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Menzies D, Obeng J, Hadisoemarto P, Ruslami R, Adjobimey M, Fisher D, Barss L, Bedingfield N, Long R, Paulsen C, Johnston J, Romanowski K, Cook VJ, Fox GJ, Nguyen TA, Valiquette C, Oxlade O, Fregonese F, Benedetti A. Sustainability and impact of an intervention to improve initiation of tuberculosis preventive treatment: results from a follow-up study of the ACT4 randomized trial. EClinicalMedicine 2024; 71:102546. [PMID: 38586588 PMCID: PMC10998081 DOI: 10.1016/j.eclinm.2024.102546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/24/2024] [Accepted: 02/29/2024] [Indexed: 04/09/2024] Open
Abstract
Background In a cluster randomized trial (clinicaltrials.gov: NCT02810678) a flexible but comprehensive health system intervention significantly increased the number of household contacts (HHC) identified and started on tuberculosis preventive treatment (TPT). A follow-up study was conducted one year later to test the hypotheses that these effects were sustained, and were reproducible with a simplified intervention. Methods We conducted a follow-up study from May 1, 2018 until April 30, 2019, as part of a multinational cluster randomized trial. Eight sites in 4 countries that had received the intervention in the original trial received no further intervention; eight other sites in the same countries that had not received the intervention (control sites in the original trial) now received a simplified version of the intervention. This consisted of repeated local evaluation of the Cascade of care for TB infection, and stakeholder decision making. The number of HHC identified and starting TPT were repeatedly measured at all 16 sites and expressed as rates per 100 newly diagnosed index TB patients. The sustained effect of the original intervention was estimated by comparing these rates after the intervention in the original trial with the last 6 months of the follow-up study. The reproducibility was estimated by comparing the pre-post intervention changes in rates at sites receiving the original intervention with the pre-post changes in rates at sites receiving the later, simplified intervention. Findings With regard to the sustained impact of the original intervention, compared to the original post-intervention period, the number of HHC identified and treated per 100 newly diagnosed TB patients was 10 more (95% confidence interval: 84 fewer to 105 more), and 1 fewer (95% CI: 22 fewer to 20 more) respectively up to 14 months after the end of the original intervention. With regard to the reproducibility of the simplified intervention, at sites that had initially served as control sites, the number of HHC identified and treated per 100 TB patients increased by 33 (95% CI: -32, 97), and 16 (-69, 100) from 3 months before, to up to 6 months after receiving a streamlined intervention, although differences were larger, and significant if the post-intervention results were compared to all pre-intervention periods. Interpretation Up to one year after it ended, a health system intervention resulted in sustained increases in the number of HHC identified and starting TPT. A simplified version of the intervention was associated with non-significant increases in the identification and treatment of HHC. Inferences are limited by potential bias due to other temporal effects, and the small number of study sites. Funding Funded by the Canadian Institutes of Health Research (Grant number 143350).
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Affiliation(s)
- Dick Menzies
- McGill International TB Centre, Montreal Chest Institute and Research Institute of the MUHC, Canada
- Department of Epidemiology & Biostatistics, McGill University, Canada
| | | | | | - Rovina Ruslami
- Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Menonli Adjobimey
- Centre National Hospitalier Universitaire de Pneumo-Phtisiologie de Cotonou, Benin
| | - Dina Fisher
- Department of Medicine, Cumming School of Medicine, University of Calgary, Canada
| | - Leila Barss
- Department of Medicine, Cumming School of Medicine, University of Calgary, Canada
| | - Nancy Bedingfield
- Department of Medicine, Cumming School of Medicine, University of Calgary, Canada
| | - Richard Long
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada
| | - Catherine Paulsen
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada
| | - James Johnston
- British Columbia Centre for Disease Control, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Kamila Romanowski
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Victoria J. Cook
- British Columbia Centre for Disease Control, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Greg J. Fox
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Thu Anh Nguyen
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Chantal Valiquette
- McGill International TB Centre, Montreal Chest Institute and Research Institute of the MUHC, Canada
| | - Olivia Oxlade
- McGill International TB Centre, Montreal Chest Institute and Research Institute of the MUHC, Canada
- School of Population and Global Health, McGill University, Canada
| | - Federica Fregonese
- McGill International TB Centre, Montreal Chest Institute and Research Institute of the MUHC, Canada
| | - Andrea Benedetti
- McGill International TB Centre, Montreal Chest Institute and Research Institute of the MUHC, Canada
- Department of Epidemiology & Biostatistics, McGill University, Canada
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Alsdurf H, Benedetti A, Buu TN, Adjobimey M, Cook VJ, Fisher D, Fox G, Fregonese F, Hadisoemarto P, Johnston J, Long R, Obeng J, Oxlade O, Ruslami R, Schwartzman K, Strumpf E, Menzies D. Human resource implications of expanding latent tuberculosis patient care activities. Front Med (Lausanne) 2024; 10:1265476. [PMID: 38283039 PMCID: PMC10811144 DOI: 10.3389/fmed.2023.1265476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction The World Health Organization (WHO) declared increasing services for latent tuberculosis infection (LTBI) a priority to eliminate tuberculosis (TB) by 2035. Yet, there is little information about thehuman resource needs required to implement LTBI treatment scale-up. Our study aimed to estimate the change in healthcare workers (HCW) time spent on different patient care activities, following an intervention to strengthen LTBI services. Methods We conducted a time and motion (TAM) study, observing HCW throughout a typical workday before and after the intervention (Evaluation and Strengthening phases, respectively) at 24 health facilities in five countries. The precise time spent on pre-specified categories of work activities was recorded. Time spent on direct patient care was subcategorized as relating to one of three conditions: LTBI, active or suspected TB, and non-TB (i.e., patients with any other medical condition). A linear mixed model (LMM) was fit to estimate the change in HCW time following the intervention. Results A total of 140 and 143 HCW participated in the TAMs during the Evaluation and Strengthening phases, respectively. Results from intervention facilities showed an increase of 9% (95% CI: 3%, 15%) in the proportion of HCW time spent on LTBI-related services, but with a corresponding change of -11% (95% CI: -21%, -1%) on active TB services. There was no change in the proportion of time spent on LTBI care in control facilities; this remained low in both phases of the study. Discussion Our findings suggest that additional HCW personnel will be required for expansion of LTBI services to ensure that this expansion does not reduce the time available for care of active TB patients.
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Affiliation(s)
- Hannah Alsdurf
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- McGill International TB Centre, McGill University, Montreal, QC, Canada
| | - Tran Ngoc Buu
- Woolcock Institute of Medical Research, Hanoi, Vietnam
| | - Menonli Adjobimey
- Programme National Contre la Tuberculose, Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin
| | - Victoria J. Cook
- Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Dina Fisher
- Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Gregory Fox
- The University of Sydney Central Clinical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Panji Hadisoemarto
- Department of Public Health, Faculty of Medicine, TB-HIV Research Center, Universitas Padjadjaran, Bandung, Indonesia
| | - James Johnston
- Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Richard Long
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Joseph Obeng
- Chest Clinic, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Olivia Oxlade
- McGill International TB Centre, McGill University, Montreal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), McGill University, Montreal, QC, Canada
| | - Rovina Ruslami
- Department of Biomedical Sciences, Division of Pharmacology and Therapy, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Kevin Schwartzman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- McGill International TB Centre, McGill University, Montreal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), McGill University, Montreal, QC, Canada
| | - Erin Strumpf
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Dick Menzies
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- McGill International TB Centre, McGill University, Montreal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), McGill University, Montreal, QC, Canada
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Trajman A, Adjobimey M, Bastos ML, Valiquette C, Oxlade O, Fregonese F, Affolabi D, Cordeiro-Santos M, Stein RT, Benedetti A, Menzies D. GeneXpert or chest-X-ray or tuberculin skin testing for household contact assessment (GXT): protocol for a cluster-randomized trial. Trials 2022; 23:624. [PMID: 35918722 PMCID: PMC9344713 DOI: 10.1186/s13063-022-06587-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background The World Health Organization recommends tuberculosis (TB) preventive treatment (TPT) for all people living with HIV (PLH) and household contacts (HHC) of index TB patients. Tests for TB infection (TBI) or to rule out TB disease (TBD) are preferred, but if not available, this should not be a barrier if access to these tests is limited for high-risk people, such as PLH and HHC under 5 years old. There is equipoise on the need for these tests in different risk populations, especially HHC aged over 5. Methods This superiority cluster-randomized multicenter trial with three arms of equal size compares, in Benin and Brazil, three strategies for HHC investigation aged 0–50: (i) tuberculin skin testing (TST) or interferon gamma release assay (IGRA) for TBI and if positive, chest X-Ray (CXR) to rule out TBD in persons with positive TST or IGRA; (ii) same as (i) but GeneXpert (GX) replaces CXR; and (iii) no TBI testing. CXR for all; if CXR is normal, TPT is recommended. All strategies start with symptom screening. Clusters are defined as HHC members of the same index patients with newly diagnosed pulmonary TBD. The main outcome is the proportion of HHC that are TPT eligible who start TPT within 3 months of the index TB patient starting TBD treatment. Societal costs, incidence of severe adverse events, and prevalence of TBD are among secondary outcomes. Stratified analyses by age (under versus over 5) and by index patient microbiological status will be conducted. All participants provide signed informed consent. The study was approved by the Research Ethic Board of the Research Institute of the McGill University Health Centre, the Brazilian National Ethical Board CONEP, and the “Comité Local d’Éthique Pour la Recherche Biomédicale (CLERB) de l’Université de Parakou,” Benin. Findings will be submitted for publication in major medical journals and presented in conferences, to WHO and National and municipal TB programs of the involved countries. Discussion This randomized trial is meant to provide high-quality evidence to inform WHO recommendations on investigation of household contacts, as currently these are based on very low-quality evidence. Trial registration ClinicalTrials.gov NCT04528823.
