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Khaitan A, Rai SK, Krishnan A, Gupta SK, Kant S, Khilnani GC. "I Would Rather Die Drinking than take the Medicine": Role of Alcohol Use Disorder in Loss-to-follow-up of Tuberculosis Treatment in a Rural Area of Ballabgarh, Haryana. Indian J Community Med 2024; 49:152-156. [PMID: 38425976 PMCID: PMC10900456 DOI: 10.4103/ijcm.ijcm_211_23] [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] [Received: 03/29/2023] [Accepted: 10/19/2023] [Indexed: 03/02/2024] Open
Abstract
Introduction Alcohol use disorder (AUD) is a significant risk factor for tuberculosis (TB) treatment loss-to-follow-up (LTFU). This field-based study was undertaken to understand the role of AUD and TB treatment LTFU and the reasons behind this association in a rural area of Ballabgarh, Haryana. Material and Methods TB patients who had completed their treatment and who had been LTFU were included in the study, along with the National TB Elimination Program (NTEP) staff, healthcare providers, family, and community members from Ballabgarh block of the north Indian state of Haryana. In-depth interviews (IDIs) and focused group discussions (FGDs) were conducted to gauge the perceptions of stakeholders regarding reasons for LTFU, especially in the context of alcohol use. Inductive analysis of the transcripts was done in keeping with the grounded theory, and themes with their sub-themes were identified. A conceptual framework of TB-AUD was constructed, and potential areas for intervention were determined. Results Fifty-eight IDIs and four FGDs were conducted in mid-2018. Almost all key informants and many patient participants believed that alcohol use makes TB patients highly susceptible to treatment LTFU. Key themes identified were shared personality traits and attitudes, combined side effects of anti-tubercular drugs and alcohol use, lack of family support, and an adverse financial situation. Conclusion These findings call for a change in NTEP's approach to AUD-TB. Interventions may include collecting alcohol use information at patient enrolment and closure, integrating brief interventions for alcohol cessation in NTEP, and linking patients to deaddiction centers with the provision of appropriate dietary and financial support.
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Affiliation(s)
- Anwita Khaitan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay K. Rai
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev K. Gupta
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gopi C. Khilnani
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
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Vidyasagaran AL, Readshaw A, Boeckmann M, Jarde A, Siddiqui F, Marshall AM, Akram J, Golub JE, Siddiqi K, Dogar O. Is Tobacco Use Associated With Risk of Recurrence and Mortality Among People With TB?: A Systematic Review and Meta-Analysis. Chest 2024; 165:22-47. [PMID: 37652295 PMCID: PMC10790178 DOI: 10.1016/j.chest.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/20/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Associations between tobacco use and poor TB treatment outcomes are well documented. However, for important outcomes such as TB recurrence or relapse and mortality during treatment, as well as for associations with smokeless tobacco (ST), the evidence is not summarized systematically. RESEARCH QUESTION Is tobacco use associated with risk of poor treatment outcomes among people with TB? STUDY DESIGN AND METHODS The MEDLINE, Embase, and Cumulative Index of Nursing and Allied Health Literature databases were searched on November 22, 2021. Epidemiologic studies reporting associations between tobacco use and at least one TB treatment outcome were eligible. Independent double-screening, extractions, and quality assessments were undertaken. Random effects meta-analyses were conducted for the two primary review outcomes (TB recurrence or relapse and mortality during treatment), and heterogeneity was explored using subgroups. Other outcomes were synthesized narratively. RESULTS Our searches identified 1,249 records, of which 28 were included in the meta-analyses. Based on 15 studies, higher risk of TB recurrence or relapse was found with ever using tobacco vs never using tobacco (risk ratio [RR], 1.78; 95% CI, 1.31-2.43; I2 = 85%), current tobacco use vs no tobacco use (RR, 1.95; 95% CI, 1.59-2.40; I2 = 72%), and former tobacco use vs never using tobacco (RR, 1.84; 95% CI, 1.21-2.80; I2 = 4%); heterogeneity arose from differences in study quality, design, and participant characteristics. Thirty-eight studies were identified for mortality, of which 13 reported mortality during treatment. Ever tobacco use (RR, 1.55; 95% CI, 1.32-1.81; I2 = 0%) and current tobacco use (RR, 1.51; 95% CI, 1.09-2.10; I2 = 87%) significantly increased the likelihood of mortality during treatment among people with TB compared with never using tobacco and not currently using tobacco, respectively; heterogeneity was explained largely by differences in study design. Almost all studies in the meta-analyses scored high or moderate on quality assessments. Narrative synthesis showed that tobacco use was a risk factor for other unfavorable TB treatment outcomes, as previously documented. Evidence on ST was limited, but identified studies suggested an increased risk for poor outcomes with its use compared with not using it. INTERPRETATION Tobacco use significantly increases the risk of TB recurrence or relapse and mortality during treatment among people with TB, highlighting the need to address tobacco use to improve TB outcomes. TRIAL REGISTRY PROSPERO; No.: CRD42017060821; URL: https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
| | - Anne Readshaw
- Department of Health Sciences, University of York, York, England; Yorkshire and North Lincolnshire Area Team, Natural England
| | - Melanie Boeckmann
- Department of Global Health, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Alexander Jarde
- Université de Paris, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, and Cochrane France, Paris, France
| | - Faraz Siddiqui
- Department of Health Sciences, University of York, York, England
| | - Anna-Marie Marshall
- Department of Health Sciences, University of York, York, England; Research Fellow in Public Health and lecturer in Public Health and Psychology, Helen McArdle Nursing and Care Research Institute, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, England
| | - Janita Akram
- Hull York Medical School, University of York, York, England
| | - Jonathan E Golub
- Center for Tuberculosis Research, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, England; Hull York Medical School, University of York, York, England
| | - Omara Dogar
- Department of Health Sciences, University of York, York, England; Usher Institute, The University of Edinburgh, Edinburgh, Scotland.
