Characteristics of Previous Tuberculosis Treatment History in Patients with Treatment Failure and the Impact on Acquired Drug-Resistant Tuberculosis

Effects of positive deviance nutrition intervention on sputum smear conversion among patients on tuberculosis medication in Kericho County, Kenya

Tuberculosis (TB) still poses a significant challenge to public health globally, especially in low- and middle-income countries such as Kenya. Despite the robust strategies, malnutrition remains a barrier to positive treatment outcomes, delaying sputum conversion. This study aimed to assess the effects of positive deviant nutrition intervention on sputum smear conversion among patients on Tuberculosis medication in Kericho County. A prospective study was conducted for patients enrolled on TB medication in both Bureti and Ainamoi Sub counties. A multistage cluster sampling was used to identify and recruit participants. The study was quasi-experimental, with a total of 192 sample units participating in the survey from the eight TB treatment catchment areas. Data was collected from January to December 2023 with sputum follow-up, a critical treatment period of six months. Data was analyzed using R 4.3.1 software. The sputum smear conversion rate for the intervention study and control arms was 96.8% and 85.2% in the 6th month, respectively. The results showed that the intervention arms demonstrated strong and significant associations between body mass index and sputum conversion at all three critical time points in 2nd month, 5th month, and 6th month with 29.51 p=<0.000, 30.85 p=<0.000, 35.19 p=<0.000, respectively compared to their counterpart. Additionally, among the intervention group, energy intake was associated with significant optimistic estimates for sputum conversion at all critical time points, 0.76, p = 0.007: 0.86, p = 0.006: 0.91, p = 0.003 compared to those in the control group. Maintaining a better weight and consuming adequate energy were a significant factor in attaining a positive sputum conversion.

Predictors of poor treatment outcomes among drug-resistant tuberculosis patients in Hunan province, China

Background

Drug-resistant tuberculosis (DR-TB) is a significant public health concern, often resulting in poor treatment outcomes. This study aims to identify predictors of poor treatment outcomes among patients with DR-TB in Hunan Province, China.

Methods

A retrospective cohort study was conducted in Hunan Province using data collected between 2013 and 2018 among patients with DR-TB treatment. Univariable and multivariable parametric survival analyses were performed using a shared frailty survival model with a Weibull distribution and Gamma frailty to identify determinants of poor treatment outcomes. Adjusted hazard ratios (AHR) with a 95 % confidence interval (CI) were calculated for the best-fitted model. The goodness of fit for the model was assessed using the Cox-Snell residual test.

Results

A total of 1384 bacteriologically confirmed DR-TB patients were included in the analysis. Of these, 9.97 % (95 % CI: 8.05-11.67 %) experienced poor treatment outcomes. The hazard of poor treatment outcomes was significantly higher among patients with a history of previous TB treatment compared to those with new TB (AHR = 1.82, 95 % CI: 1.27-2.61). Additionally, each one-day delay in diagnosis was associated with a slightly increased hazard of poor treatment outcomes (AHR = 1.00034, 95 % CI:1.000041-1.00064). Patients who received medication supervision and consistent treatment follow-up (i.e., systematic management) had a significantly lower hazard of poor treatment outcomes than those without systematic management (AHR = 0.08, 95 % CI: 0.05-0.14).

Conclusion

A substantial proportion of DR-TB patients in Hunan Province experience poor treatment outcomes, with prior TB treatment and delays in diagnosis being key predictors. Early diagnosis and systematic management, including medication supervision and consistent follow-up, significantly reduce the risk of poor treatment outcomes. Focused interventions for previously treated TB cases are crucial to improving treatment outcomes and mitigating the risk of long-term physical sequelae among DR-TB survivors.

Phenotypic and Genotypic Drug Resistance of Mycobacterium tuberculosis Strains Isolated from HIV-Infected Patients from a Third-Level Public Hospital in Mexico

BACKGROUND

Drug-resistant tuberculosis (TB) is associated with higher mortality rates in patients with human immunodeficiency virus (HIV). In Mexico, the number of deaths due to TB among the HIV-positive population has tripled in recent years.

METHODS

Ninety-three Mycobacterium tuberculosis strains isolated from the same number of HIV-infected patients treated in a public hospital in Mexico City were studied to determine the drug resistance to first- and second-line anti-TB drugs and to identify the mutations associated with the resistance.

RESULTS

Of the 93 patients, 82.7% were new TB cases, 86% were male, and 73% had extrapulmonary TB. Most patients (94%) with a CD4 T-lymphocyte count <350 cells/mm3 were associated with extrapulmonary TB (p <0.0001), whilst most patients (78%) with a CD4 T-lymphocyte count >350 cells/mm3 were associated with pulmonary TB (p = 0.0011). Eighty-two strains were pan-susceptible, four mono-resistant, four poly-resistant, two multidrug-resistant, and one was extensively drug-resistant. In the rifampicin-resistant strains, rpoB S531L was the mutation most frequently identified, whereas the inhA C15T and katG S315T1 mutations were present in isoniazid-resistant strains. The extensively drug-resistant strain also contained the mutation gyrA D94A.

CONCLUSIONS

These data highlight the need to promptly diagnose the drug resistance of M. tuberculosis among all HIV-infected patients by systematically offering access to first- and second-line drug susceptibility testing and to tailor the treatment regimen based on the resistance patterns to reduce the number of deaths in HIV-infected patients.