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Niwa M, Matos E, Rodriguez C, Wong M, Errea RA, Ramos A, Senador L, Contreras C, Galea JT, Lindeborg A, Benites C, Shin SS, Lecca L, Franke MF. Retention and Viral Suppression Among Adolescents Newly Initiating Antiretroviral Therapy in Adult HIV Care in Lima, Peru: A Retrospective Cohort Study. J Adolesc Health 2024; 74:260-267. [PMID: 37804297 PMCID: PMC10842947 DOI: 10.1016/j.jadohealth.2023.08.041] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 07/11/2023] [Accepted: 08/28/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Published data on outcomes among adolescents newly initiating antiretroviral treatment in the Latin American context are sparse. We estimated the frequency of sustained retention with viral load suppression (i.e., successful transition) and identified predictors of successful transition into adult care among youth (aged 14-21 years) with recently acquired HIV in Lima, Peru. METHODS A retrospective cohort study was conducted among 184 adolescents and young adults who initiated antiretroviral therapy in an adult public sector HIV clinic between June 2014 and June 2019. Sustained retention (no loss-to-follow-up or death) with viral suppression was calculated for the first 12 and 24 months following treatment initiation. We conducted regression analyses to assess factors associated with successful transition to adult HIV care, including gender, age, occupation, nationality, pregnancy, same-sex sexual behavior, presence of treatment supporter, number of living parents, and social risk factors that may adversely influence health (e.g., lack of social support, economic deprivation). RESULTS Patients were predominantly male (n = 167, 90.8%). Median age was 19 years (interquartile range: 18-21). Frequency of sustained retention with viral load suppression was 42.4% (78/184) and 35.3% (30/85) at 12 and 24 months following treatment initiation. In multivariable analyses, working and/or studying was inversely associated with successful transition into adult care at 12 months; number of known living parents (relative risk: 2.20; 95% confidence interval: 1.12, 4.34) and absence of social risk factors (relative risk: 1.68; 95% confidence interval: 0.91, 3.11) were positively associated with successful transition at 24 months. DISCUSSION Sustained retention in HIV care was uncommon. Parental support and interventions targeting social risk factors may contribute to successful transition into adult HIV care in this group.
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Affiliation(s)
- Miyu Niwa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Eduardo Matos
- Infectious Disease Department, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - Carly Rodriguez
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | - Jerome T Galea
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; School of Social Work, University of South Florida, Tampa, Florida; College of Public Health, University of South Florida, Tampa, Florida
| | - Andrew Lindeborg
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Carlos Benites
- Program for the Control and Prevention of HIV, STDs and Hepatitis, Peru Ministry of Health, Lima, Peru
| | - Sonya S Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Leonid Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts; Socios En Salud Sucursal Peru, Lima, Peru
| | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
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Shin SS, Shah A, North-Kabore J, Rowthorn V, Fiori KP, Dudding R, Plum RA, Parke DM, George C, Thomas S, Pinkett R, Porter KMP, Sirois A, Cordeiro V, Ogbolu Y. Global Learning for Health Equity: A Survey of Five Global Learning Sites in the United States. Community Health Equity Res Policy 2023:2752535X231210046. [PMID: 37947506 DOI: 10.1177/2752535x231210046] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Global learning is the practice of adopting and adapting global ideas to local challenges. To advance the field of global learning, we performed a case study of five communities that had implemented global health models to advance health equity in a U.S. setting. Surveys were developed using a Consolidated Framework for Implementation Research (CFIR) framework, and each site completed surveys to characterize their global learning experience with respect to community context, the learning and implementation process, implementation science considerations, and health equity. The immense diversity of sites and their experiences underscored the heterogenous nature of global learning. Nonetheless, all cases highlighted core themes of addressing social determinants of health through strong community engagement. Cross-sector participation and implementation science evaluation were strategies applied by many but not all sites. We advocate for continued global learning that advances health equity and fosters equitable partnerships with mutual benefits to origination and destination sites.
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Affiliation(s)
- Sonya S Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Ami Shah
- Consultant, Global Learning for Health Equity Network, Los Angeles, CA, USA
| | | | - Virginia Rowthorn
- Center for Global Engagement, University of Maryland Baltimore, Baltimore, MD, USA
| | - Kevin P Fiori
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
- Community Health Systems Lab, Albert Einstein College of Medicine, Montefiore Health System, Bronx, NY, USA
| | - Ruth Dudding
- Athens City County Health Department, Athens, OH, USA
| | | | - Dana M Parke
- Population Health Management, Henry Ford Health, Detroit, MI, USA
| | - Carmen George
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Stephen Thomas
- Center for Health Equity, University of Maryland School of Public Health, College Park, MD, USA
| | | | - Keshia M Pollack Porter
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adam Sirois
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | | | - Yolanda Ogbolu
- School of Nursing, University of Maryland Baltimore, Baltimore, MD, USA
- Center for Health Equity and Outcomes Research, University of Maryland Baltimore, Baltimore, MD, USA
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Kahn CB, John B, Shin SS, Whitman R, Yazzie AS, Goldtooth-Halwood R, Hecht K, Hecht C, Vollmer L, Egge M, Nelson N, Bitah K, George C. Teacher and Caregiver Perspectives on Water Is K'é: An Early Child Education Program to Promote Healthy Beverages among Navajo Children. Int J Environ Res Public Health 2023; 20:6696. [PMID: 37681836 PMCID: PMC10487536 DOI: 10.3390/ijerph20176696] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/08/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023]
Abstract
The Water is K'é program was developed to increase water consumption and decrease consumption of sugar-sweetened beverages for young children and caregivers. The pilot program was successfully delivered by three Family and Child Education (FACE) programs on the Navajo Nation using a culturally centered curriculum between 2020 to 2022. The purpose of this research was to understand teacher and caregiver perspectives of program feasibility, acceptability, impact, and other factors influencing beverage behaviors due to the pilot program. Nine caregivers and teachers were interviewed between June 2022 and December 2022, and a study team of four, including three who self-identified as Navajo, analyzed the data using inductive thematic analysis and consensus building to agree on codes. Five themes emerged, including feasibility, acceptability, impact, suggestions for future use of the program, and external factors that influenced water consumption. The analysis showed stakeholders' strong approval for continuing the program based on impact and acceptability, and identified factors that promote the program and barriers that can be addressed to make the program sustainable. Overall, the Water is K'é program and staff overcame many challenges during the COVID-19 pandemic to support healthy behavior change that had a rippled influence among children, caregivers, teachers, and many others.
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Affiliation(s)
- Carmella B. Kahn
- College of Population Health, University of New Mexico, Albuquerque, NM 87131, USA
| | - Brianna John
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Community Outreach and Patient Empowerment Program, Gallup, NM 87301, USA
| | - Sonya S. Shin
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Community Outreach and Patient Empowerment Program, Gallup, NM 87301, USA
| | - Rachel Whitman
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Community Outreach and Patient Empowerment Program, Gallup, NM 87301, USA
| | - Asia Soleil Yazzie
- Community Outreach and Patient Empowerment Program, Gallup, NM 87301, USA
| | | | - Ken Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
| | - Christina Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
| | - Laura Vollmer
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA 94607, USA
- Cooperative Extension, Division of Agriculture and Natural Resources, University of California, Davis, CA 95618, USA
| | | | | | - Kerlissa Bitah
- T’iis Nazbas Community School, Teec Nos Pos, AZ 86514, USA
| | - Carmen George
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Community Outreach and Patient Empowerment Program, Gallup, NM 87301, USA
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Parikh HB, Herman MC, Phillips AR, Shin SS. Accelerated rehabilitation following thumb ulnar collateral ligament repair with suture tape augmentation: A case series of professional basketball players. J Hand Ther 2023; 36:616-621. [PMID: 35945095 DOI: 10.1016/j.jht.2022.07.007] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/02/2022] [Accepted: 07/03/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Case series. INTRODUCTION Rehabilitation protocols following thumb metacarpophalangeal (MCP) ulnar collateral ligament (UCL) repair typically do not allow for return to sport until 12 weeks post-surgery. The potential for accelerated rehabilitation following thumb MCP UCL repair with suture tape augmentation has yet to be explored. PURPOSE OF THE STUDY To describe the accelerated rehabilitation following thumb MCP UCL repair with the suture tape augmentation in professional basketball players. METHODS Three professional basketball players underwent thumb MCP UCL repair with suture tape augmentation. The athletes followed an accelerated rehabilitation program post-surgery that began with range-of-motion exercises at 2-3 days, proximal strengthening at 7-10 days, grip/pinch strengthening at 1-2 weeks, followed by progressive sport specific intervention with a custom orthosis. RESULTS At 5-6 weeks post-surgery, active thumb MCP range of motion returned to 83%-100%, grip strength to 81%-100%, and tripod pinch strength to 73%-78% of the contralateral side. All athletes successfully returned to sport within 5-6 weeks post-surgery. DISCUSSION/CONCLUSION This is the first clinical application of an accelerated rehabilitation protocol in athletes following thumb MCP UCL repair. In this series, professional basketball players were able to return to sport in half the routine recovery time. Further prospective studies re-thinking current rehabilitation protocols are warranted.
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Affiliation(s)
- Harin Bhavin Parikh
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - M C Herman
- Pro Rehab with Mo, Redondo Beach, CA, USA
| | - A R Phillips
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - S S Shin
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Parikh HB, Herman MC, Shin SS. Can we do it faster? accelerated rehabilitation following thumb ulnar collateral ligament repair with suture tape augmentation. J Hand Ther 2021; 36:241-244. [PMID: 34253406 DOI: 10.1016/j.jht.2021.04.016] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/07/2021] [Indexed: 02/03/2023]
Abstract
Ulnar Collateral Ligament (UCL) injuries are the most common thumb metacarpophalangeal joint ligamentinjury. Rehabilitation protocols traditionally permit return to sport at 12 weeks post-surgery. In this article, we propose anacellerated rehabilitation protocol permitting return to sport at 5-6 post-surgery in the recreational athlete.
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Affiliation(s)
- H B Parikh
- Department of Orthopaedics, Cedars-Sinai Medical Center, 444 S San Vicente Blvd Suite 603, Los Angeles, California.
| | - M C Herman
- Pro Rehab with Mo, Redondo Beach, California.
| | - S S Shin
- Department of Orthopaedics, Cedars-Sinai Medical Center, 444 S San Vicente Blvd Suite 603, Los Angeles, California.
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Lee G, Scuffell J, Galea JT, Shin SS, Magill E, Jaramillo E, Sweetland AC. Impact of mental disorders on active TB treatment outcomes: a systematic review and meta-analysis. Int J Tuberc Lung Dis 2020; 24:1279-1284. [PMID: 33317672 PMCID: PMC7740071 DOI: 10.5588/ijtld.20.0458] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND: Comorbid mental disorders in patients with TB may exacerbate TB treatment outcomes. We systematically reviewed current evidence on the association between mental disorders and TB outcomes.METHODS: We searched eight databases for studies published from 1990 to 2018 that compared TB treatment outcomes among patients with and without mental disorders. We excluded studies that did not systematically assess mental disorders and studies limited to substance use. We extracted study and patient characteristics and effect measures and performed a meta-analysis using random-effects models to calculate summary odds ratios (ORs) with 95% confidence intervals (CIs).RESULTS: Of 7687 studies identified, 10 were included in the systematic review and nine in the meta-analysis. Measurement of mental disorders and TB outcomes were heterogeneous across studies. The pooled association between mental disorders and any poor outcome, loss to follow-up, and non-adherence were OR 2.13 (95%CI 0.85-5.37), 1.90 (95%CI 0.33-10.91), and 1.60 (95%CI 0.81-3.02), respectively. High statistical heterogeneity was present.CONCLUSION: Our review suggests that mental disorders in TB patients increase the risk of poor TB outcomes, but pooled estimates were imprecise due to small number of eligible studies. Integration of psychological and TB services might improve TB outcomes and progress towards TB elimination.
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Affiliation(s)
- G Lee
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - J Scuffell
- School of Population Health and Environmental Sciences, King´s College London, London, UK
| | - J T Galea
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, College of Public Health, University of South Florida, Tampa, FL
| | - S S Shin
- Sue & Bill Gross School of Nursing, University of California at Irvine, Irvine, CA
| | - E Magill
- Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
| | - E Jaramillo
- Global Tuberculosis Programme, World Health Organization, Geneva, Switzerland
| | - A C Sweetland
- Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA
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Jones LJ, VanWassenhove-Paetzold J, Thomas K, Bancroft C, Ziatyk EQ, Kim LSH, Shirley A, Warren AC, Hamilton L, George CV, Begay MG, Wilmot T, Tsosie M, Ellis E, Selig SM, Gall G, Shin SS. Impact of a Fruit and Vegetable Prescription Program on Health Outcomes and Behaviors in Young Navajo Children. Curr Dev Nutr 2020; 4:nzaa109. [PMID: 32734135 PMCID: PMC7377262 DOI: 10.1093/cdn/nzaa109] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/04/2020] [Accepted: 06/17/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Rates of childhood obesity are higher in American Indian and Alaska Native populations, and food insecurity plays a major role in diet-related disparities. To address this need, local healthcare providers and a local nonprofit launched the Navajo Fruit and Vegetable Prescription (FVRx) Program in 2015. Children up to 6 y of age and their caregivers are enrolled in the 6-mo program by healthcare providers. Families attend monthly health coaching sessions where they receive vouchers redeemable for fruits, vegetables, and healthy traditional foods at retailers participating in the FVRx program. OBJECTIVES We assessed the impact of a fruit and vegetable prescription program on the health outcomes and behaviors of participating children. METHODS Caregivers completed voluntary surveys to assess food security, fruit and vegetable consumption, hours of sleep, and minutes of physical activity; healthcare providers also measured children's body mass index [BMI (kg/m2)] z score at initiation and completion of the program. We calculated changes in health behaviors, BMI, and food security at the end of the program, compared with baseline values. RESULTS A total of 243 Navajo children enrolled in Navajo FVRx between May 2015 and September 2018. Fruit and vegetable consumption significantly increased from 5.2 to 6.8 servings per day between initiation and program completion (P < 0.001). The proportion of participant households reporting food insecurity significantly decreased from 82% to 65% (P < 0.001). Among children classified as overweight or obese at baseline, 38% achieved a healthy BMI z score at program completion (P < 0.001). Sixty-five percent of children were retained in the program. CONCLUSIONS The Navajo FVRx program improves fruit and vegetable consumption among young children. Children who are obese or overweight may benefit most from the program.
