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Kombila UD, Manomba Boulingui C, N'Gomanda F, Mouity Mavoungou JV, Ngea Epossi CBH, Bivigou N, Tsioukaka S, Tshisekedi JDD, Mahoumbou J, Boguikouma JB. [Pre-extensively and extensively drug-resistant tuberculosis, in Libreville, Gabon]. Rev Mal Respir 2024:S0761-8425(24)00238-9. [PMID: 39179426 DOI: 10.1016/j.rmr.2024.06.011] [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: 08/20/2023] [Accepted: 06/18/2024] [Indexed: 08/26/2024]
Abstract
INTRODUCTION Very few studies have been devoted to extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis (TB) in Gabon. AIM The aim of the present study is to present the epidemiology of pre-XDR and XDR TB and the evolution over time of patients with multidrug-resistant TB. METHODS This retrospective study covered the activities from 2019 to 2022 of the Nkembo anti-tuberculosis center. RESULTS Fifteen patients were eligible, including 11 (73.3%) pre-XDR patients and 4 (26.7%) XDR-TB patients. Three (20.0%) patients had HIV/TB co-infection. The sample consisted of 7 men (46.7%) and 8 women (53.3%), a sex ratio (M/F) of 0.87. The average age was 35.6 years, and the median 34 years, with extremes of 23 and 60 years. Eight patients (53.3%) represented new cases of pre-XDR or XDR-TB tuberculosis. The majority (60%; n=9) came from deprived neighborhoods with widespread promiscuity. The therapeutic success rate among pre-XDR patients was 4 (36.4%) versus 2 (50.0%) among XDR-TB patients. Reported mortality occurred 5 (33.3%) patients during treatment, including 3 pre-XDR and 2 XDR-TB patients. In all cases, they died before the end of the first trimester of follow-up. CONCLUSION The high frequency of primary pre-extensively drug-resistant tuberculosis underscores the pervasiveness of resistance to anti-tuberculosis drugs and underlines a pressing need for detection of contact cases and early treatment.
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Affiliation(s)
- U D Kombila
- Service de médecine interne, CHU de Libreville, faculté de médecine, université des sciences de la santé de Libreville, Libreville, Gabon; Faculté de médecine, université des sciences de la santé de Libreville, Libreville, Gabon.
| | - C Manomba Boulingui
- Service d'infectiologie, CHU de Libreville, Libreville, Gabon; Faculté de médecine, université des sciences de la santé de Libreville, Libreville, Gabon
| | - F N'Gomanda
- Service de médecine interne, CHU de Libreville, faculté de médecine, université des sciences de la santé de Libreville, Libreville, Gabon
| | - J V Mouity Mavoungou
- Service de médecine interne, CHU de Libreville, faculté de médecine, université des sciences de la santé de Libreville, Libreville, Gabon
| | - C B H Ngea Epossi
- Service de médecine interne, CHU de Libreville, faculté de médecine, université des sciences de la santé de Libreville, Libreville, Gabon
| | - N Bivigou
- Service de médecine interne, CHU de Libreville, faculté de médecine, université des sciences de la santé de Libreville, Libreville, Gabon
| | - S Tsioukaka
- Service de médecine interne, CHU de Libreville, faculté de médecine, université des sciences de la santé de Libreville, Libreville, Gabon
| | - J D D Tshisekedi
- Programme national de lutte contre la tuberculose (PNLT), Libreville, Gabon
| | - J Mahoumbou
- Programme national de lutte contre la tuberculose (PNLT), Libreville, Gabon
| | - J B Boguikouma
- Programme national de lutte contre la tuberculose (PNLT), Libreville, Gabon
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Mouinga-Ondeme A, Longo-Pendy NM, Moussadji Kinga IC, Ngoubangoye B, Moussavou-Boundzanga P, Boundenga L, Diane A, Sica J, Mfouo-Tynga IS, Ngoungou EB. Risk Factors Associated with Opportunistic Infections among People Living with HIV/AIDS and Receiving an Antiretroviral Therapy in Gabon, Central Africa. Viruses 2024; 16:85. [PMID: 38257785 PMCID: PMC10819398 DOI: 10.3390/v16010085] [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: 10/19/2023] [Revised: 11/11/2023] [Accepted: 11/11/2023] [Indexed: 01/24/2024] Open
Abstract
The Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is still one of the main causes of death in sub-Saharan Africa. Antiretroviral therapies (ARTs) have significantly improved the health conditions of people living with HIV/AIDS (PLWHA). Consequently, a significant drop in morbidity and mortality, along with a reduced incidence of opportunistic infections (OIs), has been observed. However, certain atypical and biological profiles emerge in ART patients post-examination. The objective of this study was to identify the risk factors that contributed to the onset of OIs in HIV patients undergoing ART in Gabon. Epidemiological and biological data were obtained from medical records (2017 to 2019) found at the outpatient treatment centre (CTA) of Franceville in Gabon. Samples for blood count, CD4, and viral load analysis at CIRMF were collected from PLWHA suffering from other pathogen-induced conditions. A survey was carried out and data were analysed using Rstudio 4.0.2 and Excel 2007 software. Biological and socio-demographic characteristics were examined concerning OIs through both a univariate analysis via Fisher's exact tests or chi2 (χ2), and a multivariate analysis via logistic regression. Out of the 300 participants initially selected, 223 were included in the study, including 154 (69.05%) women and 69 (30.95%) men. The mean age was 40 (38.6; 41.85), with individuals ranging from 2 to 77 years old. The study cohort was classified into five age groups (2 to 12, 20 to 29, 30 to 39, 40 to 49, and 50 to 77 years old), among which the groups aged 30 to 39 and 40 to 49 emerged as the largest, comprising 68 (30.5%) and 75 (33.6%) participants, respectively. It was noted that 57.9% of PLWHA had developed OIs and three subgroups were distinguished, with parasitic, viral, and bacterial infections present in 18%, 39.7%, and 55.4% of cases, respectively. There was a correlation between being male and having a low CD4 T-cell count and the onset of OIs. The study revealed a high overall prevalence of OIs, and extending the study to other regions of Gabon would yield a better understanding of the risk factors associated with the onset of these infections.