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Pourali F, Khademloo M, Abedi S, Roozbeh F, Barzegari S, Moosazadeh M. Relationship between smoking and tuberculosis recurrence: A systematic review and meta-analysis. Indian J Tuberc 2023; 70:475-482. [PMID: 37968054 DOI: 10.1016/j.ijtb.2023.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 04/02/2023] [Accepted: 04/10/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Of the problems in tuberculosis (TB) control program is the recurrence of this disease. In some studies, smoking has been reported as the most important risk factor. Therefore, the present study aimed at examining the association between smoking and tuberculosis recurrence using meta-analysis. METHODS To report the findings of this meta-analysis, we used PRISMA. The protocol of this study has been recorded in PROSPERO. The research question has been formulated based on PICO, and the search was performed using both MeSH and non-MeSH keywords. After screening and selecting the articles and evaluating their quality using the NOS checklist, the overall estimate of the odds ratio of tuberculosis recurrence in smokers was assessed with a 95% confidence interval. RESULTS Fourteen studies met the inclusion criteria. The total number of samples in the group of patients with tuberculosis recurrence was 1988 with 855 (43%) smokers, and in the group of patients affected by tuberculosis without recurrence, it was 27,226 with 7503 (27.56%) smokers. In 13 studies, the odds ratio of tuberculosis recurrence was higher in smokers; this difference was statistically significant in 12 of them. Combining the results of these 14 studies, the odds ratio of tuberculosis recurrence in smokers was 2.10 times higher, using the random effects model (95% CI:1.69, 2.61). CONCLUSION Based on the results of study present, smoking increases the risk of tuberculosis recurrence. Therefore, to eradicate tuberculosis by 2030, more serious interventions should be taken to quit smoking, which in turn reduces the incidence of tuberculosis.
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Affiliation(s)
- Fatemeh Pourali
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Khademloo
- Department of Community Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Siavosh Abedi
- Department of Internal Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Roozbeh
- Health Deputy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Saeed Barzegari
- Department of Paramedicine, Amol Faculty of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
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Kumari A, Ahuja S, Bajaj S, Zaheer S, Chaitanya V, Agarwal Y, Gupta R, Ranga S. Cytomorphological findings in drug defaulters of tuberculous lymphadenitis. Cytojournal 2023; 20:31. [PMID: 37810436 PMCID: PMC10559488 DOI: 10.25259/cytojournal_16_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/13/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives Tuberculosis (TB) is an important health problem specially in the developing countries. Although effective chemotherapy is available, compliance of patient is a major challenge. The aim of this study was to describe cytomorphological features of drug defaulters on lymph node on fine-needle aspiration cytology (FNAC) and compare it with newly diagnosed cases. Material and Methods A cross-sectional study was done for a period of 18 months, in which all patients having tuberculous lymphadenitis were included after taking detailed history regarding previous anti-TB drug intake. Cytomorphological findings in drug defaulters were evaluated and compared with newly diagnosed cases. Results There were a total of 150 cases with 120 newly diagnosed and 30 drug defaulters. Splintered epithelioid cell granuloma was seen in 40% of drug defaulters, while it was absent in case of newly diagnosed cases (P < 0.0001). Well-formed epithelioid cell granuloma was most commonly seen in newly diagnosed cases (65.83%) followed by poorly formed granuloma (26.67%). Another significant finding was distribution of eosinophils which were significantly high in case of drug defaulters (56.67%) (P < 0.0001). Conclusion Cytomorphological findings can help in identification of the drug defaulters on FNAC and thus plan further line of treatment.
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Affiliation(s)
- Aarti Kumari
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sana Ahuja
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sachin Bajaj
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sufian Zaheer
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Vinod Chaitanya
- Department of Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Yatish Agarwal
- Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ratan Gupta
- Department of Paediatrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sunil Ranga
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Prevalence of suicidal ideations and suicide attempts in patients with tuberculosis: A systematic review and meta-analysis. J Psychosom Res 2023; 167:111171. [PMID: 36753943 DOI: 10.1016/j.jpsychores.2023.111171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/13/2023] [Accepted: 01/22/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Suicide and suicidal behaviors are reported to be common in patients with Tuberculosis (TB). This systematic review and meta-analysis aimed to quantitively assess the prevalence of suicidality and identify the factors associated with suicidality in patients with TB. METHODS We searched databases PubMed, SCOPUS, Web of Science, PsycINFO, and Google Scholar for studies that reported the prevalence of suicide, suicidal ideations, or suicide attempts in patients with TB. We assessed the quality of studies with the Newcastle Ottawa scale. Random-effects models were used to calculate the pooled prevalence with 95% confidence intervals (CI). RESULTS Nine studies (8770 participants) were included. Pooled prevalence for current suicidal ideations within the last year was 8.5% [95% CI: 5.8%12.3%]. Pooled prevalence for current suicidal attempts within the last year was 3.1% [2.2%- 4.5%]. Suicide was reported in 0.92% of TB patients at the end of 2 years, whereas 2.2% to 8.4% of all TB deaths were reported due to suicide. Factors associated with suicidality were female gender, TB retreatment, comorbid HIV, presence of another chronic medical illness, psychological distress, and comorbid psychiatric illnesses. CONCLUSION The prevalence rates of suicidal ideation and attempts were higher in patients with TB than in the general population. Integrating mental health services with TB programs will help develop interventions for high-risk individuals. Prospero registration number: CRD42021281849.
