with good attitudes in post-education and ease of access to TB centers.
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Affiliation(s)
- E L P Bemba
- Faculté des sciences de la santé, université Marien Ngouabi, Brazzaville, Congo; Service de pneumologie, CHU de Brazzaville, BP : 1846, Brazzaville, Congo.
| | - R G Bopaka
- Service de pneumologie, CHU de Brazzaville, BP : 1846, Brazzaville, Congo
| | - R Ossibi-Ibara
- Faculté des sciences de la santé, université Marien Ngouabi, Brazzaville, Congo; Service des maladies infectieuses et tropicales, CHU de Brazzaville, Brazzaville, Congo
| | - S N Toungou
- Service de pneumologie, CHU de Brazzaville, BP : 1846, Brazzaville, Congo
| | - B K Ossale-Abacka
- Service de pneumologie, CHU de Brazzaville, BP : 1846, Brazzaville, Congo
| | - F H Okemba-Okombi
- Service de pneumologie, CHU de Brazzaville, BP : 1846, Brazzaville, Congo; Programme national de lutte contre la tuberculose (PNLT), Brazzaville, Congo
| | - J Mboussa
- Faculté des sciences de la santé, université Marien Ngouabi, Brazzaville, Congo; Service de pneumologie, CHU de Brazzaville, BP : 1846, Brazzaville, Congo
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Dheda K, Gumbo T, Maartens G, Dooley KE, McNerney R, Murray M, Furin J, Nardell EA, London L, Lessem E, Theron G, van Helden P, Niemann S, Merker M, Dowdy D, Van Rie A, Siu GKH, Pasipanodya JG, Rodrigues C, Clark TG, Sirgel FA, Esmail A, Lin HH, Atre SR, Schaaf HS, Chang KC, Lange C, Nahid P, Udwadia ZF, Horsburgh CR, Churchyard GJ, Menzies D, Hesseling AC, Nuermberger E, McIlleron H, Fennelly KP, Goemaere E, Jaramillo E, Low M, Jara CM, Padayatchi N, Warren RM. The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis. THE LANCET. RESPIRATORY MEDICINE 2017; 5:S2213-2600(17)30079-6. [PMID: 28344011 DOI: 10.1016/s2213-2600(17)30079-6] [Citation(s) in RCA: 377] [Impact Index Per Article: 53.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 10/24/2016] [Accepted: 12/08/2016] [Indexed: 12/25/2022]
Abstract
Global tuberculosis incidence has declined marginally over the past decade, and tuberculosis remains out of control in several parts of the world including Africa and Asia. Although tuberculosis control has been effective in some regions of the world, these gains are threatened by the increasing burden of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis. XDR tuberculosis has evolved in several tuberculosis-endemic countries to drug-incurable or programmatically incurable tuberculosis (totally drug-resistant tuberculosis). This poses several challenges similar to those encountered in the pre-chemotherapy era, including the inability to cure tuberculosis, high mortality, and the need for alternative methods to prevent disease transmission. This phenomenon mirrors the worldwide increase in antimicrobial resistance and the emergence of other MDR pathogens, such as malaria, HIV, and Gram-negative bacteria. MDR and XDR tuberculosis are associated with high morbidity and substantial mortality, are a threat to health-care workers, prohibitively expensive to treat, and are therefore a serious public health problem. In this Commission, we examine several aspects of drug-resistant tuberculosis. The traditional view that acquired resistance to antituberculous drugs is driven by poor compliance and programmatic failure is now being questioned, and several lines of evidence suggest that alternative mechanisms-including pharmacokinetic variability, induction of efflux pumps that transport the drug out of cells, and suboptimal drug penetration into tuberculosis lesions-are likely crucial to the pathogenesis of drug-resistant tuberculosis. These factors have implications for the design of new interventions, drug delivery and dosing mechanisms, and public health policy. We discuss epidemiology and transmission dynamics, including new insights into the fundamental biology of transmission, and we review the utility of newer diagnostic tools, including molecular tests and next-generation whole-genome sequencing, and their potential for clinical effectiveness. Relevant research priorities are highlighted, including optimal medical and surgical management, the role of newer and repurposed drugs (including bedaquiline, delamanid, and linezolid), pharmacokinetic and pharmacodynamic considerations, preventive strategies (such as prophylaxis in MDR and XDR contacts), palliative and patient-orientated care aspects, and medicolegal and ethical issues.