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Affiliation(s)
- Leandra J Jones
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Joan VanWassenhove-Paetzold
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
| | - Kymie Thomas
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Carolyn Bancroft
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - E Quinn Ziatyk
- Chinle Comprehensive Health Care Facility, Chinle, Arizona
| | | | - Ariel Shirley
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Abigail C Warren
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Lindsey Hamilton
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Carmen V George
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mae-Gilene Begay
- Navajo Nation Community Health Representative Outreach Program, Navajo Department of Health, Window Rock, Arizona
| | - Taylor Wilmot
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
| | - Memarie Tsosie
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Emilie Ellis
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
| | - Sara M Selig
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gail Gall
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
| | - Sonya S Shin
- Community Outreach and Patient Empowerment Program, Gallup, New Mexico
- Partners In Health, Boston, Massachusetts
- Northern Navajo Medical Center, Shiprock, New Mexico
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Trevisi L, Orav JE, Atwood S, Brown C, Curley C, King C, Muskett O, Sehn H, Nelson AK, Begay MG, Shin SS. Community Outreach for Navajo People Living with Diabetes: Who Benefits Most? Prev Chronic Dis 2020; 17:E68. [PMID: 32701432 PMCID: PMC7380292 DOI: 10.5888/pcd17.200068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The Community Outreach and Patient Empowerment (COPE) intervention provides integrated outreach through community health representatives (CHRs) to people living with diabetes in Navajo Nation. The aim of this study was to identify groups for whom the intervention had the greatest effect on glycated hemoglobin A1c (HbA1c). METHODS We analyzed de-identified data extracted from routine health records dated from December 1, 2010, through August 31, 2014, to compare net change in HbA1c among COPE patients and non-COPE patients. We used linear mixed models to assess whether the intervention was modified by age, sex, preferred language, having a primary care provider, baseline HbA1c, or having a mental health condition. RESULTS Age, having a primary care provider, and baseline HbA1c significantly modified HbA1c levels. Among patients aged 64 or younger, COPE participation was associated with a net decrease in HbA1c of 0.77%; among patients aged 65 or older, the net decrease was 0.49% (P = .03). COPE participation was associated with a steeper decrease in HbA1c among patients without a primary care physician (net decrease, 0.99%) than among patients with a primary care provider (net decrease, 0.57%) (P = .03). COPE patients with a baseline HbA1c >9% had a net decrease of 0.70%, while those with a baseline HbA1c ≤9% had a net decrease of 0.34% (P = .01). We found no significant differences based on sex, preferred language, or having a mental health condition. CONCLUSION Findings suggest that the COPE intervention was robust and equitable, benefiting all groups living with diabetes in Navajo Nation, but conferring the greatest benefit on the most vulnerable.
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Affiliation(s)
- Letizia Trevisi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - John E Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christian Brown
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Cameron Curley
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Caroline King
- School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Olivia Muskett
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hannah Sehn
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.,Partners in Health, Boston, Massachusetts
| | | | - Mae-Gilene Begay
- Navajo Nation Department of Health, Navajo Department of Health, Window Rock, Navajo Nation
| | - Sonya S Shin
- Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.
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Sweetland AC, Galea J, Shin SS, Driver C, Dlodlo RA, Karpati A, Wainberg ML. Integrating tuberculosis and mental health services: global receptivity of national tuberculosis program directors. Int J Tuberc Lung Dis 2020; 23:600-605. [PMID: 31097069 DOI: 10.5588/ijtld.18.0530] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
<sec id="st1"> <title>SETTING</title> A global survey of National Tuberculosis Program (NTP) directors. </sec> <sec id="st2"> <title>OBJECTIVES</title> To assess the perceived mental health needs of persons with tuberculosis (TB), current practices, and receptivity to integrating evidence-based mental and substance use treatment into national TB guidelines. </sec> <sec id="st3"> <title>DESIGN</title> Semi-structured survey of NTP directors from 26 countries of all income levels using a standardized questionnaire. </sec> <sec id="st4"> <title>RESULTS</title> Of the 26 countries, 21 were classified as high incidence and/or burden countries for TB, TB and human immunodeficiency virus coinfection, and/or drug-resistant TB. Two NTPs included routine screening for any mental disorder, four assessed alcohol or drug use, and five had standard protocols for the co-management of disorders. If effective and low-cost integrated care models were available, 17 NTP directors felt that it was highly likely, and five somewhat likely, that their NTPs would integrate mental health treatment into national TB guidelines and services. The main perceived barriers to service integration were limited capacity, not recognizing mental health as a problem, insufficient resources, and TB-related social stigma. </sec> <sec id="st5"> <title>CONCLUSIONS</title> NTPs currently do not address mental disorders as part of routine practice. Nevertheless, receptivity is high, which creates a ripe opportunity to integrate the management of TB and mental disorders into the policies and guidelines of NTPs worldwide. </sec>.
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Affiliation(s)
- A C Sweetland
- Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York
| | - J Galea
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida
| | - S S Shin
- Sue & Bill Gross School of Nursing, University of California at Irvine, Irvine, California
| | - C Driver
- Vital Strategies, New York, New York, USA
| | - R A Dlodlo
- International Union Against Tuberculosis and Lung Disease, Bulawayo, Zimbabwe
| | - A Karpati
- Vital Strategies, New York, New York, USA
| | - M L Wainberg
- Department of Psychiatry, Columbia Vagelos College of Physicians and Surgeons, New York State Psychiatric Institute, New York, New York
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MacKenzie OW, George CV, Pérez-Escamilla R, Lasky-Fink J, Piltch EM, Sandman SM, Clark C, Avalos QJ, Carroll DS, Wilmot TM, Shin SS. Healthy Stores Initiative Associated with Produce Purchasing on Navajo Nation. Curr Dev Nutr 2019; 3:nzz125. [PMID: 32154495 PMCID: PMC7053571 DOI: 10.1093/cdn/nzz125] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 06/28/2019] [Revised: 10/08/2019] [Accepted: 11/04/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND American Indians and Alaska Natives experience diet-related health disparities compared with non-Hispanic whites. Navajo Nation's colonial history and remote setting present unique challenges for healthy food access. OBJECTIVE This study aims to understand the impact of the Healthy Navajo Stores Initiative (HNSI) on fruit and vegetable purchasing on Navajo Nation. METHODS We conducted a cross-sectional survey of 692 customers shopping at 28 convenience stores, trading posts, and grocery stores on Navajo Nation. Individual- and household-level sociodemographic data and food purchasing behaviors were collected. Descriptive and bivariate analyses for customers' individual- and household-level characteristics were conducted using chi-squared tests. The impact of individual-, household-, and store-level factors on fruit and vegetable purchasing was assessed using multiple logistic regression modeling. RESULTS Store participation in the HNSI was significantly associated with customers' purchase of produce. Customers experienced 150% higher odds of purchasing produce if they shopped in participating stores, compared with nonparticipating stores (P < 0.001). Store type was strongly associated with customers' purchase of fruits or vegetables. Customers shopping at a grocery store had 520% higher odds of purchasing produce than did customers shopping at convenience stores (P < 0.001). Customers shopping at trading posts had 120% higher odds of purchasing fruits or vegetables than did customers shopping at convenience stores (P = 0.001). CONCLUSIONS Our findings reveal increased produce purchasing at stores participating in the HNSI. Customers were significantly more likely to purchase fruits or vegetables in stores enrolled in a healthy store intervention than in nonenrolled stores, after controlling for quantity of produce stocked and store type. Customers shopping in grocery stores and trading posts were significantly more likely to purchase produce than customers shopping in convenience stores. These findings have implications for food access in rural tribal communities.
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Affiliation(s)
- Onagh W MacKenzie
- Community Outreach and Patient Empowerment Program, Gallup, NM, USA
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Carmen V George
- Community Outreach and Patient Empowerment Program, Gallup, NM, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Emily M Piltch
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Sharon M Sandman
- Community Outreach and Patient Empowerment Program, Gallup, NM, USA
| | - Clarina Clark
- Community Outreach and Patient Empowerment Program, Gallup, NM, USA
| | - Que'sha J Avalos
- Community Outreach and Patient Empowerment Program, Gallup, NM, USA
| | - Danya S Carroll
- Community Outreach and Patient Empowerment Program, Gallup, NM, USA
| | - Taylor M Wilmot
- Community Outreach and Patient Empowerment Program, Gallup, NM, USA
| | - Sonya S Shin
- Community Outreach and Patient Empowerment Program, Gallup, NM, USA
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
- Partners in Health, Boston, MA, USA
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11
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Trevisi L, Orav JE, Atwood S, Brown C, Curley C, King C, Muskett O, Sehn H, Nelson KA, Begay MG, Shin SS. Integrating community health representatives with health care systems: clinical outcomes among individuals with diabetes in Navajo Nation. Int J Equity Health 2019; 18:183. [PMID: 31771603 PMCID: PMC6880375 DOI: 10.1186/s12939-019-1097-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/18/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We studied the impact of Community Outreach and Patient Empowerment (COPE) intervention to support Community Health Representatives (CHR) on the clinical outcomes of patients living with diabetes in the Navajo Nation extending into the States of Arizona, Utah, and New Mexico. The COPE intervention integrated CHRs into healthcare teams by providing a structured approach to referrals and home visits. METHODS We abstracted routine clinical data from the Indian Health Service's information system on individuals with diabetes mellitus seen at participating clinical sites from 2010 to 2014. We matched 173 COPE participants to 2880 patients with similar demographic and clinical characteristics who had not participated in COPE. We compared the changes in clinical outcomes between the two groups using linear mixed models. RESULTS Over the four years of the study, COPE patients had greater improvements in glycosylated hemoglobin (- 0.56%) than non-COPE participants (+ 0.07%) for a difference in differences of 0.63% (95% confidence interval (CI): 0.50, 0.76). Low-density lipoprotein fell more steeply in the COPE group (- 10.58 mg/dl) compared to the non-COPE group (- 3.18 mg/dl) for a difference in differences of 7.40 mg/dl (95%CI: 2.00, 12.80). Systolic blood pressure increased slightly more among COPE (2.06 mmHg) than non-COPE patients (0.61 mmHg). We noted no significant change for body mass index in either group. CONCLUSION Structured outreach by Community Health Representatives as part of an integrated care team was associated with improved glycemic and lipid levels in the target Navajo population. TRIAL REGISTRATION Trial registration: NCT03326206. Registered 31 October 2017 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT03326206.
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Affiliation(s)
- Letizia Trevisi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - John E Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Christian Brown
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Cameron Curley
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Caroline King
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Olivia Muskett
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Katrina A Nelson
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Sonya S Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
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12
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Shin SS, Modongo C, Zetola NM, Wang Q, Phologolo T, Kestler M, Ho-Foster A. High rates of exposure to tuberculosis patients among HIV-infected health care workers in Botswana. Int J Tuberc Lung Dis 2019; 22:366-370. [PMID: 29562982 DOI: 10.5588/ijtld.17.0376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
OBJECTIVE To compare daily exposure to tuberculosis (TB) patients between HIV-infected and non-HIV-infected health care workers (HCWs), and examine the uptake of antiretroviral therapy (ART) and isoniazid preventive therapy (IPT) among HIV-infected HCWs in Botswana. DESIGN We conducted a cross-sectional study among HCWs in 30 hospitals and clinics. We determined self-reported exposure frequency to TB patients and HIV status through in-person interviews. HCWs with unknown or negative HIV status were offered rapid HIV testing. Multivariable Poisson regression modeling with robust variance was used to estimate the association between HIV status and daily exposure to TB patients. RESULTS Of 1877 participants enrolled, 1388 (73.9%) with complete data were included in this study. Among 277 (20.0%) HIV-infected participants, 14.3% were newly diagnosed, 57.8% were on ART, and 34.3% reported previously receiving IPT. Daily exposure to TB patients was reported by respectively 48.4% and 52.9% of HIV-infected and non-infected participants. After adjusting for sex, age, occupation, and department, the rates of daily TB exposure remained similar between HIV-infected and non-HIV-infected participants (prevalence ratio 0.96, 95%CI 0.85-1.08). CONCLUSIONS We found similar rates of exposure to TB patients between HIV-infected and non-HIV-infected HCWs. Improved efforts are needed to reduce nosocomial exposure to TB among HIV-infected HCWs.
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Affiliation(s)
- S S Shin
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| | - C Modongo
- Botswana-UPenn Partnership, Gaborone, Botswana, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - N M Zetola
- Botswana-UPenn Partnership, Gaborone, Botswana, Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Q Wang
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| | - T Phologolo
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - M Kestler
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Ho-Foster
- Botswana-UPenn Partnership, Gaborone, Botswana, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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13
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Shin SS, Chang AH, Ghosh JKC, Dubé MP, Bolan R, Yang OO, Kerndt PR. Isoniazid therapy for Mycobacterium tuberculosis infection in HIV clinics, Los Angeles, California. Int J Tuberc Lung Dis 2018; 20:961-6. [PMID: 27287651 DOI: 10.5588/ijtld.15.0988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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 Publicly funded human immunodeficiency virus (HIV) clinics in Los Angeles County, California, USA. BACKGROUND HIV-infected persons are a high priority group for targeted testing and treatment for Mycobacterium tuberculosis infection in the United States. OBJECTIVE To describe rates of isoniazid (INH) initiation and completion among HIV-1 and M. tuberculosis co-infected persons in Los Angeles County. DESIGN We conducted a cross-sectional study using routinely collected surveillance data from publicly funded HIV clinics. We examined differences in INH treatment initiation and completion between four clinic categories: the three largest clinics (Clinics A, B, and C) and 'Other' clinics (pooled data for the remaining 10 clinics). RESULTS During 2010-2013, 802 (5.3%) of 15 029 HIV-1-infected persons tested positive for M. tuberculosis infection. INH was initiated in 581 (72.4%) persons, of whom 457 (78.7%) completed treatment. We found significant differences between clinics in terms of treatment initiation (range 59.1-93.4%) and completion (range 58.8-82.3%). Overall, 57% (457/802) of HIV and M. tuberculosis co-infected persons completed the recommended treatment (range across clinics 34.8-76.3%). CONCLUSION We identified significant gaps in the treatment for M. tuberculosis infection among HIV-infected persons in Los Angeles County. Interventions are needed to improve initiation and completion of treatment for M. tuberculosis infection in this population.
