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Rucsineanu O, Agbassi P, Herrera R, Low M, McKenna L, Stillo J, Winarni P, Acharya A, Sari AH. Shorter TB treatment regimens should be safer as well. Public Health Action 2023; 13:104-106. [PMID: 37736577 PMCID: PMC10446660 DOI: 10.5588/pha.23.0026] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/26/2023] [Indexed: 09/23/2023] Open
Abstract
Most ongoing and planned TB therapeutic trials are focused on shortening the duration of treatment while giving less consideration to other aspects of TB care that are important to people with TB. Here we argue that other variables besides duration of TB treatment should also be considered when developing new TB treatment regimens, including drug toxicity, time spent in monitoring and overall quality of life while on therapy. We examine the specific use of linezolid in treatment-shortening trials for drug-susceptible TB and propose additional endpoints that should be prioritised in TB treatment studies.
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Affiliation(s)
- O Rucsineanu
- Moldova National Association of Tuberculosis Patients "SMIT" (Society of Moldova against Tuberculosis), Balti, Moldova
- Global TB Community Advisory Board, New York, NY, USA
| | - P Agbassi
- Global TB Community Advisory Board, New York, NY, USA
| | - R Herrera
- Global TB Community Advisory Board, New York, NY, USA
| | - M Low
- Department of Computer Science, University of Cape Town, Cape Town, South Africa
| | - L McKenna
- Global TB Community Advisory Board, New York, NY, USA
- Treatment Action Group, New York, NY, USA
| | - J Stillo
- Global TB Community Advisory Board, New York, NY, USA
- Department of Anthropology, Wayne State University, Detroit, MI, USA
| | - P Winarni
- Global TB Community Advisory Board, New York, NY, USA
| | - A Acharya
- Independent Consultant, Mumbai, India
| | - A H Sari
- Global TB Community Advisory Board, New York, NY, USA
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Makone A, Angami K, Bhattacharya D, Frick M, Castillo JG, Herrera R, McKenna L, Moses GK, Rucsineanu O, Sari AH, Stillo J, Agbassi P. One size does not fit all: community views on choices for TB treatment and prevention. Public Health Action 2023; 13:67-69. [PMID: 37736579 PMCID: PMC10446664 DOI: 10.5588/pha.23.0034] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/04/2023] [Indexed: 09/23/2023] Open
Abstract
Treatment and prevention paradigms in TB have been dominated by a 'one-size-fits-all' approach, in which all persons are given the same treatment regimens. This stands in contrast to other health conditions, where differentiated models of care have been shown to be effective. In this Viewpoint, we make the case for considering multiple factors when deciding which regimens should be offered to people with TB infection and disease. Choice about which regimens to use should be made in conjunction with people who have TB and consider efficacy, safety, duration, pill burden, formulation, drug interactions, time spent in monitoring, drug susceptibility, compatibility with other areas of life, and availability of support services. Ideally, these choices should be considered within an equity framework with the most intensified services being offered to those considered most vulnerable.
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Affiliation(s)
- A Makone
- Stellenbosch University, Cape Town, South Africa
- Global TB Community Advisory Board, New York, NY, USA
| | - K Angami
- Global TB Community Advisory Board, New York, NY, USA
- Access to Rights and Knowledge Foundation, Kohima
| | - D Bhattacharya
- Global TB Community Advisory Board, New York, NY, USA
- Survivors Against TB, New Delhi, India
| | - M Frick
- Global TB Community Advisory Board, New York, NY, USA
- Treatment Action Group, New York, NY
| | - J G Castillo
- Global TB Community Advisory Board, New York, NY, USA
- McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA
| | - R Herrera
- Global TB Community Advisory Board, New York, NY, USA
| | - L McKenna
- Global TB Community Advisory Board, New York, NY, USA
- Survivors Against TB, New Delhi, India
| | - G K Moses
- Global TB Community Advisory Board, New York, NY, USA
| | - O Rucsineanu
- Global TB Community Advisory Board, New York, NY, USA
- Moldova National Association of Tuberculosis Patients "SMIT" (Society of Moldova against Tuberculosis), Chis¸ina˘u, Moldova
| | - A H Sari
- Global TB Community Advisory Board, New York, NY, USA
| | - J Stillo
- Global TB Community Advisory Board, New York, NY, USA
- Department of Anthropology, Wayne State University, Detroit, MI, USA
| | - P Agbassi
- Global TB Community Advisory Board, New York, NY, USA
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Almeida A, Adjuntsov M, Bushura W, Delgado E, Drasher M, Fernando-Pancho M, Gasane M, Ianoşi MV, Lessem E, Musah A, Răduţ Ş, Sánchez Ríos CH, Soe KS, Venkatesan N, Villegas VV, Stillo J. Hear us! Accounts of people treated with injectables for drug-resistant TB. Public Health Action 2021; 11:146-154. [PMID: 34567991 DOI: 10.5588/pha.21.0031] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND WHO drug-resistant TB (DR-TB) treatment recommendations now emphasize all-oral regimens, recommending against certain injectable agents and deprioritizing others due to inferior safety and efficacy. Despite increasing focus on patient-centered care, we are not aware of systematic attempts to qualitatively document patients' perspectives on injectable agents. This may inform implementation of WHO guidelines, emphasizing the importance of consultation with affected communities. METHODS Testimonies were provided by TB survivors who experienced hearing loss from treatment with injectable agents. Testimonies were submitted in writing in response to minimal, standardized, open-ended prompts. Participants provided a signed consent form (with options to participate anonymously or as a named co-author), and later gave input into the overall shape and recommendations of the article. RESULTS Fourteen TB survivors in 12 countries contributed testimonies. The following common themes emerged: lack of access to appropriate testing, information, treatment, or a collaborative treatment environment; the power of supportive care and social environments; stigma and isolation from TB treatment itself and resultant disability; and inaccessibility of cochlear implants. CONCLUSIONS Survivor testimonies indicate strong preferences for avoidance of injectable agents, supporting rapid implementation of revised WHO guidelines, as well as for quality and supportive care for both TB and disabilities.