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Oh AL, Makmor-Bakry M, Islahudin F, Wong ICK. Prevalence and predictive factors of tuberculosis treatment interruption in the Asia region: a systematic review and meta-analysis. BMJ Glob Health 2023; 8:bmjgh-2022-010592. [PMID: 36650014 PMCID: PMC9853156 DOI: 10.1136/bmjgh-2022-010592] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Tuberculosis (TB) treatment interruption remains a critical challenge leading to poor treatment outcomes. Two-thirds of global new TB cases are mostly contributed by Asian countries, prompting systematic analysis of predictors for treatment interruption due to the variable findings. METHODS Articles published from 2012 to 2021 were searched through seven databases. Studies that established the relationship for risk factors of TB treatment interruption among adult Asian were included. Relevant articles were screened, extracted and appraised using Joanna Briggs Institute's checklists for cohort, case-control and cross-sectional study designs by three reviewers. Meta-analysis was performed using the random effect model in Review Manager software. The pooled prevalence and predictors of treatment interruption were expressed in ORs with 95% CIs; heterogeneity was assessed using the I2 statistic. The publication bias was visually inspected using the funnel plot. RESULTS Fifty eligible studies (658 304 participants) from 17 Asian countries were included. The overall pooled prevalence of treatment interruption was 17% (95% CI 16% to 18%), the highest in Southern Asia (22% (95% CI 16% to 29%)), followed by Eastern Asia (18% (95% CI 16% to 20%)) and South East Asia (16% (95% CI 4% to 28%)). Seven predictors were identified to increase the risk of treatment interruption, namely, male gender (OR 1.38 (95% CI 1.26 to 1.51)), employment (OR 1.43 (95% CI 1.11 to 1.84)), alcohol intake (OR 2.24 (95% CI 1.58 to 3.18)), smoking (OR 2.74 (95% CI 1.98 to 3.78)), HIV-positive (OR 1.50 (95% CI 1.15 to 1.96)), adverse drug reactions (OR 2.01 (95% CI 1.20 to 3.34)) and previously treated cases (OR 1.77 (95% CI 1.39 to 2.26)). All predictors demonstrated substantial heterogeneity except employment and HIV status with no publication bias. CONCLUSION The identification of predictors for TB treatment interruption enables strategised planning and collective intervention to be targeted at the high-risk groups to strengthen TB care and control in the Asia region.
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Affiliation(s)
- Ai Ling Oh
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Farida Islahudin
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Ian CK Wong
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia,Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK,Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, Hong Kong
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Monique OPPERMAN, Ilse DUPREEZ. FACTORS CONTRIBUTING TO PULMONARY TB TREATMENT LOST TO FOLLOW-UP IN DEVELOPING COUNTRIES: AN OVERVIEW. Afr J Infect Dis 2022; 17:60-73. [PMID: 36756489 PMCID: PMC9885020 DOI: 10.21010/ajidv17i1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
Background Despite the available treatment options, pulmonary tuberculosis (TB) remains a leading cause of disease-related deaths worldwide. Treatment non-adherence/lost to follow-up (LTFU), particularly in developing countries, is a continuous concern. LTFU prolongs TB infectiousness and contributes to TB treatment failure, relapse, and death. Furthermore, LTFU also delays global TB eradication by promoting TB spread and drug-resistant TB strain development.[1] The purpose of this paper is to give an overview of the commonly observed risk factors associated with TB treatment LTFU in developing countries. Materials and Methods A literature survey was done of studies published in the past decade, which evaluated the risk factors for LTFU in TB patients, specifically in developing countries. Furthermore, some prospective TB treatment adherence initiatives and the feasibility of these initiatives within developing countries were assessed.[3]. Results Several variables, including socio-demographic, patient-related, TB disease and other health-related-factors, healthcare and system determinants, as well as treatment-related factors, were identified to increase the risk of TB treatment LTFU. More recently applied adherence interventions in developing countries, show potential for implementation on a larger scale. Conclusion Successful TB treatment is contingent on treatment adherence, and by addressing these persisting LTFU risk factors, treatment adherence in developing countries may be improved.
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Affiliation(s)
- OPPERMAN, Monique
- Human Metabolomics, North-West University (Potchefstroom Campus), Private Bag x6001, Box 269, Potchefstroom, South Africa, 2531
| | - DU PREEZ, Ilse
- Human Metabolomics, North-West University (Potchefstroom Campus), Private Bag x6001, Box 269, Potchefstroom, South Africa, 2531,Corresponding Author’s E-Mail:
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Dey A, Lahiri A, Jha SS, Sharma V, Shanmugam P, Chakrabartty AK. Treatment adherence status of the TB patients notified from private sector and its associated factors: Findings of a secondary data analysis from West Bengal, India. Indian J Tuberc 2022; 69:334-340. [PMID: 35760483 DOI: 10.1016/j.ijtb.2021.06.001] [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: 10/12/2020] [Accepted: 06/08/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION In India, each year, estimated one million TB cases are missing from notification, most of them being diagnosed treated in private sector. The large number of patients in private sector has raised concerns about suboptimal quality of care; lack of systems for treatment adherence thus raising the risk of drug resistance. The current analysis was conducted to find out the status of TB treatment adherence in private sector & to identify the factors associated with poor TB treatment adherence. METHODS Analysis of secondary data obtained through adherence monitoring house visit by THALI (an USAID funded project) field workers during July 2018-June 2019, was done. RESULTS Default rate among the private patients was 5%. Among the private TB patients 81.6% & among the defaulter 87.3% were in the age bracket of 15-59 years. Reasons stated for being a defaulter were 'Medicine is not working' (30%), 'Travel' (28.6%), 'Cost involved in the treatment' (21.8%), 'Side effects of ATD' (11.6%), 'Anxiety or Depression' (7.2%) & 'Feeling of completely cured' (0.8%). Despite best of efforts only 36.9% defaulter could be retrieved. Factors associated with increased risk of lost to follow-up were 15-59 years age, male sex, earning member of the family,tobacco user, alcohol user, DR-TB, continuation phase of treatment, previous history of TB, presence of symptoms & inability to walk. CONCLUSION Privately treated TB patients are vulnerable for non-adherence. Once defaulted, it is difficult to retrieve them. Economically productive age group is at higher risk of being defaulter. Commonest reason for lost to follow up is wrong impression about TB medicine. Program should think of extensive engagement & sensitization drive for the private providers; Strict adherence monitoring of private TB patients, extensive advocacy communication & social mobilization program in the community & workplaces/institutions.