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Affiliation(s)
- S S Shin
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA; Tuberculosis Control Program, Los Angeles County Department of Public Health, Los Angeles, USA
| | - A H Chang
- Tuberculosis Control Program, Los Angeles County Department of Public Health, Los Angeles, USA; Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, USA
| | - J K C Ghosh
- Tuberculosis Control Program, Los Angeles County Department of Public Health, Los Angeles, USA
| | - M P Dubé
- Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - R Bolan
- Los Angeles LGBT Center, Los Angeles, USA
| | - O O Yang
- David Geffen School of Medicine, University of California, Los Angeles, AIDS Healthcare Foundation, Los Angeles, California, USA
| | - P R Kerndt
- Tuberculosis Control Program, Los Angeles County Department of Public Health, Los Angeles, USA
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14
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Nelson AK, Miller AC, Munoz M, Rumaldo N, Kammerer B, Vibbert M, Lundy S, Soplapuco G, Lecca L, Condeso A, Valdivia Y, Atwood SA, Shin SS. CASITA: a controlled pilot study of community-based family coaching to stimulate early child development in Lima, Peru. BMJ Paediatr Open 2018; 2:e000268. [PMID: 29862331 PMCID: PMC5976100 DOI: 10.1136/bmjpo-2018-000268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine whether the 3-month, community-based early stimulation coaching and social support intervention 'CASITA', delivered by community health workers, could improve early child development and caregiver-child interaction in a resource-limited district in Lima, Peru. DESIGN A controlled two-arm proof-of-concept study. SETTING Six neighbourhood health posts in Carabayllo, a mixed rural/urban district in Lima. Sessions were held in homes and community centres. PARTICIPANTS Children aged 6-24 months who screened positive for risk of neurodevelopmental delay (using validated developmental delay tool) and poverty (using progress out of poverty tool) were enrolled with their caregivers. Dyads with children born >21 days early were excluded. INTERVENTION 12-week parenting/support intervention plus nutritional support (n=41) or nutrition alone (n=19). OUTCOME MEASURES Development and home environment differences and mean changes from baseline to 3 months postintervention were evaluated using age-adjusted z-scores on the Extended Ages and Stages Questionnaire (EASQ) and the Home Observation Measurement of the Environment (HOME) scores, respectively. RESULTS Development in CASITA improved significantly in all EASQ domains, whereas the control group's z-scores did not improve significantly in any domain. The mean adjusted difference (MAD) in change in EASQ age-adjusted z-scores between the two study arms was 1.39 (95% CI 0.55 to 2.22); Cohen's d effect size of 0.87 (95% CI 0.23 to 1.50). Likewise, intervention significantly improved global HOME scores versus control group (MAD change of 6.33 (95% CI 2.12 to 10.55); Cohen's d of 0.85 (95% CI 0.28 to 1.41)). CONCLUSIONS An evidence-based early intervention delivered weekly during 3 months by a community health worker significantly improved children's communication, motor and personal/social development in this proof-of-concept study.
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Affiliation(s)
| | - Ann C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Betsy Kammerer
- Department of Psychiatry, Children's Hospital Boston, Boston, Massachusetts, USA
| | - Martha Vibbert
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.,SPARK Center, Boston Medical Center, Boston, Massachusetts, USA
| | - Shannon Lundy
- Division of Developmental Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.,UCSF Benioff Children's Hospital, San Francisco, California, USA
| | | | - Leonid Lecca
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Socios En Salud Sucursal, Lima, Peru
| | | | | | - Sidney A Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sonya S Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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15
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Edea Z, Hong JK, Jung JH, Kim DW, Kim YM, Kim ES, Shin SS, Jung YC, Kim KS. Detecting selection signatures between Duroc and Duroc synthetic pig populations using high-density SNP chip. Anim Genet 2017; 48:473-477. [PMID: 28508507 DOI: 10.1111/age.12559] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2017] [Indexed: 01/02/2023]
Abstract
The development of high throughput genotyping techniques has facilitated the identification of selection signatures of pigs. The detection of genomic selection signals in a population subjected to differential selection pressures may provide insights into the genes associated with economically and biologically important traits. To identify genomic regions under selection, we genotyped 488 Duroc (D) pigs and 155 D × Korean native pigs (DKNPs) using the Porcine SNP70K BeadChip. By applying the FST and extended haplotype homozygosity (EHH-Rsb) methods, we detected genes under directional selection associated with growth/stature (DOCK7, PLCB4, HS2ST1, FBP2 and TG), carcass and meat quality (TG, COL14A1, FBXO5, NR3C1, SNX7, ARHGAP26 and DPYD), number of teats (LOC100153159 and LRRC1), pigmentation (MME) and ear morphology (SOX5), which are all mostly near or at fixation. These results could be a basis for investigating the underlying mutations associated with observed phenotypic variation. Validation using genome-wide association analysis would also facilitate the inclusion of some of these markers in genetic evaluation programs.
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Affiliation(s)
- Z Edea
- Department of Animal Science, Chungbuk National University, 28644, Cheongju, Korea
| | - J-K Hong
- Swine Science Division, National Institute of Animal Science, Rural Development Administration, Chunan, 31000, Korea
| | - J-H Jung
- Department of Animal Biotechnology, Chonbuk National University, Jeonju, 54896, Korea
| | - D-W Kim
- Swine Science Division, National Institute of Animal Science, Rural Development Administration, Chunan, 31000, Korea
| | - Y-M Kim
- Swine Science Division, National Institute of Animal Science, Rural Development Administration, Chunan, 31000, Korea
| | - E-S Kim
- Recombinetics, St. Paul MN, 55104, MN, USA
| | - S S Shin
- Department of Animal Science, Chungbuk National University, 28644, Cheongju, Korea
| | - Y C Jung
- Jung Pig and Customer Institute, Young-In, 16950, Korea
| | - K-S Kim
- Department of Animal Science, Chungbuk National University, 28644, Cheongju, Korea
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16
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Mitnick CD, White RA, Lu C, Rodriguez CA, Bayona J, Becerra MC, Burgos M, Centis R, Cohen T, Cox H, D'Ambrosio L, Danilovitz M, Falzon D, Gelmanova IY, Gler MT, Grinsdale JA, Holtz TH, Keshavjee S, Leimane V, Menzies D, Migliori GB, Milstein MB, Mishustin SP, Pagano M, Quelapio MI, Shean K, Shin SS, Tolman AW, van der Walt ML, Van Deun A, Viiklepp P. Multidrug-resistant tuberculosis treatment failure detection depends on monitoring interval and microbiological method. Eur Respir J 2016; 48:1160-1170. [PMID: 27587552 PMCID: PMC5045442 DOI: 10.1183/13993003.00462-2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/03/2016] [Indexed: 11/12/2022]
Abstract
Debate persists about monitoring method (culture or smear) and interval (monthly or less frequently) during treatment for multidrug-resistant tuberculosis (MDR-TB). We analysed existing data and estimated the effect of monitoring strategies on timing of failure detection. We identified studies reporting microbiological response to MDR-TB treatment and solicited individual patient data from authors. Frailty survival models were used to estimate pooled relative risk of failure detection in the last 12 months of treatment; hazard of failure using monthly culture was the reference. Data were obtained for 5410 patients across 12 observational studies. During the last 12 months of treatment, failure detection occurred in a median of 3 months by monthly culture; failure detection was delayed by 2, 7, and 9 months relying on bimonthly culture, monthly smear and bimonthly smear, respectively. Risk (95% CI) of failure detection delay resulting from monthly smear relative to culture is 0.38 (0.34–0.42) for all patients and 0.33 (0.25–0.42) for HIV-co-infected patients. Failure detection is delayed by reducing the sensitivity and frequency of the monitoring method. Monthly monitoring of sputum cultures from patients receiving MDR-TB treatment is recommended. Expanded laboratory capacity is needed for high-quality culture, and for smear microscopy and rapid molecular tests. Monthly culture monitoring is crucial to earlier detection of treatment failure in MDR-TB patientshttp://ow.ly/w2MI301mK8M
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Affiliation(s)
- Carole D Mitnick
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA
| | - Richard A White
- Dept of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Oslo, Norway Dept of Health Statistics, Norwegian Institute of Public Health, Oslo, Norway
| | - Chunling Lu
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
| | - Carly A Rodriguez
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Mercedes C Becerra
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
| | - Marcos Burgos
- Dept of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Rosella Centis
- WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy
| | - Theodore Cohen
- Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
| | - Helen Cox
- Médecins Sans Frontières, Cape Town, South Africa
| | - Lia D'Ambrosio
- WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy Public Health Consulting Group, Lugano, Switzerland
| | | | - Dennis Falzon
- Global TB Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Jennifer A Grinsdale
- Tuberculosis Control, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Timothy H Holtz
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Salmaan Keshavjee
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
| | - Vaira Leimane
- State Agency for Tuberculosis and Lung Diseases (TPSVA), Riga, Latvia
| | - Dick Menzies
- Montreal Chest Institute, McGill University, Montreal, QC, Canada
| | - Giovanni Battista Migliori
- WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri, Care and Research Institute, Tradate, Italy
| | - Meredith B Milstein
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | | | - Marcello Pagano
- Dept of Biostatistics, Harvard School of Public Health, Boston, MA, USA
| | - Maria I Quelapio
- Tropical Disease Foundation, Philippine Institute of Tuberculosis, Makati City, Philippines
| | - Karen Shean
- Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, Dept of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sonya S Shin
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners in Health, Boston, MA, USA Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA Socios en Salud Sucursal, Lima, Peru
| | - Arielle W Tolman
- Dept of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Martha L van der Walt
- South African Medical Research Council, Tuberculosis Research Platform, Pretoria, South Africa
| | | | - Piret Viiklepp
- National Institute for Heath Development, Tallinn, Estonia
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17
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Ahmad Khan F, Gelmanova IY, Franke MF, Atwood S, Zemlyanaya NA, Unakova IA, Andreev YG, Berezina VI, Pavlova VE, Shin SS, Yedilbayev AB, Becerra MC, Keshavjee S. Aggressive Regimens Reduce Risk of Recurrence After Successful Treatment of MDR-TB. Clin Infect Dis 2016; 63:214-20. [PMID: 27161772 DOI: 10.1093/cid/ciw276] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 10/22/2015] [Accepted: 04/23/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We sought to determine whether treatment with a "long aggressive regimen" was associated with lower rates of relapse among patients successfully treated for pulmonary multidrug-resistant tuberculosis (MDR-TB) in Tomsk, Russia. METHODS We conducted a retrospective cohort study of adult patients that initiated MDR-TB treatment with individualized regimens between September 2000 and November 2004, and were successfully treated. Patients were classified as having received "aggressive regimens" if their intensive phase consisted of at least 5 likely effective drugs (including a second-line injectable and a fluoroquinolone) used for at least 6 months post culture conversion, and their continuation phase included at least 4 likely effective drugs. Patients that were treated with aggressive regimens for a minimum duration of 18 months post culture conversion were classified as having received "long aggressive regimens." We used recurrence as a proxy for relapse because genotyping was not performed. After treatment, patients were classified as having disease recurrence if cultures grew MDR-TB or they re-initiated MDR-TB therapy. Data were analyzed using Cox proportional hazard regression. RESULTS Of 408 successfully treated patients, 399 (97.5%) with at least 1 follow-up visit were included. Median duration of follow-up was 42.4 months (interquartile range: 20.5-59.5), and there were 27 recurrence episodes. In a multivariable complete case analysis (n = 371 [92.9%]) adjusting for potential confounders, long aggressive regimens were associated with a lower rate of recurrence (adjusted hazard ratio: 0.22, 95% confidence interval, .05-.92). CONCLUSIONS Long aggressive regimens for MDR-TB treatment are associated with lower risk of disease recurrence.
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Affiliation(s)
- Faiz Ahmad Khan
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts Respiratory Epidemiology and Clinical Research Unit & McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| | | | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nataliya A Zemlyanaya
- Partners In Health Russia, Moscow, Russian Federation Siberian State Medical University
| | | | | | | | | | - Sonya S Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts Partners In Health, Boston, Massachusetts
| | | | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts Partners In Health, Boston, Massachusetts
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts Partners In Health, Boston, Massachusetts
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18
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Miller AC, Nelson AK, Livchits V, Greenfield SF, Yanova G, Yanov S, Connery HS, Atwood S, Lastimoso CS, Shin SS. Understanding HIV Risk Behavior among Tuberculosis Patients with Alcohol Use Disorders in Tomsk, Russian Federation. PLoS One 2016; 11:e0148910. [PMID: 26871943 PMCID: PMC4752500 DOI: 10.1371/journal.pone.0148910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 09/28/2015] [Accepted: 01/23/2016] [Indexed: 11/22/2022] Open
Abstract
Russian Federation’s (RF) HIV epidemic is the fastest growing of any country. This study explores factors associated with high HIV risk behavior in tuberculosis (TB) patients with alcohol use disorders in Tomsk, RF. This analysis was nested within the Integrated Management of Physician-delivered Alcohol Care for TB Patients (IMPACT, trial number NCT00675961) randomized controlled study of integrating alcohol treatment into TB treatment in Tomsk. Demographics, HIV risk behavior (defined as participant report of high-risk intravenous drug use and/or multiple sexual partners with inconsistent condom use in the last six months), clinical data, alcohol use, depression and psychosocial factors were collected from 196 participants (161 male and 35 female) at baseline. Forty-six participants (23.5%) endorsed HIV risk behavior at baseline. Incarceration history(Odds Ratio (OR)3.93, 95% confidence interval (CI) 1.95, 7.95), age under 41 (OR:2.97, CI:1.46, 6.04), drug addiction(OR: 3.60 CI:1.10, 11.77), history of a sexually transmitted disease(STD)(OR 2.00 CI:1.02, 3.90), low social capital (OR:2.81 CI:0.99, 8.03) and heavier alcohol use (OR:2.56 CI: 1.02, 6.46) were significantly more likely to be associated with HIV risk behavior at baseline. In adjusted analysis, age under 41(OR: 4.93, CI: 2.10, 11.58), incarceration history(OR: 3.56 CI:1.55, 8.17) and STD history (OR: 3.48, CI: 1.5, 8.10) continued to be significantly associated with HIV risk behavior. Understanding HIV transmission dynamics in Russia remains an urgent priority to inform strategies to address the epidemic. Larger studies addressing sex differences in risks and barriers to protective behavior are needed.
