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Chen EC, Owaisi R, Goldschmidt L, Maimets IK, Daftary A. Patient perceptions of video directly observed therapy for tuberculosis: a systematic review. J Clin Tuberc Other Mycobact Dis 2024; 35:100406. [PMID: 38380432 PMCID: PMC10877938 DOI: 10.1016/j.jctube.2023.100406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Virtual modes of tuberculosis (TB) treatment monitoring have become increasingly relevant in the last decade with the advancements and increasing accessibility of technology. We conducted a systematic review comparing people with TB's perceptions of standard directly observed therapy (DOT) versus video directly observed therapy (vDOT). Studies were obtained from MEDLINE and EMBASE between January 1, 1974 and February 4, 2021. Of the 22 articles reviewed, a qualitative thematic analysis was performed, drawing on common themes from people with TB's perception of their care. 21 studies showed relative preference for and acceptance of vDOT over DOT. Factors that increased acceptability toward vDOT included cost and time saving, personal sense of empowerment, convenience, and privacy. Studies also showed greater adherence to treatment and subsequent improved health outcomes. vDOT has the potential to be an empowering, person-centered treatment modality for TB therapy. The role of social determinants such as place of residence, access to technology, and patient-provider communication requires further exploration.
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Affiliation(s)
- En Chi Chen
- Dahdaleh Institute of Global Health Research, York University, 88 The Pond Rd Suite 2150, North York, ON M3J 2S5, Canada
- Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - Rumia Owaisi
- Dahdaleh Institute of Global Health Research, York University, 88 The Pond Rd Suite 2150, North York, ON M3J 2S5, Canada
- School of Global Health, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Leah Goldschmidt
- Dahdaleh Institute of Global Health Research, York University, 88 The Pond Rd Suite 2150, North York, ON M3J 2S5, Canada
- School of Global Health, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Ilo-Katryn Maimets
- Steacie Science and Engineering Library, York University, 136 Campus Walk, North York, ON M3J 1P3, Canada
| | - Amrita Daftary
- Dahdaleh Institute of Global Health Research, York University, 88 The Pond Rd Suite 2150, North York, ON M3J 2S5, Canada
- School of Global Health, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban 4001, South Africa
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SERME M, ZIDA A, BOUGMA R, KIMA A, NASSA C, OUEDRAOGO M, KABRE C, ZOROMÉ H, GUIRE I, NARE D, BOUGOUMA C. [Evaluation of therapeutic coverage of mass treatment campaign against lymphatic filariasis in two health districts in Burkina Faso]. Med Trop Sante Int 2022; 2:mtsi.v2i4.2022.174. [PMID: 36815181 PMCID: PMC9940276 DOI: 10.48327/mtsi.v2i4.2022.174] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/29/2022] [Indexed: 02/24/2023]
Abstract
Background & rationale Burkina Faso has been implementing preventive chemotherapy against lymphatic filariasis since 2001. While 61 health districts (HDs) have stopped mass drug administration (MDA), transmission persists in 9 HDs despite good reported MDA coverage. To validate the reported coverage, an independent post-MDA survey was conducted in Tenkodogo and Fada N'Gourma HDs in September 2018. Materials & methods The study population consisted of all persons in the visited communities. The Coverage survey sample builder (CSSB) tool was used to calculate the sample size and to conduct the random selection of households. A total of 30 villages per HD were selected. The investigators were Ministry of Education agents and health workers not involved in MDA. Data were collected on smartphones through the KoBoCollect application regarding age, sex, drug ingestion (ivermectin + albendazole), adverse events, and whether respondents understood MDA guidelines. Stata Version 14 software was used for data analysis. Results A total of 3,741 individuals were surveyed, 53.3% were female and the median age was 14 years. Surveyed epidemiological coverage was 74% [95% CI: 72-76.1] in Fada N'Gourma and 79.1% [95% CI: 77.2-80.9] in Tenkodogo, compared to reported coverages of 82.6% and 83% respectively. Village-level coverage ranged from 32.9% to 100% in Fada N'Gourma and from 56.7% to 93.3% in Tenkodogo. In total, 99% of those treated said they had swallowed the drugs in front of the community drug distributor (CDD) and confirmed the use of dose poles. The main reasons for non-treatment were non-visitation of the compound by CDD (54%) and absences during MDA (43%). Results showed that surveyed coverage was lower than reported coverage in both HDs, yet both were above the 65% threshold recommended by WHO. However, major variations of coverage have been noted among villages. Directly observed treatment appeared to have been well respected. Discussion & conclusion The main challenges to increase coverage will be the systematic revisiting of households with absentees and the targeting of all households in each village.
