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Xie YL, Modi N, Handler D, Yu S, Rao P, Kagan L, Petros de Guex K, Reiss R, Siemiątkowska A, Narang A, Narayanan N, Hearn J, Khalil A, Woods P, Young L, Lardizabal A, Subbian S, Peloquin CA, Vinnard C, Thomas TA, Heysell SK. Simplified urine-based method to detect rifampin underexposure in adults with tuberculosis: a prospective diagnostic accuracy study. Antimicrob Agents Chemother 2023; 67:e0093223. [PMID: 37877727 PMCID: PMC10648923 DOI: 10.1128/aac.00932-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 08/28/2023] [Indexed: 10/26/2023] Open
Abstract
Variable pharmacokinetics of rifampin in tuberculosis (TB) treatment can lead to poor outcomes. Urine spectrophotometry is simpler and more accessible than recommended serum-based drug monitoring, but its optimal efficacy in predicting serum rifampin underexposure in adults with TB remains uncertain. Adult TB patients in New Jersey and Virginia receiving rifampin-containing regimens were enrolled. Serum and urine samples were collected over 24 h. Rifampin serum concentrations were measured using validated liquid chromatography-tandem mass spectrometry, and total exposure (area under the concentration-time curve) over 24 h (AUC0-24) was determined through noncompartmental analysis. The Sunahara method was used to extract total rifamycins, and rifampin urine excretion was measured by spectrophotometry. An analysis of 58 eligible participants, including 15 (26%) with type 2 diabetes mellitus, demonstrated that urine spectrophotometry accurately identified subtarget rifampin AUC0-24 at 0-4, 0-8, and 0-24 h. The area under the receiver operator characteristic curve (AUC ROC) values were 0.80 (95% CI 0.67-0.90), 0.84 (95% CI 0.72-0.94), and 0.83 (95% CI 0.72-0.93), respectively. These values were comparable to the AUC ROC of 2 h serum concentrations commonly used for therapeutic monitoring (0.82 [95% CI 0.71-0.92], P = 0.6). Diabetes status did not significantly affect the AUC ROCs for urine in predicting subtarget rifampin serum exposure (P = 0.67-0.92). Spectrophotometric measurement of urine rifampin excretion within the first 4 or 8 h after dosing is a simple and cost-effective test that accurately predicts rifampin underexposure. This test provides critical information for optimizing tuberculosis treatment outcomes by facilitating appropriate dose adjustments.
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Affiliation(s)
- Yingda L. Xie
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Nisha Modi
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Deborah Handler
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Sijia Yu
- Department of Pharmaceutics and Center of Excellence for Pharmaceutical Translational Research and Education, Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey, Piscataway, New Jersey, USA
| | - Prakruti Rao
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
| | - Leonid Kagan
- Department of Pharmaceutics and Center of Excellence for Pharmaceutical Translational Research and Education, Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey, Piscataway, New Jersey, USA
| | - Kristen Petros de Guex
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
| | - Robert Reiss
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Anna Siemiątkowska
- Department of Pharmaceutics and Center of Excellence for Pharmaceutical Translational Research and Education, Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey, Piscataway, New Jersey, USA
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, Poznań, Poland
| | - Anshika Narang
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Navaneeth Narayanan
- Department of Pharmaceutics and Center of Excellence for Pharmaceutical Translational Research and Education, Ernest Mario School of Pharmacy, Rutgers, State University of New Jersey, Piscataway, New Jersey, USA
| | - Jasie Hearn
- Virginia Department of Health, Richmond, USA
| | | | | | - Laura Young
- Virginia Department of Health, Richmond, USA
| | - Alfred Lardizabal
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Selvakumar Subbian
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | | | - Tania A. Thomas
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
| | - Scott K. Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
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Thomas TA, Lukumay S, Yu S, Rao P, Siemiątkowska A, Kagan L, Augustino D, Mejan P, Mosha R, Handler D, Petros de Guex K, Mmbaga B, Pfaeffle H, Reiss R, Peloquin CA, Vinnard C, Mduma E, Xie YL, Heysell SK. Rifampin urinary excretion to predict serum targets in children with tuberculosis: a prospective diagnostic accuracy study. Arch Dis Child 2023; 108:616-621. [PMID: 37171408 PMCID: PMC10766442 DOI: 10.1136/archdischild-2022-325250] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/13/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Pharmacokinetic variability drives tuberculosis (TB) treatment outcomes but measurement of serum drug concentrations for personalised dosing is inaccessible for children in TB-endemic settings. We compared rifampin urine excretion for prediction of a serum target associated with treatment outcome. DESIGN Prospective diagnostic accuracy study. SETTING Inpatient wards and outpatient clinics, northern Tanzania. PATIENTS Children aged 4-17 years were consecutively recruited on initiation of WHO-approved treatment