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Affiliation(s)
- Anete Trajman
- McGill University, Montreal, Canada. .,Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Menonli Adjobimey
- Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin
| | | | | | | | - Federica Fregonese
- Research Institute of the McGill University Health Center, Montreal, Canada
| | - Dissou Affolabi
- Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin
| | - Marcelo Cordeiro-Santos
- Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.,Universidade Do Estado Do Amazonas, Manaus, Brazil
| | - Renato T Stein
- Programa PROADI-SUS, Hospital Moinho de Vento, Porto Alegre, Brazil.,Escola de Medicina, Pontifícia Universidade Católica RGS, Porto Alegre, Brazil
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Arbiv OA, Kim JM, Yan M, Romanowski K, Campbell JR, Trajman A, Asadi L, Fregonese F, Winters N, Menzies D, Johnston JC. High-dose rifamycins in the treatment of TB: a systematic review and meta-analysis. Thorax 2022; 77:1210-1218. [PMID: 34996847 DOI: 10.1136/thoraxjnl-2020-216497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/02/2020] [Accepted: 12/02/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is growing interest in using high-dose rifamycin (HDR) regimens in TB treatment, but the safety and efficacy of HDR regimens remain uncertain. We performed a systematic review and meta-analysis comparing HDR to standard-dose rifamycin (SDR) regimens. METHODS We searched MEDLINE, Embase, CENTRAL, Cochrane Database of Systematic Reviews and clinicaltrials.gov for prospective studies comparing daily therapy with HDRs to SDRs. Rifamycins included rifampicin, rifapentine and rifabutin. Our primary outcome was the rate of severe adverse events (SAEs), with secondary outcomes of death, all adverse events, SAE by organ and efficacy outcomes of 2-month culture conversion and relapse. This study was prospectively registered in the International Prospective Register of Systematic Reviews (CRD42020142519). RESULTS We identified 9057 articles and included 13 studies with 6168 participants contributing 7930 person-years (PY) of follow-up (HDR: 3535 participants, 4387 PY; SDR: 2633 participants, 3543 PY). We found no significant difference in the pooled incidence rate ratio (IRR) of SAE between HDR and SDR (IRR 1.00, 95% CI 0.82 to 1.23, I 2=41%). There was no significant difference when analysis was limited to SAE possibly, probably or likely medication-related (IRR 1.07, 95% CI 0.82 to 1.41, I 2=0%); studies with low risk of bias (IRR 0.98, 95% CI 0.79 to 1.20, I 2=44%); or studies using rifampicin (IRR 1.00, 95% CI 0. 0.75-1.32, I 2=38%). No significant differences were noted in pooled outcomes of death, 2-month culture conversion and relapse. CONCLUSIONS HDRs were not associated with a significant difference in SAEs, 2-month culture conversion or death. Further studies are required to identify specific groups who may benefit from HDR.
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Affiliation(s)
- Omri A Arbiv
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - JeongMin M Kim
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marie Yan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kamila Romanowski
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,TB Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | | | - Anete Trajman
- McGill International TB Centre, McGill University, Montreal, Québec, Canada.,Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leyla Asadi
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Federica Fregonese
- McGill International TB Centre, McGill University, Montreal, Québec, Canada
| | - Nicholas Winters
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Dick Menzies
- McGill International TB Centre, McGill University, Montreal, Québec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada.,Montreal Chest Institute, McGill University Health Centre, Montreal, Québec, Canada
| | - James C Johnston
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada .,TB Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada.,McGill International TB Centre, McGill University, Montreal, Québec, Canada
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Bastos ML, Oxlade O, Benedetti A, Fregonese F, Valiquette C, Lira SCC, Carvalho-Cordeiro D, Cavalcante JR, Faerstein E, Albuquerque MFM, Cordeiro-Santos M, Hill PC, Menzies D, Trajman A. A public health approach to increase treatment of latent TB among household contacts in Brazil. Int J Tuberc Lung Dis 2021; 24:1000-1008. [PMID: 33126931 DOI: 10.5588/ijtld.19.0728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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
SETTING: Two consecutive trials were conducted to evaluate the effectiveness of a public health approach to identify and correct problems in the care cascade for household contacts (HHCs) of TB patients in three Brazilian high TB incidence cities.METHODS: In the first trial, 12 clinics underwent standardised evaluation using questionnaires administered to TB patients, HHCs and healthcare workers, and analysis of the cascade of latent TB care among HHCs. Six clinics were then randomised to receive interventions to strengthen management of latent TB infection (LTBI), including in-service training provided by nurses, work process organisation and additional clinic-specific solutions. In the second trial, a similar but streamlined evaluation was conducted in two clinics, who then received initial and subsequent intensive in-service training provided by a physician.RESULTS: In the evaluation phase of both trials, many HHCs were identified, but few started LTBI treatment. After the intervention, the number of HHCs initiating treatment per 100 active TB patients increased by 10 (95%CI - 11 to 30) in the first trial, and by 44 (95%CI 26 to 61) in the second trial.DISCUSSION: A public health approach with standardised evaluation, local decisions for improvements, followed by intensive initial and in-service training appears promising for improved LTBI management.
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Affiliation(s)
- M L Bastos
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil, Respiratory Epidemiology & Clinical Research Unit
| | | | - A Benedetti
- Respiratory Epidemiology & Clinical Research Unit, Departments of Epidemiology, Biostatistics & Occupational Health, and Medicine, McGill University, Montreal, QC, Canada
| | - F Fregonese
- Respiratory Epidemiology & Clinical Research Unit
| | - C Valiquette
- Respiratory Epidemiology & Clinical Research Unit
| | - S C C Lira
- Recife Municipal Health Secretariat, Recife, PE, Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Pernambuco, Recife, PE
| | - D Carvalho-Cordeiro
- Manaus Municipal Health Secretariat, Manaus, AM, Programa de Pós-gradução em Enfermagem, Universidade Federal do Amazonas, Manaus, AM
| | - J R Cavalcante
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - E Faerstein
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - M Cordeiro-Santos
- Tropical Medicine Post-Graduation Program, Amazonas State University, Manaus, AM, Tropical Medicine Foundation Dr Heitor Vieira Dourado, Manaus, AM, Brazil
| | - P C Hill
- Centre for International Health, Otago Medical School, University of Otago, Otago, New Zealand
| | - D Menzies
- Respiratory Epidemiology & Clinical Research Unit, McGill International TB Centre, Departments of Epidemiology, Biostatistics & Occupational Health, and Medicine, McGill University, Montreal, QC, Canada
| | - A Trajman
- McGill International TB Centre, Internal Medicine Post-Graduation Program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Primary Health Care Post-Graduation Program, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Oxlade O, Benedetti A, Adjobimey M, Alsdurf H, Anagonou S, Cook VJ, Fisher D, Fox GJ, Fregonese F, Hadisoemarto P, Hill PC, Johnston J, Khan FA, Long R, Nguyen NV, Nguyen TA, Obeng J, Ruslami R, Schwartzman K, Trajman A, Valiquette C, Menzies D. Effectiveness and cost-effectiveness of a health systems intervention for latent tuberculosis infection management (ACT4): a cluster-randomised trial. Lancet Public Health 2021; 6:e272-e282. [PMID: 33765453 DOI: 10.1016/s2468-2667(20)30261-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Reaching the UN General Assembly High-Level Meeting on Tuberculosis target of providing tuberculosis preventive treatment to at least 30 million people by 2022, including 4 million children under the age of 5 years and 20 million other household contacts, will require major efforts to strengthen health systems. The aim of this study was to evaluate the effectiveness and cost-effectiveness of a health systems intervention to strengthen management for latent tuberculosis infection (LTBI) in household contacts of confirmed tuberculosis cases. METHODS ACT4 was a cluster-randomised, open-label trial involving 24 health facilities in Benin, Canada, Ghana, Indonesia, and Vietnam randomly assigned to either a three-phase intervention (LTBI programme evaluation, local decision making, and strengthening activities) or control (standard LTBI care). Tuberculin and isoniazid were provided to control and intervention sites if not routinely available. Randomisation was stratified by country and restricted to ensure balance of index patients with tuberculosis by arm and country. The primary outcome was the number of household contacts who initiated tuberculosis preventive treatment at each health facility within 4 months of the diagnosis of the index case, recorded in the first or last 6 months of our 20-month study. To ease interpretation, this number was standardised per 100 newly diagnosed index patients with tuberculosis. Analysis was by intention to treat. Masking of staff at the coordinating centre and sites was not possible; however, those analysing data were masked to assignment of intervention or control. An economic analysis of the intervention was done in parallel with the trial. ACT4 is registered at ClinicalTrials.gov, NCT02810678. FINDINGS The study was done between Aug 1, 2016, and March 31, 2019. During the first 6 months of the study the crude overall proportion of household contacts initiating tuberculosis preventive treatment out of those eligible at intervention sites was 0·21. After the implementation of programme strengthening activities, the proportion initiating tuberculosis preventive treatment increased to 0·35. Overall, the number of household contacts initiating tuberculosis preventive treatment per 100 index patients with tuberculosis increased between study phases in intervention sites (adjusted rate difference 60, 95% CI 4 to 116), while control sites showed no statistically significant change (-12, -33 to 10). There was a difference in rate differences of 72 (95% CI 10 to 134) contacts per 100 index patients with tuberculosis initiating preventive treatment associated with the intervention. The total cost for the intervention, plus LTBI clinical care per additional contact initiating treatment was estimated to be CA$1348 (range 724 to 9708). INTERPRETATION A strategy of standardised evaluation, local decision making, and implementation of health systems strengthening activities can provide a mechanism for scale-up of tuberculosis prevention, particularly in low-income and middle-income countries. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- Olivia Oxlade
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Andrea Benedetti
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Mênonli Adjobimey
- Centre National Hospitalier Universitaire de Pneumo-Pthisiologie de Cotonou, Cotonou, Benin
| | - Hannah Alsdurf
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | | | - Victoria J Cook
- Provincial TB Services, BC Centre for Disease Control, Vancouver, BC, Canada; Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Greg J Fox
- The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Federica Fregonese
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Panji Hadisoemarto
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Philip C Hill
- Centre for International Health, Faculty of Medicine, University of Otago, Otago, New Zealand
| | - James Johnston
- Provincial TB Services, BC Centre for Disease Control, Vancouver, BC, Canada; Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Faiz Ahmad Khan
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Richard Long
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Thu Anh Nguyen
- The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The Woolcock Institute of Medical Research in Vietnam, Hanoi, Vietnam
| | | | - Rovina Ruslami
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Kevin Schwartzman
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Anete Trajman
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada; Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Chantal Valiquette
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Dick Menzies
- McGill International TB Centre, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada.
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7
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Yanes-Lane M, Trajman A, Bastos ML, Oxlade O, Valiquette C, Rufino N, Fregonese F, Menzies D. Effects of programmatic interventions to improve the management of latent tuberculosis: a follow up study up to five months after implementation. BMC Public Health 2021; 21:177. [PMID: 33478452 PMCID: PMC7819253 DOI: 10.1186/s12889-021-10195-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/07/2021] [Indexed: 02/01/2023] Open
Abstract
Background Less than 19% of those needing tuberculosis (TB) preventive treatment complete it, due to losses in several steps of the cascade of care for latent TB infection. A cluster randomized trial of a programmatic public health intervention to improve management of latent TB infection in household contacts was conducted in Rio de Janeiro. Interventions included contact registry, initial and in-service training, and a TB booklet. We conducted a follow-up study starting one month after the conclusion of this trial, to measure the effect of interventions implemented, and to identify remaining barriers and facilitators to latent TB infection treatment, from different perspectives. Methods In two health clinics in Rio de Janeiro that received the interventions in the trial, data for the latent TB infection cascade of care for household contacts was collected over a five-month period. The number of household contacts initiating treatment per 100 index-TB patients was compared with the cascade of care data obtained before and during the intervention trial. Semi-structured open-ended questionnaires were administered to healthcare workers, household contacts and index-TB patients regarding knowledge and perceptions about TB and study interventions. Results In this follow-up study, 184 household contacts per 100 index-TB patients were identified. When compared to the intervention period, there were 65 fewer household contacts per 100 index-TB patients, (95% CI -115, − 15) but the number starting latent TB infection treatment was sustained (difference -2, 95% CI -8,5). A total of 31 index-TB patients, 22 household contacts and 19 health care workers were interviewed. Among index-TB patients, 61% said all their household contacts had been tested for latent TB infection. All health care workers said it was very important to test household contacts, and 95% mentioned that possessing correct knowledge on the benefits of latent TB infection treatment was the main facilitator to enable them to recommend this treatment. Conclusion In this follow-up study, we observed a sustained effect of interventions to strengthen the latent TB infection cascade of care on increasing the number of household contacts starting latent TB infection treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10195-z.