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Affiliation(s)
- Ann C. Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- * E-mail:
| | - A. Katrina Nelson
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Viktoria Livchits
- Partners In Health Representative Office in Russian Federation, Moscow, Russia
| | - Shelly F. Greenfield
- Alcohol and Drug Abuse Treatment Program, McLean Hospital, Belmont, MA United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Division of Women's Mental Health, McLean Hospital, Belmont, MA, United States of America
| | - Galina Yanova
- Tomsk Oblast Tuberculosis Hospital, Tomsk, Russian Federation
| | - Sergei Yanov
- Tomsk Oblast Tuberculosis Hospital, Tomsk, Russian Federation
| | - Hilary S. Connery
- Alcohol and Drug Abuse Treatment Program, McLean Hospital, Belmont, MA United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Charmaine S. Lastimoso
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Sonya S. Shin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, United States of America
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Velásquez GE, Cegielski JP, Murray MB, Yagui MJA, Asencios LL, Bayona JN, Bonilla CA, Jave HO, Yale G, Suárez CZ, Sanchez E, Rojas C, Atwood SS, Contreras CC, Santa Cruz J, Shin SS. Impact of HIV on mortality among patients treated for tuberculosis in Lima, Peru: a prospective cohort study. BMC Infect Dis 2016; 16:45. [PMID: 26831140 PMCID: PMC4736097 DOI: 10.1186/s12879-016-1375-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 01/22/2016] [Indexed: 11/17/2022] Open
Abstract
Background Human immunodeficiency virus (HIV)-associated tuberculosis deaths have decreased worldwide over the past decade. We sought to evaluate the effect of HIV status on tuberculosis mortality among patients undergoing treatment for tuberculosis in Lima, Peru, a low HIV prevalence setting. Methods We conducted a prospective cohort study of patients treated for tuberculosis between 2005 and 2008 in two adjacent health regions in Lima, Peru (Lima Ciudad and Lima Este). We constructed a multivariate Cox proportional hazards model to evaluate the effect of HIV status on mortality during tuberculosis treatment. Results Of 1701 participants treated for tuberculosis, 136 (8.0 %) died during tuberculosis treatment. HIV-positive patients constituted 11.0 % of the cohort and contributed to 34.6 % of all deaths. HIV-positive patients were significantly more likely to die (25.1 vs. 5.9 %, P < 0.001) and less likely to be cured (28.3 vs. 39.4 %, P = 0.003). On multivariate analysis, positive HIV status (hazard ratio [HR] = 6.06; 95 % confidence interval [CI], 3.96–9.27), unemployment (HR = 2.24; 95 % CI, 1.55–3.25), and sputum acid-fast bacilli smear positivity (HR = 1.91; 95 % CI, 1.10–3.31) were significantly associated with a higher hazard of death. Conclusions We demonstrate that positive HIV status was a strong predictor of mortality among patients treated for tuberculosis in the early years after Peru started providing free antiretroviral therapy. As HIV diagnosis and antiretroviral therapy provision are more widely implemented for tuberculosis patients in Peru, future operational research should document the changing profile of HIV-associated tuberculosis mortality.
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Affiliation(s)
- Gustavo E Velásquez
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA. .,Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - J Peter Cegielski
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Megan B Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
| | - Martin J A Yagui
- Oficina General de Investigación y Transferencia Tecnológica, Instituto Nacional de Salud, Lima, Perú. .,Departamento Académico de Medicina Preventiva y Salud Pública, Universidad Nacional Mayor de San Marcos, Lima, Perú.
| | - Luis L Asencios
- Laboratorio Nacional de Referencia de Micobacterias, Instituto Nacional de Salud, Lima, Perú.
| | - Jaime N Bayona
- Health, Nutrition and Population, The World Bank Group, Washington DC, USA.
| | - César A Bonilla
- Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis, Ministerio de Salud del Perú, Lima, Perú.
| | - Hector O Jave
- Estrategia Sanitaria Nacional de Prevención y Control de la Tuberculosis, Ministerio de Salud del Perú, Lima, Perú.
| | - Gloria Yale
- Dirección de Salud V Lima Ciudad, Programa de Control de Tuberculosis, Lima, Perú.
| | - Carmen Z Suárez
- Dirección de Salud IV Lima Este, Programa de Control de Tuberculosis, Lima, Perú.
| | - Eduardo Sanchez
- Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Hipólito Unanue, Lima, Perú.
| | - Christian Rojas
- Servicio de Neumología, Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo", Lima, Perú.
| | - Sidney S Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
| | | | | | - Sonya S Shin
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA. .,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA. .,Partners In Health / Socios En Salud, Lima, Perú.
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Fox GJ, Mitnick CD, Benedetti A, Chan ED, Becerra M, Chiang CY, Keshavjee S, Koh WJ, Shiraishi Y, Viiklepp P, Yim JJ, Pasvol G, Robert J, Shim TS, Shin SS, Menzies D. Surgery as an Adjunctive Treatment for Multidrug-Resistant Tuberculosis: An Individual Patient Data Metaanalysis. Clin Infect Dis 2016; 62:887-895. [DOI: 10.1093/cid/ciw002] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 12/22/2015] [Indexed: 11/14/2022] Open
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Franke MF, Nelson AK, Muñoz M, Cruz JS, Atwood S, Lecca L, Shin SS. Validation of 2 Spanish-Language Scales to Assess HIV-Related Stigma in Communities. J Int Assoc Provid AIDS Care 2014; 14:527-35. [PMID: 25294853 DOI: 10.1177/2325957414547738] [Citation(s) in RCA: 3] [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] [Indexed: 11/15/2022] Open
Abstract
We report the psychometric properties of 2 Spanish-language scales designed to measure (1) opinions about HIV in the community and particularly among health care workers and (2) observed acts of stigma toward people living with HIV/AIDS (PLWHA) by health care workers. The Opinions about HIV Scale included 3 components (policy, avoidance, and empathy) and 9 items, while an adapted version of the HIV/AIDS Stigma Instrument-Nurse, designed to capture acts of stigma, included 2 components (discrimination related to clinical care and refusal to share or exchange food/gifts). Scales demonstrated good reliability and construct validity. Relative to community health workers, treatment supporters were more likely to have stigmatizing opinions related to avoidance and empathy. We offer 2 Spanish-language scales that could be used to identify populations with high levels of stigmatizing opinions and behaviors toward PLWHA. Formal training of health care workers, especially treatment supporters, may raise awareness and reduce stigma toward HIV.
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Affiliation(s)
- Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners In Health / Socios En Salud, Lima, Peru
| | - Adrianne K Nelson
- Partners In Health / Socios En Salud, Lima, Peru Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Sidney Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Leonid Lecca
- Partners In Health / Socios En Salud, Lima, Peru
| | - Sonya S Shin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Partners In Health / Socios En Salud, Lima, Peru Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
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22
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Shin SS, Laniado-Laborin R, Moreno PG, Novotny TE, Strathdee SA, Garfein RS. Dose-response association between salivary cotinine levels and Mycobacterium tuberculosis infection. Int J Tuberc Lung Dis 2014; 17:1452-8. [PMID: 24125450 DOI: 10.5588/ijtld.13.0311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Tijuana, Mexico. OBJECTIVE To describe the association between salivary cotinine levels and interferon-gamma (IFN-γ) release assay results. DESIGN We conducted a cross-sectional study among injection drug users. Salivary cotinine levels were measured using NicAlert, a semi-quantitative dipstick assay. QuantiFERON©-TB Gold In-Tube (QFT-GIT) was used to determine Mycobacterium tuberculosis infection. RESULTS Among 234 participants, the prevalence of QFT-GIT positivity for NicAlert cotinine categories 0 (non-smoking), 1 (second-hand smoke exposure or low-level smoking) and 26 (regular smoking) were respectively 42.1%, 46.4% and 65.2% (Ptrend 0.012). We found increasing trends in QFT-GIT positivity (Ptrend 0.003) and IFN-γ concentrations (Spearman's r 0.200, P 0.002) across cotinine levels 0 to 6. In multivariable log-binomial regression models adjusted for education, cotinine levels were not associated with QFT-GIT positivity when included as smoking categories (1 and 26 vs. 0), but were independently associated with QFT-GIT positivity when included as an ordinal variable (prevalence ratio 1.09 per 1 cotinine level, 95%CI 1.021.16). CONCLUSION Our findings suggest that a dose-response relationship exists between tobacco smoke exposure and M. tuberculosis infection. Longitudinal studies that use biochemical measures for smoking status are needed to confirm our findings.
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Affiliation(s)
- S S Shin
- Joint Doctoral Program in Public Health (Global Health), San Diego State University/University of California San Diego, San Diego, California, USA
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23
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Velásquez GE, Becerra MC, Gelmanova IY, Pasechnikov AD, Yedilbayev A, Shin SS, Andreev YG, Yanova G, Atwood SS, Mitnick CD, Franke MF, Rich ML, Keshavjee S. Improving outcomes for multidrug-resistant tuberculosis: aggressive regimens prevent treatment failure and death. Clin Infect Dis 2014; 59:9-15. [PMID: 24729493 DOI: 10.1093/cid/ciu209] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evidence is sparse regarding the optimal construction of regimens to treat multidrug-resistant (MDR) tuberculosis disease due to strains of Mycobacterium tuberculosis resistant to at least both isoniazid and rifampin. Given the low potency of many second-line antituberculous drugs, we hypothesized that an aggressive regimen of at least 5 likely effective drugs during the intensive phase, including a fluoroquinolone and a parenteral agent, would be associated with a reduced risk of death or treatment failure. METHODS We conducted a retrospective cohort study of patients initiating MDR tuberculosis treatment between 2000 and 2004 in Tomsk, Russian Federation. We used a multivariate Cox proportional hazards model to assess whether monthly exposure to an aggressive regimen was associated with the risk of death or treatment failure. RESULTS Six hundred fourteen individuals with confirmed MDR tuberculosis were eligible for analysis. On multivariable analysis that adjusted for extensively drug-resistant (XDR) tuberculosis-MDR tuberculosis isolates resistant to fluoroquinolones and parenteral agents-we found that monthly exposure to an aggressive regimen was significantly associated with a lower risk of death or treatment failure (hazard ratio, 0.52 [95% confidence interval, .29-.94]; P = .030). CONCLUSIONS Receipt of an aggressive treatment regimen was a robust predictor of decreased risk of death or failure during MDR tuberculosis treatment. These findings further support the use of this regimen definition as the benchmark for the standard of care of MDR tuberculosis patients and should be used as the basis for evaluating novel therapies.
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Affiliation(s)
| | - Mercedes C Becerra
- Department of Global Health and Social Medicine, Harvard Medical School Partners In Health, Boston, Massachusetts Partners In Health, Moscow, Russian Federation Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Irina Y Gelmanova
- Partners In Health, Boston, Massachusetts Partners In Health, Moscow, Russian Federation
| | | | - Askar Yedilbayev
- Partners In Health, Boston, Massachusetts Partners In Health, Moscow, Russian Federation
| | - Sonya S Shin
- Partners In Health, Boston, Massachusetts Partners In Health, Moscow, Russian Federation Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Galina Yanova
- Tomsk Oblast Tuberculosis Hospital, Russian Federation
| | - Sidney S Atwood
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Carole D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School Partners In Health, Boston, Massachusetts Partners In Health, Moscow, Russian Federation Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School Partners In Health, Boston, Massachusetts Partners In Health, Moscow, Russian Federation
| | - Michael L Rich
- Department of Global Health and Social Medicine, Harvard Medical School Partners In Health, Boston, Massachusetts Partners In Health, Moscow, Russian Federation Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School Partners In Health, Boston, Massachusetts Partners In Health, Moscow, Russian Federation Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts
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Connery H, Greenfield S, Livchits V, McGrady L, Patrick N, Lastimoso CS, Heney JH, Nelson AK, Shields A, Stepanova YP, Petrova LY, Anastasov OV, Novoseltseva OI, Shin SS. Training and fidelity monitoring of alcohol treatment interventions integrated into routine tuberculosis care in Tomsk, Russia: the IMPACT Effectiveness Trial. Subst Use Misuse 2013; 48:784-92. [PMID: 23750742 PMCID: PMC4010131 DOI: 10.3109/10826084.2013.793715] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
IMPACT (Integrated Management of Physician-Delivered Alcohol Care for Tuberculosis patients) is a randomized, controlled effectiveness trial based in Tomsk, Russia, that assesses the effect of oral naltrexone and brief behavioral counseling on tuberculosis outcomes and alcohol use in 200 patients. Tuberculosis physicians without addiction experience delivered interventions as part of routine care over a 6-month period, focusing on alcohol intake reduction to support successful tuberculosis treatment. We describe design, training, and fidelity monitoring using a Russian and American team of physicians, bilingual coders, and supervisors. Culturally appropriate adaptations, limitations, and implications for future trials are discussed. The clinical trial identification number is NCT00675961. Funding came from the National Institutes of Health and National Institute on Drug Abuse.