regimens. INTERVENTIONS Samples were collected after directly observed therapy at least 2 weeks after initiation in the intensive phase: serum at pre-dose and 1, 2 and 6 hours post-dose, later analysed by liquid chromatography-tandem mass spectrometry for calculation of rifampin total exposure or area under the concentration time curve (AUC0-24); urine at post-dose intervals of 0-4, 4-8 and 8-24 hours, with rifampin excretion amount measured onsite by spectrophotometry. MAIN OUTCOME MEASURES Receiver operating characteristic (ROC) curve for percentage of rifampin dose excreted in urine measured by spectrophotometry to predict serum rifampin AUC0-24 target of 31.7 mg*hour/L. RESULTS 89 children, 52 (58%) female, with median age of 9.1 years, had both serum and urine collection. Only 59 (66%) reached the serum AUC0-24 target, reflected by a range of urine excretion patterns. Area under the ROC curve for percentage of rifampin dose excreted in urine over 24 hours predicting serum AUC0-24 target was 69.3% (95% CI 56.7% to 81.8%), p=0.007. CONCLUSIONS Urine spectrophotometry correlated with a clinically relevant serum target for rifampin, representing a step toward personalised dosing for children in TB-endemic settings.
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Affiliation(s)
- Tania A Thomas
- Department of Medicine, Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Saning'o Lukumay
- Department of Global Health Research, Haydom Lutheran Hospital, Mbulu, Tanzania, United Republic of
| | - Sijia Yu
- Pharmacy, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Prakruti Rao
- Department of Medicine, Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Anna Siemiątkowska
- Pharmacy, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
- Pharmacy, Poznań University, Poznan, Poland
| | - Leonid Kagan
- Pharmacy, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Domitila Augustino
- Department of Global Health Research, Haydom Lutheran Hospital, Mbulu, Tanzania, United Republic of
| | - Paulo Mejan
- Department of Global Health Research, Haydom Lutheran Hospital, Mbulu, Tanzania, United Republic of
| | - Restituta Mosha
- Department of Global Health Research, Haydom Lutheran Hospital, Mbulu, Tanzania, United Republic of
| | - Deborah Handler
- Department of Medicine, Infectious Diseases, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Kristen Petros de Guex
- Department of Medicine, Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Blandina Mmbaga
- Department of Pediatrics, Kilimanjaro Christian Medical College, Moshi, Tanzania, United Republic of
| | - Herman Pfaeffle
- Department of Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Robert Reiss
- Department of Medicine, Infectious Diseases, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | - Christopher Vinnard
- Department of Medicine, Infectious Diseases, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Estomih Mduma
- Department of Global Health Research, Haydom Lutheran Hospital, Mbulu, Tanzania, United Republic of
| | - Yingda L Xie
- Department of Medicine, Infectious Diseases, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Scott K Heysell
- Department of Medicine, Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
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Ilaiwy G, Lukumay S, Augustino D, Mejan P, Bukhay R, Justine M, Massong C, Rao P, Petros de Guex K, Pfaeffle H, Mduma E, Vinnard C, Xie YL, Heysell SK, Thomas TA. Duration of Symptoms Prior to Pediatric and Adolescent Tuberculosis Diagnosis and Its Impact on Schooling in Tanzania: A Mixed Methods Study. Am J Trop Med Hyg 2023; 108:1235-1239. [PMID: 37094782 PMCID: PMC10540103 DOI: 10.4269/ajtmh.22-0798] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/13/2023] [Indexed: 04/26/2023] Open
Abstract
At least a third of tuberculosis (TB) cases remain undiagnosed, disproportionately so in children and adolescents, which is hampering global elimination goals. Prolonged symptom duration presents a high-risk scenario for childhood TB in endemic areas, but the prolonged period of symptoms and its impact on educational attainment are rarely documented. Using a mixed method approach, we aimed to quantify the duration of respiratory symptoms and describe their impact on education among children from a rural area of Tanzania. We used data from a prospectively enrolled cohort of children and adolescents aged 4-17 years in rural Tanzania at the start of active TB treatment. We report on the cohort's baseline characteristics and explore the correlation between duration of symptoms and other variables. In-depth qualitative interviews were designed on the basis of a grounded theory approach to explore the impact of TB on educational attainment among school-aged children. In this cohort, children and adolescents diagnosed with TB experienced symptoms for a median of 85 days (interquartile range: 30, 231 days) prior to treatment initiation. In addition, 56 participants (65%) had a TB exposure in the household. Of the 16 families with school-aged children who were interviewed, 15 (94%) reported a significant negative impact of TB on the schooling of their children. Children in this cohort experienced a long duration of TB symptoms; the extent of illness impacted absenteeism at school. Screening initiatives for households affected by TB may lead to a shortened duration of symptoms and may minimize the impact on school attendance.