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Affiliation(s)
- Augustin Mouinga-Ondeme
- Unité des Infections Rétrovirales et Pathologies Associées, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (P.M.-B.); (A.D.); (I.S.M.-T.)
| | - Neil Michel Longo-Pendy
- Unité de Recherches en Ecologie de la Santé, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (N.M.L.-P.); (L.B.)
| | - Ivan Cyr Moussadji Kinga
- Centre de Primatologie, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (I.C.M.K.); (B.N.)
| | - Barthélémy Ngoubangoye
- Centre de Primatologie, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (I.C.M.K.); (B.N.)
| | - Pamela Moussavou-Boundzanga
- Unité des Infections Rétrovirales et Pathologies Associées, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (P.M.-B.); (A.D.); (I.S.M.-T.)
| | - Larson Boundenga
- Unité de Recherches en Ecologie de la Santé, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (N.M.L.-P.); (L.B.)
- Département d’Anthropologie, Université de Durham, South Road, Durham DH1 3LE, UK
| | - Abdoulaye Diane
- Unité des Infections Rétrovirales et Pathologies Associées, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (P.M.-B.); (A.D.); (I.S.M.-T.)
| | - Jeanne Sica
- Centre de Traitement Ambulatoire, Franceville BP 277, Gabon;
| | - Ivan Sosthene Mfouo-Tynga
- Unité des Infections Rétrovirales et Pathologies Associées, Centre Interdisciplinaire de Recherches Médicales de Franceville (CIRMF), Franceville BP 769, Gabon; (P.M.-B.); (A.D.); (I.S.M.-T.)
| | - Edgard Brice Ngoungou
- Département d’Epidémiologie, Biostatistiques et Informatique Médicale (DEBIM)/Unité de Recherche en Epidémiologie des Maladies Chroniques et Santé Environnement (UREMCSE), Faculté de Médecine, Université des Sciences de la Santé, Libreville-Owendo BP 18231, Gabon;
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Building sustainable clinical trial sites in Sub-Saharan Africa through networking, infrastructure improvement, training and conducting clinical studies: The PanACEA approach. Acta Trop 2023; 238:106776. [PMID: 36502888 DOI: 10.1016/j.actatropica.2022.106776] [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: 09/27/2021] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The Pan-African Consortium for the Evaluation of Anti-Tuberculosis Antibiotics (PanACEA) was designed to build tuberculosis (TB) trial capacity whilst conducting clinical trials on novel and existing agents to shorten and simplify TB treatment. PanACEA has now established a dynamic network of 11 sub-Saharan clinical trial sites and four European research institutions. OBJECTIVES In 2011, a capacity development program, funded by the European & Developing Countries Clinical Trials Partnership (EDCTP), was launched with four objectives, aiming at strengthening collaborating TB research sites to reach the ultimate goal of becoming self-sustainable institutions: networking; training; conducting clinical trials; and infrastructure scaling-up of sites. METHODS Assessment in six sub-Saharan TB-endemic countries (Gabon, Kenya, South Africa, Tanzania, Uganda and Zambia) were performed through a structured questionnaire, site visits, discussion with the PanACEA consortium, setting of milestones and identification of priorities and followed-up with evaluations of each site. The results of this needs-based assessment was then translated into capacity development measures. RESULTS In the initial phase, over a four-year period (March 2011 - June 2014), the programme scaled-up six sites; conducted a monitoring training program for 11 participants; funded five MSc and four PhD students, fostering gender balance; conducted four epidemiological studies; supported sites to conduct five Phase II studies and formed a sustainable platform for TB research (panacea-tb.net). CONCLUSION Our experience of conducting TB clinical trials within the PanACEA programme environment of mentoring, networking and training has provided a sound platform for establishing future sustainable research centres. Our goal of facilitating emergent clinical TB trial sites to better initiate and lead research activities has been mostly successful.
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Resistance patterns among drug-resistant tuberculosis patients and trends-over-time analysis of national surveillance data in Gabon, Central Africa. Infection 2022; 51:697-704. [DOI: 10.1007/s15010-022-01941-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022]
Abstract
Abstract
Objective
Routinely generated surveillance data are important for monitoring the effectiveness of MDR-TB control strategies. Incidence of rifampicin-resistant tuberculosis (RR-TB) is a key indicator for monitoring MDR-TB.
Methods
In a longitudinal nationwide retrospective study, 8 years (2014–2021) of sputum samples from presumptively drug-resistant tuberculosis patients from all regions of Gabon were referred to the national tuberculosis reference laboratory. Samples were analysed using GeneXpert MTB/RIF and Genotype MTBDRsl version 2/Line Probe Assay.
Results
Of 3057 sputum samples from presumptive tuberculosis patients, both from local hospital and from referral patients, 334 were RR-TB. The median patient age was 33 years (interquartile range 26–43); one third was newly diagnosed drug-resistant tuberculosis patients; one-third was HIV-positive. The proportion of men with RR-TB was significantly higher than that of women (55% vs 45%; p < 0.0001). Patients aged 25–35 years were most affected (32%; 108/334). The cumulative incidence of RR-TB was 17 (95% CI 15–19)/100,000 population over 8 years. The highest incidences were observed in 2020 and 2021. A total of 281 samples were analysed for second-line drug resistance. The proportions of study participants with MDR-TB, pre-XDR-TB and XDR-TB were 90.7% (255/281), 9% (25/281) and 0.3% (1/281), respectively. The most-common mutations in fluoroquinolones resistance isolates was gyrA double mutation gyrA MUT3B and MUT3C (23%; 4/17). Most (64%; 6/8) second-line injectable drugs resistance isolates were characterised by missing both rrs WT2 and MUT2 banding.