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Affiliation(s)
- Mercedes Yanes-Lane
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
| | - Anete Trajman
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada.,Internal Medicine Graduate Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mayara Lisboa Bastos
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada.,Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Olivia Oxlade
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada.,McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - Chantal Valiquette
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
| | - Nathalia Rufino
- Vector Bourne Diseases Department, Oswaldo Cruz Institute, Rio de Janeiro, Brazil
| | - Federica Fregonese
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada
| | - Dick Menzies
- Research Institute McGill University Health Centre, Montreal, Quebec, Canada. .,McGill International TB Centre, McGill University, Montreal, Quebec, Canada.
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Campbell JR, Uppal A, Oxlade O, Fregonese F, Bastos ML, Lan Z, Law S, Oh CE, Russell WA, Sulis G, Winters N, Yanes-Lane M, Brisson M, Laszlo S, Evans TG, Menzies D. Dépistage actif chez les groupes courant un risque accru de contracter le SRAS-CoV-2 au Canada : coûts et ressources humaines nécessaires. CMAJ 2020; 192:E1734-E1746. [DOI: 10.1503/cmaj.201128-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 11/01/2022] Open
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Turcotte-Tremblay AM, Fregonese F, Kadio K, Alam N, Merry L. Global health is more than just 'Public Health Somewhere Else'. BMJ Glob Health 2020; 5:bmjgh-2020-002545. [PMID: 32381653 PMCID: PMC7228490 DOI: 10.1136/bmjgh-2020-002545] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 01/19/2023] Open
Affiliation(s)
| | - Federica Fregonese
- Research Institute of McGill University Health Center, Montreal, Quebec, Canada
| | - Kadidiatou Kadio
- Institut de Recherche en Science de la Santé (IRSS), Centre National de la Recherche Scientifique et Technologique (CNRST), Ouagadougou, Burkina Faso.,Institut de Recherche pour le Développement, Ouagadougou, Burkina Faso
| | - Nazmul Alam
- Department of Public Health, Asian University for Women, Chittagong, Bangladesh
| | - Lisa Merry
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
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Yanes-Lane M, Winters N, Fregonese F, Bastos M, Perlman-Arrow S, Campbell JR, Menzies D. Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: A systematic review and meta-analysis. PLoS One 2020; 15:e0241536. [PMID: 33141862 PMCID: PMC7608887 DOI: 10.1371/journal.pone.0241536] [Citation(s) in RCA: 190] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/18/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The study objective was to conduct a systematic review and meta-analysis on the proportion of asymptomatic infection among coronavirus disease 2019 (COVID-19) positive persons and their transmission potential. METHODS We searched Embase, Medline, bioRxiv, and medRxiv up to 22 June 2020. We included cohorts or cross-sectional studies which systematically tested populations regardless of symptoms for COVID-19, or case series of any size reporting contact investigations of asymptomatic index patients. Two reviewers independently extracted data and assessed quality using pre-specified criteria. Only moderate/high quality studies were included. The main outcomes were proportion of asymptomatic infection among COVID-19 positive persons at testing and through follow-up, and secondary attack rate among close contacts of asymptomatic index patients. A qualitative synthesis was performed. Where appropriate, data were pooled using random effects meta-analysis to estimate proportions and 95% confidence intervals (95% CI). RESULTS Of 6,137 identified studies, 71 underwent quality assessment after full text review, and 28 were high/moderate quality and were included. In two general population studies, the proportion of asymptomatic COVID-19 infection at time of testing was 20% and 75%, respectively; among three studies in contacts it was 8.2% to 50%. In meta-analysis, the proportion (95% CI) of asymptomatic COVID-19 infection in obstetric patients was 95% (45% to 100%) of which 59% (49% to 68%) remained asymptomatic through follow-up; among nursing home residents, the proportion was 54% (42% to 65%) of which 28% (13% to 50%) remained asymptomatic through follow-up. Transmission studies were too heterogenous to meta-analyse. Among five transmission studies, 18 of 96 (18.8%) close contacts exposed to asymptomatic index patients were COVID-19 positive. CONCLUSIONS Despite study heterogeneity, the proportion of asymptomatic infection among COVID-19 positive persons appears high and transmission potential seems substantial. To further our understanding, high quality studies in representative general population samples are required.
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Affiliation(s)
- Mercedes Yanes-Lane
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nicholas Winters
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
| | - Federica Fregonese
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mayara Bastos
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sara Perlman-Arrow
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jonathon R. Campbell
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
- McGill International TB Centre, Montreal, Quebec, Canada
| | - Dick Menzies
- Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Quebec, Canada
- McGill International TB Centre, Montreal, Quebec, Canada
- Division of Respiratory Medicine, Department of Medicine, McGill University, Quebec, Canada
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11
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Campbell JR, Uppal A, Oxlade O, Fregonese F, Bastos ML, Lan Z, Law S, Oh CE, Russell WA, Sulis G, Winters N, Yanes-Lane M, Brisson M, Laszlo S, Evans TG, Menzies D. Active testing of groups at increased risk of acquiring SARS-CoV-2 in Canada: costs and human resource needs. CMAJ 2020; 192:E1146-E1155. [PMID: 32907820 DOI: 10.1503/cmaj.201128] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is largely passive, which impedes epidemic control. We defined active testing strategies for SARS-CoV-2 using reverse transcription polymerase chain reaction (RT-PCR) for groups at increased risk of acquiring SARS-CoV-2 in all Canadian provinces. METHODS We identified 5 groups who should be prioritized for active RT-PCR testing: contacts of people who are positive for SARS-CoV-2, and 4 at-risk populations - hospital employees, community health care workers and people in long-term care facilities, essential business employees, and schoolchildren and staff. We estimated costs, human resources and laboratory capacity required to test people in each group or to perform surveillance testing in random samples. RESULTS During July 8-17, 2020, across all provinces in Canada, an average of 41 751 RT-PCR tests were performed daily; we estimated this required 5122 personnel and cost $2.4 million per day ($67.8 million per month). Systematic contact tracing and testing would increase personnel needs 1.2-fold and monthly costs to $78.9 million. Conducted over a month, testing all hospital employees would require 1823 additional personnel, costing $29.0 million; testing all community health care workers and persons in long-term care facilities would require 11 074 additional personnel and cost $124.8 million; and testing all essential employees would cost $321.7 million, requiring 25 965 added personnel. Testing the larger population within schools over 6 weeks would require 46 368 added personnel and cost $816.0 million. Interventions addressing inefficiencies, including saliva-based sampling and pooling samples, could reduce costs by 40% and personnel by 20%. Surveillance testing in population samples other than contacts would cost 5% of the cost of a universal approach to testing at-risk populations. INTERPRETATION Active testing of groups at increased risk of acquiring SARS-CoV-2 appears feasible and would support the safe reopening of the economy and schools more broadly. This strategy also appears affordable compared with the $169.2 billion committed by the federal government as a response to the pandemic as of June 2020.
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Affiliation(s)
- Jonathon R Campbell
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Aashna Uppal
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Olivia Oxlade
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Federica Fregonese
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Mayara Lisboa Bastos
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Zhiyi Lan
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Stephanie Law
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Chi Eun Oh
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - W Alton Russell
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Giorgia Sulis
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Nicholas Winters
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Mercedes Yanes-Lane
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Marc Brisson
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Sonia Laszlo
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Timothy G Evans
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que
| | - Dick Menzies
- Research Institute of the McGill University Health Centre (Campbell, Oxlade, Fregonese, Menzies, Oh, Bastos, Sulis); Faculty of Medicine (Campbell, Menzies, Winters, Sulis, Uppal, Yanes-Lane, Lan), McGill University; McGill International TB Centre (Campbell, Oxlade, Fregonese, Menzies, Bastos, Sulis, Law); Department of Economics (Laszlo) and School of Population and Global Health (Evans), McGill University, Montréal, Que.; Department of Management Science and Engineering (Russell), Stanford University, Stanford, Calif.; Department of Pediatrics (Oh), Kosin University College of Medicine, Busan, Republic of Korea; Department of Epidemiology (Bastos), Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Department of Global Health and Social Medicine (Law), Harvard Medical School, Boston, Mass.; Département de médicine social et preventive (Brisson), Université Laval, Québec, Que.
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12
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Barss L, Obeng J, Fregonese F, Oxlade O, Adomako B, Afriyie AO, Frimpong ED, Winters N, Valiquette C, Menzies D. Solutions to improve the latent tuberculosis Cascade of Care in Ghana: a longitudinal impact assessment. BMC Infect Dis 2020; 20:352. [PMID: 32423422 PMCID: PMC7236456 DOI: 10.1186/s12879-020-05060-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Loss of patients in the latent tuberculosis infection (LTBI) cascade of care is a major barrier to LTBI management. We evaluated the impact and acceptability of local solutions implemented to strengthen LTBI management of household contacts (HHCs) at an outpatient clinic in Ghana. Methods Local solutions to improve LTBI management were informed by a baseline evaluation of the LTBI cascade and questionnaires administered to index patients, HHCs, and health care workers at the study site in Offinso, Ghana. Solutions aimed to reduce patient costs and improve knowledge. We evaluated the impact and acceptability of the solutions. Specific objectives were to: 1) Compare the proportion of eligible HHCs completing each step in the LTBI cascade of care before and after solution implementation; 2) Compare knowledge, attitude, and practices (KAP) before and after solution implementation, based on responses of patients and health care workers (HCW) to structured questionnaires; 3) Evaluate patient and HCW acceptability of solutions using information obtained from these questionnaires. Results Pre and Post-Solution LTBI Cascades included 58 and 125 HHCs, respectively. Before implementation, 39% of expected < 5-year-old HHCs and 66% of ≥5-year-old HHCs were identified. None completed any further cascade steps. Post implementation, the proportion of eligible HHCs who completed identification, assessment, evaluation, and treatment initiation increased for HHCs < 5 to 94, 100, 82, 100%, respectively, and for HHCs ≥5 to 96, 69, 67, 100%, respectively. Pre and Post-Solutions questionnaires were completed by 80 and 95 respondents, respectively. Study participants most frequently mentioned financial support and education as the solutions that supported LTBI management. Conclusion Implementation of locally selected solutions was associated with an increase in the proportion of HHCs completing all steps in the LTBI cascade. Tuberculosis programs should consider prioritizing financial support, such as payment for chest x-rays, to support LTBI cascade completion.
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Affiliation(s)
- Leila Barss
- McGill International TB Centre, Montreal, QC, Canada
| | | | | | - Olivia Oxlade
- McGill International TB Centre, Montreal, QC, Canada
| | | | | | | | | | | | - Dick Menzies
- McGill International TB Centre, Montreal, QC, Canada. .,Respiratory Epidemiology and Clinical Research Unit, 5252 Boul. de Maisonneuve Ouest, Office 3.58, Montreal, QC, H4A 3S5, Canada.