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Affiliation(s)
- Hilary Connery
- Alcohol and Drug Abuse Treatment Program, McLean Hospital, Belmont, Massachusetts 02478, USA.
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25
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Magee MJ, Bloss E, Shin SS, Contreras C, Huaman HA, Ticona JC, Bayona J, Bonilla C, Yagui M, Jave O, Cegielski JP. Clinical characteristics, drug resistance, and treatment outcomes among tuberculosis patients with diabetes in Peru. Int J Infect Dis 2013; 17:e404-12. [PMID: 23434400 DOI: 10.1016/j.ijid.2012.12.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/10/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES Diabetes is a risk factor for active tuberculosis (TB). Data are limited regarding the association between diabetes and TB drug resistance and treatment outcomes. We examined characteristics of TB patients with and without diabetes in a Peruvian cohort at high risk for drug-resistant TB. Among TB patients with diabetes (TB-DM), we studied the association between diabetes clinical/management characteristics and TB drug resistance and treatment outcomes. METHODS During 2005-2008, adults with suspected TB with respiratory symptoms in Lima, Peru, who received rapid drug susceptibility testing (DST), were prospectively enrolled and followed during treatment. Bivariate and Kaplan-Meier analyses were used to examine the relationships of diabetes characteristics with drug-resistant TB and TB outcomes. RESULTS Of 1671 adult TB patients enrolled, 186 (11.1%) had diabetes. TB-DM patients were significantly more likely than TB patients without diabetes to be older, have had no previous TB treatment, and to have a body mass index (BMI) >18.5 kg/m(2) (p<0.05). In patients without and with previous TB treatment, the prevalence of multidrug-resistant TB was 23% and 26%, respectively, among patients without diabetes, and 12% and 28%, respectively, among TB-DM patients. Among 149 TB-DM patients with DST results, 104 (69.8%) had drug-susceptible TB and 45 (30.2%) had drug-resistant TB, of whom 29 had multidrug-resistant TB. There was no association between diabetes characteristics and drug-resistant TB. Of 136 TB-DM patients with outcome information, 107 (78.7%) had a favorable TB outcome; active diabetes management was associated with a favorable outcome. CONCLUSIONS Diabetes was common in a cohort of TB patients at high risk for drug-resistant TB. Despite prevalent multidrug-resistant TB among TB-DM patients, the majority had a favorable TB treatment outcome.
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Affiliation(s)
- M J Magee
- Rollins School of Public Health, Emory University, Atlanta, USA
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26
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Lin HH, Shin SS, Contreras C, Asencios L, Paciorek CJ, Cohen T. Use of spatial information to predict multidrug resistance in tuberculosis patients, Peru. Emerg Infect Dis 2013; 18:811-3. [PMID: 22516236 PMCID: PMC3358052 DOI: 10.3201/eid1805.111467] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Knowing whether a patient has multidrug-resistant tuberculosis is crucial for prescribing the best treatment. The challenge is choosing the most effective drug with the fewest side effects while saving the “big guns” for the most resistant infections. The best way to find out whether a patient has this type of infection is to conduct drug-susceptibility testing. Unfortunately, this testing requires laboratory capabilities that are in short supply, so often only patients at high risk are tested. But who is at high risk? A recent study found an association between patients’ locations (health center at which they were seen) and likelihood of multidrug-resistant infection. Added to other known risk factors (young age, previous TB treatment, or contact with someone with similar infection), this information can further pinpoint who should be tested, which will ultimately lead to faster diagnoses, better treatments and less spread of multidrug-resistant TB. To determine whether spatiotemporal information could help predict multidrug resistance at the time of tuberculosis diagnosis, we investigated tuberculosis patients who underwent drug susceptibility testing in Lima, Peru, during 2005–2007. We found that crude representation of spatial location at the level of the health center improved prediction of multidrug resistance.
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Affiliation(s)
- Hsien-Ho Lin
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Shin SS, Asencios L, Yagui M, Yale G, Suárez C, Bayona J, Bonilla C, Jave O, Contreras CC, Atwood S, Blaya JA, Ershova J, Cegielski JP. Impact of rapid drug susceptibility testing for tuberculosis: program experience in Lima, Peru. Int J Tuberc Lung Dis 2012; 16:1538-43. [PMID: 22990138 DOI: 10.5588/ijtld.12.0071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Programmatic implementation of decentralized rapid drug susceptibility testing (DST) in Lima, Peru. OBJECTIVE Pre-post analysis compared time to diagnosis, treatment outcome and survival among patients tested with direct nitrate reductase assay (NRA) vs. indirect conventional methods. DESIGN From 2005 to 2009, we prospectively followed all patients referred for DST before (control) and after (intervention) NRA implementation. Among those referred for DST, NRA was used for smear-positive samples of patients with no prior history of multidrug resistance or treatment for multidrug-resistant tuberculosis (TB). Data were abstracted from patient charts and laboratory registers. Endpoints were favorable outcomes, time to result and time to death. RESULTS Of those patients who met the criteria for NRA, 740 underwent NRA and 621 underwent conventional DST. NRA yielded test results for 78.4% of cases vs. 68.8% for conventional DST (P < 0.0001); the median time to result was 44 vs. 133 days, respectively (adjusted HR 0.64, 95%CI 0.56-0.73). Among individuals without previous anti-tuberculosis treatment, NRA was associated with a favorable treatment outcome (adjusted OR 1.39, 95%CI 1.01-1.90) and prolonged survival (adjusted HR 0.53, 95%CI 0.31-0.90). CONCLUSION Direct NRA significantly shortened time to test result and improved treatment outcomes and survival in certain groups.
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Affiliation(s)
- S S Shin
- Division of Global Health Equity, and Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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Drobac PC, Shin SS, Huamani P, Atwood S, Furin J, Franke MF, Lastimoso C, del Castillo H. Risk factors for in-hospital mortality among children with tuberculosis: the 25-year experience in Peru. Pediatrics 2012; 130:e373-9. [PMID: 22826566 PMCID: PMC3408686 DOI: 10.1542/peds.2011-3048] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We examined factors associated with in-hospital death among children with tuberculosis (TB). We hypothesized that a negative response to tuberculin skin testing (TST) would predict decreased survival. METHODS This retrospective cohort comprised 2392 children ages 0 to 14 years hospitalized with TB at a Peruvian referral hospital over the 25-year study period. Detailed chart abstraction captured clinical history including TB contacts, physical examination findings, diagnostic data, treatment regimen, and hospitalization outcome. We used Cox proportional hazards regression analyses to determine risk factors for mortality. RESULTS Of 2392 children, 2 (0.1%) were known to be HIV-positive, 5 (0.2%) had documented multidrug-resistant TB, and 266 (11%) died. The median time from hospitalization to death was 16 days (interquartile range: 4-44 days). Reaction of <5 mm induration on TST predicted death in a multivariable analysis (hazard ratio [HR]: 3.01; 95% confidence interval [CI]: 2.15-4.21; P < .0001). Younger age, period of admission, alteration of mental status (HR: 3.25; 95% CI: 2.48-4.27; P < .0001), respiratory distress (HR: 1.40; 95% CI: 1.07-1.83; P = .01), peripheral edema (HR: 1.97; 95% CI: 1.42-2.73; P < .0001), and hemoptysis (HR: 0.57; 95% CI: 0.32-1.00; P = .05) were associated with mortality. Treatment regimens that contained rifampicin (HR: 0.47; 95% CI: 0.33-0.68; P < .0001) were associated with improved survival. CONCLUSIONS Negative reaction to TST is highly predictive of death among children with active TB. In children with clinical and radiographic findings suggestive of TB, a negative TST should not preclude or delay anti-TB therapy.
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Miller AC, Gelmanova IY, Keshavjee S, Atwood S, Yanova G, Mishustin S, Furin JJ, Shin SS. Alcohol use and the management of multidrug-resistant tuberculosis in Tomsk, Russian Federation. Int J Tuberc Lung Dis 2012; 16:891-6. [PMID: 22507895 DOI: 10.5588/ijtld.11.0795] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Alcohol use increases the risk of multidrug-resistant tuberculosis (MDR-TB) and poses challenges for successful MDR-TB treatment, including the potential for additional adverse events. AIM To investigate the association between alcohol consumption during MDR-TB treatment and adverse events and treatment outcomes in a cohort of patients in Tomsk, Russia. DESIGN From 2000 to 2004, retrospective data were collected on 407 MDR-TB patients in Tomsk. Factors associated with treatment outcomes were assessed using logistic regression. RESULTS Of the 407 patients, 253 (62.2%) consumed alcohol during treatment ('drinkers'), and 367 (90.2%) had at least one documented adverse advent. No significant differences were noted in frequency of adverse events in drinkers vs. non-drinkers. Drinkers had less favourable treatment outcomes (OR 0.28, 95%CI 0.18-0.45). Among drinkers, favourable treatment outcome was associated with adherence to at least 80% of prescribed doses (OR 2.89, 95%CI 1.30-6.43) and the occurrence of an adverse event requiring treatment interruption (OR 2.49, 95%CI 1.11-5.59). CONCLUSIONS Alcohol use did not appear to increase the risk of adverse events during MDR-TB treatment; however, alcohol consumption was associated with poor outcome. Our findings suggest that individuals who drink alcohol should receive aggressive attention to optimise treatment adherence and manage adverse events.
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Affiliation(s)
- A C Miller
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Keshavjee S, Gelmanova IY, Shin SS, Mishustin SP, Andreev YG, Atwood S, Furin JJ, Miller A. Hepatotoxicity during treatment for multidrug-resistant tuberculosis: occurrence, management and outcome. Int J Tuberc Lung Dis 2012; 16:596-603. [PMID: 22410436 DOI: 10.5588/ijtld.11.0591] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Multidrug-resistant tuberculosis (MDR-TB) treatment program in Tomsk, Russia. OBJECTIVE To describe the incidence and management of hepatotoxicity during treatment of MDR-TB, and to assess risk factors associated with its development and impact on treatment outcomes. DESIGN A retrospective case series performed among 608 patients. RESULTS Hepatotoxicity, using American Thoracic Society (2006) definitions, was observed in 91/568 patients (16.5%). The median time to the first hepatotoxic event was 196 days post treatment commencement. Baseline factors associated with hepatotoxicity included elevated alanine aminotransferase/aspartate aminotransferase/bilirubin (OR 53.9, 95%CI 6.30-438.7), and renal insufficiency (OR 19.6, 95%CI 2.71-141.6). High treatment adherence (OR 3.25, 95%CI 2.07-5.09) and starting treatment in prison (OR 1.77, 95%CI 1.04-3.01) were associated with treatment success. Smoking (OR 0.44, 95%CI 0.21-0.92) and bilateral cavitary disease (OR 0.51, 95%CI 0.34-0.77) were associated with worse outcomes. For alcohol users, developing hepatotoxicity was associated with better outcomes (OR 4.40, 95%CI 1.79-10.81) than not (OR 0.42, 95%CI 0.25-0.68). One or more medications were permanently stopped in 10/91 patients, but in no case was treatment entirely discontinued. CONCLUSION MDR-TB treatment in the face of hepatotoxicity during therapy did not result in a statistically significant increase in poor outcomes.
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Affiliation(s)
- S Keshavjee
- Program in Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts 02139, USA.
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Shin SS, Livchits V, Nelson AK, Lastimoso CS, Yanova GV, Yanov SA, Mishustin SP, Connery HS, Greenfield SF. Implementing evidence-based alcohol interventions in a resource-limited setting: novel delivery strategies in Tomsk, Russia. Harv Rev Psychiatry 2012; 20:58-67. [PMID: 22335183 PMCID: PMC3318976 DOI: 10.3109/10673229.2012.649121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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] [Indexed: 12/05/2022]
Abstract
Effective implementation of evidence-based interventions in "real-world" settings can be challenging. Interventions based on externally valid trial findings can be even more difficult to apply in resource-limited settings, given marked differences-in provider experience, patient population, and health systems-between those settings and the typical clinical trial environment. Under the auspices of the Integrated Management of Physician-Delivered Alcohol Care for Tuberculosis Patients (IMPACT) study, a randomized, controlled effectiveness trial, and as an integrated component of tuberculosis treatment in Tomsk, Russia, we adapted two proven alcohol interventions to the delivery of care to 200 patients with alcohol use disorders. Tuberculosis providers performed screening for alcohol use disorders and also delivered naltrexone (with medical management) or a brief counseling intervention either independently or in combination as a seamless part of routine care. We report the innovations and challenges to intervention design, training, and delivery of both pharmacologic and behavioral alcohol interventions within programmatic tuberculosis treatment services. We also discuss the implications of these lessons learned within the context of meeting the challenge of providing evidence-based care in resource-limited settings.