Conclusion
The increasing incidence of MDR-TB infection in Gabon is alarming. It is highest in the 25–35 years age category. The incidence of MDR-TB infection in treatment-naïve patients calls for case finding and contact tracing strategy improvement.
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Anley DT, Akalu TY, Merid MW, Tsegaye T. Development and Validation of a Nomogram for the Prediction of Unfavorable Treatment Outcome Among Multi-Drug Resistant Tuberculosis Patients in North West Ethiopia: An Application of Prediction Modelling. Infect Drug Resist 2022; 15:3887-3904. [PMID: 35903578 PMCID: PMC9317379 DOI: 10.2147/idr.s372351] [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: 04/26/2022] [Accepted: 07/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Multidrug-resistant tuberculosis (MDR-TB) is a global problem and a health security threat, which makes “Ending the global TB epidemic in 2035” unachievable. Globally, the unfavourable treatment outcome remains unacceptably high. Therefore, this study aimed to develop a risk prediction model for unfavorable treatment outcomes in MDR-TB patients, which can be used by clinicians as a simple clinical tool in their decision-making. Objective The objective of this study was to develop and validate a risk prediction model for the prediction of unfavorable treatment outcomes among MDR-TB patients in North-West Ethiopia. Methods We used MDR-TB data collected from the University of Gondar and Debre Markos referral hospitals. A retrospective follow-up study was conducted and a total of 517 patients were included in the study. STATA version 16 statistical software and R version 4.0.5 were used for the analysis. Descriptive statistics were carried out. A multivariable model was fitted using all potent predictors selected by the lasso regression method. A simplified risk prediction model (nomogram) was developed based on the binomial logit-based model, and its performance was described by assessing its discriminatory power and calibration. Finally, decision curve analysis (DCA) was done to evaluate the clinical and public health impact of the developed model. Results The developed nomogram comprised six predictors: baseline anemia, major adverse event, comorbidity, age, marital status, and treatment supporter. The model has a discriminatory power of 0.753 (95% CI: 0.708, 0.798) and calibration test of (P-value = 0.695). It was internally validated by bootstrapping method, and it has a relatively corrected discrimination performance (AUC = 0.744, 95CI: 0.699, 0.788). The optimism coefficient was found to be 0.009. The decision curve analysis showed the net benefit of the model as threshold probabilities varied. Conclusion The developed nomogram can be used for individualized prediction of unfavorable treatment outcomes in MDR-TB patients for it has a satisfactory level of accuracy and good calibration. The model is clinically interpretable and was found to have added benefits in clinical practice.
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Affiliation(s)
- Denekew Tenaw Anley
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Tsegaye
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Adegbite BR, Edoa JR, Agbo Achimi Abdul JBP, Epola M, Mevyann C, Dejon-Agobé JC, Zinsou JF, Honkpehedji YJ, Mpagama SG, Alabi AS, Kremsner PG, Klipstein-Grobusch K, Adegnika AA, Grobusch MP. Non-communicable disease co-morbidity and associated factors in tuberculosis patients: A cross-sectional study in Gabon. EClinicalMedicine 2022; 45:101316. [PMID: 35243277 PMCID: PMC8885570 DOI: 10.1016/j.eclinm.2022.101316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/31/2022] [Accepted: 02/09/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There are only limited data from resource-limited settings available on the prevalence of non-communicable diseases and associated risk factors of tuberculosis patients. This study investigated non-communicable disease co-morbidity in tuberculosis patients from Moyen Ogooué Province, Gabon. METHODS All patients aged 18 years or older consulting for tuberculosis (TB) symptoms in Gabon's Moyen Ogooué province and neighbouring provinces from November 2018 to November 2020 were screened for diabetes mellitus, hypertension, and risk factors thereof (obesity, dyslipidaemia, smoking and alcohol consumption). Logistic regression was performed to identify factors associated with TB-diabetes and TB-hypertension co-morbidities. FINDINGS Of 583 patients included, 227 (39%) were diagnosed with tuberculosis. In tuberculosis-confirmed patients, the prevalences of hypertension and diabetes were 16·3% and 12·8%, respectively. The prevalence of diabetes was twice as high in tuberculosis patients compared to non-tuberculosis patients. Factors independently associated with hypertension-tuberculosis co-morbidity were age >55 years (aOR=8·5, 95% CI 2·43, 32·6), age 45-54 years (aOR=4.9, 95%CI 1.3-19.8), and moderate alcohol consumption (aOR=2·4; 95% CI 1·02- 5·9), respectively. For diabetes-tuberculosis co-morbidity, age >55 years was positively (aOR=9·13; 95% CI 2·4-39·15), and moderate alcohol consumption inversely associated (aOR=0·26, 95% CI 0·08- 0·73). One-hundred-and-four (46%) of the tuberculosis patients had at least either dyslipidaemia, hypertension, diabetes, or obesity with a majority of newly-diagnosed hypertension and diabetes. INTERPRETATION Integration of screening of non-communicable diseases and their risk factors during TB assessment for early diagnosis, treatment initiation and chronic care management for better health outcomes should be implemented in all tuberculosis healthcare facilities. FUNDING This study was supported by WHO AFRO/TDR/EDCTP (2019/893,805) and Deutsches Zentrum für Infektiologie (DZIF/ TTU 02.812).
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Affiliation(s)
- BR Adegbite
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
| | - JR Edoa
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
| | - JBP Agbo Achimi Abdul
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
| | - M Epola
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
| | - C Mevyann
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
| | - JC Dejon-Agobé
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
| | - JF Zinsou
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - YJ Honkpehedji
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - SG Mpagama
- Kibong'oto Infectious Diseases Hospital - Sanya Juu Siha/Kilimanjaro Clinical Research Institute Kilimanjaro Tanzania, Mae Street, Lomakaa Road, Siha Kilimanjaro, Tanzania
| | - AS Alabi
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
| | - PG Kremsner
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
| | - K Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - AA Adegnika
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - MP Grobusch
- German Center for Infection Research, Centre de Recherches Médicales de Lambaréné and African Partner Institution, Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands
- Universität Tübingen and German Center for Infection Research, Institut für Tropenmedizin, Tübingen, Germany
- Masanga Medical Research Unit (MMRU), Masanga, Sierra Leone
- Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Corresponding author at: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, location AMC, Amsterdam Public Health, Amsterdam Infection and Immunity, University of Amsterdam, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands.