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Alsdurf H, Oxlade O, Adjobimey M, Ahmad Khan F, Bastos M, Bedingfield N, Benedetti A, Boafo D, Buu TN, Chiang L, Cook V, Fisher D, Fox GJ, Fregonese F, Hadisoemarto P, Johnston JC, Kassa F, Long R, Moayedi Nia S, Nguyen TA, Obeng J, Paulsen C, Romanowski K, Ruslami R, Schwartzman K, Sohn H, Strumpf E, Trajman A, Valiquette C, Yaha L, Menzies D. Resource implications of the latent tuberculosis cascade of care: a time and motion study in five countries. BMC Health Serv Res 2020; 20:341. [PMID: 32316963 PMCID: PMC7175545 DOI: 10.1186/s12913-020-05220-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The End TB Strategy calls for global scale-up of preventive treatment for latent tuberculosis infection (LTBI), but little information is available about the associated human resource requirements. Our study aimed to quantify the healthcare worker (HCW) time needed to perform the tasks associated with each step along the LTBI cascade of care for household contacts of TB patients. METHODS We conducted a time and motion (TAM) study between January 2018 and March 2019, in which consenting HCWs were observed throughout a typical workday. The precise time spent was recorded in pre-specified categories of work activities for each step along the cascade. A linear mixed model was fit to estimate the time at each step. RESULTS A total of 173 HCWs in Benin, Canada, Ghana, Indonesia, and Vietnam participated. The greatest amount of time was spent for the medical evaluation (median: 11 min; IQR: 6-16), while the least time was spent on reading a tuberculin skin test (TST) (median: 4 min; IQR: 2-9). The greatest variability was seen in the time spent for each medical evaluation, while TST placement and reading showed the least variability. The total time required to complete all steps along the LTBI cascade, from identification of household contacts (HHC) through to treatment initiation ranged from 1.8 h per index TB patient in Vietnam to 5.2 h in Ghana. CONCLUSIONS Our findings suggest that the time requirements are very modest to perform each step in the latent TB cascade of care, but to achieve full identification and management of all household contacts will require additional human resources in many settings.
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Affiliation(s)
- H Alsdurf
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - O Oxlade
- McGill International TB Centre, McGill University, 5252 Boulevard de Maisonneuve, Room 3D.58, Montreal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit (RECRU), McGill University, Montreal, QC, Canada
| | - M Adjobimey
- Programme National contre la Tuberculose-Bénin, Centre National Hospitalier Universitaire de Pneumo-Phtisiologie-Cotonou, Cotonou, Benin
| | - F Ahmad Khan
- McGill International TB Centre, McGill University, 5252 Boulevard de Maisonneuve, Room 3D.58, Montreal, QC, Canada
| | - M Bastos
- Respiratory Epidemiology and Clinical Research Unit (RECRU), McGill University, Montreal, QC, Canada.,Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - A Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,McGill International TB Centre, McGill University, 5252 Boulevard de Maisonneuve, Room 3D.58, Montreal, QC, Canada
| | - D Boafo
- Chest Clinic, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - T N Buu
- Woolcock Institute of Medical Research, Hanoi, Vietnam
| | - L Chiang
- Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - V Cook
- Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - D Fisher
- Division of Respiratory Medicine, University of Calgary, Calgary, AB, Canada
| | - G J Fox
- The Faculty of Medicine and Health, The University of Sydney Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - F Fregonese
- McGill International TB Centre, McGill University, 5252 Boulevard de Maisonneuve, Room 3D.58, Montreal, QC, Canada
| | - P Hadisoemarto
- Department of Public Health, Faculty of Medicine, TB-HIV Research Center, Universitas Padjadjaran, Bandung, Indonesia
| | - J C Johnston
- Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - F Kassa
- Programme National contre la Tuberculose-Bénin, Centre National Hospitalier Universitaire de Pneumo-Phtisiologie-Cotonou, Cotonou, Benin
| | - R Long
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - S Moayedi Nia
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, QC, Canada
| | - T A Nguyen
- Woolcock Institute of Medical Research, Hanoi, Vietnam
| | - J Obeng
- Chest Clinic, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - C Paulsen
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - K Romanowski
- Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - R Ruslami
- Department of Biomedical Sciences, Division of Pharmacology & Therapy, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - K Schwartzman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada.,McGill International TB Centre, McGill University, 5252 Boulevard de Maisonneuve, Room 3D.58, Montreal, QC, Canada.,Respiratory Epidemiology and Clinical Research Unit (RECRU), McGill University, Montreal, QC, Canada
| | - H Sohn
- Department of Epidemiology, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - E Strumpf
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - A Trajman
- Social Medicine Institute, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - C Valiquette
- McGill International TB Centre, McGill University, 5252 Boulevard de Maisonneuve, Room 3D.58, Montreal, QC, Canada
| | - L Yaha
- Programme National contre la Tuberculose-Bénin, Centre National Hospitalier Universitaire de Pneumo-Phtisiologie-Cotonou, Cotonou, Benin
| | - D Menzies
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada. .,McGill International TB Centre, McGill University, 5252 Boulevard de Maisonneuve, Room 3D.58, Montreal, QC, Canada. .,Respiratory Epidemiology and Clinical Research Unit (RECRU), McGill University, Montreal, QC, Canada.
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14
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Nahid P, Mase SR, Migliori GB, Sotgiu G, Bothamley GH, Brozek JL, Cattamanchi A, Cegielski JP, Chen L, Daley CL, Dalton TL, Duarte R, Fregonese F, Horsburgh CR, Ahmad Khan F, Kheir F, Lan Z, Lardizabal A, Lauzardo M, Mangan JM, Marks SM, McKenna L, Menzies D, Mitnick CD, Nilsen DM, Parvez F, Peloquin CA, Raftery A, Schaaf HS, Shah NS, Starke JR, Wilson JW, Wortham JM, Chorba T, Seaworth B. Treatment of Drug-Resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 200:e93-e142. [PMID: 31729908 PMCID: PMC6857485 DOI: 10.1164/rccm.201909-1874st] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: The American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America jointly sponsored this new practice guideline on the treatment of drug-resistant tuberculosis (DR-TB). The document includes recommendations on the treatment of multidrug-resistant TB (MDR-TB) as well as isoniazid-resistant but rifampin-susceptible TB.Methods: Published systematic reviews, meta-analyses, and a new individual patient data meta-analysis from 12,030 patients, in 50 studies, across 25 countries with confirmed pulmonary rifampin-resistant TB were used for this guideline. Meta-analytic approaches included propensity score matching to reduce confounding. Each recommendation was discussed by an expert committee, screened for conflicts of interest, according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.Results: Twenty-one Population, Intervention, Comparator, and Outcomes questions were addressed, generating 25 GRADE-based recommendations. Certainty in the evidence was judged to be very low, because the data came from observational studies with significant loss to follow-up and imbalance in background regimens between comparator groups. Good practices in the management of MDR-TB are described. On the basis of the evidence review, a clinical strategy tool for building a treatment regimen for MDR-TB is also provided.Conclusions: New recommendations are made for the choice and number of drugs in a regimen, the duration of intensive and continuation phases, and the role of injectable drugs for MDR-TB. On the basis of these recommendations, an effective all-oral regimen for MDR-TB can be assembled. Recommendations are also provided on the role of surgery in treatment of MDR-TB and for treatment of contacts exposed to MDR-TB and treatment of isoniazid-resistant TB.
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15
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Merry L, Turcotte-Tremblay AM, Alam N, D’souza N, Fillion M, Fregonese F, Gautier L, Kadio K. The Global Health Research Capacity Strengthening (GHR-CAPS) Program: trainees’ experiences and perspectives. Journal of Global Health Reports 2019. [DOI: 10.29392/joghr.3.e2019086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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16
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Oxlade O, Trajman A, Benedetti A, Adjobimey M, Cook VJ, Fisher D, Fox GJ, Fregonese F, Hadisoemarto P, Hill PC, Johnston J, Long R, Obeng J, Ruslami R, Valiquette C, Menzies D. Enhancing the public health impact of latent tuberculosis infection diagnosis and treatment (ACT4): protocol for a cluster randomised trial. BMJ Open 2019; 9:e025831. [PMID: 30898826 PMCID: PMC6527985 DOI: 10.1136/bmjopen-2018-025831] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Treatment of latent tuberculosis (TB) infection (LTBI) is an important component of the End-TB strategy. However, the number of individuals who successfully complete LTBI treatment remains low as there are losses at all steps in the LTBI 'cascade-of-care'. The reasons for these losses are variable and highly dependent on the setting. We have planned a trial of a standardised public health approach to strengthen the management of household contacts (HHCs) of newly diagnosed patients with pulmonary TB. Assessing costs related to approach is a secondary objective of the study. METHODS AND ANALYSIS A cluster randomised trial will be conducted in 24 randomisation units (health facilities or groups of health facilities) in five countries. In Phase 1, at intervention sites, we will conduct a standardised assessment of the current LTBI programme, with a focus on cascade-of-care endpoints. Standardised open-ended questionnaires on practices, knowledge, attitudes and beliefs regarding TB prevention are then administered to key patient groups and healthcare workers. At each site, local stake-holders will review study findings and select solutions based on their acceptability, cost and effectiveness. In Phase 2, intervention clinics will implement the selected solutions, along with contact measurement registries and regular in-service LTBI management training. Control sites will continue their usual LTBI care with no explicit evaluation, strengthening or training activities. The primary study outcome is the number of HHC initiating LTBI treatment per newly diagnosed active TB patient, within 3 months of diagnosis of the index patient. An intention-to-treat analysis will be performed, using a Poisson regression approach. ETHICS AND DISSEMINATION Ethics approval from the MUHC ethical review board (ERB) was obtained in November 2015. During the study standardised tools will be developed and made publicly available. Key study findings and novel methodologic contributions will be detailed in publications and other dissemination activities. TRIAL REGISTRATION NUMBER NCT02810678; Pre-Results.
