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Seung KJ, Khan U, Varaine F, Ahmed S, Bastard M, Cloez S, Damtew D, Franke MF, Herboczek K, Huerga H, Islam S, Karakozian H, Khachatryan N, Kliesckova J, Khan AJ, Khan M, Khan P, Kotrikadze T, Lachenal N, Lecca L, Lenggogeni P, Maretbayeva S, Melikyan N, Mesic A, Mitnick CD, Mofolo M, Perrin C, Richard M, Tassew YM, Telnov A, Vilbrun SC, Wanjala S, Rich ML, Hewison C. Introducing new and repurposed TB drugs: the endTB experience. Int J Tuberc Lung Dis 2020; 24:1081-1086. [PMID: 33126943 DOI: 10.5588/ijtld.20.0141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In 2015, the initiative Expand New Drug Markets for TB (endTB) began, with the objective of reducing barriers to access to the new and repurposed TB drugs. Here we describe the major implementation challenges encountered in 17 endTB countries. We provide insights on how national TB programmes and other stakeholders can scale-up the programmatic use of new and repurposed TB drugs, while building scientific evidence about their safety and efficacy. For any new drug or diagnostic, multiple market barriers can slow the pace of scale-up. During 2015-2019, endTB was successful in increasing the number of patients receiving new and repurposed TB drugs in 17 countries. The endTB experience has many lessons, which are relevant to country level introduction of new TB drugs, as well as non-TB drugs and diagnostics. For example: the importation of TB drugs is possible even in the absence of registration; emphasis on good clinical monitoring is more important than pharmacovigilance reporting; national guidelines and expert committees can both facilitate and hinder innovative practice; clinicians use new and repurposed TB drugs when they are available; data collection to generate scientific evidence requires financial and human resources; pilot projects can drive national scale-up.
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Affiliation(s)
- K J Seung
- Partners In Health (PIH), Brigham and Women´s Hospital, Harvard Medical School, Boston, MA, USA
| | - U Khan
- Interactive Research and Development (IRD) Global, Singapore
| | - F Varaine
- Médecins Sans Frontières (MSF), Paris, France
| | | | - M Bastard
- Field Epidemiology Department, Epicentre, Paris, France
| | - S Cloez
- Médecins Sans Frontières (MSF), Paris, France
| | - D Damtew
- Ministry of Health, Addis Ababa, Ethiopia
| | - M F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, PIH, Boston, MA, USA
| | | | - H Huerga
- Field Epidemiology Department, Epicentre, Paris, France
| | | | | | | | | | - A J Khan
- Interactive Research and Development (IRD) Global, Singapore
| | - M Khan
- IRD, Durban, South Africa
| | - P Khan
- Interactive Research and Development (IRD) Global, Singapore
| | | | | | | | | | | | - N Melikyan
- Field Epidemiology Department, Epicentre, Paris, France
| | | | - C D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, PIH, Boston, MA, USA
| | | | - C Perrin
- Médecins Sans Frontières (MSF), Paris, France
| | - M Richard
- Programme national de Lutte contre la Tuberculose, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | | | | | - S C Vilbrun
- Groupe Haitien d´Etudes du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti
| | | | - M L Rich
- Partners In Health (PIH), Brigham and Women´s Hospital, Harvard Medical School, Boston, MA, USA
| | - C Hewison
- Médecins Sans Frontières (MSF), Paris, France
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Bastard M, Sanchez-Padilla E, Hayrapetyan A, Kimenye K, Khurkhumal S, Dlamini T, Fadul Perez S, Telnov A, Hewison C, Varaine F, Bonnet M. What is the best culture conversion prognostic marker for patients treated for multidrug-resistant tuberculosis? Int J Tuberc Lung Dis 2019; 23:1060-1067. [PMID: 31627770 DOI: 10.5588/ijtld.18.0649] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION: Identification of good prognostic marker for tuberculosis (TB) treatment response is a necessary step on the path towards a surrogate marker to reduce TB trial duration.METHODS: We performed a retrospective analysis on routinely collected data in 6 drug-resistant TB (DRTB) programs. Culture conversion, defined as two consecutive negative cultures, was assessed, and performance of culture conversion at Month 2 and Month 6 to predict treatment success were explored. To explore factors associated with positive predicted value (PPV) and the specificity of culture conversion, a multinomial logistic regression was fitted.RESULTS: This study included 634 patients: 68.5% were males; the median age was 35 years, 75.2% were previously treated for TB, 59.4% were resistant only to isoniazid and rifampicin and 18.1% resistant to fluoroquinolones. Culture conversion at Month 2 and 6 showed similar PPV while specificity was much higher for culture conversion at Month 2: 91.3% (95%CI 86.1-95.1). PPV of culture conversion at Month 2 did not vary strongly according to patients' characteristics, while specificity was slightly higher among patients with fluoroquinolone-resistant strains.CONCLUSION: Culture conversion at Month 2 is an acceptable prognostic marker for MDR-TB treatment. Considering the advantage of using an earlier marker, further evaluation as a surrogate marker is warranted to shorten TB trials.