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Vigenschow A, Adegbite BR, Edoa JR, Alabi A, Adegnika AA, Grobusch MP, Massinga-Loembe M. Tuberculosis infection control measures in healthcare facilities in Moyen-Ogooué Province, Gabon. BMC Health Serv Res 2021; 21:1200. [PMID: 34740361 PMCID: PMC8571857 DOI: 10.1186/s12913-021-07236-z] [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: 04/26/2021] [Accepted: 10/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background Healthcare workers (HCW) are at higher risk of tuberculosis (TB) than the general population. We assessed healthcare facilities for their TB infection control standards and priorities. Methods A standardised tool was applied. The assessment was conducted by direct observation, documents review and interviews with the facility heads. Results Twenty healthcare facilities were assessed; 17 dispensaries, an HIV-clinic, a private not-for-profit hospital and a public regional hospital. In both hospitals, outpatient departments, internal medicine wards, paediatric wards, emergency departments; and the MDR-TB unit of the public regional hospital were assessed. In Gabon, there are currently no national guidelines for TB infection control (TBIC) in healthcare settings. Consequently, none of the facilities had an infection control plan or TBIC focal point. In three departments of two facilities (2/20 facilities), TB patients and presumed TB cases were observed to be consistently provided with surgical masks. One structure reported to regularly test some of its personnel for TB. Consultation rooms were adequately ventilated in six primary care level facilities (6/17 dispensaries) and in none of the hospitals, due to the use of air conditioning. Adequate personal protective equipment was not provided regularly by the facilities and was only found to be supplied in the MDR-TB unit and one of the paediatric wards. Conclusions In Moyen-Ogooué province, implementation of TBIC in healthcare settings is generally low. Consequently, HCW are not sufficiently protected and therefore at risk for M. tuberculosis infection. There is an urgent need for national TBIC guidelines and training of health workers to safeguard implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07236-z.
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Affiliation(s)
- Anja Vigenschow
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
| | - Bayodé Romeo Adegbite
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany.,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health, Amsterdam University Medical Centers, location Amsterdam, Amsterdam Infection & Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - Jean-Ronald Edoa
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
| | - Abraham Alabi
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon
| | - Akim A Adegnika
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
| | - Martin P Grobusch
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon. .,Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany. .,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam Public Health, Amsterdam University Medical Centers, location Amsterdam, Amsterdam Infection & Immunity, University of Amsterdam, Amsterdam, The Netherlands. .,Masanga Medical Research Unit, Masanga, Sierra Leone. .,Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
| | - Marguerite Massinga-Loembe
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
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[Epidemiological and evolutionary profile of tuberculosis under the influence og HIV]. Rev Mal Respir 2021; 39:1-7. [PMID: 34756503 DOI: 10.1016/j.rmr.2021.10.003] [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: 01/01/2021] [Accepted: 09/05/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION We conducted this study to understand the impact of HIV infection on the epidemiology of tuberculosis (TB) in an outpatient care center. PATIENTS AND METHODS This is a retrospective and comparative study between subjects infected or not infected with HIV, using TB case notification data registered from October 2017 to September 2019 in the intermediate care facility (CDT) of the University Hospital of Libreville. Comparisons were made by bivariate analysis; proportions were compared using the Chi2 or the Fisher Exact test. Variables of significant interest were included in a binary logistic regression model for multivariate analysis. RESULTS Prevalence of HIV infection was 30.4%. Average age was 35.2 years with extremes at 15 and 83 years. In the results of the multivariate analysis, female patients were more frequently infected with HIV (p=0.002; OR=1.960, 95% CI [1.275 - 3.015]) and HIV infection was associated with a reduction in the proportion of PTB (+) (p=0.001; OR=0.483, 95% CI [0.311 - 0.752]). HIV infection was also associated with an increased proportion of new cases (P=0.007; OR=2.987, 95% CI [1.353 - 6.597]), EPT (p<0.001; OR=1.084, 95% CI [1.054 - 1.131] and an unfavorable therapeutic outcome (p=0.016; OR=2.744, 95% CI [1.208 - 6.233]). CONCLUSION TB/HIV co-infection remains high. It continues to negatively impact outpatient management of TB.
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9
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Vigenschow A, Edoa JR, Adegbite BR, Agbo PA, Adegnika AA, Alabi A, Massinga-Loembe M, Grobusch MP. Knowledge, attitudes and practices regarding tuberculosis amongst healthcare workers in Moyen-Ogooué Province, Gabon. BMC Infect Dis 2021; 21:486. [PMID: 34039304 PMCID: PMC8157668 DOI: 10.1186/s12879-021-06225-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background In countries with a high tuberculosis incidence such as Gabon, healthcare workers are at enhanced risk to become infected with tuberculosis due to their occupational exposure. In addition, transmission can occur between patients and visitors, if a tuberculosis infection is not suspected in time. Knowledge about tuberculosis and correct infection control measures are therefore highly relevant in healthcare settings. Methods We conducted an interviewer-administered knowledge, attitude and practice survey amongst healthcare workers in 20 healthcare facilities at all levels in the Moyen-Ogooué province, Gabon. Correctly answered knowledge questions were scored and then categorised into four knowledge levels. Additionally, factors associated with high knowledge levels were identified. Fisher’s Exact test was used to identify factors associated with high knowledge levels. Results A total of 103 questionnaires were completed by various healthcare personnel. The most-frequently scored category was ‘intermediate knowledge’, which was scored by 40.8% (42/103), followed by ‘good knowledge’ with 28.2% (29/103) and ‘poor knowledge’ with 21.4% (22/103) of participating healthcare workers, respectively. ‘Excellent knowledge’ was achieved by 9.7% (10/103) of the interviewees. Apart from the profession, education level, type of employing healthcare facility, as well as former training on tuberculosis were significantly associated with high knowledge scores. Attitudes were generally positive towards tuberculosis infection control efforts. Of note, healthcare workers reported that infection control measures were not consistently practiced; 72.8% (75/103) of the participants were scared of becoming infected with tuberculosis, and 98.1% saw a need for improvement of local tuberculosis control. Conclusions The survey results lead to the assumption that healthcare workers in the Moyen-Ogooué province are at high risk to become infected with tuberculosis. There is an urgent need for improvement of tuberculosis infection control training for local healthcare personnel, particularly for less trained staff such as assistant nurses. Furthermore, the lack of adequate infection control measures reported by staff could possibly be correlated with a lack of adequate facility structures and protective equipment and requires further investigation. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06225-1.