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Affiliation(s)
- Abhijit Dey
- Tuberculosis Health Action Learning Initiative (THALI), SukrishnaBhawan757/1, Madurdaha Main Road, Madurdaha, Hussainpur, Kolkata, West Bengal, 700107, India.
| | - Arista Lahiri
- Department of Community Medicine, College of Medicine & Sagore Dutta Hospital, North 24 Paraganas, Kamarhati, West Bengal, 700058, India
| | - Sweety Suman Jha
- Department of Preventive Social Medicine, All India Institute of Hygiene Public Health, Kolkata, West Bengal, 700 073, India
| | - Vivek Sharma
- Tuberculosis Health Action Learning Initiative (THALI), SukrishnaBhawan757/1, Madurdaha Main Road, Madurdaha, Hussainpur, Kolkata, West Bengal, 700107, India
| | - Parthiban Shanmugam
- Tuberculosis Health Action Learning Initiative (THALI), SukrishnaBhawan757/1, Madurdaha Main Road, Madurdaha, Hussainpur, Kolkata, West Bengal, 700107, India
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Wang EY, Arrazola RA, Mathema B, Ahluwalia IB, Mase SR. The impact of smoking on tuberculosis treatment outcomes: a meta-analysis. Int J Tuberc Lung Dis 2021; 24:170-175. [PMID: 32127100 DOI: 10.5588/ijtld.19.0002] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Cigarette smoking contributes to tuberculosis (TB) epidemiology. However, limited evidence exists on how smoking impacts TB treatment outcomes such as treatment loss to follow-up and culture conversion.METHODS: This meta-analysis assessed current evidence of the impact of active cigarette smoking on TB treatment outcomes. PubMed, Scopus, Embase, and the Cochrane Library were searched for English-language articles published from database inception through 2017. Articles addressing active pulmonary TB and cigarette smoking were identified and data abstracted. Smokers were defined as those who smoked every day or some days at the time of interview/diagnosis. Non-smokers did not smoke at the time of interview/diagnosis. Unfavorable outcomes included any outcome other than cure or completion of TB treatment. Three different data sets were examined: 8 articles addressing unfavorable treatment outcomes, 9 analyzing only treatment loss to follow-up, and 5 addressing delayed smear or culture conversion. Studies that had <20 subjects or that addressed only populations with comorbidities were excluded.RESULTS: We identified 1030 studies; 21 studies fulfilled the inclusion/exclusion criteria. Smokers had greater odds of unfavorable outcomes (pooled odds ratio [pOR] 1.23, 95%CI 1.14-1.33), delayed smear or culture conversion (pOR 1.55, 95%CI 1.04-2.07), and treatment loss to follow-up (pOR 1.35, 95%CI 1.21-1.50).CONCLUSION: Cigarette smoking is associated with negative treatment results and delayed conversion to negative smear or culture, suggesting smoking is an important factor for consideration in TB elimination efforts.
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Affiliation(s)
- E Y Wang
- ORISE (Oak Ridge Institute for Science and Education) Research Program, Centers for Disease Control and Prevention (CDC), Atlanta, GA, Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - R A Arrazola
- Global Tobacco Control Branch, Office on Smoking and Health, CDC, Atlanta, GA
| | - B Mathema
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - I B Ahluwalia
- Global Tobacco Control Branch, Office on Smoking and Health, CDC, Atlanta, GA
| | - S R Mase
- Division of Tuberculosis Elimination, CDC, Atlanta, GA, USA, World Health Organization, South-East Asian Regional Office, New Delhi, India
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Ahmed M, Mohan R. A comparative study of factors for interruption of antitubercular treatment among defaulters in urban and rural areas of Kamrup District, Assam. J Family Med Prim Care 2021; 10:127-131. [PMID: 34017714 PMCID: PMC8132822 DOI: 10.4103/jfmpc.jfmpc_1027_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 09/09/2020] [Accepted: 10/28/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Defaulting from treatment is an important challenge for tuberculosis (TB) control. As per the Revised National Tuberculosis Control Programme quarterly reports of Kamrup District (Assam), among the registered cases default rate was 13.3%(2008) & 13.1 % (2009). Objectives: To elicit reasons & factors responsible for interruption of treatment from a cohort of TB defaulters of urban & rural areas in Kamrup District. Methods: The cross-sectional study was conducted among 1/3rd of all defaulters who were put on Directly Observed Treatment Short-course chemotherapy in 2011 under 1 urban Tuberculosis Unit (TU) & 2 rural TUs of Kamrup District. From these 3 TUs, total 210 patients interrupted treatment in 2011; so 70 defaulters (35 from 1 urban TU & 35 from 2 rural TUs) were interviewed in their residences by using a pretested and predesigned schedule. Study was conducted in January - June, 2012. Results: Majority of the defaulters was illiterate (51.4%) in rural areas but in urban areas majority studied upto high school level (37.1%). Maximum defaulters were in the age group 25-44 years (55.7% in urban areas & 62.9% in rural areas). The number of defaulters decreased uniformly with increasing income in the rural areas & but not so in urban areas. More number of new cases defaulted in rural areas (82.8%) compared to urban areas (57.1%). Improvement in symptoms was found to be the most common reason (45.7% in urban areas & 40 % in rural areas), leading to treatment interruption. Conclusions: Early improvement in symptom was the most common reason leading to treatment interruption. Continuous health education should be provided to TB patients emphasizing the need to continue treatment despite early improvement in symptoms.