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Affiliation(s)
- Olivia Oxlade
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - Anete Trajman
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
- Internal Medicine Graduate Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Andrea Benedetti
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - Mênonli Adjobimey
- Centre National Hospitalier, Universitaire de Pneumo-Pthisiologie de Cotonou, Cotonou, Benin
| | - Victoria J Cook
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dina Fisher
- University of Calgary, Calgary, Alberta, Canada
| | - Gregory James Fox
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Federica Fregonese
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - Panji Hadisoemarto
- Department of Public Health, Faculty of Medicine, TB-HIV Research Center, Universitas Padjadjaran, Bandung, Indonesia
| | - Philip C Hill
- Faculty of Medicine, Centre for International Health, University of Otago, Otago, New Zealand
| | - James Johnston
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard Long
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Rovina Ruslami
- Department of Biomedical Sciences, Faculty of Medicine, TB-HIV Research Center, Universitas Padjadjaran, Bandung, Indonesia
| | - Chantal Valiquette
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - Dick Menzies
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
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17
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Romanowski K, Campbell JR, Oxlade O, Fregonese F, Menzies D, Johnston JC. The impact of improved detection and treatment of isoniazid resistant tuberculosis on prevalence of multi-drug resistant tuberculosis: A modelling study. PLoS One 2019; 14:e0211355. [PMID: 30677101 PMCID: PMC6345486 DOI: 10.1371/journal.pone.0211355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/13/2019] [Indexed: 11/27/2022] Open
Abstract
Introduction Isoniazid-resistant, rifampin susceptible tuberculosis (INHR-TB) is the most common form of drug resistant TB globally. Treatment of INHR-TB with standard first-line therapy is associated with high rates of multidrug resistant TB (MDR-TB). We modelled the potential impact of INHR-TB detection and appropriate treatment on MDR-TB prevalence. Methods A decision analysis model was developed to compare three different strategies for the detection of TB (AFB smear, Xpert MTB/RIF, and Line-Probe Assays (LPA)), combined with appropriate treatment. The population evaluated were patients with a globally representative prevalence of newly diagnosed, drug-susceptible (88.6%), isoniazid-resistant (7.3%), and multidrug resistant (4.1%) pulmonary TB. Our primary outcome was the proportion of patients with MDR-TB after initial attempt at diagnosis and treatment within a 2-year period. Secondary outcomes were the proportion of i) individuals with detected TB who acquired MDR-TB ii) individuals who died after initial attempt at diagnosis and treatment. Results After initial attempt at diagnosis and treatment, LPA combined with appropriate INHR-TB therapy resulted in a lower proportion of prevalent MDR-TB (1.61%; 95% Uncertainty Range (UR: 2.5th and 97.5th percentiles generated from 10 000 Monte Carlo simulation trials) 1.61–1.65), when compared to Xpert (1.84%; 95% UR 1.82–1.85) and AFB smear (3.21%; 95% UR 3.19–3.26). LPA also resulted in fewer cases of acquired MDR-TB in those with detected TB (0.35%; 95% UR 0.34–0.35), when compared to Xpert (0.67%; 95% UR 0.65–0.67) and AFB smear (0.68%; 95% UR 0.67–0.69). The majority of acquired MDR-TB arose from the treatment of INHR-TB in all strategies. Xpert-based strategies resulted in a lower proportion of death (2.89%; 95% UR 2.87–2.90) compared to LPA (2.93%; 95% UR 2.91–2.94) and AFB smear (3.21%; 95% UR 3.19–3.23). Conclusion Accurate diagnosis and tailored treatment of INHR-TB with LPA led to an almost 50% relative decrease in acquired MDR-TB when compared with an Xpert MTB/RIF strategy. Continued reliance on diagnostic and treatment protocols that ignore INHR-TB will likely result in further generation of MDR-TB.
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Affiliation(s)
- Kamila Romanowski
- TB Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | | | - Olivia Oxlade
- McGill International TB Centre, Montreal, Quebec, Canada
| | | | - Dick Menzies
- McGill International TB Centre, Montreal, Quebec, Canada
- Division of Respiratory Medicine, Department of Medicine, McGill University, Quebec, Canada
| | - James C. Johnston
- TB Services, BC Centre for Disease Control, Vancouver, British Columbia, Canada
- McGill International TB Centre, Montreal, Quebec, Canada
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Canada
- * E-mail:
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18
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Diallo T, Adjobimey M, Ruslami R, Trajman A, Sow O, Obeng Baah J, Marks GB, Long R, Elwood K, Zielinski D, Gninafon M, Wulandari DA, Apriani L, Valiquette C, Fregonese F, Hornby K, Li PZ, Hill PC, Schwartzman K, Benedetti A, Menzies D. Safety and Side Effects of Rifampin versus Isoniazid in Children. N Engl J Med 2018; 379:454-463. [PMID: 30067928 DOI: 10.1056/nejmoa1714284] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The treatment of latent infection with Mycobacterium tuberculosis is important in children because of their vulnerability to life-threatening forms of tuberculosis disease. The current standard treatment - 9 months of isoniazid - has been associated with poor adherence and toxic effects, which have hampered the effectiveness of the drug. In adults, treatment with 4 months of rifampin has been shown to be safer and to have higher completion rates than 9 months of isoniazid. METHODS In this multicenter, open-label trial, we randomly assigned 844 children (<18 years of age) with latent M. tuberculosis infection to receive either 4 months of rifampin or 9 months of isoniazid. The primary outcome was adverse events of grade 1 to 5 that resulted in the permanent discontinuation of a trial drug. Secondary outcomes were treatment adherence, side-effect profile, and efficacy. Independent review panels whose members were unaware of trial-group assignments adjudicated all adverse events and progression to active tuberculosis. RESULTS Of the children who underwent randomization, 829 were eligible for inclusion in the modified intention-to-treat analysis. A total of 360 of 422 children (85.3%) in the rifampin group completed per-protocol therapy, as compared with 311 of 407 (76.4%) in the isoniazid group (adjusted difference in the rates of treatment completion, 13.4 percentage points; 95% confidence interval [CI], 7.5 to 19.3). There were no significant between-group differences in the rates of adverse events, with fewer than 5% of the children in the combined groups with grade 1 or 2 adverse events that were deemed to be possibly related to a trial drug. Active tuberculosis, including 1 case with resistance to isoniazid, was diagnosed in 2 children in the isoniazid group during 542 person-years of follow-up, as compared with no cases in the rifampin group during 562 person-years (rate difference, -0.37 cases per 100 person-years; 95% CI, -0.88 to 0.14). CONCLUSIONS Among children under the age of 18 years, treatment with 4 months of rifampin had similar rates of safety and efficacy but a better rate of adherence than 9 months of treatment with isoniazid. (Funded by the Canadian Institutes of Health Research and Conselho Nacional de Pesquisa; ClinicalTrials.gov number, NCT00170209 .).
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Affiliation(s)
- Thierno Diallo
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Menonli Adjobimey
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Rovina Ruslami
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Anete Trajman
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Oumou Sow
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Joseph Obeng Baah
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Guy B Marks
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Richard Long
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Kevin Elwood
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - David Zielinski
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Martin Gninafon
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Diah A Wulandari
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Lika Apriani
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Chantal Valiquette
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Federica Fregonese
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Karen Hornby
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Pei-Zhi Li
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Philip C Hill
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Kevin Schwartzman
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Andrea Benedetti
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
| | - Dick Menzies
- From Service de Pneumophtisiologie, Hôpital National Ignace Deen, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea (T.D., O.S.); the Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre Research Institute (T.D., A.T., D.Z., C.V., F.F., K.H., P.Z.L., K.S., A.B., D.M.), the Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health (A.B.), and Montreal Children's Hospital (D.Z.), McGill University, Montreal, the TB Program Evaluation and Research Unit, University of Alberta, Edmonton (R.L.), and the British Columbia Centre for Disease Control and University of British Columbia, Vancouver (K.E.) - all in Canada; Centre National Hospitalier Universitaire de Pneumo-Phtisiologie, Cotonou, Benin (M.A., M.G.); Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia (R.R., D.A.W., L.A.); the Social Medicine Institute, Rio de Janeiro State University, Rio de Janeiro (A.T.); Komfo Anokye Teaching Hospital, Kumasi, Ghana (J.O.B.); the University of New South Wales, Sydney (G.B.M.); and the Centre for International Health, University of Otago, Dunedin, New Zealand (P.C.H.)
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Abstract
BACKGROUND Community involvement in research has been advocated by researchers, communities, regulatory agencies, and funders with the aim of reinforcing subjects' protection and improving research efficiency. Community involvement also has the potential to improve dissemination, uptake, and implementation of research findings. The fields of community based participatory research conducted with indigenous populations and of participatory action research offer a large base of experience in community involvement in research. Rules on involving the population affected when conducting research have been established in these fields. But what is the role of community engagement in clinical research and observational studies conducted in biomedical research outside of these specific areas? More than 20 years ago, in the field of HIV medicine, regulatory bodies and funding agencies (such as the US National Institutes of Health) recommended the constitution of a formal organism, the Community Advisory Board (CAB), as part of the study requirements for HIV trials. More recently, CABs have been adopted and used in other fields of medical research, such as malaria. CABs are not without limitations, however, and there is little research on the effectiveness of their use in achieving community protection and participation. Nevertheless, CABs could be a model to import into clinical trials and observational research where no alternative model of community representation is currently being used. CONCLUSIONS Allocating more resources to training and shifting more power to community representatives could be part of the solution to current CAB limitations. However, for researchers to be able to apply these recommendations on community involvement, certain conditions need to be met. In particular, funding agencies need to recognize the human and financial resources required for serious community involvement, and the academic environment needs to take community involvement into account when appraising, mentoring, and training researchers.
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Zarowsky C, Haddad S, O'Hearn S, Belaid L, Fregonese F. Strengthening systems and scholarship for global health - and public health. Can J Public Health 2016; 107:e339-e341. [PMID: 28026694 PMCID: PMC6972318 DOI: 10.17269/cjph.107.5986] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 06/06/2023]
Abstract
No abstract available.
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Affiliation(s)
- Christina Zarowsky
- Senior Editor, CJPH, Université de Montréal; HSR2016 Programme Co-Chair.
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Fregonese F, Siekmans K, Kouanda S, Druetz T, Ly A, Diabaté S, Haddad S. Impact of contaminated household environment on stunting in children aged 12-59 months in Burkina Faso. J Epidemiol Community Health 2016; 71:356-363. [PMID: 27986863 DOI: 10.1136/jech-2016-207423] [Citation(s) in RCA: 12] [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: 02/23/2016] [Revised: 08/15/2016] [Accepted: 09/11/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Stunting affects 165 million children worldwide, with repercussions on their survival and development. A contaminated environment is likely to contribute to stunting: frequent faecal-oral transmission possibly causes environmental enteropathy, a chronic inflammatory disorder that may contribute to faltering growth in children. This study's objective was to assess the effect of contaminated environment on stunting in Burkina Faso, where stunting prevalence is persistently high. METHODS Panel study of children aged 1-5 years in Kaya. Household socioeconomic characteristics, food needs and sanitary conditions were measured once, and child growth every year (2011-2014). Using multiple correspondence analysis and 12 questions and observations on water, sanitation, hygiene behaviours, yard cleanliness and animal proximity, we constructed a 'contaminated environment' index as a proxy of faecal-oral transmission exposure. Analysis was performed using a generalised structural equation model (SEM), adjusting for repeat observations and hierarchical data. RESULTS Stunting (<2 SD height-for-age) prevalence was 29% among 3121 children (median (IQR) age 36 (25-48) months). Environment contamination was widespread, particularly in rural and peri-urban areas, and was associated with stunting (prevalence ratio 1.30; p=0.008), controlling for sex, age, survey year, setting, mother's education, father's occupation, household food security and wealth. This association was significant for children of all ages (1-5 years) and settings. Lower contamination and higher food security had effects of comparable magnitude. CONCLUSIONS Environment contamination can be at least as influential as nutritional components in the pathway to stunting. There is a rationale for including interventions to reduce environment contamination in stunting prevention programmes.