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Affiliation(s)
- Anja Vigenschow
- Centre de Recherches Médicales de Lambaréné and African. Partner Institution, German Center for Infection Research, Lambaréné, Gabon.,Institute of Tropical Medicine, Tübingen University, Tübingen, Germany
| | - Jean Ronald Edoa
- Centre de Recherches Médicales de Lambaréné and African. Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Bayode Romeo Adegbite
- Centre de Recherches Médicales de Lambaréné and African. Partner Institution, German Center for Infection Research, Lambaréné, Gabon.,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Pacome Achimi Agbo
- Centre de Recherches Médicales de Lambaréné and African. Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Ayola A Adegnika
- Centre de Recherches Médicales de Lambaréné and African. Partner Institution, German Center for Infection Research, Lambaréné, Gabon.,Institute of Tropical Medicine, Tübingen University, Tübingen, Germany
| | - Abraham Alabi
- Centre de Recherches Médicales de Lambaréné and African. Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Marguerite Massinga-Loembe
- Centre de Recherches Médicales de Lambaréné and African. Partner Institution, German Center for Infection Research, Lambaréné, Gabon.,Institute of Tropical Medicine, Tübingen University, Tübingen, Germany
| | - Martin P Grobusch
- Centre de Recherches Médicales de Lambaréné and African. Partner Institution, German Center for Infection Research, Lambaréné, Gabon. .,Institute of Tropical Medicine, Tübingen University, Tübingen, Germany. .,Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands.
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10
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Bogale L, Tsegaye T, Abdulkadir M, Akalu TY. Unfavorable Treatment Outcome and Its Predictors Among Patients with Multidrug-Resistance Tuberculosis in Southern Ethiopia in 2014 to 2019: A Multi-Center Retrospective Follow-Up Study. Infect Drug Resist 2021; 14:1343-1355. [PMID: 33854347 PMCID: PMC8041603 DOI: 10.2147/idr.s300814] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/16/2021] [Indexed: 12/16/2022] Open
Abstract
Background According to the 2017 global report, Ethiopia is among the top 30 high tuberculosis (TB) and multidrug-resistant tuberculosis (MDR-TB) burden countries. However, studies on MDR-TB treatment outcomes in Southern Ethiopia was very limited. Therefore, the study was aimed at determining the unfavorable treatment outcome and its predictors among patients with multidrug-resistant tuberculosis in Southern Ethiopia MDR-TB treatment centers. Subjects and Methods A retrospective follow-up study was conducted in Southern Ethiopia MDR-TB treatment initiating centers. Three hundred sixty-three patients were included in the study. Kaplan–Meier failure curve, median time, and Log rank test were used to present the descriptive findings. Then, a Cox regression analysis was used to identify predictors of unfavorable treatment outcome. The strength of the association was reported using an adjusted hazard ratio (AHR) and a 95% confidence interval (CI). Finally, the Cox Snell residual test was used to check the goodness of fit. Results For the entire cohort, the unfavorable treatment outcome was 23.68% (19.29, 28.09). Hospitalization for care (AHR = 2.07; 95% CI = 1.21, 3.63), male sex (AHR = 1.85; 95% CI = 1.002, 3.42), attending tertiary education (AHR = 0.31; 95% CI = 0.11, 0.91), and those with low hemoglobin (AHR = 2.89; 95% CI = 1.55, 5.38) were predictors for unfavorable treatment outcome. Conclusion The unfavorable treatment outcome was higher compared with the national goal of END-TB by 2020. Hospitalizations for care, male sex, and low hemoglobin level increased the hazard of the unfavorable treatment outcome. On the other hand, attending territory education decreased the hazard of the unfavorable treatment outcome.
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Affiliation(s)
- Lemlem Bogale
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Tsegaye
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohamed Abdulkadir
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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11
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Development of sustainable research excellence with a global perspective on infectious diseases: Centre de Recherches Médicales de Lambaréné (CERMEL), Gabon. Wien Klin Wochenschr 2021; 133:500-508. [PMID: 33398458 PMCID: PMC7781170 DOI: 10.1007/s00508-020-01794-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022]
Abstract
Medical research in sub-Saharan Africa is of high priority for societies to respond adequately to local health needs. Often enough it remains a challenge to build up capacity in infrastructure and human resources to highest international standards and to sustain this over mid-term to long-term periods due to difficulties in obtaining long-term institutional core funding, attracting highly qualified scientists for medical research and coping with ever changing structural and political environments. The Centre de Recherches Médicales de Lambaréné (CERMEL) serves as model for how to overcome such challenges and to continuously increase its impact on medical care in Central Africa and beyond. Starting off as a research annex to the Albert Schweitzer Hospital in Lambaréné, Gabon, it has since then expanded its activities to academic and regulatory clinical trials for drugs, vaccines and diagnostics in the field of malaria, tuberculosis, and a wide range of poverty related and neglected tropical infectious diseases. Advancing bioethics in medical research in Africa and steadily improving its global networks and infrastructures, CERMEL serves as a reference centre for several international consortia. In close collaboration with national authorities, CERMEL has become one of the main training hubs for medical research in Central Africa. It is hoped that CERMEL and its leitmotiv “to improve medical care for local populations” will serve as an inspiration to other institutions in sub-Saharan Africa to further increase African capacity to advance medicine.