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Affiliation(s)
- A Almeida
- Treatment Action Group, New York, NY, USA
| | | | - W Bushura
- Independent advocate and TB survivor
| | - E Delgado
- Independent advocate and TB survivor
| | - M Drasher
- Wayne State University, Detroit, MI, USA
| | | | - M Gasane
- Independent advocate and TB survivor
| | | | - E Lessem
- Treatment Action Group, New York, NY, USA
| | - A Musah
- Independent advocate and TB survivor
| | - Ş Răduţ
- Independent advocate and TB survivor
| | | | - K S Soe
- Independent advocate and TB survivor
| | | | | | - J Stillo
- Wayne State University, Detroit, MI, USA
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Stillo J, Frick M, Cong Y. Upholding ethical values and human rights at the frontier of TB research. Int J Tuberc Lung Dis 2020; 24:48-56. [PMID: 32553044 DOI: 10.5588/ijtld.17.0897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Until recently, human rights have played a minor role in the fight against tuberculosis (TB), even less so in TB research. This is changing, however. The WHO's End TB Strategy and Ethics Guidance stress respect for human rights and ethical principles in every area of TB care, including research. The desired reductions in TB incidence and mortality are impossible without new tools and strategies to fight the disease. Yet, little suggests that the current state of TB research-including funding levels, evidence being produced, and community involvement-will alleviate concerns related to the availability, accessibility, and acceptability of TB diagnostics, drugs, and prevention in the near future. In this article, we consider these ethics concerns in relation to the right to enjoy the benefits of scientific progress and the right to health. We also reflect on community involvement in research and offer recommendations in the spirit of the rights to health and science, such as involving affected communities in all aspects of research planning, execution, and dissemination. Finally, we argue that states have a responsibility under international law for the continued realization of the right to health. This realization rests, in part, on the realization of the right to science.
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Affiliation(s)
- J Stillo
- College of Liberal Arts and Sciences, Wayne State University, Detroit, MI
| | - M Frick
- Treatment Action Group, New York, NY, USA
| | - Y Cong
- Program of Medical Ethics, Peking University Health Science Center, Beijing, China
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Cox V, Cox H, Pai M, Stillo J, Citro B, Brigden G. Health care gaps in the global burden of drug-resistant tuberculosis. Int J Tuberc Lung Dis 2020; 23:125-135. [PMID: 30808447 DOI: 10.5588/ijtld.18.0866] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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
The drug-resistant tuberculosis (DR-TB) cascade-from estimated or incident cases to numbers successfully treated or disease-free survival-has long been characterised by sharp declines at each step in the cascade. The losses along the cascade vary across different settings, and the reasons why some countries have a higher burden of DR-TB are complex and multifactorial; broadly, weak health systems, inadequate financing and poverty all impact differential access to DR-TB care. Within a human rights framework that mandates the right to health and the right to benefit from scientific progress, the aim of this review is to focus on describing inequities in access to DR-TB care at critical points in the cascade.
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Affiliation(s)
- V Cox
- Center for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town
| | - H Cox
- Division of Medical Microbiology and the Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - M Pai
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | - J Stillo
- College of Liberal Arts and Sciences, Wayne State University, Detroit, Michigan
| | - B Citro
- Northwestern Pritzker School of Law, Chicago, Illinois, USA
| | - G Brigden
- International Union Against TB and Lung Disease, Paris, France
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Abstract
Tuberculosis (TB) is the leading infectious cause of death among people living with HIV, causing one third of AIDS-related deaths globally. The concerning number of missing TB cases, ongoing high TB mortality, slow reduction in TB incidence, and limited uptake of TB preventive treatment among people living with HIV, all indicate the urgent need to improve quality of TB services within HIV programs. In this mini-review we discuss major gaps in quality of TB care that impede achieving prevention and treatment targets within the TB-HIV care cascades, show approaches of assessing gaps in TB service provision, and describe outcomes from innovative quality improvement projects among HIV and TB programs. We also offer recommendations for measuring quality of TB care.