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Affiliation(s)
- Mustaque Ahmed
- Assistant Professor, Department of Community Medicine, Fakhruddin Ali Ahmed Medical College, Barpeta, Assam, India
| | - Roopshekhar Mohan
- Assistant Professor, Department of Community Medicine, Fakhruddin Ali Ahmed Medical College, Barpeta, Assam, India
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Afshari M, Aarabi M, Parsaee M, Nezammahalleh A, Moosazadeh M. Treatment default and its related factors among tuberculosis patients, a case-control study in Iran. GMS HYGIENE AND INFECTION CONTROL 2020; 15:Doc33. [PMID: 33391968 PMCID: PMC7745648 DOI: 10.3205/dgkh000368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Treatment default is one of the main challenges in tuberculosis (TB) control and is considered a major barrier to achieving the sustainable development goals (SDG). Identifying the factors associated with this outcome can help us provide appropriate strategies for decision making. This study investigates the determining factors of treatment default among TB patients. Methodology: In this case-control study, all 88 TB patients experiencing treatment default during an11-year-period in Mazandaran province, Iran, were compared with 176 randomly selected TB patients without a history of default. Cases and controls were matched based on the year of incidence as well as the treatment center. Related factors of treatment default were determined using multivariate logistic regression models. Results: For men, the odds ratio of experiencing treatment default was 1.67 (p=0.165). In addition, considering ages >64 years as the reference group, the odds ratios for 15- to 24- and 55- to 64-year-olds were 0.95 (p=0.940) and 0.37 (p=0.123), respectively. The corresponding odds ratios for patients 25-34, 35-44 and 45-54 years of age were 1.29 (p=0.547), 1.40 (p=0.472), and 1.39 (p=0.512) respectively. Moreover, the odds ratios for urban residents, patients with a history of imprisonment, a history of previous treatment, adverse treatment effects, previous exposure, non-Iranians and patients with smear-positive TB were 1.72 (p=0.070), 1.24 (p=0.657), 1.47 (p=0.756), 0.99 (p=0.998), 0.98 (p=0.960), 9.29 (p=0.010), and 2.27 (p=0.049) respectively. Conclusion: Non-Iranian nationality and smear-positive TB were detected as predictors of treatment default among patients with tuberculosis.
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Affiliation(s)
- Mahdi Afshari
- Department of Community Medicine, School of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Mohsen Aarabi
- Department of Family Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | | | | | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
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Karthikeyan V, Ganapathy K. Determinants of Categories of TB Retreatment with Special Reference to Sources of Primary Anti-TB Treatment. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2020. [DOI: 10.1055/s-0040-1716313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Introduction Retreatment (previously treated) cases are the tuberculosis (TB) patients who have been treated previously with anti-TB drugs for at least a month and who have now been registered for category II anti-TB therapy. Retreatment cases arise due to inadequate and improper treatment of the new TB cases.
Objective The aim of the study is to assess the information regarding sources of previous TB drug exposure and treatment practices leading to retreatment cases (category II) and determinants leading to retreatment.
Material and Methods It was a community-based cross-sectional study of patients registered as retreatment TB cases under revised national TB control program (RNTCP) in the TB unit of Puducherry between October 2013 and September 2014. The study was held between October 2013 and October 2015. Initially the quantitative data were collected and followed by qualitative data. Data were collected by interviewing the patients using a predesigned questionnaire. Data were entered and analyzed by using Epi Info (Version 3.4.3) software package.
Results Out of the 193 study participants, relapse cases were the most common 50.8%, followed by treatment after default cases 23.8%, failure cases 11.9%, and retreatment others 13.5%. There is a significant association between the retreatment categories such as failure, TAD (treatment after default), retreatment others, and ever usage of tobacco (p < 0.05). There is also a significant association between the retreatment categories such as TAD, retreatment others, and ever usage of alcohol (p < 0.05). The sources of previous antitubercular therapy for 90.16% retreatment cases were from government health care facilities under RNTCP, whereas for 9.84% retreatment cases the sources of previous antitubercular treatment were private health care facilities. There is a significant association between public health care facility where patients were previously treated for TB and relapse (p = 0.001) and private health care facility where patients were previously treated for TB and TAD (p = 0.008).
Conclusion As 90% of the patients have utilized the government health services for treatment, it shows the effective functioning of RNTCP-STF (state task force-revised national TB control program) mechanism in Puducherry.