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12
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Adegbite BR, Edoa JR, Achimi Agbo P, Dejon-Agobé JC, N Essone P, Lotola-Mougeni F, Mbong Ngwese M, Mfoumbi A, Mevyann C, Epola M, Zinsou JF, Honkpehedji YJ, Agnandji ST, Kremsner PG, Alabi AS, Adegnika AA, Grobusch MP. Epidemiological, Mycobacteriological, and Clinical Characteristics of Smoking Pulmonary Tuberculosis Patients, in Lambaréné, Gabon: A Cross-Sectional Study. Am J Trop Med Hyg 2020; 103:2501-2505. [PMID: 32975178 DOI: 10.4269/ajtmh.20-0424] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Gabon carries a high burden of both tuberculosis (TB) and smoking. This study examines the disease characteristics of smoking pulmonary TB patients in Lambaréné. We interviewed adult pulmonary TB patients in Lambaréné, between March 2016 and April 2019. Clinical and biological patient characteristics were collected. Bivariate and logistic regression analyses were performed to assess factors associated with smoking. The mean age of patients included was 31 years (±13). The proportion of smokers in our study was 30% (89/295). Smoking was significantly associated with patient-related diagnostic delay (adjusted odds ratio [AOR] = 8.18; 95% CI = 3.67-19.56), a higher number of pulmonary TB signs and symptoms (AOR = 2.74; 95% CI = 1.18-6.73), and a higher sputum mycobacterial load (AOR = 3.18; 95% CI = 1.33-8.11). The prevalence of smoking among TB patients is high, and leading to aggravated disease as compared with controls. Our study findings suggest that smoking patients should be regularly screened for TB, to reduce diagnostic delay and TB transmission within community. Smoking cessation activities should be included in the national TB control program in Gabon.
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Affiliation(s)
- Bayode Romeo Adegbite
- Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands.,Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Jean Ronald Edoa
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Pacome Achimi Agbo
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Jean Claude Dejon-Agobé
- Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands.,Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Paulin N Essone
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Fabrice Lotola-Mougeni
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Mirabeau Mbong Ngwese
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Arnault Mfoumbi
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Chester Mevyann
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Micheska Epola
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Jeannot Frejus Zinsou
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.,Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Yabo Josiane Honkpehedji
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.,Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Selidji Todagbe Agnandji
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Peter Gottfried Kremsner
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Abraham Sunday Alabi
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Ayola Akim Adegnika
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands.,Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany.,Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon
| | - Martin Peter Grobusch
- Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research, Lambaréné, Gabon.,Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany.,Amsterdam Infection and Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
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13
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Pettit AC, Jenkins CA, Blevins Peratikos M, Yotebieng M, Diero L, Do CD, Ross J, Veloso VG, Hawerlander D, Marcy O, Shepherd BE, Fenner L, Sterling TR. Directly observed therapy and risk of unfavourable tuberculosis treatment outcomes among an international cohort of people living with HIV in low- and middle-income countries. J Int AIDS Soc 2019; 22:e25423. [PMID: 31814312 PMCID: PMC6900483 DOI: 10.1002/jia2.25423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 11/08/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Identification of persons living with human immunodeficiency virus (HIV)-associated tuberculosis (TB) at increased risk for unfavourable TB outcomes would inform efforts to improve such outcomes. We sought to identify factors associated with a decreased risk of unfavourable TB treatment outcomes among people living with HIV-infection (PLHIV) in low- and middle-income countries (LMIC), with a specific focus on directly observed therapy (DOT) compared with self-administered therapy (SAT) during the continuation phase of anti-TB therapy. METHODS We conducted a retrospective cohort study among adults diagnosed with HIV-associated TB in Africa, Asia and the Americas from 2012 to 2013; data were collected from 2012 to 2016. Unfavourable TB treatment outcomes (death during TB treatment, and TB treatment failure or recurrence) were defined according to World Health Organization criteria. Receipt of DOT was obtained at the site level and defined as ≥5 days of DOT per week. The person administering DOT and treatment location varied by site. Lack of receipt of DOT was defined as SAT. Multivariable logistic regression estimated the adjusted odds of unfavourable TB treatment outcomes. RESULTS Among 1862 adults with HIV-associated TB included, 252 (13.5%) had unfavourable TB outcomes (226 deaths, 26 recurrences/failures). Overall, 1825 (98%) received DOT in the intensive phase and 1617 (87%) received DOT in the continuation phase. DOT in the continuation phase was not significantly associated with unfavourable TB outcomes (aOR 1.43, 95% CI 0.86 to 2.38) compared to SAT. Body mass index (BMI) change during anti-TB treatment (per 2 units increase, aOR 0.74, 95% CI 0.68 to 0.82) and CD4+ count at TB diagnosis (200 vs. 50 cells/µL, aOR 0.54, 95% CI 0.39 to 0.73) were both independently associated with decreased odds of unfavourable TB treatment outcomes. CONCLUSIONS In this large, international cohort of people living with HIV-associated TB in LMIC who received intensive phase DOT, DOT during the continuation phase of anti-TB therapy was not associated with a decreased odds of unfavourable TB treatment outcomes compared to SAT. Randomized trials evaluating the effect of continuation-phase DOT on TB outcomes among PLHIV are needed.