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Affiliation(s)
- Keertan Dheda
- Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
| | - Tawanda Gumbo
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kelly E Dooley
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ruth McNerney
- Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Megan Murray
- Department of Global Health and Social Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Edward A Nardell
- TH Chan School of Public Health, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Leslie London
- School of Public Health and Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Grant Theron
- SA MRC Centre for Tuberculosis Research/DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Tygerberg, South Africa
| | - Paul van Helden
- SA MRC Centre for Tuberculosis Research/DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Tygerberg, South Africa
| | - Stefan Niemann
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Schleswig-Holstein, Germany; German Centre for Infection Research (DZIF), Partner Site Borstel, Borstel, Schleswig-Holstein, Germany
| | - Matthias Merker
- Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Schleswig-Holstein, Germany
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Annelies Van Rie
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; International Health Unit, Epidemiology and Social Medicine, Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Gilman K H Siu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China
| | - Jotam G Pasipanodya
- Center for Infectious Diseases Research and Experimental Therapeutics, Baylor Research Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Camilla Rodrigues
- Department of Microbiology, P.D. Hinduja National Hospital & Medical Research Centre, Mumbai, India
| | - Taane G Clark
- Faculty of Infectious and Tropical Diseases and Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Frik A Sirgel
- SA MRC Centre for Tuberculosis Research/DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Tygerberg, South Africa
| | - Aliasgar Esmail
- Lung Infection and Immunity Unit, Department of Medicine, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Sachin R Atre
- Center for Clinical Global Health Education (CCGHE), Johns Hopkins University, Baltimore, MD, USA; Medical College, Hospital and Research Centre, Pimpri, Pune, India
| | - H Simon Schaaf
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kwok Chiu Chang
- Tuberculosis and Chest Service, Centre for Health Protection, Department of Health, Hong Kong SAR, China
| | - Christoph Lange
- Division of Clinical Infectious Diseases, German Center for Infection Research, Research Center Borstel, Borstel, Schleswig-Holstein, Germany; International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany; Department of Medicine, Karolinska Institute, Stockholm, Sweden; Department of Medicine, University of Namibia School of Medicine, Windhoek, Namibia
| | - Payam Nahid
- Division of Pulmonary and Critical Care, San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Zarir F Udwadia
- Pulmonary Department, Hinduja Hospital & Research Center, Mumbai, India
| | | | - Gavin J Churchyard
- Aurum Institute, Johannesburg, South Africa; School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Advancing Treatment and Care for TB/HIV, South African Medical Research Council, Johannesburg, South Africa
| | - Dick Menzies
- Montreal Chest Institute, McGill University, Montreal, QC, Canada
| | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Eric Nuermberger
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Helen McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kevin P Fennelly
- Pulmonary Clinical Medicine Section, Division of Intramural Research, National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Eric Goemaere
- MSF South Africa, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Marcus Low
- Treatment Action Campaign, Johannesburg, South Africa
| | | | - Nesri Padayatchi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), MRC HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
| | - Robin M Warren
- SA MRC Centre for Tuberculosis Research/DST/NRF Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Tygerberg, South Africa
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Nathavitharana RR, Bond P, Dramowski A, Kotze K, Lederer P, Oxley I, Peters JA, Rossouw C, van der Westhuizen HM, Willems B, Ting TX, von Delft A, von Delft D, Duarte R, Nardell E, Zumla A. Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis. Presse Med 2017; 46:e53-e62. [PMID: 28256382 DOI: 10.1016/j.lpm.2017.01.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/04/2017] [Accepted: 01/17/2017] [Indexed: 11/29/2022] Open
Abstract
Healthcare workers (HCWs) play a central role in global tuberculosis (TB) elimination efforts but their contributions are undermined by occupational TB. HCWs have higher rates of latent and active TB than the general population due to persistent occupational TB exposure, particularly in settings where there is a high prevalence of undiagnosed TB in healthcare facilities and TB infection control (TB-IC) programmes are absent or poorly implemented. Occupational health programmes in high TB burden settings are often weak or non-existent and thus data that record the extent of the increased risk of occupational TB globally are scarce. HCWs represent a limited resource in high TB burden settings and occupational TB can lead to workforce attrition. Stigma plays a role in delayed diagnosis, poor treatment outcomes and impaired well-being in HCWs who develop TB. Ensuring the prioritization and implementation of TB-IC interventions and occupational health programmes, which include robust monitoring and evaluation, is critical to reduce nosocomial TB transmission to patients and HCWs. The provision of preventive therapy for HCWs with latent TB infection (LTBI) can also prevent progression to active TB. Unlike other patient groups, HCWs are in a unique position to serve as agents of change to raise awareness, advocate for necessary resource allocation and implement TB-IC interventions, with appropriate support from dedicated TB-IC officers at the facility and national TB programme level. Students and community health workers (CHWs) must be engaged and involved in these efforts. Nosocomial TB transmission is an urgent public health problem and adopting rights-based approaches can be helpful. However, these efforts cannot succeed without increased political will, supportive legal frameworks and financial investments to support HCWs in efforts to decrease TB transmission.