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Affiliation(s)
- Ghassan Ilaiwy
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Saning’o Lukumay
- Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Domitila Augustino
- Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Paulo Mejan
- Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Rehema Bukhay
- Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Museveni Justine
- Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Cornel Massong
- Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Prakruti Rao
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Kristen Petros de Guex
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Herman Pfaeffle
- Department of Internal Medicine, Navy Medicine and Readiness Training Command Portsmouth, Portsmouth, Virginia
| | - Estomih Mduma
- Haydom Global Health Research Center, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Christopher Vinnard
- Division of Infectious Diseases, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Yingda L. Xie
- Division of Infectious Diseases, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Scott K. Heysell
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Tania A. Thomas
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia
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Mpagama SG, Mvungi HC, Mbelele PM, Semvua HH, Liyoyo AA, de Guex KP, Sloan D, Kibiki GS, Boeree M, Phillips PPJ, Heysell SK. Protocol for a feasibility randomized controlled trial to evaluate the efficacy, safety and tolerability of N-acetylcysteine in reducing adverse drug reactions among adults treated for multidrug-resistant tuberculosis in Tanzania. Pilot Feasibility Stud 2023; 9:55. [PMID: 37005695 PMCID: PMC10066962 DOI: 10.1186/s40814-023-01281-7] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/10/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Adverse drug reactions (ADRs) frequently occur in patients using second-line anti-tuberculosis medicine for treatment of multidrug resistant tuberculosis (MDR-TB). ADRs contribute to treatment interruptions which can compromise treatment response and risk acquired drug resistance to critical newer drugs such as bedaquiline, while severe ADRs carry considerable morbidity and mortality. N-acetylcysteine (NAC) has shown promise in reducing ADRs for medications related to TB in case series or randomized controlled trials in other medical conditions, yet evidence is lacking in MDR-TB patients. TB endemic settings have limited capacity to conduct clinical trials. We designed a proof-of-concept clinical trial primarily to explore the preliminary evidence on the protective effect of NAC among people treated for MDR-TB with second-line anti-TB medications. METHODS This is a proof-of-concept randomized open label clinical trial with 3 treatment arms including a control arm, an interventional arm of NAC 900 mg daily, and an interventional arm of NAC 900 mg twice-daily administered during the intensive phase of MDR-TB treatment. Patients initiating MDR-TB treatment will be enrolled at Kibong'oto National Center of Excellence for MDR-TB in the Kilimanjaro region of Tanzania. The minimum anticipated sample size is 66; with 22 participants in each arm. ADR monitoring will be performed at baseline and daily follow-up over 24 weeks including blood and urine specimen collection for hepatic and renal function and electrolyte abnormalities, and electrocardiogram. Sputum will be collected at baseline and monthly thereafter and cultured for mycobacteria as well as assayed for other molecular targets of Mycobacterium tuberculosis. Adverse drug events will be analysed over time using mixed effect models. Mean differences between arms in change of the ADRs from baseline (with 95% confidence intervals) will be derived from the fitted model. DISCUSSION Given that NAC promotes synthesis of glutathione, an intracellular antioxidant that combats the impact of oxidative stress, it may protect against medication induced oxidative damage in organs such as liver, pancreas, kidney, and cells of the immune system. This randomized controlled trial will determine if NAC leads to fewer ADRs, and if this protection is dose dependent. Fewer ADRs among patients treated with MDR-TB may significantly improve treatment outcomes for multidrug regimens that necessitate prolonged treatment durations. Conduct of this trial will set the needed infrastructure for clinical trials. TRIAL REGISTRATION PACTR202007736854169 Registered 03 July 2020.