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Affiliation(s)
- April C Pettit
- Department of MedicineVanderbilt University Medical CenterNashvilleTNUSA
- Vanderbilt Tuberculosis CenterNashvilleTNUSA
| | - Cathy A Jenkins
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
| | | | | | - Lameck Diero
- Academic Model Providing Access To Healthcare (AMPATH)EldoretKenya
| | | | - Jeremy Ross
- TREAT Asia/amfAR – The Foundation for AIDS ResearchBangkokThailand
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroRJBrazil
| | - Denise Hawerlander
- Centre Intégré de Recherches Biocliniques d'Abidjan CIRBAAbidjanCôte d'Ivoire
| | - Olivier Marcy
- Centre INSERM U1219Bordeaux Population HealthUniversity of BordeauxBordeauxFrance
| | - Bryan E Shepherd
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTNUSA
| | - Lukas Fenner
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Timothy R Sterling
- Department of MedicineVanderbilt University Medical CenterNashvilleTNUSA
- Vanderbilt Tuberculosis CenterNashvilleTNUSA
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14
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Use of Antiplatelet Agents and Survival of Tuberculosis Patients: A Population-Based Cohort Study. J Clin Med 2019; 8:jcm8070923. [PMID: 31252593 PMCID: PMC6678265 DOI: 10.3390/jcm8070923] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/19/2019] [Accepted: 06/24/2019] [Indexed: 12/12/2022] Open
Abstract
While evidence is accumulating that platelets contribute to tissue destruction in tuberculosis (TB) disease, it is still not known whether antiplatelet agents are beneficial to TB patients. We performed this retrospective cohort study and identified incident TB cases in the Taiwan National Tuberculosis Registry from 2008 to 2014. These cases were further classified into antiplatelet users and non-users according to the use of antiplatelet agents prior to the TB diagnosis, and the cohorts were matched using propensity scores (PSs). The primary outcome was survival after a TB diagnosis. In total, 74,753 incident TB cases were recruited; 9497 (12.7%) were antiplatelet users, and 7764 (10.4%) were aspirin (ASA) users. A 1:1 PS-matched cohort with 8864 antiplatelet agent users and 8864 non-users was created. After PS matching, antiplatelet use remained associated with a longer survival (adjusted hazard ratio (HR): 0.91, 95% confidence interval (CI): 0.88–0.95, p < 0.0001). The risk of major bleeding was not elevated in antiplatelet users compared to non-users (p = 0.604). This study shows that use of antiplatelet agents has been associated with improved survival in TB patients. The immunomodulatory and anti-inflammatory effects of antiplatelet agents in TB disease warrant further investigation. Antiplatelets are promising as an adjunct anti-TB therapy.
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15
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Ateba-Ngoa U, Edoa JR, Adegbite BR, Rossatanga EG, Madiou D, Mfoumbi A, Mevyann C, Achimi Agbo P, Mahoumbou J, Gould S, Lell B, Adegnika AA, Köhler C, Kremsner PG, Massinga-Loembe M, Alabi A, Grobusch MP. Implementation of multidrug-resistant tuberculosis (MDR-TB) treatment in Gabon: lessons learnt from the field. Infection 2019; 47:811-816. [PMID: 31073710 DOI: 10.1007/s15010-019-01314-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/30/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Since May 2016, WHO recommended a 9-12 month short-treatment regimen for multidrug-resistant tuberculosis (MDR-TB) treatment known as the 'Bangladesh Regimen'. However, limited data exist on the appropriateness thereof, and its implementation in low- and middle-income countries (LMIC). We report here on the pilot phase of the evaluation of the Bangladesh regimen in Gabon, prior to its endorsement by the WHO. METHODS This ongoing observational study started in September 2015. Intensive training of hospital health workers as well as community information and education were conducted. GeneXpert-confirmed MDR-TB patients received the second-line anti-tuberculosis drugs (4KmMfxPtoHCfzEZ/5MfxCfzEZ). Sputum smears and cultures were done monthly. Adverse events were monitored daily. RESULTS Eleven patients have been treated for MDR-TB piloting the short regimen. All were HIV-negative and presented in poor health with extensive pulmonary lesions. The overall sputum culture conversion rate was 64% after 4 months of treatment. Three patients developed marked hearing loss; one a transient cutaneous rash. Of 11 patients in our continuous care, 7 (63.6%) significantly improved clinically and bacteriologically. One (9.1%) patient experienced a treatment failure, two (18.2%) died, and one (9.1%) was lost to follow up. CONCLUSIONS Our pioneering data on systematic MDR-TB treatment in Gabon, with currently almost total absence of resistance against the second-line drugs, demonstrate that a 9-month regimen has the capacity to facilitate early culture negativity and sustained clinical improvement. Close adverse events monitoring and continuous care are vital to success.
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Affiliation(s)
- U Ateba-Ngoa
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - J R Edoa
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - B R Adegbite
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - E G Rossatanga
- Centre Hospitalier Régional Georges Rawiri de Lambaréné, Lambarene, Gabon
| | - D Madiou
- Centre Hospitalier Régional Georges Rawiri de Lambaréné, Lambarene, Gabon
| | - A Mfoumbi
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
| | - C Mevyann
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
| | - P Achimi Agbo
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
| | - J Mahoumbou
- Programme National de Lutte contre la Tuberculose, Ministry of Health, Libreville, Gabon
| | - S Gould
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
| | - B Lell
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - A A Adegnika
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - C Köhler
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - P G Kremsner
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - M Massinga-Loembe
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - A Alabi
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany
| | - M P Grobusch
- Centre des Recherches Médicales de Lambaréné, Lambarene, Gabon.
- Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen, Germany.
- Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, Amsterdam, The Netherlands.