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Affiliation(s)
- Veerabadran Karthikeyan
- Department of Community Medicine, Government Tiruvannamalai Medical College and Hospital, Tiruvannamalai, Tamil Nadu, India
| | - Kalaiselvan Ganapathy
- Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
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13
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Zhou TJ, Lakshminarayanan S, Sarkar S, Knudsen S, Horsburgh CR, Muthaiah M, Kan CK, Salgame P, Ellner JJ, Roy G, Jenkins HE, Hochberg NS. Predictors of Loss to Follow-Up among Men with Tuberculosis in Puducherry and Tamil Nadu, India. Am J Trop Med Hyg 2020; 103:1050-1056. [PMID: 32618243 PMCID: PMC7470548 DOI: 10.4269/ajtmh.19-0415] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Identifying predictors of loss to follow-up (LTFU; treatment lapse ≥ 2 months) among people with tuberculosis (TB) may assist programmatic efforts in controlling the spread of TB. Newly diagnosed smear-positive TB patients were enrolled in the Regional Prospective Observational Research for TB study in Puducherry and Tamil Nadu, India. Treatment records were used to identify LTFU of those who were enrolled from May 2014 through December 2017. This nested case–control study evaluated male TB patients. Predictors were assessed using multivariable logistic regression. Of 425 men with TB, 82 (19%) were LTFU. In the adjusted analyses of males, divorced/separated marital status (adjusted odds ratio [aOR] 3.80; 95% CI: 1.39–10.38) and at-risk alcohol use (aOR 1.92; 95% CI: 1.12–3.27) were significant predictors for increased risk of LTFU, and diabetes was a significant predictor for decreased risk of LTFU (aOR 0.52; 95% CI: 0.29–0.92). Of 53 men with recorded date of last treatment visit, 23 (43%) and 43 (81%) had LTFU within the first 2 and first 4 months of treatment, respectively. Addressing at-risk alcohol use and providing more intensive follow-up could lead to improved treatment completion.
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Affiliation(s)
- Thomas J Zhou
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Subitha Lakshminarayanan
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Selby Knudsen
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts
| | - C Robert Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.,Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.,Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Muthuraj Muthaiah
- Intermediate Reference Laboratory, Government Hospital for Chest Diseases, Puducherry, India
| | - Carolyn K Kan
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Padmini Salgame
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jerrold J Ellner
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Gautam Roy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Helen E Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Natasha S Hochberg
- Department of Medicine, Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts.,Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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14
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Burusie A, Enquesilassie F, Addissie A, Dessalegn B, Lamaro T. Effect of smoking on tuberculosis treatment outcomes: A systematic review and meta-analysis. PLoS One 2020; 15:e0239333. [PMID: 32941508 PMCID: PMC7498109 DOI: 10.1371/journal.pone.0239333] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 09/04/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Numerous studies have explored an effect of cigarette smoking on tuberculosis treatment outcomes but with dissimilar conclusions. OBJECTIVE To determine the effect of cigarette smoking on tuberculosis treatment outcomes. METHODS PubMed, Cochrane library and Google scholar databases were searched last on February 27, 2019. We applied the random-effects model for the analysis. Publication bias was assessed using funnel plot and Egger's regression. Furthermore, we performed Orwin's Fail-Safe N and cumulative meta-analysis to check for small studies' effect. RESULTS Out of 22 studies we included in the qualitative synthesis, 12 studies reported p-values less than 0.05 where smoking significantly favored poor treatment outcomes. The remaining 10 studies reported p-values larger than 0.05 implying that smoking does not affect the treatment outcomes. Twenty studies met the criteria for inclusion in a meta-analysis. The meta-analysis found that smoking significantly increased the likelihood of poor tuberculosis treatment outcomes by 51% (OR = 1.51; 95% CI = 1.30 to 1.75 and I-square = 75.1%). In a sub-group analysis, the effect was higher for low- and middle-income countries (OR = 1.74; 95% CI = 1.31 to 2.30) and upper-middle-income economies (OR = 1.52; 95% CI = 1.16 to 1.98) than for high-income ones (OR = 1.34; 95% CI = 1.03 to 1.75) even though the differences in the effects among the strata were not statistically significant as demonstrated by overlapping of confidence intervals of the effects. Meta-regression analysis, adjusted for income economies, found the effect of smoking has not significantly improved over the years (p = 0.92) and thus implying neither of the covariates were source of the heterogeneity. Egger's regression test indicated that publication bias is unlikely (p = 0.403). CONCLUSION Cigarette smoking is significantly linked with poor tuberculosis treatment outcomes.
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Affiliation(s)
- Abay Burusie
- Department of Public Health, College of Health Sciences, Arsi University, Asella, Ethiopia
- * E-mail:
| | - Fikre Enquesilassie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Berhe Dessalegn
- Department of Public Health, College of Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Tafesse Lamaro
- Department of Nursing, College of Health Sciences, Mizan-Tepi University, Tepi, Ethiopia
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15
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Moodley N, Saimen A, Zakhura N, Motau D, Setswe G, Charalambous S, Chetty-Makkan CM. 'They are inconveniencing us' - exploring how gaps in patient education and patient centred approaches interfere with TB treatment adherence: perspectives from patients and clinicians in the Free State Province, South Africa. BMC Public Health 2020; 20:454. [PMID: 32252703 PMCID: PMC7137430 DOI: 10.1186/s12889-020-08562-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) treatment loss to follow up (LTFU) plays an important contributory role to the staggering TB epidemic in South Africa. Reasons for treatment interruption are poorly understood. Treatment interruption appears to be the culmination of poor health literacy of patients and inadequate health education provided by clinicians. We explored clinician and patient perspectives of the gaps in TB messaging that influence TB treatment LTFU. METHODS We conducted semi-structured in-depth interviews between January and May 2018 with a sample of 15 clinicians managing TB and 7 patients identified as LTFU in public clinics in the Free State Province, South Africa. Thematic analysis using a mixed deductive/inductive thematic approach was used. RESULTS Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Patients felt that the TB messaging received was inadequate. Many of the clinicians interviewed felt that improving patient's TB knowledge would reinforce adherence to treatment and thus focused on sharing information on treatment completion, side effects and infection control. However, the inability of clinicians to establish rapport with patients or to identify social support challenged TB treatment adherence by patients. Clinicians perceived this as patients not following their instructions despite what they considered lengthy TB education. Having said this, clinicians concurred that their medical management of TB lacked the psycho-social dimension to treat a social disease of this magnitude. CONCLUSIONS Limited occupational opportunities, fear of disclosure and stigmatization all contributed to treatment LTFU. Clinicians concurred that poor patient understanding of TB and that biomedical management lacking a psycho-social dimension further exacerbated the poor treatment outcome. TB remains a social disease, the successful management of which hinges on patient-centred care.