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Affiliation(s)
- Stellah G Mpagama
- Kibong'oto Infectious Diseases Hospital-Sanya Juu Siha/Kilimanjaro Clinical Research Institute, Mae Street, Lomakaa Road, Siha Kilimanjaro, Tanzania.
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania.
| | - Happiness C Mvungi
- Kibong'oto Infectious Diseases Hospital-Sanya Juu Siha/Kilimanjaro Clinical Research Institute, Mae Street, Lomakaa Road, Siha Kilimanjaro, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Peter M Mbelele
- Kibong'oto Infectious Diseases Hospital-Sanya Juu Siha/Kilimanjaro Clinical Research Institute, Mae Street, Lomakaa Road, Siha Kilimanjaro, Tanzania
- Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - Hadija H Semvua
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Alphonce A Liyoyo
- Kibong'oto Infectious Diseases Hospital-Sanya Juu Siha/Kilimanjaro Clinical Research Institute, Mae Street, Lomakaa Road, Siha Kilimanjaro, Tanzania
| | - Kristen Petros de Guex
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
| | | | | | - Martin Boeree
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Patrick P J Phillips
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, USA
| | - Scott K Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
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de Guex KP, Augustino D, Mejan P, Gadiye R, Massong C, Lukumay S, Msoka P, Sariko M, Kimathi D, Vinnard C, Xie Y, Mmbaga B, Pfaeffle H, Geba M, Heysell SK, Mduma E, Thomas TA. Roadblocks and resilience: A qualitative study of the impact of pediatric tuberculosis on Tanzanian households and solutions from caregivers. Glob Public Health 2023; 18:2196569. [PMID: 37021699 PMCID: PMC10228591 DOI: 10.1080/17441692.2023.2196569] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/24/2023] [Indexed: 04/07/2023]
Abstract
Distinct from quantifying the economic sequelae of tuberculosis (TB) in adults, data are scarce regarding lived experiences of youth and their caregivers seeking and sustaining TB treatment in low income communities. Children ages 4-17 diagnosed with TB and their caregivers were recruited from rural and semi-urban northern Tanzania. Using a grounded theory approach, a qualitative interview guide was developed, informed by exploratory research. Twenty-four interviews were conducted in Kiswahili, audio-recorded and analyzed for emerging and consistent themes. Dominant themes found were socioemotional impacts of TB on households, including adverse effects on work productivity, and facilitators and obstacles to TB care, including general financial hardship and transportation challenges. The median percentage of household monthly income spent to attend a TB clinic visit was 34% (minimum: 1%, maximum: 220%). The most common solutions identified by caregivers to mitigate adverse impacts were transportation assistance and nutrition supplementation. To end TB, healthcare systems must acknowledge the total financial burden shouldered by low wealth families seeking pediatric TB care, provide consultations and medications locally, and increase access to TB-specific communal funds to mitigate burdens such as inadequate nutrition.Trial registration: planned sub-study of the registered prospective study, NCT05283967.Trial registration: ClinicalTrials.gov identifier: NCT05283967.