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Nagu TJ, Aboud S, Matee MI, Maeurer MJ, Fawzi WW, Mugusi F. Effects of isoniazid resistance on TB treatment outcomes under programmatic conditions in a high-TB and -HIV setting: a prospective multicentre study. J Antimicrob Chemother 2017; 72:876-881. [PMID: 27999054 DOI: 10.1093/jac/dkw503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/25/2016] [Indexed: 12/11/2022] Open
Abstract
Objectives The scale and impact of background isoniazid resistance in TB- and HIV-endemic countries requires definition to improve treatment success and guide the scale-up of isoniazid preventive therapy (IPT). We describe the effects of isoniazid resistance on TB treatment outcomes among patients with or without HIV infection in Dar es Salaam, Tanzania. Methods A multicentre, prospective observational study was conducted among TB patients commencing WHO-recommended first-line TB treatment. In multivariate analysis we ascertained the relationship between isoniazid resistance at presentation with a composite of poor treatment outcomes (death, failure or default from TB therapy). Results Of 861 patients, 250 (29.0%) were HIV infected and 23 (2.7%) had isoniazid resistance. Seven hundred and ninety-seven (92.6%) of the patients were successfully treated and 25 (2.9%) died. Isoniazid resistance [relative risk (RR) = 6.0; 95% CI = 1.9-18.7; P < 0.01] and HIV infection with (RR = 2.3; 95% CI = 1.0-5.2; P = 0.05) or without (RR = 3.1; 95% CI = 1.5-6.2; P < 0.01) ART were independent predictors of poor treatment outcomes. Conclusions Background isoniazid resistance and HIV infection adversely affected TB treatment outcomes. Early laboratory detection of isoniazid resistance is important for successful TB therapy. Studies on the impact of background isoniazid resistance on the efficacy of isoniazid prophylaxis are recommended.
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Affiliation(s)
- Tumaini J Nagu
- Division of Therapeutic Immunology, Department of Laboratory Medicine (LABMED), Karolinska Institutet, Stockholm, Sweden.,Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Said Aboud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Mecky I Matee
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Markus J Maeurer
- Division of Therapeutic Immunology, Department of Laboratory Medicine (LABMED), Karolinska Institutet, Stockholm, Sweden
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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17
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Use of GeneXpert Remnants for Drug Resistance Profiling and Molecular Epidemiology of Tuberculosis in Libreville, Gabon. J Clin Microbiol 2017; 55:2105-2115. [PMID: 28446574 PMCID: PMC5483912 DOI: 10.1128/jcm.02257-16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/18/2017] [Indexed: 02/06/2023] Open
Abstract
Multidrug-resistant (MDR) and extensively drug resistant (XDR) strains of Mycobacterium tuberculosis pose major problems for global health. The GeneXpert MTB/RIF (Xpert) assay rapidly detects resistance to rifampin (RIFr), but for detection of the additional resistance that defines MDR-TB (MDR tuberculosis) and XDR-TB, and for molecular epidemiology, specimen cultures and a biosafe infrastructure are generally required. We sought to determine whether the remnants of sputa prepared for the Xpert assay could be used directly to find mutations associated with drug resistance and to study molecular epidemiology, thus providing precise characterization of MDR-TB cases in countries lacking biosafety level 3 (BSL3) facilities for M. tuberculosis cultures. After sputa were processed and run on the Xpert instrument, the leftovers of the samples prepared for the Xpert assay were used for PCR amplification and sequencing or for a line probe assay to detect mutations associated with resistance to additional drugs, as well as for molecular epidemiology with spoligotyping and selective mycobacterial interspersed repetitive-unit–variable-number tandem-repeat (MIRU-VNTR) typing. Of 130 sputum samples from Gabon tested with the Xpert assay, 124 yielded interpretable results; 21 (17%) of these were determined to be RIFr. Amplification and sequencing or a line probe assay of the Xpert remnants confirmed 18/21 samples as MDR, corresponding to 12/116 (9.5%) new and 6/8 (75%) previously treated TB patients. Spoligotyping and MIRU typing with hypervariable loci identified an MDR Beijing strain present in five samples. We conclude that the remnants of samples processed for the Xpert assay can be used in PCRs to find mutations associated with the resistance to the additional drugs that defines MDR and XDR-TB and to study molecular epidemiology without the need for culturing or a biosafe infrastructure.
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18
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Janssen S, Osbak K, Holman R, Hermans S, Moekotte A, Knap M, Rossatanga E, Massinga-Loembe M, Alabi A, Adegnika A, Meenken C, van Vugt M, Kremsner PG, Meintjes G, van der Poll T, Grobusch MP. Low incidence of the immune reconstitution inflammatory syndrome among HIV-infected patients starting antiretroviral therapy in Gabon: a prospective cohort study. Infection 2017; 45:669-676. [PMID: 28349491 PMCID: PMC5630650 DOI: 10.1007/s15010-017-1000-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/21/2017] [Indexed: 11/30/2022]
Abstract
There is a paucity of data on the immune reconstitution inflammatory syndrome (IRIS) in the Central African region. We followed ART-naive HIV-infected patients initiating antiretroviral therapy in an HIV clinic in Gabon, for 6 months. Among 101 patients, IRIS was diagnosed in five. All IRIS cases were mucocutaneous manifestations. There were no cases of tuberculosis (TB) IRIS, but active TB (n = 20) was associated with developing other forms of IRIS (p = 0.02). Six patients died. The incidence of IRIS is low in Gabon, with mild, mucocutaneous manifestations.
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Affiliation(s)
- S Janssen
- Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands. .,Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon. .,Centre de Traitement Ambulatoire Lambaréné, Lambaréné, Gabon. .,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany. .,Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa. .,Division of Internal Medicine, Department of Infectious Diseases, Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
| | - K Osbak
- Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.,Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon.,Centre de Traitement Ambulatoire Lambaréné, Lambaréné, Gabon
| | - R Holman
- Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - S Hermans
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands.,Faculty of Health Sciences, Desmond Tutu HIV Centre, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - A Moekotte
- Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.,Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon
| | - M Knap
- Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.,Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon
| | - E Rossatanga
- Centre de Traitement Ambulatoire Lambaréné, Lambaréné, Gabon
| | - M Massinga-Loembe
- Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - A Alabi
- Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - A Adegnika
- Centre de Traitement Ambulatoire Lambaréné, Lambaréné, Gabon.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - C Meenken
- Department of Ophthalmology, VU Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - M van Vugt
- Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands
| | - P G Kremsner
- Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
| | - G Meintjes
- Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - T van der Poll
- Division of Internal Medicine, Department of Infectious Diseases, Center for Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - M P Grobusch
- Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.,Centre de Recherches Médicales en Lambaréné, Lambaréné, Gabon.,Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.,Clinical Infectious Diseases Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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