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Affiliation(s)
- Federica Fregonese
- Centre de Recherche du CHUM (CRCHUM), Études de populations, Montréal, Québec, Canada
| | | | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Thomas Druetz
- Centre de Recherche du CHUM (CRCHUM), Études de populations, Montréal, Québec, Canada
| | - Antarou Ly
- Institut de Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso.,Centre de Recherche du Centre Hospitalier Universitaire de Québec, Hôpital Saint-Sacrement, Montréal, Québec, Canada
| | - Souleymane Diabaté
- Centre de Recherche du Centre Hospitalier Universitaire de Québec, Hôpital Saint-Sacrement, Montréal, Québec, Canada
| | - Slim Haddad
- Centre de Recherche du Centre Hospitalier Universitaire de Québec, Hôpital Saint-Sacrement, Montréal, Québec, Canada
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Costenaro P, Massavon W, Lundin R, Nabachwa SM, Fregonese F, Morelli E, Alowo A, Nannyonga Musoke M, Namisi CP, Kizito S, Bilardi D, Mazza A, Cotton MF, Giaquinto C, Penazzato M. Implementation and Operational Research: Implementation of the WHO 2011 Recommendations for Isoniazid Preventive Therapy (IPT) in Children Living With HIV/AIDS: A Ugandan Experience. J Acquir Immune Defic Syndr 2016; 71:e1-8. [PMID: 26761275 DOI: 10.1097/qai.0000000000000806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intensified tuberculosis (TB) case finding and isoniazid preventive therapy (IPT) are strongly recommended for children who are HIV infected. Data are needed to assess the feasibility of the WHO 2011 intensified tuberculosis case finding/IPT clinical algorithm. METHODS Children who are HIV infected and attending Nsambya Home Care at Nsambya Hospital, Uganda, were screened for TB following WHO recommendations. IPT was given for 6 months after excluding TB. Factors associated with time to IPT initiation were investigated by multivariate Cox proportional hazard regression. Health care workers were interviewed on reasons for delay in IPT initiation. RESULTS Among the 899 (49% male) children with HIV, 529 (58.8%) were screened for TB from January 2011 to February 2013. Children with active TB were 36/529 (6.8%), 24 (4.5%) were lost to follow-ups and 280 (52.9%) started IPT, 86/280 (30.7%) within 3 months of TB screening and 194/280 (69.3%) thereafter. Among the 529 children screened for TB, longer time to IPT initiation was independently associated with cough at TB screening (hazard ratio 0.62, P = 0.02, 95% confidence interval: 0.41 to 0.94). Four children (1% of those starting treatments) interrupted IPT because of a 5-fold increase in liver function measurements. In the survey, Health care workers reported poor adherence to antiretroviral therapy, poor attendance to periodic HIV follow-ups, and pill burden as the 3 main reasons to delay IPT. CONCLUSION In resource-constrained settings, considerable delays in IPT initiation may occur, particularly in children with HIV who are presenting with cough at TB screening. The good safety profile of isoniazid in antiretroviral-therapy-experienced children provides further support to IPT implementation in this population.
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Affiliation(s)
- Paola Costenaro
- *Department of Mother and Child Health, University of Padova, Padova, Italy;†Nsambya Home Care of St. Raphael of St. Francis Hospital, Kampala, Uganda;‡Research Center of Montreal University Health Center (CRCHUM)-Global Health, Montreal, Québec, Canada;§Associazione Casa Accoglienza alla Vita Padre Angelo, Trento, Italy;‖Department of Paediatrics and Child Health, Tygerberg Children's Hospital and Stellenbosch University, Tygerberg, South Africa; and¶MRC Clinical Trials Unit at UCL, London, United Kingdom
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Diabaté S, Druetz T, Millogo T, Ly A, Fregonese F, Kouanda S, Haddad S. Domestic Larval Control Practices and Malaria Prevalence among Under-Five Children in Burkina Faso. PLoS One 2015; 10:e0141784. [PMID: 26517727 PMCID: PMC4627816 DOI: 10.1371/journal.pone.0141784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/13/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction Larval source management has contributed to malaria decline over the past years. However, little is known about the impact of larval control practices undertaken at the household level on malaria transmission. Methods The study was conducted in Kaya health district after the 2010 mass distribution of insecticide treated-nets and the initiation of malaria awareness campaigns in Burkina Faso. The aim was to (i) estimate the level of domestic larval control practices (cleaning of the house and its surroundings, eradication of larval sources, and elimination of hollow objects that might collect water); (ii) identify key determinants; and (iii) explore the structural relationships between these practices, participation in awareness-raising activities and mothers’ knowledge/attitudes/practices, and malaria prevalence among under-five children. Results Overall, 2004 households were surveyed and 1,705 under-five children were examined. Half of the mothers undertook at least one action to control larval proliferation. Mothers who had gone to school had better knowledge about malaria and were more likely to undertake domestic larval control practices. Living in highly exposed rural areas significantly decreased the odds of undertaking larval control actions. Mothers’ participation in malaria information sessions increased the adoption of vector control actions and bednet use. Malaria prevalence was statistically lower among children in households where mothers had undertaken at least one vector control action or used bed-nets. There was a 0.16 standard deviation decrease in malaria prevalence for every standard deviation increase in vector control practices. The effect of bednet use on malaria prevalence was of the same magnitude. Conclusion Cleaning the house and its surroundings, eradicating breeding sites, and eliminating hollow objects that might collect water play a substantial role in preventing malaria among under-five. There is a need for national malaria control programs to include or reinforce training activities for community health workers aimed at promoting domestic larval control practices.
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Affiliation(s)
- Souleymane Diabaté
- Faculty of Medicine, Laval University, Québec, QC, Canada
- CHU de Québec Research Center, Saint-Sacrement Hospital, Québec, QC, Canada
- * E-mail:
| | - Thomas Druetz
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - Tiéba Millogo
- Institut Africain de Santé Publique, Ouagadougou, Burkina Faso
| | - Antarou Ly
- Institut de Recherche en Sciences de la Santé (IRSS) du CNRST, Ouagadougou, Burkina Faso
| | - Federica Fregonese
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - Seni Kouanda
- Institut de Recherche en Sciences de la Santé (IRSS) du CNRST, Ouagadougou, Burkina Faso
| | - Slim Haddad
- Faculty of Medicine, Laval University, Québec, QC, Canada
- CHU de Québec Research Center, Saint-Sacrement Hospital, Québec, QC, Canada
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Druetz T, Fregonese F, Bado A, Millogo T, Kouanda S, Diabaté S, Haddad S. Abolishing Fees at Health Centers in the Context of Community Case Management of Malaria: What Effects on Treatment-Seeking Practices for Febrile Children in Rural Burkina Faso? PLoS One 2015; 10:e0141306. [PMID: 26501561 PMCID: PMC4621040 DOI: 10.1371/journal.pone.0141306] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/06/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction Burkina Faso started nationwide community case management of malaria (CCMm) in 2010. In 2011, health center user fees for children under five were abolished in some districts. Objective To assess the effects of concurrent implementation of CCMm and user fees abolition on treatment-seeking practices for febrile children. Methods This is a natural experiment conducted in the districts of Kaya (CCMm plus user fees abolition) and Zorgho (CCMm only). Registry data from 2005 to 2014 on visits for malaria were collected from all eight rural health centers in the study area. Annual household surveys were administered during malaria transmission season in 2011 and 2012 in 1,035 randomly selected rural households. Interrupted time series models were fitted for registry data and Fine and Gray’s competing risks models for survey data. Results User fees abolition in Kaya significantly increased health center use by eligible children with malaria (incidence rate ratio for intercept change = 2.1, p <0.001). In 2011, in Kaya, likelihood of health center use for febrile children was three times higher and CHW use three times lower when caregivers knew services were free. Among the 421 children with fever in 2012, the delay before visiting a health center was significantly shorter in Kaya than in Zorgho (1.46 versus 1.79 days, p <0.05). Likelihood of visiting a health center on the first day of fever among households <2.5km or <5 km from a health center was two and three times higher in Kaya than in Zorgho, respectively (p <0.001). Conclusions User fees abolition reduced visit delay for febrile children living close to health centers. It also increased demand for and use of health center for children with malaria. Concurrently, demand for CHWs’ services diminished. User fees abolition and CCMm should be coordinated to maximize prompt access to treatment in rural areas.
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Affiliation(s)
- Thomas Druetz
- School of Public Health, University of Montreal, 7101 avenue du Parc, Montréal, Québec, H3N 1X9, Canada
- University of Montreal Hospital Research Centre, 850 rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
- * E-mail:
| | - Federica Fregonese
- University of Montreal Hospital Research Centre, 850 rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada
| | - Aristide Bado
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé, Ouagadougou 03 BP 7192, Burkina Faso
| | - Tieba Millogo
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé, Ouagadougou 03 BP 7192, Burkina Faso
| | - Seni Kouanda
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé, Ouagadougou 03 BP 7192, Burkina Faso
| | - Souleymane Diabaté
- Laval University Medical Research Center (CHUQ), Saint-Sacrement Hospital, 1050, chemin Sainte-Foy, Québec, Québec, G1S 4L8, Canada
| | - Slim Haddad
- Laval University Medical Research Center (CHUQ), Saint-Sacrement Hospital, 1050, chemin Sainte-Foy, Québec, Québec, G1S 4L8, Canada
- Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Québec, Québec, G1V 0A6, Canada
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Osokogu OU, Fregonese F, Ferrajolo C, Verhamme K, de Bie S, 't Jong G, Catapano M, Weibel D, Kaguelidou F, Bramer WM, Hsia Y, Wong ICK, Gazarian M, Bonhoeffer J, Sturkenboom M. Pediatric drug safety signal detection: a new drug-event reference set for performance testing of data-mining methods and systems. Drug Saf 2015; 38:207-17. [PMID: 25663078 PMCID: PMC4328124 DOI: 10.1007/s40264-015-0265-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Better evidence regarding drug safety in the pediatric population might be generated from existing data sources such as spontaneous reporting systems and electronic healthcare records. The Global Research in Paediatrics (GRiP)-Network of Excellence aims to develop pediatric-specific methods that can be applied to these data sources. A reference set of positive and negative drug-event associations is required. OBJECTIVE The aim of this study was to develop a pediatric-specific reference set of positive and negative drug-event associations. METHODS Considering user patterns and expert opinion, 16 drugs that are used in individuals aged 0-18 years were selected and evaluated against 16 events, regarded as important safety outcomes. A cross-table of unique drug-event pairs was created. Each pair was classified as potential positive or negative control based on information from the drug's Summary of Product Characteristics and Micromedex. If both information sources consistently listed the event as an adverse event, the combination was reviewed as potential positive control. If both did not, the combination was evaluated as potential negative control. Further evaluation was based on published literature. RESULTS Selected drugs include ibuprofen, flucloxacillin, domperidone, methylphenidate, montelukast, quinine, and cyproterone/ethinylestradiol. Selected events include bullous eruption, aplastic anemia, ventricular arrhythmia, sudden death, acute kidney injury, psychosis, and seizure. Altogether, 256 unique combinations were reviewed, yielding 37 positive (17 with evidence from the pediatric population and 20 with evidence from adults only) and 90 negative control pairs, with the remainder being unclassifiable. CONCLUSION We propose a drug-event reference set that can be used to compare different signal detection methods in the pediatric population.