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Affiliation(s)
- Sonya S Shin
- Harvard Medical School, Division of Global Health Equity, Brigham & Women's Hospital, Boston, MA 02115, USA.
| | | | - Adrianne K Nelson
- Division of Global Health Equity, Brigharn & Women's Hospital, Boston, MA
| | | | | | - Sergey A Yanov
- Tomsk Oblast Clinical Tuberculosis Hospital, Belmont, MA
| | - Sergey P Mishustin
- Tomsk Oblast Clinical Tuberculosis Hospital, Belmont, MA,Tomsk Oblast Tuberculosis Dispensary, Belmont, MA
| | - Hilary S Connery
- Harvard Medical School, Brigharn & Women's Hospital, Boston, MA,Tomsk, Russian Federation; McLean Hospital, Belmont, MA
| | - Shelly F Greenfield
- Harvard Medical School, Brigharn & Women's Hospital, Boston, MA,Tomsk, Russian Federation; McLean Hospital, Belmont, MA
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Ahuja SD, Ashkin D, Avendano M, Banerjee R, Bauer M, Bayona JN, Becerra MC, Benedetti A, Burgos M, Centis R, Chan ED, Chiang CY, Cox H, D'Ambrosio L, DeRiemer K, Dung NH, Enarson D, Falzon D, Flanagan K, Flood J, Garcia-Garcia ML, Gandhi N, Granich RM, Hollm-Delgado MG, Holtz TH, Iseman MD, Jarlsberg LG, Keshavjee S, Kim HR, Koh WJ, Lancaster J, Lange C, de Lange WCM, Leimane V, Leung CC, Li J, Menzies D, Migliori GB, Mishustin SP, Mitnick CD, Narita M, O'Riordan P, Pai M, Palmero D, Park SK, Pasvol G, Peña J, Pérez-Guzmán C, Quelapio MID, Ponce-de-Leon A, Riekstina V, Robert J, Royce S, Schaaf HS, Seung KJ, Shah L, Shim TS, Shin SS, Shiraishi Y, Sifuentes-Osornio J, Sotgiu G, Strand MJ, Tabarsi P, Tupasi TE, van Altena R, Van der Walt M, Van der Werf TS, Vargas MH, Viiklepp P, Westenhouse J, Yew WW, Yim JJ. Multidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes: an individual patient data meta-analysis of 9,153 patients. PLoS Med 2012; 9:e1001300. [PMID: 22952439 PMCID: PMC3429397 DOI: 10.1371/journal.pmed.1001300] [Citation(s) in RCA: 365] [Impact Index Per Article: 30.4] [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: 09/27/2011] [Accepted: 07/17/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB. METHODS AND FINDINGS Three recent systematic reviews were used to identify studies reporting treatment outcomes of microbiologically confirmed MDR-TB. Study authors were contacted to solicit individual patient data including clinical characteristics, treatment given, and outcomes. Random effects multivariable logistic meta-regression was used to estimate adjusted odds of treatment success. Adequate treatment and outcome data were provided for 9,153 patients with MDR-TB from 32 observational studies. Treatment success, compared to failure/relapse, was associated with use of: later generation quinolones, (adjusted odds ratio [aOR]: 2.5 [95% CI 1.1-6.0]), ofloxacin (aOR: 2.5 [1.6-3.9]), ethionamide or prothionamide (aOR: 1.7 [1.3-2.3]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.3 [1.3-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 2.7 [1.7-4.1]). Similar results were seen for the association of treatment success compared to failure/relapse or death: later generation quinolones, (aOR: 2.7 [1.7-4.3]), ofloxacin (aOR: 2.3 [1.3-3.8]), ethionamide or prothionamide (aOR: 1.7 [1.4-2.1]), use of four or more likely effective drugs in the initial intensive phase (aOR: 2.7 [1.9-3.9]), and three or more likely effective drugs in the continuation phase (aOR: 4.5 [3.4-6.0]). CONCLUSIONS In this individual patient data meta-analysis of observational data, improved MDR-TB treatment success and survival were associated with use of certain fluoroquinolones, ethionamide, or prothionamide, and greater total number of effective drugs. However, randomized trials are urgently needed to optimize MDR-TB treatment. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Shama D. Ahuja
- Bureau of Tuberculosis, New York, New York, United States of America
| | - David Ashkin
- A.G. Holley Hospital, Lantana, Florida, United States of America
| | | | - Rita Banerjee
- Mayo Clinic, Rochester, Minnesota, United States of America
| | - Melissa Bauer
- Montreal Chest Institute, McGill University, Montreal, Canada
| | - Jamie N. Bayona
- The Dartmouth Center for Health Care Delivery Science, Hanover, New Hampshire, United States of America
| | - Mercedes C. Becerra
- Harvard Medical School, Boston, Massachusetts, United States of America
- Partners in Health, Boston, Massachusetts, United States of America
| | | | - Marcos Burgos
- University of New Mexico School of Medicine, Albuquerque, New Mexico, United States of America
| | - Rosella Centis
- WHO Collaborating Centre for TB and Lung Diseases, Care and Research Institute, Fondazione S. Maugeri, Tradate, Italy
| | - Eward D. Chan
- Denver Veterans Affair Medical Center, Denver, Colorado, United States of America
| | - Chen-Yuan Chiang
- Wan Fang Hospital, School of Medicine-Taipei Medical University, Taiwan
| | - Helen Cox
- Médecins Sans Frontières, Capetown, South Africa
| | - Lia D'Ambrosio
- WHO Collaborating Centre for TB and Lung Diseases, Care and Research Institute, Fondazione S. Maugeri, Tradate, Italy
| | - Kathy DeRiemer
- UC Davis School of Medicine, Davis, California, United States of America
| | | | - Donald Enarson
- International Union against Tuberculosis and Lung Disease, Paris, France
| | | | | | - Jennifer Flood
- California Department of Public Health, Sacramento, California, United States of America
| | | | - Neel Gandhi
- Albert Einstein College of Medicine, Bronx, New York, United States of America
| | | | | | | | | | - Leah G. Jarlsberg
- University of California, San Francisco, San Francisco, United States of America
| | - Salmaan Keshavjee
- Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | - Joey Lancaster
- South African Medical Research Council, Pretoria, South Africa
| | | | | | - Vaira Leimane
- Clinic of Tuberculosis and Lung Diseases, Riga, Latvia
| | | | - Jiehui Li
- New York City Health and Mental Hygiene, New York, New York, United States of America
| | - Dick Menzies
- Montreal Chest Institute, McGill University, Montreal, Canada
- * E-mail:
| | - Giovanni B. Migliori
- WHO Collaborating Centre for TB and Lung Diseases, Care and Research Institute, Fondazione S. Maugeri, Tradate, Italy
| | | | - Carole D. Mitnick
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Masa Narita
- University of Washington, Seattle, Washington, United States of America
| | | | - Madhukar Pai
- Montreal Chest Institute, McGill University, Montreal, Canada
| | | | | | | | - Jose Peña
- Universidad Autonoma Madrid, Madrid, Spain
| | | | | | - Alfredo Ponce-de-Leon
- Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Mexico, Mexico
| | | | | | - Sarah Royce
- University of California, San Francisco, San Francisco, United States of America
| | | | - Kwonjune J. Seung
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Lena Shah
- Montreal Chest Institute, McGill University, Montreal, Canada
| | - Tae Sun Shim
- University of Ulsan College of Medicine, Seoul, Korea
| | - Sonya S. Shin
- Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | | | - José Sifuentes-Osornio
- Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Mexico, Mexico
| | | | | | | | | | | | | | | | - Mario H. Vargas
- Instituto Nacional de Enfermedades Respiratorias, Mexico, Mexico
| | | | - Janice Westenhouse
- Center for Infectious Diseases-California Department of Public Health, Sacramento, California, United States of America
| | | | - Jae-Joon Yim
- Seoul National University College of Medicine, Seoul, Korea
| | - Collaborative Group for Meta-Analysis of Individual Patient Data in MDR-TBAhujaShama D.Bureau of Tuberculosis, New York, New York, United States of AmericaAshkinDavidA.G. Holley Hospital, Lantana, Florida, United States of AmericaAvendanoMonikaUniversity of Toronto, Toronto, Canada,BanerjeeRitaMayo Clinic, Rochester, Minnesota, United States of AmericaBauerMelissaMontreal Chest Institute, McGill University, Montreal, CanadaBayonaJamie N.The Dartmouth Center for Health Care Delivery Science, Hanover, New Hampshire, United States of AmericaBecerraMercedes C.Harvard Medical School, Boston, Massachusetts, United States of America; Partners in Health, Boston, Massachusetts, United States of AmericaBenedettiAndreaMontreal Chest Institute, McGill University, Montreal, CanadaBurgosMarcosUniversity of New Mexico School of Medicine, Albuquerque, New Mexico, United States of AmericaCentisRosellaWHO Collaborating Centre for TB and Lung Diseases, Care and Research Institute, Fondazione S. Maugeri, Tradate, ItalyChanEward D.Denver Veterans Affair Medical Center, Denver, Colorado, United States of AmericaChiangChen-YuanWan Fang Hospital, School of Medicine-Taipei Medical University, TaiwanCoxHelenMédecins Sans Frontières, Capetown, South AfricaD'AmbrosioLiaWHO Collaborating Centre for TB and Lung Diseases, Care and Research Institute, Fondazione S. Maugeri, Tradate, ItalyDeRiemerKathyUC Davis School of Medicine, Davis, California, United States of AmericaDungNguyen HuyNational TB Control Program, Hanoi, VietnamEnarsonDonaldInternational Union against Tuberculosis and Lung Disease, Paris, FranceFalzonDennisWorld Health Organization, Geneva, SwitzerlandFlanaganKatherineMRC Laboratories, Banjul, The GambiaFloodJenniferCalifornia Department of Public Health, Sacramento, California, United States of AmericaGarcia-GarciaMaria L.Instituto Nacional de Salud Pública, Mexico, MexicoGandhiNeelAlbert Einstein College of Medicine, Bronx, New York, United States of AmericaGranichReuben M.World Health Organization, Geneva, SwitzerlandHollm-DelgadoMaria G.Montreal Chest Institute, McGill University, Montreal, CanadaHoltzTimothy H.Thailand MOPH & US CDC Collaboration, Bangkok, ThailandIsemanMichael D.National Jewish Health, Denver, Colorado, United States of AmericaJarlsbergLeah G.University of California, San Francisco, San Francisco, United States of AmericaKeshavjeeSalmaanHarvard Medical School, Boston, Massachusetts, United States of AmericaKimHye-RyounKorea Cancer Center Hospital, Seoul, KoreaKohWon-JungSamsung Medical Center, Seoul, KoreaLancasterJoeySouth African Medical Research Council, Pretoria, South AfricaLangeChristopheMedical Clinic, Tuberculosis Center Borstel, Borstel, Germanyde LangeWiel C. M.University Medical Center Groningen, Groningen, The NetherlandsLeimaneVairaClinic of Tuberculosis and Lung Diseases, Riga, LatviaLeungChi ChiuTuberculosis and Chest Services, Hong KongLiJiehuiNew York City Health and Mental Hygiene, New York, New York, United States of AmericaMenziesDickMontreal Chest Institute, McGill University, Montreal, CanadaMiglioriGiovanni B.WHO Collaborating Centre for TB and Lung Diseases, Care and Research Institute, Fondazione S. Maugeri, Tradate, ItalyMishustinSergey P.Tomsk Oblast Tuberculosis Dispensary, Tomsk, RussiaMitnickCarole D.Harvard Medical School, Boston, Massachusetts, United States of AmericaNaritaMasaUniversity of Washington, Seattle, Washington, United States of AmericaO'RiordanPhillyCity Road Medical Centre, London, United KingdomPaiMadhukarMontreal Chest Institute, McGill University, Montreal, CanadaPalmeroDomingoHospital F.J. Muñiz, Buenos Aires, ArgentinaParkSeung-kyuTB Center, Seoul, KoreaPasvolGeoffreyImperial College London, London, United KingdomPeñaJoseUniversidad Autonoma Madrid, Madrid, SpainPérez-GuzmánCarlosInstituto de Salud del Estado de Aguascalientes, Mexico, MexicoQuelapioMaria I. D.Tropical Disease Foundation, Makati City, PhilippinesPonce-de-LeonAlfredoInstituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Mexico, MexicoRiekstinaVijaClinic of Tuberculosis and Lung Diseases, Riga, LatviaRobertJeromeBactériologie-Hygiène – UPMC, Paris, FranceRoyceSarahUniversity of California, San Francisco, San Francisco, United States of AmericaSchaafH. SimonStellenbosch University, Stellenbosch, South AfricaSeungKwonjune J.Brigham and Women's Hospital, Boston, Massachusetts, United States of AmericaShahLenaMontreal Chest Institute, McGill University, Montreal, CanadaShimTae SunUniversity of Ulsan College of Medicine, Seoul, KoreaShinSonya S.Brigham and Women's Hospital, Boston, Massachusetts, United States of AmericaShiraishiYujiFukujuji Hospital, Tokyo, JapanSifuentes-OsornioJoséInstituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, Mexico, MexicoSotgiuGiovanniUniversity of Sassari, Sassari, ItalyStrandMatthew J.National Jewish Health, Denver, Colorado, United States of AmericaTabarsiPayamShaheed Beheshti Medical University, Tehran, IranTupasiThelma E.Tropical Disease Foundation, Makati City, Philippinesvan AltenaRobertUniversity Medical Center Groningen, Groningen, The NetherlandsVan der WaltMartieSouth African Medical Research Council, Pretoria, South AfricaVan der WerfTjip S.University Medical Center Groningen, Groningen, The NetherlandsVargasMario H.Instituto Nacional de Enfermedades Respiratorias, Mexico, MexicoViikleppPirettNational Institute for Health Development, Tallinn, EstoniaWestenhouseJaniceCenter for Infectious Diseases-California Department of Public Health, Sacramento, California, United States of AmericaYewWing WaiGrantham Hospital, Hong Kong
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Franke MF, Murray MB, Muñoz M, Hernández-Díaz S, Sebastián JL, Atwood S, Caldas A, Bayona J, Shin SS. Food insufficiency is a risk factor for suboptimal antiretroviral therapy adherence among HIV-infected adults in urban Peru. AIDS Behav 2011; 15:1483-9. [PMID: 20714923 DOI: 10.1007/s10461-010-9789-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [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] [Indexed: 12/01/2022]
Abstract
We examined the relationship between food insufficiency and antiretroviral therapy (ART) adherence. A cohort of HIV-infected adults in urban Peru was followed for a two-year period after ART initiation. ART adherence was measured using a 30-day self-report tool and classified as suboptimal if <95% adherence was reported. We conducted a repeated measures cohort analysis to examine whether food insufficiency was more common during months of suboptimal adherence relative to months with optimal adherence. 1,264 adherence interviews were conducted for 134 individuals. Participants who reported food insufficiency in the month prior to interview were more likely to experience suboptimal adherence than those who did not (odds ratio [O.R.]:2.4; 95% confidence interval [C.I.]:1.4, 4.1), even after adjusting for baseline social support score (O.R. per 5 point increase:0.91; C.I.:[0.85, 0.98]) and good baseline adherence self-efficacy (O.R.:0.25; C.I.:[0.09, 0.69]). Interventions that ensure food security for HIV-infected individuals may help sustain high levels of adherence.