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Affiliation(s)
- Mamadou SERME
- Programme national de lutte contre les maladies tropicales négligées (PNMTN), Burkina Faso,*
| | - Adama ZIDA
- École doctorale Sciences et Santé, Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso,Centre National de Formation et de Recherche sur le Paludisme (CNRFP), Ouagadougou, Burkina Faso
| | - Roland BOUGMA
- Programme national de lutte contre les maladies tropicales négligées (PNMTN), Burkina Faso
| | - Appolinaire KIMA
- Programme national de lutte contre les maladies tropicales négligées (PNMTN), Burkina Faso
| | - Christophe NASSA
- Programme national de lutte contre les maladies tropicales négligées (PNMTN), Burkina Faso
| | | | - Cathérine KABRE
- Programme national de lutte contre les maladies tropicales négligées (PNMTN), Burkina Faso
| | - Harouna ZOROMÉ
- Programme national de lutte contre les maladies tropicales négligées (PNMTN), Burkina Faso
| | - Issa GUIRE
- Direction régionale de la santé du Centre-Est, Burkina Faso
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Wong YJ, Ng KY, Lee SWH. Community pharmacists-led interventions in tuberculosis care: A systematic review. Res Social Adm Pharm 2022:S1551-7411(22)00300-X. [PMID: 36096865 DOI: 10.1016/j.sapharm.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND A multidisciplinary approach is required to tackle the tuberculosis (TB) epidemic, which is one of the most pressing public health concerns worldwide. However, community pharmacists are underutilized in TB programs. OBJECTIVE To identify community pharmacists-led interventions in TB management with their corresponding impacts in TB case detection and treatment outcomes. METHODS A systematic search was performed in six electronic databases and health organization websites, from database inception to August 2, 2022. Studies which described TB screening, referral and/or treatment monitoring by community pharmacists with their corresponding outcomes were screened and reviewed independently by two reviewers. The studies were checked for the risk of bias using Cochrane risk of bias tools. All data of included studies were analysed qualitatively and presented narratively. RESULTS The search yielded 8,121 studies and five reports for initial screening. Sixteen studies and two case study reports were included in this review. Community pharmacists were involved throughout the TB care cascade, contributing their services in TB screening, referrals and in directly observed treatment-short course (DOTS) program. These interventions showed improvements in the effective control and prevention of further spread of TB, which improves individual, community and population level outcomes. CONCLUSIONS The inclusion of community pharmacists into TB program can improve the continuity of care, bridging the gaps in TB case detection and treatment monitoring. Adequate training and support are essential, to further empower the role of community pharmacists in TB control and prevention, in building a TB-free world.
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Al-Sahafi A, Al-Sayali MM, Mandoura N, Shah HB, Al Sharif K, Almohammadi EL, Abdul-Rashid OA, Assiri M, Buksh MF, Alali MM, Al-Garni A, Al-Garni F, Al-Zahrani A, Khalawi A, Alawi M, Moawwad AL, Almalki AI, Al-Osaimi MM. Treatment outcomes among tuberculosis patients in Jeddah, Saudi Arabia: Results of a community mobile outreach directly observed Treatment, Short-course (DOTS) project, compared to a standard facility-based DOTS: A randomized controlled trial. J Clin Tuberc Other Mycobact Dis 2021; 22:100210. [PMID: 33490640 PMCID: PMC7809390 DOI: 10.1016/j.jctube.2020.100210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Tuberculosis (TB) remains a global public health threat affecting people in many developing countries, including the Kingdom of Saudi Arabia. Maintaining a long-term treatment regimen has always been the cornerstone of successful treatment outcomes among tuberculosis patients. In the Jeddah region, the National Tuberculosis Control and Prevention Program is now treating TB patients by means of a community mobile outreach team approach.The objective of this study was to compare the effectiveness of the community mobile outreach approach in improving treatment outcomes (success rate) among local tuberculosis patients with those being treated with a facility-based directly observed treatment, short-course (DOTS). STUDY DESIGN Our study consisted of a two-sample, parallel design [1:1], statistician -blind randomized control trial with 200 newly diagnosed, TB patients as subjects. SETTING/PARTICIPANTS The patients had all presented at the Madain Alfahd Primary Health Care Center, Jeddah. Between Nov 2017 and Nov 2018, a total of 221 TB patients were screened of whom 200 were randomly selected using randomly generated sequences. INTERVENTION Patients in the intervention sample group were treated by means of mobile outreach teams with oral anti-TB treatment under the DOTS, and control group patients were given the traditional facility-based DOTS treatment according to the WHO recommendations and national guidelines. MAIN OUTCOME