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Affiliation(s)
- Ruvandhi R Nathavitharana
- TB Proof, Cape Town, South Africa; Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Boston, MA 02215, USA.
| | | | - Angela Dramowski
- TB Proof, Cape Town, South Africa; Paediatric Infectious Diseases, Stellenbosch University, Department of Paediatrics and Child Health, Cape Town, South Africa
| | - Koot Kotze
- TB Proof, Cape Town, South Africa; East London Hospital Complex, East London, South Africa
| | - Philip Lederer
- TB Proof, Cape Town, South Africa; Massachusetts General Hospital, Division of Infectious Diseases, , Boston, MA 02215, USA
| | - Ingrid Oxley
- Nelson Mandela Metropolitan University, Dietetics Division, , Port Elizabeth, South Africa
| | - Jurgens A Peters
- TB Proof, Cape Town, South Africa; London School of Hygiene and Tropical Medicine, Faculty of Infectious and Tropical Diseases, Clinical Research Department, London, UK
| | | | | | - Bart Willems
- TB Proof, Cape Town, South Africa; Stellenbosch University, Division of Community Health, Faculty of Medicine and Health Sciences, , Cape Town, South Africa
| | - Tiong Xun Ting
- TB Proof, Cape Town, South Africa; Clinical Research Center, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Arne von Delft
- TB Proof, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, 7925 Observatory, South Africa
| | | | - Raquel Duarte
- Institute of Public Health, Porto University, EpiUnit, Portugal; Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Edward Nardell
- Brigham and Women's Hospital, Division of Global Health and Social Medicine, 02115 Boston, MA, USA
| | - Alimuddin Zumla
- TB Proof, Cape Town, South Africa; University College London, and NIHR Biomedical Research Centre, University College London Hospital, Division of Infection and Immunity, London, UK
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Shah NS, Auld SC, Brust JCM, Mathema B, Ismail N, Moodley P, Mlisana K, Allana S, Campbell A, Mthiyane T, Morris N, Mpangase P, van der Meulen H, Omar SV, Brown TS, Narechania A, Shaskina E, Kapwata T, Kreiswirth B, Gandhi NR. Transmission of Extensively Drug-Resistant Tuberculosis in South Africa. N Engl J Med 2017; 376:243-253. [PMID: 28099825 PMCID: PMC5330208 DOI: 10.1056/nejmoa1604544] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Drug-resistant tuberculosis threatens recent gains in the treatment of tuberculosis and human immunodeficiency virus (HIV) infection worldwide. A widespread epidemic of extensively drug-resistant (XDR) tuberculosis is occurring in South Africa, where cases have increased substantially since 2002. The factors driving this rapid increase have not been fully elucidated, but such knowledge is needed to guide public health interventions. METHODS We conducted a prospective study involving 404 participants in KwaZulu-Natal Province, South Africa, with a diagnosis of XDR tuberculosis between 2011 and 2014. Interviews and medical-record reviews were used to elicit information on the participants' history of tuberculosis and HIV infection, hospitalizations, and social networks. Mycobacterium tuberculosis isolates underwent insertion sequence (IS)6110 restriction-fragment-length polymorphism analysis, targeted gene sequencing, and whole-genome sequencing. We used clinical and genotypic case definitions to calculate the proportion of cases of XDR tuberculosis that were due to inadequate treatment of multidrug-resistant (MDR) tuberculosis (i.e., acquired resistance) versus those that were due to transmission (i.e., transmitted resistance). We used social-network analysis to identify community and hospital locations of transmission. RESULTS Of the 404 participants, 311 (77%) had HIV infection; the median CD4+ count was 340 cells per cubic millimeter (interquartile range, 117 to 431). A total of 280 participants (69%) had never received treatment for MDR tuberculosis. Genotypic analysis in 386 participants revealed that 323 (84%) belonged to 1 of 31 clusters. Clusters ranged from 2 to 14 participants, except for 1 large cluster of 212 participants (55%) with a LAM4/KZN strain. Person-to-person or hospital-based epidemiologic links were identified in 123 of 404 participants (30%). CONCLUSIONS The majority of cases of XDR tuberculosis in KwaZulu-Natal, South Africa, an area with a high tuberculosis burden, were probably due to transmission rather than to inadequate treatment of MDR tuberculosis. These data suggest that control of the epidemic of drug-resistant tuberculosis requires an increased focus on interrupting transmission. (Funded by the National Institute of Allergy and Infectious Diseases and others.).