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Affiliation(s)
- N Moodley
- The Aurum Institute, Johannesburg, South Africa. .,College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Douglas, Townsville, Queensland, 4814, Australia.
| | - A Saimen
- The Aurum Institute, Johannesburg, South Africa
| | - N Zakhura
- TB Programme, Department of Health, Bloemfontein, Free State Province, South Africa
| | - D Motau
- TB Programme, Department of Health, Bloemfontein, Free State Province, South Africa
| | - G Setswe
- The Aurum Institute, Johannesburg, South Africa
| | - S Charalambous
- The Aurum Institute, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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16
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Zaheer S, Sharma R, Beg F, Sherwani RK. Splintered tubercular granuloma-A consistent cytological findings in drug defaulters. Diagn Cytopathol 2020; 48:554-558. [PMID: 32134209 DOI: 10.1002/dc.24401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/01/2020] [Accepted: 02/20/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Tuberculosis remains a major health problem in the less developed nations and is now a major health problem in developed countries, owing to the emergence of human immunodeficiency virus (HIV) infection and (AIDS). However, despite the availability of effective chemotherapy, patient noncompliance with regimens is the most common reason for therapeutic failures. The aim of this study is to describe the cytological features of drug defaulters on lymph node fine-needle aspiration cytology (FNAC). OBJECTIVE Due to the common problem of drug defaulters in developing countries like India, we had carried out a study to see the cytological features of drug defaulters on FNAC of the lymph node. METHOD Three hundred fifty tuberculosis cases, diagnosed based on Mantoux (Mx) test, acid-fast bacilli and/or culture, were followed up for drug compliance by cervical lymph node FNAC. RESULT Forty cases were found to be drug defaulters on detailed and meticulous follow-up. These patients were found to have splintered epithelioid cell granuloma with some viable epithelioid cells enmeshed in fibrous tissue elements. Other findings were degenerating epithelioid cells with or without surrounding eosinophilic infiltration and leaching of the degenerating lymphoid and epithelioid cells. CONCLUSION Lymph node FNAC can be used to identify tubercular drug defaulters, which may be time consuming and/or expensive by culture or other ancillary means.
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Affiliation(s)
- Sufian Zaheer
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital (VMMC and SJH), New Delhi, India
| | - Rohit Sharma
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital (VMMC and SJH), New Delhi, India
| | - Farzana Beg
- Department of Paediatrics, Jawaharlal Nehru Medical College (JNMC), Aligarh, India
| | - Rana K Sherwani
- Department of Pathology, Jawaharlal Nehru Medical College (JNMC), Aligarh, India
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17
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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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18
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Bhatt AN, Tharyan P, Michael JS, Christopher DJ, Varghese GM, Sathyendra S, Rajan SJ, George K, Prasad JH. Treatment outcomes with daily self-administered treatment and thrice-weekly directly-observed treatment in two cohorts of newly-diagnosed, sputum-positive adults with pulmonary tuberculosis. Indian J Tuberc 2020; 67:105-111. [PMID: 32192603 DOI: 10.1016/j.ijtb.2017.05.012] [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: 01/10/2017] [Accepted: 05/11/2017] [Indexed: 06/10/2023]
Abstract
BACKGROUND The Revised National Tuberculosis Control Program (RNTCP) envisages shifting from thrice-weekly to a daily anti-tuberculosis treatment (ATT) regimen. The potential merits and demerits of both regimens continue to be debated. METHODS This retrospective study compared treatment outcomes in 191 HIV-negative, newly diagnosed, sputum-positive adults with pulmonary tuberculosis from Vellore district of Tamil Nadu who were treated at a private medical college during 2009 to 2012 with intermittent Directly Observed Treatment Short Course (intermittent DOTS cohort, n=132) or who opted for daily Self-Administered Treatment (daily SAT cohort, n=59). Treatment outcomes obtained from medical records were supplemented by interviews with consenting, traceable patients. RESULTS The rates for the RNTCP-recommended sputum smear examinations were suboptimal (42% for daily SAT and 72% for intermittent DOTS). However, treatment success with daily SAT and intermittent DOTS (76.2% vs. 70.4%); default (11.9% vs. 18.2%); death (6.8% vs. 5.3%); treatment failure (5.1% vs. 4.6%); and relapse (0% vs. 1.5%) did not significantly differ. CONCLUSIONS While evaluable treatment outcomes were not significantly different with daily SAT and intermittent DOTS, rates for timely smear examinations and for treatment success were lower, and for default higher, in both cohorts than comparable RNTCP data from Vellore district. Further strengthening of RNTCP facilities within private medical colleges and regular, real-time audits of performance and outcomes are needed if daily ATT regimen under the RNTCP is to succeed.
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Affiliation(s)
- Arun N Bhatt
- Post Graduate Resident, Community Health Department, Christian Medical College, Vellore 632002, Tamil Nadu, India
| | - Prathap Tharyan
- Professor & Director, B. V. Moses Centre for Evidence-Informed Health Care & Health Policy, Christian Medical College, Vellore, India
| | - Joy S Michael
- Professor, Department of Microbiology, Christian Medical College, Vellore, India
| | - D J Christopher
- Professor, Department of Pulmonary Medicine, Christian Medical College, Vellore, India
| | - George M Varghese
- Professor, Department of Internal Medicine, Christian Medical College, Vellore, India
| | - Sowmya Sathyendra
- Associate Professor, Department of Internal Medicine, Christian Medical College, Vellore, India
| | - Sudha Jasmine Rajan
- Associate Professor, Department of Internal Medicine, Christian Medical College, Vellore, India
| | - Kuryan George
- Professor, Department of Community Health, Christian Medical College, Vellore, India
| | - Jasmin Helan Prasad
- Professor, Department of Community Health, Christian Medical College, Vellore, India.