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Affiliation(s)
- Osemeke U Osokogu
- Department of Medical Informatics, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands,
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26
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MacLaren D, Tommbe R, Mafile’o T, Manineng C, Fregonese F, Redman-MacLaren M, Wood M, Browne K, Muller R, Kaldor J, McBride WJ. Foreskin cutting beliefs and practices and the acceptability of male circumcision for HIV prevention in Papua New Guinea. BMC Public Health 2013; 13:818. [PMID: 24015786 PMCID: PMC3846639 DOI: 10.1186/1471-2458-13-818] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 09/05/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Male circumcision (MC) reduces HIV acquisition and is a key public health intervention in settings with high HIV prevalence, heterosexual transmission and low MC rates. In Papua New Guinea (PNG), where HIV prevalence is 0.8%, there is no medical MC program for HIV prevention. There are however many different foreskin cutting practices across the country's 800 language groups. The major form exposes the glans but does not remove the foreskin. This study aimed to describe and quantify foreskin cutting styles, practices and beliefs. It also aimed to assess the acceptability of MC for HIV prevention in PNG. METHODS Cross-sectional multicentre study, at two university campuses (Madang Province and National Capital District) and at two 'rural development' sites (mining site Enga Province; palm-oil plantation in Oro Province). Structured questionnaires were completed by participants originating from all regions of PNG who were resident at each site for study or work. RESULTS Questionnaires were completed by 861 men and 519 women. Of men, 47% reported a longitudinal foreskin cut (cut through the dorsal surface to expose the glans but foreskin not removed); 43% reported no foreskin cut; and 10% a circumferential foreskin cut (complete removal). Frequency and type of cut varied significantly by region of origin (p < .001). Most men (72-82%) were cut between the ages of 10-20 years. Longitudinal cuts were most often done in a village by a friend, with circumferential cuts most often done in a clinic by a health professional. Most uncut men (71%) and longitudinal cut men (84%) stated they would remove their foreskin if it reduced the risk of HIV infection. More than 95% of uncut men and 97% of longitudinal cut men would prefer the procedure in a clinic or hospital. Most men (90%) and women (74%) stated they would remove the foreskin of their son if it reduced the risk of HIV infection. CONCLUSION Although 57% of men reported some form of foreskin cut only 10% reported the complete removal of the foreskin, the procedure on which international HIV prevention strategies are based. The acceptability of MC (complete foreskin removal) is high among men (for themselves and their sons) and women (for their sons). Potential MC services need to be responsive to the diversity of beliefs and practices and consider health system constraints. A concerted research effort to investigate the potential protective effects of longitudinal cuts for HIV acquisition is essential given the scale of longitudinal cuts in PNG.
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Affiliation(s)
- David MacLaren
- School of Medicine and Dentistry, James Cook University, McGregor Road, Smithfield, Cairns 4878, Queensland, Australia
| | - Rachael Tommbe
- School of Health Science, Pacific Adventist University, Port Moresby, National Capital District, Papua New Guinea
| | - Tracie Mafile’o
- Deputy Vice Chancellor, Pacific Adventist University, Port Moresby, National Capital District, Papua New Guinea
| | - Clement Manineng
- Faculty of Health Science, Divine Word University, Madang, Madang Province, Papua New Guinea
| | - Federica Fregonese
- Global Health Unit, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Michelle Redman-MacLaren
- School of Medicine and Dentistry, James Cook University, McGregor Road, Smithfield, Cairns 4878, Queensland, Australia
| | - Michael Wood
- School of Arts and Social Science, James Cook University, Cairns, Queensland, Australia
| | - Kelwyn Browne
- Rural Primary Health Services Delivery Project, National Department of Health, Port Moresby, Papua New Guinea
| | - Reinhold Muller
- School of Public Health, Tropical Medicine and Rehabilitation Science, James Cook University, Cairns, Queensland, Australia
- Tropical Health Solutions, Townsville, Australia
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - William John McBride
- School of Medicine and Dentistry, James Cook University, McGregor Road, Smithfield, Cairns 4878, Queensland, Australia
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27
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Jourdain G, Le Cœur S, Ngo-Giang-Huong N, Traisathit P, Cressey TR, Fregonese F, Leurent B, Collins IJ, Techapornroong M, Banchongkit S, Buranabanjasatean S, Halue G, Nilmanat A, Luekamlung N, Klinbuayaem V, Chutanunta A, Kantipong P, Bowonwatanuwong C, Lertkoonalak R, Leenasirimakul P, Tansuphasawasdikul S, Sang-a-gad P, Pathipvanich P, Thongbuaban S, Wittayapraparat P, Eiamsirikit N, Buranawanitchakorn Y, Yutthakasemsunt N, Winiyakul N, Decker L, Barbier S, Koetsawang S, Sirirungsi W, McIntosh K, Thanprasertsuk S, Lallemant M. Switching HIV treatment in adults based on CD4 count versus viral load monitoring: a randomized, non-inferiority trial in Thailand. PLoS Med 2013; 10:e1001494. [PMID: 23940461 PMCID: PMC3735458 DOI: 10.1371/journal.pmed.1001494] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 06/27/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Viral load (VL) is recommended for monitoring the response to highly active antiretroviral therapy (HAART) but is not routinely available in most low- and middle-income countries. The purpose of the study was to determine whether a CD4-based monitoring and switching strategy would provide a similar clinical outcome compared to the standard VL-based strategy in Thailand. METHODS AND FINDINGS The Programs for HIV Prevention and Treatment (PHPT-3) non-inferiority randomized clinical trial compared a treatment switching strategy based on CD4-only (CD4) monitoring versus viral-load (VL). Consenting participants were antiretroviral-naïve HIV-infected adults (CD4 count 50-250/mm(3)) initiating non-nucleotide reverse transcriptase inhibitor (NNRTI)-based therapy. Randomization, stratified by site (21 public hospitals), was performed centrally after enrollment. Clinicians were unaware of the VL values of patients randomized to the CD4 arm. Participants switched to second-line combination with confirmed CD4 decline >30% from peak (within 200 cells from baseline) in the CD4 arm, or confirmed VL >400 copies/ml in the VL arm. Primary endpoint was clinical failure at 3 years, defined as death, new AIDS-defining event, or CD4 <50 cells/mm(3). The 3-year Kaplan-Meier cumulative risks of clinical failure were compared for non-inferiority with a margin of 7.4%. In the intent to treat analysis, data were censored at the date of death or at last visit. The secondary endpoints were difference in future-drug-option (FDO) score, a measure of resistance profiles, virologic and immunologic responses, and the safety and tolerance of HAART. 716 participants were randomized, 356 to VL monitoring and 360 to CD4 monitoring. At 3 years, 319 participants (90%) in VL and 326 (91%) in CD4 were alive and on follow-up. The cumulative risk of clinical failure was 8.0% (95% CI 5.6-11.4) in VL versus 7.4% (5.1-10.7) in CD4, and the upper-limit of the one-sided 95% CI of the difference was 3.4%, meeting the pre-determined non-inferiority criterion. Probability of switch for study criteria was 5.2% (3.2-8.4) in VL versus 7.5% (5.0-11.1) in CD4 (p=0.097). Median time from treatment initiation to switch was 11.7 months (7.7-19.4) in VL and 24.7 months (15.9-35.0) in CD4 (p=0.001). The median duration of viremia >400 copies/ml at switch was 7.2 months (5.8-8.0) in VL versus 15.8 months (8.5-20.4) in CD4 (p=0.002). FDO scores were not significantly different at time of switch. No adverse events related to the monitoring strategy were reported. CONCLUSIONS The 3-year rates of clinical failure and loss of treatment options did not differ between strategies although the longer-term consequences of CD4 monitoring would need to be investigated. These results provide reassurance to treatment programs currently based on CD4 monitoring as VL measurement becomes more affordable and feasible in resource-limited settings. TRIAL REGISTRATION ClinicalTrials.govNCT00162682 Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Gonzague Jourdain
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Sophie Le Cœur
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Unité Mixte de Recherche 196, Centre Français de la Population et du Développement, (INED-IRD-Paris V University), Paris, France
| | - Nicole Ngo-Giang-Huong
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Tim R. Cressey
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Federica Fregonese
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
| | - Baptiste Leurent
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
| | - Intira J. Collins
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | | | | | | | - Guttiga Halue
- Phayao Provincial Hospital, Ministry of Public Health, Phayao, Thailand
| | | | | | | | | | - Pacharee Kantipong
- Chiangrai Prachanukroh Hospital, Ministry of Public Health, Chiang Rai, Thailand
| | | | - Rittha Lertkoonalak
- Maharat Nakhon Ratchasima Hospital, Ministry of Public Health, Nakhon Ratchasima, Thailand
| | | | | | | | | | | | | | - Naree Eiamsirikit
- Samutprakarn Hospital, Ministry of Public Health, Samutprakarn, Thailand
| | | | | | - Narong Winiyakul
- Regional Health Promotion Centre 6, Ministry of Public Health, Khon Kaen, Thailand
| | - Luc Decker
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Sylvaine Barbier
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
| | - Suporn Koetsawang
- Family Health Research Center, Mahidol University, Bangkok, Thailand
| | - Wasna Sirirungsi
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Kenneth McIntosh
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
- Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Marc Lallemant
- Unité Mixte Internationale 174, Institut de Recherche pour le Développement (IRD)-Programs for HIV Prevention and Treatment (PHPT), Chiang Mai, Thailand
- Department of Medical Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, Massachusetts, United States of America
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Jourdain G, Wagner TA, Ngo-Giang-Huong N, Sirirungsi W, Klinbuayaem V, Fregonese F, Nantasen I, Techapornroong M, Halue G, Nilmanat A, Wittayapraparat P, Chalermpolprapa V, Pathipvanich P, Yuthavisuthi P, Frenkel LM, Lallemant M. Association between detection of HIV-1 DNA resistance mutations by a sensitive assay at initiation of antiretroviral therapy and virologic failure. Clin Infect Dis 2010; 50:1397-404. [PMID: 20377404 DOI: 10.1086/652148] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) has become more available throughout the developing world during the past 5 years. The World Health Organization recommends nonnucleoside reverse-transcriptase inhibitor-based regimens as initial ART. However, their efficacy may be compromised by resistance mutations selected by single-dose nevirapine (sdNVP) used to prevent mother-to-child transmission of human immunodeficiency virus (HIV)-1. There is no simple and efficient method to detect such mutations at the initiation of ART. METHODS One hundred eighty-one women who were participating in a clinical trial to prevent mother-to-child transmission and who started NVP-ART after they had received sdNVP or a placebo were included in the study. One hundred copies of each patient's HIV-1 DNA were tested for NVP-resistance point-mutations (K103N, Y181C, and G190A) with a sensitive oligonucleotide ligation assay that was able to detect mutants even at low concentrations (> or = 5% of the viral population). Virologic failure was defined as confirmed plasma HIV-1 RNA >50 copies/mL after 6 to 18 months of NVP-ART. RESULTS At initiation of NVP-ART, resistance mutations were identified in 38 (26%) of 148 participants given sdNVP (K103N in 19 [13%], Y181C in 8 [5%], G190A in 28 [19%], and > or = 2 mutations in 15 [10%]), at a median 9.3 months after receipt of sdNVP. The risk of virologic failure was 0.62 (95% confidence interval [CI], 0.46-0.77) in women with > or = 1% resistance mutation, compared with a risk of 0.25 (95% CI, 0.17-0.35) in those without detectable resistance mutations (P < .001). Failure was independently associated with resistance, an interval of <6 months between sdNVP and NVP-ART initiation, and a viral load higher than the median at NVP-ART initiation. CONCLUSIONS Access to simple and inexpensive assays to detect low concentrations of NVP-resistant HIV-1 DNA before the initiation of ART could help improve the outcome of first-line ART.