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Affiliation(s)
- Molly F Franke
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
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34
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Velásquez GE, Yagui M, Cegielski JP, Asencios L, Bayona J, Bonilla C, Jave HO, Yale G, Suárez C, Atwood S, Contreras CC, Shin SS. Targeted drug-resistance testing strategy for multidrug-resistant tuberculosis detection, Lima, Peru, 2005-2008. Emerg Infect Dis 2011; 17:432-40. [PMID: 21392434 PMCID: PMC3166030 DOI: 10.3201/eid1703.101553] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Running head: Targeted Drug-Resistance Testing Strategy for MDR TB The Peruvian National Tuberculosis Control Program issued guidelines in 2006 specifying criteria for culture and drug-susceptibility testing (DST), including district-level rapid DST. All patients referred for culture and DST in 2 districts of Lima, Peru, during January 2005–November 2008 were monitored prospectively. Of 1,846 patients, 1,241 (67.2%) had complete DST results for isoniazid and rifampin; 419 (33.8%) patients had multidrug-resistant (MDR) TB at the time of referral. Among patients with new smear-positive TB, household contact and suspected category I failure were associated with MDR TB, compared with concurrent regional surveillance data. Among previously treated patients with smear-positive TB, adult household contact, suspected category II failure, early relapse after category I, and multiple previous TB treatments were associated with MDR TB, compared with concurrent regional surveillance data. The proportion of MDR TB detected by using guidelines was higher than that detected by a concurrent national drug-resistance survey, indicating that the strategy effectively identified patients for DST.
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Jeon CY, Calver AD, Victor TC, Warren RM, Shin SS, Murray MB. Use of fluoroquinolone antibiotics leads to tuberculosis treatment delay in a South African gold mining community. Int J Tuberc Lung Dis 2011; 15:77-83. [PMID: 21276301] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Empiric use of fluoroquinolone (FQ) antibiotics could delay tuberculosis (TB) treatment and lead to FQ-resistant TB. METHODS We examined the impact of FQ use on TB outcomes, including smear status, treatment delay and FQ resistance, through a retrospective cohort study of 440 FQ-exposed and 511 non-exposed patients in a gold mining community in South Africa. We considered both recent (≤ 100 days before sputum collection) and distant exposure (≤ 1 year). We examined 201 and 180 isolates from FQ-exposed and non-exposed individuals for the presence of gyrA mutations. RESULTS Patients recently exposed to ≥ 5 days of FQ were less likely to be smear-positive (OR 0.27, 95%CI 0.11-0.63), with an increased time to treatment (time ratio 2.02, 95%CI 1.19-3.44). The strength of association decreased when we considered distant exposure. Adjusting for smear status nullified the effect of FQ exposure on treatment delay. We detected a gyrA mutation in one isolate (0.5%) taken from an individual exposed to FQ for 8 days. CONCLUSION FQ exposure is associated with treatment delay, mediated by negative smear status. Short exposures to FQ do not routinely lead to resistance encoded by gyrA mutations. We recommend prudent use of FQ in settings with a high burden of human immunodeficiency virus and TB.
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Affiliation(s)
- C Y Jeon
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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Shin SS, Mathew TA, Yanova GV, Fitzmaurice GM, Livchits V, Yanov SA, Strelis AK, Mishustin SP, Bokhan NA, Lastimoso CS, Connery HS, Hart JE, Greenfield SF. Alcohol consumption among men and women with tuberculosis in Tomsk, Russia. Cent Eur J Public Health 2010; 18:132-8. [PMID: 21033607 DOI: 10.21101/cejph.a3590] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Drinking behavior among Russian women remains poorly described. We analyzed gender differences in alcohol use among 374 tuberculosis patients in Tomsk, Siberia. Twenty-six (28.3%) women had lifetime alcohol abuse or dependence, compared with 70.6% of men. Women with alcohol use disorders drank 12.7 +/- 14.0 standard drinks per day and > or = 34.6% drank 2 three days per week. Among individuals with a lifetime alcohol use disorder, age of onset and typical consumption did not differ significantly by gender. We conclude that Russian women with alcohol use disorders consume almost as much alcohol as men and may be at greater risk for negative social and medical consequences.
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Affiliation(s)
- Sonya S Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Blaya JA, Shin SS, Yale G, Suarez C, Asencios L, Contreras C, Rodriguez P, Kim J, Cegielski P, Fraser HSF. Electronic laboratory system reduces errors in National Tuberculosis Program: a cluster randomized controlled trial. Int J Tuberc Lung Dis 2010; 14:1009-1015. [PMID: 20626946 PMCID: PMC8324019] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
OBJECTIVE To evaluate the impact of the e-Chasqui laboratory information system in reducing reporting errors compared to the current paper system. DESIGN Cluster randomized controlled trial in 76 health centers (HCs) between 2004 and 2008. METHODS Baseline data were collected every 4 months for 12 months. HCs were then randomly assigned to intervention (e-Chasqui) or control (paper). Further data were collected for the same months the following year. Comparisons were made between intervention and control HCs, and before and after the intervention. RESULTS Intervention HCs had respectively 82% and 87% fewer errors in reporting results for drug susceptibility tests (2.1% vs. 11.9%, P = 0.001, OR 0.17, 95%CI 0.09-0.31) and cultures (2.0% vs. 15.1%, P < 0.001, OR 0.13, 95%CI 0.07-0.24), than control HCs. Preventing missing results through online viewing accounted for at least 72% of all errors. e-Chasqui users sent on average three electronic error reports per week to the laboratories. CONCLUSIONS e-Chasqui reduced the number of missing laboratory results at point-of-care health centers. Clinical users confirmed viewing electronic results not available on paper. Reporting errors to the laboratory using e-Chasqui promoted continuous quality improvement. The e-Chasqui laboratory information system is an important part of laboratory infrastructure improvements to support multidrug-resistant tuberculosis care in Peru.
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Affiliation(s)
- J A Blaya
- Decision Systems Group, Brigham & Women's Hospital, Boston, Massachusetts 02215 , USA.
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Shin SS, Keshavjee S, Gelmanova IY, Atwood S, Franke MF, Mishustin SP, Strelis AK, Andreev YG, Pasechnikov AD, Barnashov A, Tonkel TP, Cohen T. Development of extensively drug-resistant tuberculosis during multidrug-resistant tuberculosis treatment. Am J Respir Crit Care Med 2010; 182:426-32. [PMID: 20413630 DOI: 10.1164/rccm.200911-1768oc] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Extensively drug-resistant (XDR) tuberculosis (TB) may arise in individuals on treatment for multidrug-resistant (MDR) TB. Preventing this amplification of resistance will likely improve clinical outcomes and delay the secondary spread of XDR-TB. OBJECTIVES To measure the proportion of individuals that develops XDR-TB during the course of MDR-TB treatment, and to identify those factors associated with the development of XDR. METHODS We performed a retrospective analysis of 608 consecutive patients with documented MDR-TB who were started on MDR-TB treatment between September 10, 2000 and November 1, 2004 in the Tomsk Oblast TB Treatment Services in Western Siberia, Russian Federation. MEASUREMENTS AND MAIN RESULTS A total of 6% of patients were observed to develop XDR-TB while on MDR-TB treatment. These patients were significantly less likely to be cured or to complete treatment. Using Cox proportional hazard models, we found that the presence of bilateral and cavitary lesions was associated with a greater than threefold increase in hazard (adjusted hazard ratio [HR], 3.47; 95% confidence interval [CI], 1.32-9.14). Prior exposure to a second-line injectable antibiotic was associated with a greater than threefold increase in hazard (adjusted HR, 3.65; 95% CI, 1.81-7.37), and each additional month in which a patient failed to take at least 80% of their prescribed drugs was associated with nearly an additional 20% hazard of developing XDR-TB (adjusted HR, 1.17; 95% CI, 1.01-1.35). CONCLUSIONS Early and rapid diagnosis, timely initiation of appropriate therapy, and programmatic efforts to optimize treatment adherence during MDR-TB therapy are crucial to avoiding the generation of excess XDR-TB in MDR-TB treatment programs.
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Affiliation(s)
- Sonya S Shin
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Franke MF, Muñoz M, Finnegan K, Zeladita J, Sebastian JL, Bayona JN, Shin SS. Validation and abbreviation of an HIV stigma scale in an adult spanish-speaking population in urban Peru. AIDS Behav 2010; 14:189-99. [PMID: 18841460 PMCID: PMC8577883 DOI: 10.1007/s10461-008-9474-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [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: 06/02/2008] [Accepted: 09/24/2008] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to validate the Spanish version of the Berger HIV Stigma Scale in an urban Spanish-speaking population in Peru and create a valid and reliable abridged version of the scale. Participants were HIV-infected adults enrolled in an observational study to examine the effectiveness of a community-based antiretroviral therapy adherence intervention. Approximately half of participants were female, and the median age at enrollment was 30.5 years. The Spanish version of the full HIV Stigma Scale was internally reliable, demonstrated good construct validity, and was sensitive to change over time. The full HIV Stigma Scale was abbreviated by removing items that impaired subscale internal reliability, did not correlate with other subscale items, or demonstrated low factor correlations. The resulting abridged scale contained 21 of the 40 original items and revealed properties similar to the full Spanish version.
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40
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Mathew TA, Shields AL, Imasheva A, Shin SS, Furin JJ, Mishustin SP, Peremitin GG, Strelis AK, Yanova GV, Greenfield SF. Knowledge, attitudes, and practices of physicians in Tomsk Oblast tuberculosis services regarding alcohol use among tuberculosis patients in Tomsk, Russia. Cult Med Psychiatry 2009; 33:523-37. [PMID: 19768525 PMCID: PMC3042364 DOI: 10.1007/s11013-009-9148-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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] [Indexed: 10/20/2022]
Abstract
In recent years, the Russian Federation has seen a dramatic rise in morbidity and mortality from tuberculosis (TB), attributed in part to an increase in alcohol use disorders (AUDs), which are associated with worse TB treatment outcomes. This study describes the knowledge, attitudes and practices of physicians who treat TB patients in Tomsk, Russia. We conducted semistructured interviews with 16 TB physicians and 1 addiction specialist. Interviews were audiorecorded, transcribed, translated and systematically analyzed. We identified four key domains: definitions of alcohol use and abuse and physicians' knowledge, attitudes and practices regarding these problems. Physicians described patients as largely precontemplative and reluctant to seek treatment. Physicians recognized their limited knowledge in diagnosing and treating AUDs but expressed interest in acquiring these skills. Few options are currently available for treatment of AUDs in TB patients in Tomsk. These findings suggest that Tomsk physicians are aware of the need to engage AUDs in TB patients but identify a knowledge gap that restricts their ability to do so. Training TB physicians to use simple screening instruments and deliver evidence-based alcohol interventions improves TB outcomes among patients with co-occurring AUDs.
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Affiliation(s)
- Trini A. Mathew
- Division of Infectious Diseases, University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi 39216, United States of America
| | - Alan L. Shields
- Department of Psychology, East Tennessee State University, Box 70649, Johnson City, Tennessee 37614, United States of America
| | - Aizhan Imasheva
- 1230 13th Street, Apt 918, NW, Washington, District of Columbia 20005, United States of America
| | - Sonya S. Shin
- Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, 651 Huntington Avenue, Boston, Massachusetts 02115, United States of America
| | - Jennifer J. Furin
- Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, 651 Huntington Avenue, Boston, Massachusetts 02115, United States of America
| | - Sergey P. Mishustin
- Tomsk Oblast Tuberculosis Services, R. Luxembourg 17, Tomsk, Tomsk Oblast, 634009, Russian Federation
| | - Gennady G. Peremitin
- Tomsk Oblast Tuberculosis Services, R. Luxembourg 17, Tomsk, Tomsk Oblast, 634009, Russian Federation
| | - Aivar K. Strelis
- Tuberculosis and Pulmonology Department, Siberian State Medical University, Moskovky trakt 2, Tomsk, Tomsk Oblast, 634050, Russian Federation
| | - Galina V. Yanova
- Tomsk Oblast Clinical Tuberculosis Hospital, Ul. Novaya 1, Timiryazevo, Tomsk, Tomsk Oblast, 634510, Russian Federation
| | - Shelly F. Greenfield
- Harvard Medical School, Alcohol and Drug Abuse Treatment Program, McLean Hospital, 115 Mill Street, Belmont, Massachusetts 02478, United States of America
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Hong JP, Lee SW, Song SY, Ahn SD, Shin SS, Choi EK, Kim JH. Recombinant human epidermal growth factor treatment of radiation-induced severe oral mucositis in patients with head and neck malignancies. Eur J Cancer Care (Engl) 2009; 18:636-41. [PMID: 19456848 PMCID: PMC2776929 DOI: 10.1111/j.1365-2354.2008.00971.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Mucositis of the oral cavity and pharynx is a major dose-limiting factor in the application of radiotherapy (RT) to patients with head and neck cancer. Therefore, we evaluated the wound healing effect of human recombinant epidermal growth factor (rhEGF) in head and neck cancer and lymphoma patients with irradiation (with or without combined chemotherapy-induced oral mucositis). Patients at Asan Medical Center who had undergone definitive RT of the head and neck region with or without combined chemotherapy and who had developed severe oral mucositis (higher than the Radiation Therapy Oncology Group grade 3) were treated with topical rhEGF twice daily for 7 days. The evaluation of response with regard to oral mucositis was performed 1 week later. Of the 11 treated patients, three had nasopharyngeal carcinoma, three had carcinoma of the oropharynx, two had carcinoma of the oral cavity, one had carcinoma of the hypopharynx and two had lymphoma of the head and neck. Six patients received RT only, and five patients received concurrent chemoradiotherapy. All patients showed improvements in their oral mucositis after topical treatment with rhEGF in that the Radiation Therapy Oncology Group grade was significantly decreased (P = 0.0000). This finding suggests that rhEGF is effective and safe for the treatment of radiation-induced mucositis. Further studies are needed to determine the optimal dosage and fractionation schedule.