The primary outcome was the level of overall treatment success rate. It was finally determined and compared in the two sample groups using chi-square analysis and relative risk assessment. RESULTS In the analysis stage, 97 patients were in the intervention group, while the control group consisted of 76. The overall response rate was 86.5% (173/200). We found that the percentage of overall treatment success rate among the patients served by the mobile outreach team was 97%, compared to 76% in the non-mobile team treated patients. The relative risk of treatment success rate among the intervention group was 1.27 (95% CI = 1.13-1.43) times greater than that amongst the control group. Log-rank test (log-rank statistics = 18.91; p < 0.001) identified a significant difference in the default rate after six months of treatment. CONCLUSION This study has shown that a mobile outreach DOTS approach is an effective and acceptable strategy for treating TB patients. It also provides important data on the efficacy of using mobile outreach teams to improve TB treatment outcomes in Jeddah. Our results provide evidence and highlight the positive and significant impact of mobile outreach teams in mitigating TB recurrence rates and in improving TB treatment outcomes.Clinical Trial Registration: Clinicaltrials.gov: NCT03787914.
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Affiliation(s)
- Abdullah Al-Sahafi
- Ministry of Health, Directorate of Health Affairs for Public Health Division, Jeddah, Saudi Arabia
| | - Mashal M. Al-Sayali
- Ministry of Health, General Directorate of Health Affairs, Jeddah, Saudi Arabia
| | - Najlaa Mandoura
- Ministry of Health, Directorate of Health Affairs for Public Health Division, Jeddah, Saudi Arabia
| | - Hassan B.U. Shah
- Ministry of Health, Directorate of Health Affairs for Public Health Division, Jeddah, Saudi Arabia
- The Kirby Institute, UNSW, Sydney, Australia
| | - Khalid Al Sharif
- Ministry of Health, Directorate of Health Affairs for Public Health Division, Jeddah, Saudi Arabia
| | | | - Ola A. Abdul-Rashid
- Ministry of Health, Directorate of Health Affairs for Public Health Division, Jeddah, Saudi Arabia
| | - Muhammad Assiri
- Ministry of Health Infectious Disease Department, Jeddah, Saudi Arabia
| | - Mohammed F. Buksh
- Ministry of Health Infectious Disease Department, Jeddah, Saudi Arabia
| | - Mahmoud M. Alali
- Ministry of Health, General Directorate of Health Affairs, Jeddah, Saudi Arabia
| | - Abdullah Al-Garni
- Ministry of Health, Directorate of Health Affairs for Public Health Division, Jeddah, Saudi Arabia
| | - Fatima Al-Garni
- Ministry of Health, Directorate of Health Affairs for Public Health Division, Jeddah, Saudi Arabia
| | - Abdullah Al-Zahrani
- Ministry of Health, Directorate of Health Affairs for Public Health Division, Jeddah, Saudi Arabia
| | - Alaa Khalawi
- Ministry of Health Infectious Disease Department, Jeddah, Saudi Arabia
| | - Maha Alawi
- Department of Medical Microbiology and Parasitology King Abdulaziz University, Infection Control and Environment Health Unit King Abdulaziz University Hospital, Saudi Arabia
- National Tuberculosis Program, Ministry of Health Riyadh, Saudi Arabia
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Yadav S, Rawal G. The organizational challenges in the management of the revised national tuberculosis control program of India: an overview. Pan Afr Med J 2021; 36:213. [PMID: 32963679 PMCID: PMC7490127 DOI: 10.11604/pamj.2020.36.213.16501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 12/17/2019] [Indexed: 11/11/2022] Open
Abstract
The developing world is facing a serious problem of tuberculosis (TB) since ages. The condition is really profound in resource-constrained countries. The situation in some of the high TB burden countries is so grave that there are huge numbers of TB patients and deaths due to TB. TB control in most of the countries is done by the national TB control programs. In India, this is popularly known as the Revised National Tuberculosis Control Program (RNTCP). The RNTCP comes under the umbrella of the national health mission. The main components of RNTCP are directly observed treatment, short-course (DOTS) and DOTS-Plus. The effective and adequate implementation of the RNTCP is the most effective solution to control the ever growing cases of TB. The present situation, as detailed in the WHO global annual TB report, with ever-rising cases of various categories of TB is really scary and demands prompt attention. In this paper, the authors highlight the important issues related to the RNTCP in India. The main motto of writing this paper was to address the challenges associated with the organizational structure of the national TB control program of India and to suggest solutions for the same. The authors believe that these challenges could pose a serious threat to the efforts aimed at TB elimination from India. Besides, this paper will serve as a tool to modify and/or to formulate new guidelines for the betterment of the program. Also, the challenges detailed here are usually common in the other high TB burden countries of the world and this will help the program managers worldwide.