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Affiliation(s)
- N Sarita Shah
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Sara C Auld
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - James C M Brust
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Barun Mathema
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Nazir Ismail
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Pravi Moodley
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Koleka Mlisana
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Salim Allana
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Angela Campbell
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Thuli Mthiyane
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Natashia Morris
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Primrose Mpangase
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Hermina van der Meulen
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Shaheed V Omar
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Tyler S Brown
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Apurva Narechania
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Elena Shaskina
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Thandi Kapwata
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Barry Kreiswirth
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
| | - Neel R Gandhi
- From the Emory University Rollins School of Public Health and School of Medicine (N.S.S., S.C.A., S.A., A.C., N.R.G.) and the Centers for Disease Control and Prevention (N.S.S.) - both in Atlanta; Albert Einstein College of Medicine and Montefiore Medical Center (N.S.S., J.C.M.B., N.R.G.), Columbia University Mailman School of Public Health (B.M., T.S.B.), and the American Museum of Natural History (A.N.) - all in New York; the National Institute for Communicable Diseases, Johannesburg (N.I., H.M., S.V.O.), University of KwaZulu-Natal and National Health Laboratory Service, Durban (P. Moodley, K.M., T.M., P. Mpangase), and the South African Medical Research Council, Cape Town (N.M., T.K.) - all in South Africa; and the Public Health Research Institute, New Jersey Medical School-Rutgers University, Newark (E.S., B.K.)
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Muralikrishnan B, Dan VM, Vinodh JS, Jamsheena V, Ramachandran R, Thomas S, Dastager SG, Kumar KS, Lankalapalli RS, Kumar RA. Anti-microbial activity of chrysomycin A produced by Streptomyces sp. against Mycobacterium tuberculosis. RSC Adv 2017. [DOI: 10.1039/c7ra05576e] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chrysomycin A isolated fromStreptomycessp. OA161 is bactericidal toMycobacterium tuberculosis, methicillin resistantStaphylococcus aureusand vancomycin resistantEnterococcus faecalis.