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Affiliation(s)
| | | | - A Hayrapetyan
- National Tuberculosis Control Office, Yerevan, Armenia
| | - K Kimenye
- Programmatic Management of Drug-resistant Tuberculosis, Ministry of Health, Nairobi, Kenya
| | | | - T Dlamini
- Ministry of Health-TB National Control Program National Manager, Mbabane, Swaziland
| | - S Fadul Perez
- Respiratory Disease Department, National Public Health Institute, Bogota, Colombia
| | - A Telnov
- Médecins Sans Frontières, Geneva, Switzerland
| | | | | | - M Bonnet
- Epicentre, Paris, France, Unité Mixte Internationale UMI233-U1175, Institute of Research for Development, Montpellier, France
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Ousley J, Soe KP, Kyaw NTT, Anicete R, Mon PE, Lwin H, Win T, Cristofani S, Telnov A, Fernandez M, Ciglenecki I. IPT during HIV treatment in Myanmar: high rates of coverage, completion and drug adherence. Public Health Action 2018; 8:20-24. [PMID: 29581939 DOI: 10.5588/pha.17.0087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 02/08/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: A southern Myanmar district providing isoniazid preventive therapy (IPT) in one of the last countries to formally recommend it as part of human immunodeficiency virus (HIV) care. Objective: To assess coverage and adherence and the feasibility of IPT scale-up in a routine care setting in Myanmar. Design: A retrospective analysis of people living with HIV (PLHIV) screened for tuberculosis (TB) and enrolled in IPT over a 3-year period (July 2011-June 2014) using clinical databases. Results: Among 3377 patients under HIV care and screened for TB, 2740 (81.1%) initiated IPT, with 2651 (96.8%) completing a 6- or 9-month course of IPT; 83 (3.1%) interrupted treatment for different reasons, including loss to follow-up (n = 41), side effects (n = 15) or drug adherence issues (n = 9); 6 (0.2%) died. Among the IPT patients, 33 (1.2%) were diagnosed with TB, including 9 (0.3%) while on IPT and 24 (0.9%) within 1 year of completion of therapy. Among the PLHIV who completed IPT, one case of isoniazid resistance was detected. Conclusion: Scaling up IPT in Myanmar HIV settings is feasible with high rates of drug adherence and completion, and a low rate of discontinuation due to side effects. IPT scale-up should be prioritised in HIV clinical settings in Myanmar.
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Affiliation(s)
- J Ousley
- Médecins Sans Frontières, Geneva, Switzerland
| | - K P Soe
- Médecins Sans Frontières, Geneva, Switzerland
| | - N T T Kyaw
- Médecins Sans Frontières, Geneva, Switzerland
| | - R Anicete
- Médecins Sans Frontières, Geneva, Switzerland
| | - P E Mon
- Médecins Sans Frontières, Geneva, Switzerland
| | - H Lwin
- National Tuberculosis Programme, Department of Health, Ministry of Health, Yangon, Myanmar
| | - T Win
- National Tuberculosis Programme, Department of Health, Ministry of Health, Yangon, Myanmar
| | | | - A Telnov
- Médecins Sans Frontières, Geneva, Switzerland
| | - M Fernandez
- Médecins Sans Frontières, Geneva, Switzerland
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Bonnet M, Bastard M, du Cros P, Khamraev A, Kimenye K, Khurkhumal S, Hayrapetyan A, Themba D, Telnov A, Sanchez-Padilla E, Hewison C, Varaine F. Identification of patients who could benefit from bedaquiline or delamanid: a multisite MDR-TB cohort study. Int J Tuberc Lung Dis 2016; 20:177-86. [DOI: 10.5588/ijtld.15.0962] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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van den Berk GEL, Telnov A, Venis SF, Mills CF, O'Brien DP. [The Médicins sans Frontières HIV/AIDS programme in Ukraine]. Ned Tijdschr Geneeskd 2007; 151:2685-2689. [PMID: 18179088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In 1999, Médicins sans Frontières started an HIV/AIDS programme in Ukraine, a country with an estimated 410,000 people with HIV (1.4% prevalence), including 53,000 in urgent need of antiretroviral therapy. Between 1999 and 2004, a comprehensive HIV/AIDS programme was implemented in close collaboration with the Ministry of Health in AIDS centres in Odessa, Mikolaev and Simferopol. Initial activities included prevention and treatment advocacy campaigns, which were later followed by prevention of mother-to-child transmission, treatment of opportunistic infections, antiretroviral therapy for infants and adults and palliative care. This programme has served as a model and has led to meaningful improvements in HIV/AIDS care in Ukraine. It demonstrates that adequate care for patients with HIV or AIDS is possible in countries like Ukraine.
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