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Affiliation(s)
- Sankalp Yadav
- Department of Medicine and Tuberculosis, Chest Clinic Moti Nagar, New Delhi, India
| | - Gautam Rawal
- Department of Respiratory Intensive Care, Max Super Specialty Hospital, New Delhi, India
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Peresu E, Heunis JC, Kigozi NG, De Graeve D. Task-shifting directly observed treatment and multidrug-resistant tuberculosis injection administration to lay health workers: stakeholder perceptions in rural Eswatini. Hum Resour Health 2020; 18:97. [PMID: 33272307 PMCID: PMC7712623 DOI: 10.1186/s12960-020-00541-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/02/2019] [Accepted: 11/24/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Eswatini is facing a critical shortage of human resources for health (HRH) and limited access to multidrug-resistant tuberculosis (MDR-TB) treatment in rural areas. This study assessed multiple stakeholders' perceptions of task-shifting directly observed treatment (DOT) supervision and administration of intramuscular MDR-TB injections to lay health workers (LHWs). METHODS A mixed methods study comprising a cross-sectional survey using a semi-structured questionnaire with community treatment supporters (CTSs) and a focus group discussion with key stakeholders including representatives from the Eswatini Ministry of Health (MOH), donor organisations, professional regulatory institutions, nursing academia, civil society and healthcare providers was conducted in May 2017. Descriptive statistics, thematic content analysis and data triangulation aided in the interpretation of results. RESULTS A large majority of CTSs (n = 78; 95.1%) were female and 33 (40.2%) were older than 50 years. Most (n = 7; 70.0%) key stakeholders had over 10 years of work experience in policy-making, advocacy in the fields of HRH or day-to-day practice in MDR-TB management. Task-shifting of MDR-TB injection administration was implemented without national policy guidance and regulation. Stakeholders viewed the strategy to be driven by the prevailing shortage of professional frontline HRH and limited access to MDR-TB treatment. Task-shifting was perceived to improve medication adherence, and reduce stigma and transport-related MDR-TB treatment access barriers. Frontline healthcare workers and implementing donor partners fully supported task-shifting. Policy-makers and other stakeholders accepted task-shifting conditionally due to fears of poor standards of care related to perceived incompetence of CTSs. Appropriate compensation, adequate training and supervision, and non-financial incentives were suggested to retain CTSs. A holistic task-shifting policy and collaboration between the MOH, academia and nursing council in regulating the practice were recommended. CONCLUSIONS Stakeholders generally accepted the delegation of DOT supervision and administration of intramuscular MDR-TB injections to LHWs as a strategy to increase access to treatment, albeit with some apprehension. Findings from this study stress that task-shifting is not a panacea for HRH shortages, but a short-term solution that must form part of an overall simultaneous strategy to train, attract and retain adequate numbers of professional healthcare workers in Eswatini. To address some of the apprehension and ambivalence about expanding access to MDR-TB services through task-shifting, attention should be paid to important aspects such as competence-based training, certification and accreditation, adequate supportive on-the-job supervision, recognition, compensation, and expediting policy and regulatory support for LHWs.