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Affiliation(s)
- J P Hong
- Department of Plastic and Reconstructive Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Mathew TA, Yanov SA, Mazitov R, Mishustin SP, Strelis AK, Yanova GV, Golubchikova VT, Taran DV, Golubkov A, Shields AL, Greenfield SF, Shin SS. Integration of alcohol use disorders identification and management in the tuberculosis programme in Tomsk Oblast, Russia. Eur J Public Health 2008; 19:16-8. [PMID: 19112073 DOI: 10.1093/eurpub/ckn093] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Alcohol use disorders (AUDs) among tuberculosis (TB) patients are associated with nonadherence and poor treatment outcomes. We developed a multidisciplinary model to manage AUDs among TB patients in Tomsk, Russia. First, we assessed current standards of care through stakeholder meetings and ethnographic work. The Alcohol Use Disorders Identification Test (AUDIT) was incorporated into routine assessment of all patients starting TB treatment. We established treatment algorithms based on AUDIT scores. We then hired specialists and addressed licensing requirements to provide on-site addictions care. Our experience offers a successful model in the management of co-occurring AUDs among patients with chronic medical problems.
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Affiliation(s)
- Trini A Mathew
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Blaya JA, Yagui M, Contreras CC, Palma B, Shin SS, Yale G, Suarez C, Fraser HSF. Using the e-Chasqui, web-based information system, to determine laboratory guidelines and data available to clinical staff. AMIA Annu Symp Proc 2008:881. [PMID: 18998910] [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] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 06/17/2008] [Indexed: 05/27/2023]
Abstract
13% of all drug susceptibility tests (DSTs) performed at a public laboratory in Peru were duplicate. To determine reasons for duplicate requests an online survey was implemented in the e-Chasqui laboratory information system. Results showed that 59.6% of tests were ordered because clinical staff was unaware of ordering guidelines or of a previous result. This shows a benefit of using a web-based system and the lack of laboratory information available to clinical staff in Peru.
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Affiliation(s)
- Joaquin A Blaya
- Harvard-MIT Health Sciences & Technology, Cambridge, MA; Partners in Health, Boston, MA, USA
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Keshavjee S, Gelmanova IY, Farmer PE, Mishustin SP, Strelis AK, Andreev YG, Pasechnikov AD, Atwood S, Mukherjee JS, Rich ML, Furin JJ, Nardell EA, Kim JY, Shin SS. Treatment of extensively drug-resistant tuberculosis in Tomsk, Russia: a retrospective cohort study. Lancet 2008; 372:1403-9. [PMID: 18723218 DOI: 10.1016/s0140-6736(08)61204-0] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [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: 11/29/2022]
Abstract
BACKGROUND Mycobacterium tuberculosis strains that cause untreatable drug-resistant disease are a threat worldwide. We describe the treatment, management, and outcomes of patients with extensively drug-resistant tuberculosis in Tomsk, Russia. METHODS We undertook a retrospective cohort study of 608 patients with multidrug resistant tuberculosis who had treatment in civilian or prison services, between Sept 10, 2000, and Nov 1, 2004, according to the treatment strategy recommended by WHO. Clinical characteristics, management practices, and treatment outcomes of patients with extensively drug-resistant (XDR) tuberculosis and non-extensively drug-resistant (non-XDR) tuberculosis are described. The main outcome was the frequency of poor and favourable outcomes at the end of treatment. FINDINGS Of 608 patients with multidrug resistant tuberculosis, 29 (4.8%) patients had baseline XDR tuberculosis. Treatment failure was more common in patients with XDR tuberculosis than in those with non-XDR tuberculosis (31%vs 8.5%, p=0.0008). 48.3% of patients with XDR tuberculosis and 66.7% of patients with non-XDR tuberculosis had treatment cure or completion (p=0.04). The frequency and management of adverse events did not differ between patients with XDR and non-XDR tuberculosis. INTERPRETATION The chronic features of tuberculosis in these patients suggest that extensively drug-resistant tuberculosis may be acquired through previous treatments that include second-line drugs. Aggressive management of this infectious disease is feasible and can prevent high mortality rates and further transmission of drug-resistant strains of Mycobacterium tuberculosis.
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Affiliation(s)
- Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Abstract
Multidrug resistant tuberculosis is now thought to afflict between 1 and 2 million patients annually. Although significant regional variability in the distribution of disease has been recorded, surveillance data are limited by several factors. The true burden of disease is likely underestimated. Nevertheless, the estimated burden is substantial enough to warrant concerted action. A range of approaches is possible, but all appropriate interventions require scale-up of laboratories and early treatment with regimens containing a sufficient number of second-line drugs. Ambulatory treatment for most patients, and improved infection control, can facilitate scale-up with decreased risk of nosocomial transmission. Several obstacles have been considered to preclude worldwide scale-up of treatment, mostly attributable to inadequate human, drug, and financial resources. Further delays in scale-up, however, risk continued generation and transmission of resistant tuberculosis, as well as associated morbidity and mortality.
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Affiliation(s)
- Carole D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts 02199, USA.
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Mitnick CD, Shin SS, Seung KJ, Rich ML, Atwood SS, Furin JJ, Fitzmaurice GM, Alcantara Viru FA, Appleton SC, Bayona JN, Bonilla CA, Chalco K, Choi S, Franke MF, Fraser HSF, Guerra D, Hurtado RM, Jazayeri D, Joseph K, Llaro K, Mestanza L, Mukherjee JS, Muñoz M, Palacios E, Sanchez E, Sloutsky A, Becerra MC. Comprehensive treatment of extensively drug-resistant tuberculosis. N Engl J Med 2008; 359:563-74. [PMID: 18687637 PMCID: PMC2673722 DOI: 10.1056/nejmoa0800106] [Citation(s) in RCA: 237] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Extensively drug-resistant tuberculosis has been reported in 45 countries, including countries with limited resources and a high burden of tuberculosis. We describe the management of extensively drug-resistant tuberculosis and treatment outcomes among patients who were referred for individualized outpatient therapy in Peru. METHODS A total of 810 patients were referred for free individualized therapy, including drug treatment, resective surgery, adverse-event management, and nutritional and psychosocial support. We tested isolates from 651 patients for extensively drug-resistant tuberculosis and developed regimens that included five or more drugs to which the infecting isolate was not resistant. RESULTS Of the 651 patients tested, 48 (7.4%) had extensively drug-resistant tuberculosis; the remaining 603 patients had multidrug-resistant tuberculosis. The patients with extensively drug-resistant tuberculosis had undergone more treatment than the other patients (mean [+/-SD] number of regimens, 4.2+/-1.9 vs. 3.2+/-1.6; P<0.001) and had isolates that were resistant to more drugs (number of drugs, 8.4+/-1.1 vs. 5.3+/-1.5; P<0.001). None of the patients with extensively drug-resistant tuberculosis were coinfected with the human immunodeficiency virus (HIV). Patients with extensively drug-resistant tuberculosis received daily, supervised therapy with an average of 5.3+/-1.3 drugs, including cycloserine, an injectable drug, and a fluoroquinolone. Twenty-nine of these patients (60.4%) completed treatment or were cured, as compared with 400 patients (66.3%) with multidrug-resistant tuberculosis (P=0.36). CONCLUSIONS Extensively drug-resistant tuberculosis can be cured in HIV-negative patients through outpatient treatment, even in those who have received multiple prior courses of therapy for tuberculosis.
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Franke MF, Appleton SC, Bayona J, Arteaga F, Palacios E, Llaro K, Shin SS, Becerra MC, Murray MB, Mitnick CD. Risk factors and mortality associated with default from multidrug-resistant tuberculosis treatment. Clin Infect Dis 2008; 46:1844-51. [PMID: 18462099 DOI: 10.1086/588292] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Completing treatment for multidrug-resistant (MDR) tuberculosis (TB) may be more challenging than completing first-line TB therapy, especially in resource-poor settings. The objectives of this study were to (1) identify risk factors for default from MDR TB therapy (defined as prolonged treatment interruption), (2) quantify mortality among patients who default from treatment, and (3) identify risk factors for death after default from treatment. METHODS We performed a retrospective chart review to identify risk factors for default from MDR TB therapy and conducted home visits to assess mortality among patients who defaulted from such therapy. RESULTS Sixty-seven (10.0%) of 671 patients defaulted from MDR TB therapy. The median time to treatment default was 438 days (interquartile range, 152-710 days), and 27 (40.3%) of the 67 patients who defaulted from treatment had culture-positive sputum at the time of default. Substance use (hazard ratio, 2.96; 95% confidence interval, 1.56-5.62; P = .001), substandard housing conditions (hazard ratio, 1.83; 95% confidence interval, 1.07-3.11; P = .03), later year of enrollment (hazard ratio, 1.62, 95% confidence interval, 1.09-2.41; P = .02), and health district (P = .02) predicted default from therapy in a multivariable analysis. Severe adverse events did not predict default from therapy. Forty-seven (70.1%) of 67 patients who defaulted from therapy were successfully traced; of these, 25 (53.2%) had died. Poor bacteriologic response, <1 year of treatment at the time of default, low education level, and diagnosis with a psychiatric disorder significantly predicted death after default in a multivariable analysis. CONCLUSIONS The proportion of patients who defaulted from MDR TB treatment was relatively low. The large proportion of patients who had culture-positive sputum at the time of treatment default underscores the public health importance of minimizing treatment default. Prognosis for patients who defaulted from therapy was poor. Interventions aimed at preventing treatment default may reduce TB-related mortality.
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Affiliation(s)
- Molly F Franke
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA.
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Shin SS, Yagui M, Ascencios L, Yale G, Suarez C, Quispe N, Bonilla C, Blaya J, Taylor A, Contreras C, Cegielski P. Scale-up of multidrug-resistant tuberculosis laboratory services, Peru. Emerg Infect Dis 2008; 14:701-8. [PMID: 18439349 PMCID: PMC2600242 DOI: 10.3201/eid1405.070721] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
One-sentence summary for table of contents: Strategic design and implementation of these services is feasible in resource-poor settings. Over the past 10 years, the Peruvian National Tuberculosis (TB) Program, the National Reference Laboratory (NRL), Socios en Salud, and US partners have worked to strengthen the national TB laboratory network to support treatment of multidrug-resistant TB. We review key lessons of this experience. The preparation phase involved establishing criteria for drug susceptibility testing (DST), selecting appropriate DST methods, projecting the quantity of DST and culture to ensure adequate supplies, creating biosafe laboratory facilities for DST, training laboratory personnel on methods, and validating DST methods at the NRL. Implementation involved training providers on DST indications, validating conventional and rapid first-line DST methods at district laboratories, and eliminating additional delays in specimen transport and result reporting. Monitoring included ongoing quality control and quality assurance procedures. Hurdles included logistics, coordinating with policy, competing interests, changing personnel, communications, and evaluation. Operational research guided laboratory scale-up and identified barriers to effective capacity building.
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Affiliation(s)
- Sonya S Shin
- Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts 02120, USA.
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Abstract
The subcutaneous course of the superficial radial nerve over the radial border of the wrist and hand renders it very susceptible to injury. Both traumatic and iatrogenic injury can produce tethering of this nerve, presenting as dysaesthesia. This study was designed to evaluate the efficacy of neurolysis of the distal superficial radial nerve for this condition. Twenty-five cases of tethered superficial radial nerves underwent neurolysis. At final follow-up (mean 3.5 years), fourteen cases reported symptomatic resolution while eleven continued to experience dysaesthesia. Intra-operatively, evidence of external abnormality, scarring, or compression was identified in only six cases, and its presence did not correlate with symptomatic outcome. Although the majority of patients were improved postoperatively, the success rate was lower than anticipated. Therefore, while neurolysis of the superficial radial nerve offers the opportunity for pain relief, it does not reliably produce success.
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Affiliation(s)
- R P Calfee
- Division of Hand, Upper Extremity, and Microvascular Surgery, Department of Orthopaedics, Brown University School of Medicine, Rhode Island Hospital, Providence, RI, USA
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50
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Shin SS, Pasechnikov AD, Gelmanova IY, Peremitin GG, Strelis AK, Mishustin S, Barnashov A, Karpeichik Y, Andreev YG, Golubchikova VT, Tonkel TP, Yanova GV, Yedilbayev A, Rich ML, Mukherjee JS, Furin JJ, Atwood S, Farmer PE, Keshavjee S. Adverse reactions among patients being treated for MDR-TB in Tomsk, Russia. Int J Tuberc Lung Dis 2007; 11:1314-1320. [PMID: 18034952] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND AND SIGNIFICANCE Treatment of multidrug-resistant tuberculosis (MDR-TB) is challenging because of the toxicity of second-line medications. Little is known about whether adverse events impact treatment outcome. METHODS We conducted a retrospective case series of 244 MDR-TB patients enrolled in Tomsk between 10 September 2000 and 10 September 2002. Adverse reactions were determined by laboratory data and/or clinical criteria. A multiple logistic regression model was performed to determine whether the occurrence of adverse reactions was associated with poor treatment outcome. RESULTS In this cohort, 76.0% were cured, 6.6% failed, 4.9% died and 11.5% defaulted. Adverse events were observed in 73.3% of patients, occurring in 74.8% of patients who were adherent (taking at least 80% of prescribed doses) and 59.1% of non-adherent individuals (P = 0.11). The impact of adverse events on outcome was modified by non-adherence; among adherent patients, the occurrence of any adverse reaction was associated with treatment cure (adjusted odds ratio 3.24, 95% confidence interval 1.56-6.70). CONCLUSION Adverse reactions occurred frequently in MDR-TB patients in Tomsk, Russia, but did not negatively impact treatment outcome. The occurrence of adverse reactions among adherent patients was associated with treatment cure.
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Affiliation(s)
- S S Shin
- Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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