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Affiliation(s)
- Gonzague Jourdain
- Institut de Recherche pour le Développement, UMI 174-PHPT, Thailand.
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29
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Montini G, Rigon L, Zucchetta P, Fregonese F, Toffolo A, Gobber D, Cecchin D, Pavanello L, Molinari PP, Maschio F, Zanchetta S, Cassar W, Casadio L, Crivellaro C, Fortunati P, Corsini A, Calderan A, Comacchio S, Tommasi L, Hewitt IK, Da Dalt L, Zacchello G, Dall'Amico R. Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics 2008; 122:1064-71. [PMID: 18977988 DOI: 10.1542/peds.2007-3770] [Citation(s) in RCA: 199] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Febrile urinary tract infections are common in children and associated with the risk for renal scarring and long-term complications. Antimicrobial prophylaxis has been used to reduce the risk for recurrence. We performed a study to determine whether no prophylaxis is similar to antimicrobial prophylaxis for 12 months in reducing the recurrence of febrile urinary tract infections in children after a first febrile urinary tract infection. METHODS The study was a controlled, randomized, open-label, 2-armed, noninferiority trial comparing no prophylaxis with prophylaxis (co-trimoxazole 15 mg/kg per day or co-amoxiclav 15 mg/kg per day) for 12 months. A total of 338 children who were aged 2 months to <7 years and had a first episode of febrile urinary tract infection were enrolled: 309 with a confirmed pyelonephritis on a technetium 99m dimercaptosuccinic acid scan with or without reflux and 27 with a clinical pyelonephritis and reflux. The primary end point was recurrence rate of febrile urinary tract infections during 12 months. Secondary end point was the rate of renal scarring produced by recurrent urinary tract infections on technetium 99m dimercaptosuccinic acid scan after 12 months. RESULTS Intention-to-treat analysis showed no significant differences in the primary outcome between no prophylaxis and prophylaxis: 12 (9.45%) of 127 vs 15 (7.11%) of 211. In the subgroup of children with reflux, the recurrence of febrile urinary tract infections was 9 (19.6%) of 46 on no prophylaxis and 10 (12.1%) of 82 on prophylaxis. No significant difference was found in the secondary outcome: 2 (1.9%) of 108 on no prophylaxis versus 2 (1.1%) of 187 on prophylaxis. Bivariate analysis and Cox proportional hazard model showed that grade III reflux was a risk factor for recurrent febrile urinary tract infections. Whereas increasing age was protective, use of no prophylaxis was not a risk factor. CONCLUSIONS For children with or without primary nonsevere reflux, prophylaxis does not reduce the rate of recurrent febrile urinary tract infections after the first episode.
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Affiliation(s)
- Giovanni Montini
- Department of Pediatric Nephrology, Azienda Ospedaliera-University of Padua, Italy.
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Giaquinto C, Morelli E, Fregonese F, Rampon O, Penazzato M, de Rossi A, D'Elia R. Current and future antiretroviral treatment options in paediatric HIV infection. Clin Drug Investig 2008; 28:375-97. [PMID: 18479179 DOI: 10.2165/00044011-200828060-00005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Because of a lack of prevention policies or problems in implementing prevention of mother-to-child transmission (P-MTCT), most of the 1500 daily new HIV infections in children aged<15 years are caused by MTCT. Fifteen percent of all HIV-infected individuals are children, but the vast majority lack access to highly active antiretroviral therapy (HAART), which can drastically reduce morbidity and mortality. There are 22 antiretroviral drugs currently approved by the US FDA for use in the treatment of HIV-infected adults and adolescents, but only 12 of these drugs are approved for use in children. Antiretroviral drugs belong to four major classes: nucleoside and nucleotide analogue reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors and fusion inhibitors. According to international guidelines developed by organizations including WHO, the Paediatric European Network for Treatment of AIDS (PENTA) and the US National Institutes of Health (US-NIH), the treatment of choice for HIV-infected children and adults is a combination of two NRTIs (backbone treatment) plus a third potent agent from a different class, either an NNRTI or a ritonavir-boosted protease inhibitor. There are specific challenges in treating HIV-infected children, including uncertainty about the best time to start treatment, the need for more paediatric formulations, the lack of pharmacokinetic studies for new drugs, and incomplete dosing guidelines. Furthermore, the most appropriate regimen for an individual child depends on a variety of factors, including the age of the child; the availability of appropriate drug formulations; the potency, complexity and toxicity of the drug regimen; the home situation; the child and caregiver's ability to adhere to the regimen; and the child's antiretroviral treatment history. In addition, antiretroviral drugs are not licensed for all age groups and the drugs are often not affordable. This review describes NNRTI and protease inhibitors as key components of first- and second-line antiretroviral therapy (ART), focusing on the rationale for choosing an NNRTI- versus protease inhibitor-based regimen based on the results of available phase II and III studies. Some of the new agents available for children as second-line and salvage therapy both on- and off-label are also discussed. The drug regimens described in this review are relevant to clinicians in developed and developing countries. The availability of new, potent compounds with different resistance and toxicity profiles may represent an alternative option to interclass switching and could redefine ART strategy, including the option of first-line NRTI-sparing regimens.
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Affiliation(s)
- Carlo Giaquinto
- Department of Paediatrics, University of Padova, Padova, Italy.
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Abstract
By the end of 2006, approximately 2.3 million children worldwide were living with HIV infection, representing about 15% of all HIV-infected individuals but only 5-7% of the total population of treated patients worldwide. Despite a general increase in the use of antiretroviral therapy (ART) in resource-limited settings, appropriate care and ART remain inaccessible for most of the world's HIV-infected children. ART of children is challenging because of a general lack of paediatric formulations (including tablets in paediatric strengths), limited options of drugs available for children (some have been approved only for use in adults), different viral and immunological responses, dependency on caregivers for administration of the therapy, and specific issues of toxicity in long-term therapy related to maturation and development. As in adults, nucleoside reverse transcriptase inhibitors (NRTIs) are a key component of any ART schedule in children, being the recommended 'backbone' treatment in US, European and WHO guidelines, and, indeed, NRTIs have been extensively studied in children. NRTIs are the class of antiretroviral drugs that have more drugs licensed for paediatric use and more paediatric formulations.Generally, the dual NRTI backbone treatment of combination with a non-NRTI (NNRTI) or protease inhibitor (PI) should comprise a cytidine analogue (lamivudine, emtricitabine) and a thymidine analogue (stavudine, zidovudine), guanosine analogue (i.e. abacavir), or nucleotide RTI (NtRTI; i.e. tenofovir). European and US guidelines recommend the use of triple NRTI therapy (abacavir/lamivudine/zidovudine) in children with anticipated poor adherence to other treatment regimens because of tablet burden. In conclusion, while use of ART in children needs to be dramatically increased, selecting and administering the best drug combination for children is still limited by a lack of paediatric formulations and knowledge of drug metabolism, safety and efficacy in children. NRTIs are already a key component of paediatric ART, but fixed-dose combinations and specific research in children are needed to optimise their use. In this article we review the available information to facilitate selection of the best NRTI for backbone treatment in combination ART for HIV-infected children.
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Affiliation(s)
- Carlo Giaquinto
- Department of Pediatrics, Università di Padova, Padova, Italy.
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Cressey TR, Plipat N, Fregonese F, Chokephaibulkit K. Indinavir/ritonavir remains an important component of HAART for the treatment of HIV/AIDS, particularly in resource-limited settings. Expert Opin Drug Metab Toxicol 2007; 3:347-61. [PMID: 17539743 DOI: 10.1517/17425255.3.3.347] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
For over a decade, indinavir has been approved for the treatment of HIV/AIDS; however, following the introduction of new protease inhibitors (PIs) with improved safety and pharmacologic profiles, its use in developed countries has become almost obsolete. In contrast, in resource-limited settings where the majority of people living with HIV/AIDS reside, indinavir is part of the most affordable PI-based highly active antiretroviral treatment regimen. A major drawback of indinavir use is renal toxicity, but low-dose indinavir plus ritonavir (400/100 mg) twice daily is both efficacious and tolerable. Similar low dosing levels in children have also proven successful, but data in pregnant women remains limited. Due to its low cost and proven efficacy indinavir remains a key component of HIV/AIDS treatment in resource-limited settings.
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Affiliation(s)
- Tim R Cressey
- Chiang Mai University, Program for HIV Prevention and Treatment (PHPT-IRD174), 29/7-8 Samlan Road, Soi 1 Prasing, Muang, Chiang Mai, 50205, Thailand.
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Zignol M, Peracchi M, Tridello G, Pillon M, Fregonese F, D'Elia R, Zanesco L, Cesaro S. Assessment of humoral immunity to poliomyelitis, tetanus, hepatitis B, measles, rubella, and mumps in children after chemotherapy. Cancer 2004; 101:635-41. [PMID: 15274078 DOI: 10.1002/cncr.20384] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND To evaluate the effect of chemotherapy on humoral immunity to vaccine-preventable disease, the authors investigated the persistence of protective antibody titers in a group of patients who were alive and well after they were treated for pediatric malignancies. METHODS Serum antibody levels were evaluated for polio, tetanus, hepatitis B, rubella, mumps, and measles in 192 children. The terms lack of immunity and loss of immunity, respectively, were used to describe the absence of immunity in patients who were tested only after chemotherapy and in patients who were tested both before and after chemotherapy and determined to have immunity before chemotherapy. RESULTS Overall, the absence of a protective serum antibody titer for hepatitis B, measles, mumps, rubella, tetanus, and polio was detected in 46%, 25%, 26%, 24%, 14%, and 7% of patients, respectively. On univariate analysis, loss of antibodies against rubella, mumps, and tetanus was associated significantly with younger age (P < 0.001, P = 0.02, and P = 0.001, respectively), and loss of antibodies against measles was significantly associated with younger age and female gender (P = 0.0003 and P = 0.008, respectively). The administration of 59 booster vaccinations to 51 patients who had lost > or = 1 protective antibody titer resulted in an overall response rate of 93%. CONCLUSIONS Chemotherapy induced different rates of loss of protective antibody titers depending on the type of vaccination administered. This finding may be responsible for the failure of vaccination programs for patients who have undergone chemotherapy. The administration of a booster dose after the completion of chemotherapy is a simple and cost-effective way to restore humoral immunity against most vaccine-preventable diseases.
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Affiliation(s)
- Matteo Zignol
- Department of Pediatrics, Faculty of Medicine and Surgery, University of Padua, Padua, Italy
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Ruga E, Fregonese F, Facchin P, D'Elia R. Antibiotic utilization for pediatric patients: retrospective study in Department of Pediatrics, University of Padua. Int J Infect Dis 2002. [DOI: 10.1016/s1201-9712(02)90247-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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