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Affiliation(s)
- Ernest Peresu
- Centre for Development Support, Faculty of Economic and Management Sciences, University of the Free State, P.O. Box 399, Bloemfontein, 9300, South Africa.
| | - J Christo Heunis
- Centre for Health Systems Research & Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300, South Africa
| | - N Gladys Kigozi
- Centre for Health Systems Research & Development, University of the Free State, P.O. Box 399, Bloemfontein, 9300, South Africa
| | - Diana De Graeve
- Faculty of Business and Economics, University of Antwerp, Prinsstraat 13, 2000, Antwerp, Belgium
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Chen SH, Wang I, Hsu HL, Huang CC, Liu YJ, Putri DU, Lee CH. Advantage in privacy protection by using synchronous video observed treatment enhances treatment adherence among patients with latent tuberculosis infection. J Infect Public Health 2020; 13:1354-1359. [PMID: 32376234 DOI: 10.1016/j.jiph.2020.03.013] [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] [Received: 12/19/2019] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Treatment of latent tuberculosis infection (LTBI) is an important strategy for active disease prevention. Conventional in-person DOT (CDOT) programs are challenged by patient dissatisfaction over problems of convenience and privacy. The present study assessed satisfaction to DOT program and treatment adherence of synchronous video observed treatment (SVOT) programs from patients' perspectives. METHODS A two-part questionnaire was presented to 240 subjects with LTBI who received a 9-month isoniazid treatment regimen along with mandatory DOT monitoring during January 2014 to December 2017. RESULTS Satisfactions with location arrangement (p<0.001), ensuring treatment adherence (p=0.027), and privacy issues (p=0.005) were superior in the SVOT group. The overall rate of LTBI treatment completion was 91.25%. One (1.25%) and 20 (12.50%) of the participants in the SVOT and CDOT groups, respectively, quit LTBI treatment (p=0.008). Development of adverse events [adjusted hazard ratio, aHR 8.01 (3.42-18.79)], and the concern of privacy infringement [aHR 5.86 (2.69-12.76)] by the DOT program independently increase the risk of withdrawal. SVOT program [aHR 0.21 (0.06-0.68)] and a belief in the importance of adherence on treatment efficacy [aHR 0.29 (0.08-0.98)] were independent predictors preventing patients from withdrawing from treatment. CONCLUSIONS A comprehensive patient-centered DOT program enables high treatment adherence for the 9-month isoniazid LTBI treatment. Furthermore, SVOT was associated with superior patients' satisfactions which translate into higher treatment completion rates. As treatment adherence is the key to the efficacy of LTBI treatment, SVOT should be a reasonable supplement for LTBI treatment.
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Affiliation(s)
- Szu-Hsuan Chen
- Department of Health, Taipei City Government, Taipei 11008, Taiwan
| | - Irene Wang
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; Pulmonary Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Han-Lin Hsu
- Pulmonary Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan; School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Chi-Ching Huang
- Department of Health, Taipei City Government, Taipei 11008, Taiwan
| | - Yi-Jun Liu
- Pulmonary Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Denise Utami Putri
- Pulmonary Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Chih-Hsin Lee
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan; Pulmonary Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan.
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Lin CB, Sun HC, Chiang CY, Wu CW, Chou HW, Tang TQ, Lee JJ. Treatment outcomes for multidrug-resistant tuberculosis in Eastern Taiwan. Tzu Chi Med J 2019; 31:35-39. [PMID: 30692830 PMCID: PMC6334570 DOI: 10.4103/tcmj.tcmj_18_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives: The objective of this study is to evaluate the treatment outcomes of patients with multidrug-resistant tuberculosis (MDR-TB) under special programmatic management in Eastern Taiwan over the past 10 years. Materials and Methods: All newly diagnosed MDR-TB patients and MDR-TB patients enrolled previously with persistent positive cultures were included in this study, from May 2007 to April 2017, in Eastern Taiwan. A panel of pulmonologists designed the initial MDR-TB regimens. Subsequently, regimens were adjusted according to drug susceptibility test results for second-line drugs. Mobile teams were organized for treatment support, and several measures were adapted to safeguard effective treatment support. Results: A total of 178 patients with bacteriological confirmed pulmonary MDR-TB were identified, of whom 167 had treatment outcomes when the study was conducted. Of these 167 patients, 120 (71.9%) were cured, 11 (6.5%) completed therapy (78.4% had successful treatment), 25 (15.0%) died, 9 (5.4%) had treatment failure, none were transferred out, and 2 (1.2%) were lost to follow-up. Surgery was performed on 8 (4.8%). Conclusions: This is an analysis of the treatment outcomes after adopting the Directly Observed Treatment, Short-course Plus program to treat MDR-TB patients in Eastern Taiwan. We had a low proportion of loss-to-follow-up, resulting in a high treatment success rate. This program serves as an effective model in providing quality care to patients with MDR-TB.