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Affiliation(s)
- Balaji Muralikrishnan
- Mycobacterium Research Laboratory
- Rajiv Gandhi Centre for Biotechnology
- Trivandrum
- India
| | - Vipin Mohan Dan
- Mycobacterium Research Laboratory
- Rajiv Gandhi Centre for Biotechnology
- Trivandrum
- India
| | - J. S. Vinodh
- Mycobacterium Research Laboratory
- Rajiv Gandhi Centre for Biotechnology
- Trivandrum
- India
| | - Vellekkatt Jamsheena
- Chemical Sciences and Technology Division
- National Institute for Interdisciplinary Science and Technology
- CSIR
- Trivandrum
- India
| | - Ranjit Ramachandran
- Mycobacterium Research Laboratory
- Rajiv Gandhi Centre for Biotechnology
- Trivandrum
- India
| | - Sabu Thomas
- Cholera and Biofilm Research Laboratory
- Rajiv Gandhi Centre for Biotechnology
- Trivandrum
- India
| | | | - K. Santhosh Kumar
- Chemical and Environmental Biology
- Rajiv Gandhi Centre for Biotechnology
- Trivandrum
- India
| | - Ravi Shankar Lankalapalli
- Chemical Sciences and Technology Division
- National Institute for Interdisciplinary Science and Technology
- CSIR
- Trivandrum
- India
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Abstract
As we move into the era of the Sustainable Development Goals (SDGs), the World Health Organization (WHO) has developed the End TB strategy 2016-2035 with a goal to end the global epidemic of tuberculosis (TB) by 2035. Achieving the targets laid out in the Strategy will require strengthening of the whole TB diagnosis and treatment cascade, including improved case detection, the establishment of universal drug susceptibility testing and rapid treatment initiation. An estimated 3.9% of new TB cases and 21% of previously treated cases had rifampicin-resistant (RR) or multidrug-resistant (MDR) TB in 2015. These levels have remained stable over time, although limited data are available from major high burden settings. In addition to the emergence of drug resistance due to inadequate treatment, there is growing evidence that direct transmission is a large contributor to the RR/MDR-TB epidemic. Only 340,000 of the estimated 580,000 incident cases of RR/MDR-TB were notified to WHO in 2015. Among these, only 125,000 were initiated on second-line treatment. RR/MDR-TB epidemics are likely to be driven by direct transmission. The most important risk factor for MDR-TB is a history of previous treatment. Other risk factors vary according to setting but can include hospitalisation, incarceration and HIV infection. Children have the same risk of MDR-TB as adults and represent a diagnostic and treatment challenge. Rapid molecular technologies have revolutionized the diagnosis of drug-resistant TB. Until capacity can be established to test every TB patient for rifampicin resistance, countries should focus on gradually expanding their coverage of testing. DNA sequencing technologies are being increasingly incorporated into patient management and drug resistance surveillance. They offer additional benefits over conventional culture-based phenotypic testing, including a faster turn-around time for results, assessment of resistance patterns to a range of drugs, and investigation of strain clustering and transmission.
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Tupasi TE, Garfin AMCG, Kurbatova EV, Mangan JM, Orillaza-Chi R, Naval LC, Balane GI, Basilio R, Golubkov A, Joson ES, Lew WJ, Lofranco V, Mantala M, Pancho S, Sarol JN. Factors Associated with Loss to Follow-up during Treatment for Multidrug-Resistant Tuberculosis, the Philippines, 2012-2014. Emerg Infect Dis 2016; 22:491-502. [PMID: 26889786 PMCID: PMC4766881 DOI: 10.3201/eid2203.151788] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Most commonly reported was medication side effects or fear of side effects. To identify factors associated with loss to follow-up during treatment for multidrug-resistant (MDR) tuberculosis (TB) in the Philippines, we conducted a case–control study of adult patients who began receiving treatment for rifampin-resistant TB during July 1–December 31, 2012. Among 91 case-patients (those lost to follow-up) and 182 control-patients (those who adhered to treatment), independent factors associated with loss to follow-up included patients’ higher self-rating of the severity of vomiting as an adverse drug reaction and alcohol abuse. Protective factors included receiving any type of assistance from the TB program, better TB knowledge, and higher levels of trust in and support from physicians and nurses. These results provide insights for designing interventions aimed at reducing patient loss to follow-up during treatment for MDR TB.