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Affiliation(s)
- Kogieleum Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.,MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, South Africa
| | | | - Satvinder Singh
- TBHIV and Quality of Care, HIV Department, World Health Organization, Geneva, Switzerland
| | - Jonathan Stillo
- Wayne State University, College of Liberal Arts and Sciences, Detroit, MI, United States
| | - Nesri Padayatchi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.,MRC-CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, University of KwaZulu-Natal, South Africa
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Reuter A, Tisile P, von Delft D, Cox H, Cox V, Ditiu L, Garcia-Prats A, Koenig S, Lessem E, Nathavitharana R, Seddon JA, Stillo J, von Delft A, Furin J. The devil we know: is the use of injectable agents for the treatment of MDR-TB justified? Int J Tuberc Lung Dis 2017; 21:1114-1126. [DOI: 10.5588/ijtld.17.0468] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A. Reuter
- Médecins Sans Frontières, Khayeltisha
| | | | | | - H. Cox
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - V. Cox
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - L. Ditiu
- Stop TB Partnership, Geneva, Switzerland
| | - A. Garcia-Prats
- Desmond Tutu TB Center, Stellenbosch University, Cape Town, South Africa
| | - S. Koenig
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - E. Lessem
- HIV/TB Project, Treatment Action Group, New York, New York
| | | | - J. A. Seddon
- Centre for International Health, Imperial College, London, UK
| | - J. Stillo
- College of Liberal Arts and Sciences, Wayne State University, Detroit, Michigan, USA
| | - A. von Delft
- TB Proof, Cape Town, Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - J. Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
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Ndishimye P, Domokos B, Stillo J, Seghrouchni F, Mrabet O, Homorodean D, Pop CM, Sadak A. A case control study of risk factors associated with pulmonary tuberculosis in romania: experience at a clinical hospital of pneumology. ACTA ACUST UNITED AC 2017; 90:54-59. [PMID: 28246498 PMCID: PMC5305089 DOI: 10.15386/cjmed-652] [Citation(s) in RCA: 7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/24/2016] [Accepted: 04/06/2016] [Indexed: 11/26/2022]
Abstract
Background and aim Tuberculosis (TB) remains a major public health issue in Romania. The aim of the present study was to evaluate the potential demographic, socioeconomic and behavioral risk factors for TB among hospitalized patients in Romania. Methods This is a case-control study conducted between March 1st 2014 and March 30th 2015 at Leon Daniello Clinical Hospital of Pneumology, Cluj Napoca. A total of 150 TB patients defined as “cases” were matched for age, sex and county of residence to 150 controls selected from patients attending the same hospital with respiratory diseases other than TB. Data collection was obtained through patient interviews using a structured questionnaire. Factors potentially associated with TB infection were analyzed using univariate and multivariate logistic regression. Results Factors independently associated with TB were illiteracy (OR=2.42, 95% CI 1.09–5.37), unemployment (OR=2.08, 95% CI 1.23–3.53), low household income (OR=4.12, 95% CI 2.53–6.71), smoking (more than 20 cigarettes per day) (OR=2.12, 95% CI 1.20–3.74), poor knowledge of TB (OR=3.46, 95% CI 1.97–6.07), presence of TB patient in household (OR=4.35, 95% CI 1.42–13.36), prior TB treatment (OR=2.2, 95% CI 1.93–2.5) and diabetes (OR=3.32, 95% CI 1.36–8.08). Conclusion This study provided useful information that might help to develop and adapt effective policies for TB control in Romania.
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Affiliation(s)
- Pacifique Ndishimye
- National Institute of Hygiene, Rabat, Morocco; Faculty of Sciences, Mohammed V University, Rabat, Morocco; Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bianca Domokos
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Leon Daniello Pneumology Hospital, Cluj-Napoca, Romania
| | - Jonathan Stillo
- The City University of New York Graduate Center, New York, USA
| | | | | | - Daniela Homorodean
- Leon Daniello Pneumology Hospital, Cluj-Napoca, Romania; National Tuberculosis Reference Laboratory, Cluj-Napoca, Romania
| | - Carmen Monica Pop
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Leon Daniello Pneumology Hospital, Cluj-Napoca, Romania
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Lessem E, Cox H, Daniels C, Furin J, McKenna L, Mitnick CD, Mosidi T, Reed C, Seaworth B, Stillo J, Tisile P, von Delft D. Access to new medications for the treatment of drug-resistant tuberculosis: Patient, provider and community perspectives. Int J Infect Dis 2015; 32:56-60. [DOI: 10.1016/j.ijid.2014.12.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/03/2014] [Accepted: 12/05/2014] [Indexed: 10/23/2022] Open
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Diel R, Vandeputte J, de Vries G, Stillo J, Wanlin M, Nienhaus A. Costs of tuberculosis disease in the European Union: a systematic analysis and cost calculation. Eur Respir J 2013; 43:554-65. [DOI: 10.1183/09031936.00079413] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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