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Affiliation(s)
- Kristen Petros de Guex
- University of Virginia, Division of Infectious Diseases and International Health, Charlottesville, USA
| | | | - Paulo Mejan
- Haydom Global Health Research Center, Haydom, Tanzania
| | - Rehema Gadiye
- Haydom Global Health Research Center, Haydom, Tanzania
| | | | | | - Perry Msoka
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | | | | | - Yingda Xie
- Rutgers New Jersey Medical School, Division of Infectious Diseases, Newark, USA
| | | | | | - Maria Geba
- University of Virginia, Division of Infectious Diseases and International Health, Charlottesville, USA
| | - Scott K. Heysell
- University of Virginia, Division of Infectious Diseases and International Health, Charlottesville, USA
| | - Estomih Mduma
- Haydom Global Health Research Center, Haydom, Tanzania
| | - Tania A. Thomas
- University of Virginia, Division of Infectious Diseases and International Health, Charlottesville, USA
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Flickinger TE, Sherbuk JE, Petros de Guex K, Añazco Villarreal D, Hilgart M, McManus KA, Ingersoll K, Dillingham R. Adapting an m-Health Intervention for Spanish-Speaking Latinx People Living with HIV in the Nonurban Southern United States. Telemed Rep 2021; 2:46-55. [PMID: 33817694 PMCID: PMC8009288 DOI: 10.1089/tmr.2020.0018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
Background: Latinx people in the United States are disproportionately diagnosed with HIV and are more likely to experience worse HIV-related health outcomes. Although m-health has demonstrated success in improving HIV care, a gap remains in the development of m-health platforms tailored to Latinx populations. Methods: We conducted formative study to guide the adaptation of an evidence-based m-health intervention, PositiveLinks (PL), for Spanish-speaking Latinx people living with HIV (PLWH). Spanish-speaking Latinx PLWH in the nonurban Southern United States completed semistructured interviews and viewed a demo version of the m-health intervention. Qualitative analysis was performed using a grounded theory approach. Emerging themes were identified in four topic areas: (1) prior experiences with technology, (2) desired m-health features, (3) experiences with prototype app, and (4) iteration of prototype. Results: All PLWH who participated (n = 22) were born outside the continental United States. Participants included 10 men, 10 women, and 2 transgender participants. Mean age was 41.1 years (standard deviation 11.6 years). Participants expressed concerns about privacy, a need for reliable information, and interest in practical m-health features such as appointment and medication reminders. After trialing the Spanish-language PL prototype, participants reported that peer support and positive reinforcement were strong motivators to use the app. The ability to individualize the app to meet one's own needs was also considered important. Conclusion: This formative study provides baseline attitudes about m-health among Latinx PLWH as well as desired m-health features. m-Health interventions are acceptable to Spanish-speaking PLWH and involving the target population in a user-centered formative process led to improvements in app accessibility and usability.
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Affiliation(s)
- Tabor E. Flickinger
- University of Virginia Department of Medicine, Division of General Medicine, Geriatrics, and Palliative Care, Charlottesville, Virginia, USA
| | - Jacqueline E. Sherbuk
- University of Virginia Department of Medicine, Division of Infectious Disease and International Health, Charlottesville, Virginia, USA
| | - Kristen Petros de Guex
- University of Virginia Department of Medicine, Division of Infectious Disease and International Health, Charlottesville, Virginia, USA
| | - Diego Añazco Villarreal
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
| | - Michelle Hilgart
- University of Virginia Center for Behavioral Health and Technology, Charlottesville, Virginia, USA
| | - Kathleen A. McManus
- University of Virginia Department of Medicine, Division of Infectious Disease and International Health, Charlottesville, Virginia, USA
| | - Karen Ingersoll
- University of Virginia Department of Psychiatry and Neurobehavioral Sciences, Charlottesville, VA, USA
| | - Rebecca Dillingham
- University of Virginia Department of Medicine, Division of Infectious Disease and International Health, Charlottesville, Virginia, USA