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Altice FL, Azbel L, Stone J, Brooks-Pollock E, Smyrnov P, Dvoriak S, Taxman FS, El-Bassel N, Martin NK, Booth R, Stöver H, Dolan K, Vickerman P. The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia. Lancet 2016; 388:1228-48. [PMID: 27427455 PMCID: PMC5087988 DOI: 10.1016/s0140-6736(16)30856-x] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Despite global reductions in HIV incidence and mortality, the 15 UNAIDS-designated countries of Eastern Europe and Central Asia (EECA) that gained independence from the Soviet Union in 1991 constitute the only region where both continue to rise. HIV transmission in EECA is fuelled primarily by injection of opioids, with harsh criminalisation of drug use that has resulted in extraordinarily high levels of incarceration. Consequently, people who inject drugs, including those with HIV, hepatitis C virus, and tuberculosis, are concentrated within prisons. Evidence-based primary and secondary prevention of HIV using opioid agonist therapies such as methadone and buprenorphine is available in prisons in only a handful of EECA countries (methadone or buprenorphine in five countries and needle and syringe programmes in three countries), with none of them meeting recommended coverage levels. Similarly, antiretroviral therapy coverage, especially among people who inject drugs, is markedly under-scaled. Russia completely bans opioid agonist therapies and does not support needle and syringe programmes-with neither available in prisons-despite the country's high incarceration rate and having the largest burden of people with HIV who inject drugs in the region. Mathematical modelling for Ukraine suggests that high levels of incarceration in EECA countries facilitate HIV transmission among people who inject drugs, with 28-55% of all new HIV infections over the next 15 years predicted to be attributable to heightened HIV transmission risk among currently or previously incarcerated people who inject drugs. Scaling up of opioid agonist therapies within prisons and maintaining treatment after release would yield the greatest HIV transmission reduction in people who inject drugs. Additional analyses also suggest that at least 6% of all incident tuberculosis cases, and 75% of incident tuberculosis cases in people who inject drugs are due to incarceration. Interventions that reduce incarceration itself and effectively intervene with prisoners to screen, diagnose, and treat addiction and HIV, hepatitis C virus, and tuberculosis are urgently needed to stem the multiple overlapping epidemics concentrated in prisons.
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Affiliation(s)
- Frederick L Altice
- School of Medicine and School Public Health, Yale University, New Haven, CT, USA.
| | - Lyuba Azbel
- Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jack Stone
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | | | - Pavlo Smyrnov
- ICF International Alliance for Public Health, Kiev, Ukraine
| | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kiev, Ukraine
| | - Faye S Taxman
- Department of Criminology, Law and Society, George Mason University, Fairfax, VA, USA
| | | | - Natasha K Martin
- School of Social and Community Medicine, Bristol University, Bristol, UK; Division of Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Robert Booth
- Department of Psychiatry, University of Colorado, Denver, CO, USA
| | - Heino Stöver
- Institute of Addiction Research, Frankfurt University of Applied Sciences, Frankfurt, Germany
| | - Kate Dolan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Peter Vickerman
- School of Social and Community Medicine, Bristol University, Bristol, UK
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Fox GJ, Schaaf HS, Mandalakas A, Chiappini E, Zumla A, Marais BJ. Preventing the spread of multidrug-resistant tuberculosis and protecting contacts of infectious cases. Clin Microbiol Infect 2016; 23:147-153. [PMID: 27592087 DOI: 10.1016/j.cmi.2016.08.024] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 01/23/2023]
Abstract
Prevention of multidrug-resistant and extensively drug-resistant tuberculosis (MDR/XDR-TB) is a top priority for global TB control, given the need to limit epidemic spread and considering the high cost, toxicity and poor treatment outcomes with available therapies. We performed a systematic literature review to evaluate the evidence for strategies to reduce MDR/XDR-TB transmission and disease progression. Rapid detection and timely initiation of effective treatment is critical to rendering MDR/XDR-TB cases non-infectious. The scale-up of rapid molecular testing has transformed the capacity of high-incidence settings to identify and treat patients with MDR/XDR-TB. Optimized infection control measures in hospitals and clinics are critical to protect other patients and healthcare workers, whereas creative measures to reduce transmission within community hotspots require consideration. Targeted screening of high-risk communities may enhance early case-detection and limit the spread of MDR/XDR-TB. Among infected contacts, preventive therapy promises to reduce the risk of disease progression. This is supported by observational cohort studies, but randomized trials are urgently needed to confirm these observations and guide policy formulation. Substantial investment in MDR/XDR-TB prevention and care will be critical if the ambitious global goal of TB elimination is to be realized.
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Affiliation(s)
- G J Fox
- Sydney Medical School, University of Sydney, Sydney, Australia.
| | - H S Schaaf
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A Mandalakas
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - E Chiappini
- Paediatric Infectious Disease Unit, Meyer University Hospital, Department of Health Science, University of Florence, Florence, Italy
| | - A Zumla
- University College London and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK
| | - B J Marais
- The Children's Hospital at Westmead and the Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Sydney, Australia
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