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19
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Saleh Jaber AA, Khan AH, Syed Sulaiman SA. Evaluation of tuberculosis defaulters in Yemen from the perspective of health care service. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2018. [DOI: 10.1111/jphs.12259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ammar Ali Saleh Jaber
- Department of Clinical Pharmacy; School of Pharmaceutical Sciences; Universiti Sains Malaysia; Penang Malaysia
| | - Amer Hayat Khan
- Department of Clinical Pharmacy; School of Pharmaceutical Sciences; Universiti Sains Malaysia; Penang Malaysia
| | - Syed Azhar Syed Sulaiman
- Department of Clinical Pharmacy; School of Pharmaceutical Sciences; Universiti Sains Malaysia; Penang Malaysia
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20
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Velayutham B, Chadha VK, Singla N, Narang P, Gangadhar Rao V, Nair S, Ramalingam S, Narayanan Sivaramakrishnan G, Joseph B, Selvaraju S, Shanmugam S, Narang R, Pachikkaran P, Bhat J, Ponnuraja C, Bajaj Bhalla B, Shivashankara BA, Sebastian G, Yadav R, Kumar Sharma R, Sarin R, Myneedu VP, Singla R, Khayyam K, Mrithunjayan SK, Jayasankar SP, Sanker P, Viswanathan K, Viswambharan R, Mathuria K, Bhalla M, Singh N, Tumane KB, Dawale A, Tiwari CP, Bansod R, Jayabal L, Murali L, Khaparde SD, Rao R, Jawahar MS, Natrajan M. Recurrence of tuberculosis among newly diagnosed sputum positive pulmonary tuberculosis patients treated under the Revised National Tuberculosis Control Programme, India: A multi-centric prospective study. PLoS One 2018; 13:e0200150. [PMID: 29979738 PMCID: PMC6034867 DOI: 10.1371/journal.pone.0200150] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/20/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction There is lack of information on the proportion of new smear—positive pulmonary tuberculosis (PTB) patients treated with a 6-month thrice-weekly regimen under Revised National Tuberculosis Control Programme (RNTCP) who develop recurrent TB after successful treatment outcome. Objective To estimate TB recurrence among newly diagnosed PTB patients who have successfully completed treatment and to document endogenous reactivation or re-infection. Risk factors for unfavourable outcomes to treatment and TB recurrence were determined. Methodology Adult (aged ≥ 18 yrs) new smear positive PTB patients initiated on treatment under RNTCP were enrolled from sites in Tamil Nadu, Karnataka, Delhi, Maharashtra, Madhya Pradesh and Kerala. Those declared “treatment success” at the end of treatment were followed up with 2 sputum examinations each at 3, 6 and 12 months after treatment completion. MIRU-VNTR genotyping was done to identify endogenous re-activation or exogenous re-infection at TB recurrence. TB recurrence was expressed as rate per 100 person-years (with 95% confidence interval [95%CI]). Regression models were used to identify the risk factors for unfavourable response to treatment and TB recurrence. Results Of the1577 new smear positive PTB patients enrolled, 1565 were analysed. The overall cure rate was 77% (1207/1565) and treatment success was 77% (1210 /1565). The cure rate varied from 65% to 86%. There were 158 of 1210 patients who had TB recurrence after treatment success. The pooled TB recurrence estimate was 10.9% [95%CI: 0.2–21.6] and TB recurrence rate per 100 person–years was 12.7 [95% CI: 0.4–25]. TB recurrence per 100 person–years varied from 5.4 to 30.5. Endogenous reactivation was observed in 56 (93%) of 60 patients for whom genotyping was done. Male gender was associated with TB recurrence. Conclusion A substantial proportion of new smear positive PTB patients successfully treated with 6 –month thrice-weekly regimen have TB recurrence under program settings.
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Affiliation(s)
| | | | - Neeta Singla
- National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Pratibha Narang
- Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, Wardha, Maharashtra, India
| | - Vikas Gangadhar Rao
- ICMR-National Institute for Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Sanjeev Nair
- Thiruvananthapuram Medical College, Thiruvananthapuram (TMCT), Kerala, India
| | | | | | - Bency Joseph
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Sriram Selvaraju
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | | | - Rahul Narang
- Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sevagram, Wardha, Maharashtra, India
| | | | - Jyothi Bhat
- ICMR-National Institute for Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | | | | | | | - George Sebastian
- National Tuberculosis Institute (NTI), Bangalore, Karnataka, India
| | - Rajiv Yadav
- ICMR-National Institute for Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Ravendra Kumar Sharma
- ICMR-National Institute for Research in Tribal Health (NIRTH), Jabalpur, Madhya Pradesh, India
| | - Rohit Sarin
- National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Vithal Prasad Myneedu
- National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Rupak Singla
- National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Khalidumer Khayyam
- National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | | | | | | | | | | | - Kapil Mathuria
- National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Manpreet Bhalla
- National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi, India
| | - Nitu Singh
- District TB Centre, Malviya Nagar, India
| | | | | | | | | | | | | | | | | | | | - Mohan Natrajan
- ICMR-National Institute for Research in Tuberculosis (NIRT), Chennai, India
- * E-mail:
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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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