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Mpagama SG, Ezekiel MJ, Mbelele PM, Chongolo AM, Kibiki GS, de Guex KP, Heysell SK. Gridlock from diagnosis to treatment of multidrug resistant tuberculosis (MDR-TB) in Tanzania: patients' perspectives from a focus group discussion. BMC Public Health 2020; 20:1667. [PMID: 33160327 PMCID: PMC7648291 DOI: 10.1186/s12889-020-09774-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Molecular diagnostics have revolutionized the diagnosis of multidrug resistant tuberculosis (MDR-TB). Yet in Tanzania we found delay in diagnosis with more than 70% of MDR-TB patients having a history of several previous treatment courses for TB signaling prior opportunities for diagnosis. We aimed to explore patients' viewpoints and experiences with personal and socio-behavioral obstacles from MDR-TB diagnosis to treatment in an attempt to understand these prior findings. METHODS The study was conducted in December 2016 with MDR-TB patients admitted at Kibong'oto Infectious Diseases Hospital. A qualitative approach deploying focus group discussions (FGDs) was used to gather information. Groups were sex aggregated to allow free interaction and to gauge gender specific issues in the social and behavioral contexts. The FGDs explored pathways and factors in the service delivery that may have contributed in the delay in accessing MDR-TB diagnostics and/or treatment. Collected data were coded, categorized and thematically interpreted. RESULTS Forty MDR-TB patients participated in six FGDs. Challenges and barriers contributing to the delay in accessing MDR-TB diagnosis to treatment were as follows: 1) Participants had a different understanding of MDR-TB that led to seeking services outside the conventional health system; 2) Socio-economic adversity made health-seeking behavior difficult and often unproductive; 3) In the health system, challenges included inadequacy of MDR-TB diagnostic centers, lack of knowledge on behalf of health care providers to consider MDR-TB and order appropriate diagnostics; 4) The specimen referral system for early diagnosis of MDR-TB was inefficient. Non-adherence of TB patients to first-line anti-TB drugs prior to MDR-TB diagnosis, given the multitude of barriers discussed, was coupled with both intentional and unintentional non-adherence of health care providers to international standards of TB care. CONCLUSION Patient-centered strategies bridging communities and the health system are urgently required for optimum MDR-TB control in Tanzania.
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Affiliation(s)
- Stellah G. Mpagama
- Kibong’oto Infectious Diseases Hospital –Sanya Juu Siha/Kilimanjaro Clinical Research Institute Kilimanjaro Tanzania, Mae Street, Lomakaa road, Siha Kilimanjaro, Tanzania
| | - Mangi J. Ezekiel
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Peter M. Mbelele
- Kibong’oto Infectious Diseases Hospital –Sanya Juu Siha/Kilimanjaro Clinical Research Institute Kilimanjaro Tanzania, Mae Street, Lomakaa road, Siha Kilimanjaro, Tanzania
| | - Anna M. Chongolo
- Kibong’oto Infectious Diseases Hospital –Sanya Juu Siha/Kilimanjaro Clinical Research Institute Kilimanjaro Tanzania, Mae Street, Lomakaa road, Siha Kilimanjaro, Tanzania
| | | | - Kristen Petros de Guex
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA USA
| | - Scott K. Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA USA
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8
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Sherbuk JE, Petros de Guex K, Anazco Villarreal D, Knight S, McManus KA, Flickinger T, Dillingham R. Beyond Interpretation: The Unmet Need for Linguistically and Culturally Competent Care for Latinx People Living with HIV in a Southern Region with a Low Density of Spanish Speakers. AIDS Res Hum Retroviruses 2020; 36:933-941. [PMID: 32772713 DOI: 10.1089/aid.2020.0088] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Latinx people living with HIV (PLWH) experience disparities in health outcomes and face unique barriers to care related to language, intersectional stigma, and immigration status. We aimed to explore the lived experience of Spanish-speaking Latinx PLWH in the nonurban South to better understand how to improve care for this minority language population. We conducted semistructured interviews with 22 participants (10 men, 10 women, 2 transgender women) who were recruited from a Ryan White HIV/AIDS program (RWHAP) and a community-based organization. Almost all participants were foreign born. Emerging themes included language barriers, cultural differences, inadequate interpreter services, HIV-related and intersectional stigma, isolation, and relationships as a source of support. These barriers may contribute to disparities in outcomes for Latinx PLWH. New interventions are needed to overcome barriers, foster community, and ensure culturally tailored models of care. Potential clinic-level interventions include the development of specialized training for RWHAP interpreters and inclusion of interpreters in care teams.
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Affiliation(s)
- Jacqueline E. Sherbuk
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Kristen Petros de Guex
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Diego Anazco Villarreal
- Colegio de Ciencias de la Salud, Escuela de Medicina, Universidad San Francisco de Quito, Quito, Ecuador
| | - Sarah Knight
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Kathleen A. McManus
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Tabor Flickinger
- Division of General, Geriatric, Palliative, and Hospital Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
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