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Affiliation(s)
- Chih-Bin Lin
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hung-Chieh Sun
- Department of Internal Medicine, Mennonite Christian Hospital, Hualien, Taiwan
| | - Chen-Yuan Chiang
- International Union Against Tuberculosis and Lung Disease, Paris, France.,Department of Internal Medicine, Wan Fang Hospital and School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Che-Wei Wu
- Department of Internal Medicine, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan
| | - Hsu-Wen Chou
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tao-Qian Tang
- Division of General Internal Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
| | - Jen-Jyh Lee
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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McLaughlin MM, Franke MF, Muñoz M, Nelson AK, Saldaña O, Cruz JS, Wong M, Zhang Z, Lecca L, Ticona E, Arevalo J, Sanchez E, Sebastián JL, Shin S. Community-Based Accompaniment with Supervised Antiretrovirals for HIV-Positive Adults in Peru: A Cluster-Randomized Trial. AIDS Behav 2018; 22:287-296. [PMID: 28074421 DOI: 10.1007/s10461-017-1680-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We conducted a cluster-randomized trial to estimate effects of directly observed combination antiretroviral therapy (DOT-cART) on retention with viral suppression among HIV-positive adults in Peru. We randomly allocated facilities to receive the 12-month intervention plus the standard of care, including adherence support provided through accompaniment. In the intervention arm, health workers supervised doses, twice daily, and accompanied patients to appointments. Among 356 patients, intention-to-treat analyses showed no statistically significant benefit of DOT, relative to no-DOT, at 12 or 24 months (adjusted probability of primary outcome: 0.81 vs. 0.73 and 0.76 vs. 0.68, respectively). A statistically significant benefit of DOT was found in per-protocol and as-treated analyses at 12 months (0.83 for DOT vs. 0.73 for no DOT, p value: 0.02 per-protocol, 0.01 as-treated), but not 24 months. Rates of retention with viral suppression were high in both arms. Among adults receiving robust adherence support, the added effect of time-limited DOT, if any, is small-to-moderate.
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Affiliation(s)
| | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.
| | | | - Adrianne K Nelson
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | | | | | | | - Zibiao Zhang
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Eduardo Ticona
- Peru Ministry of Health, Lima, Peru
- Universidad Nacional Mayor de San Marcos, Lima, Peru
| | | | | | | | - Sonya Shin
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
- Socios En Salud, Lima, Peru
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
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Mustafa MS, Rastogi V. Artemisinin-naphthoquine combination: A directly observed treatment option in malaria. Med J Armed Forces India 2017; 73:287-289. [PMID: 28790788 DOI: 10.1016/j.mjafi.2016.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/04/2015] [Accepted: 02/09/2016] [Indexed: 11/29/2022] Open
Abstract
Resistance to standard antimalarials has led to the need for newer options. Artemisinin-based combination therapies (ACTs), which require a tedious three-day treatment schedule, have been introduced for the treatment of drug-resistant malaria. Of late, the new generation artemisinin-naphthoquine (ANQ) combination has been developed, which requires a single dose treatment. Artemisinin initiates the action through the cleavage of the endoperoxide bridge while naphtoquine maintains the process by getting concentrated in the digestive vacuole of the parasite. One ANQ tablet contains 50 mg naphthoquine and 125 mg of artemisinin in the ratio of 1:2.5. The optimal dosage in adults is 400 mg of naphthoquine and 1000 mg artemisinin; which amounts to 8 tablets in a single dose. The dosage for children is adjusted based on the body-weight. The combination has been found to be quite effective with and safe. Studies have demonstrated an adequate clinical and parasitologic response of 98.1-100% in both adults and children. However, further trials are required to confirm its non-inferiority with other ACTs. Adverse reactions with ANQ have been mild. Further studies are needed before safety can be established during pregnancy. ANQ increases the compliance rates because of single dosage. It may be administered by the peripheral health workers as a directly observed therapy, which would be of special benefit to troops in the North-Eastern Sector.
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Affiliation(s)
- M S Mustafa
- Officer Commanding, Station Health Organisation (Large), Chennai 600032, India
| | - V Rastogi
- Brig IC Adm & Cdr Tps, Command Hospital (Southern Command), Pune 411040, India
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Ndwiga JM, Kikuvi G, Omolo JO. Factors influencing knowledge on completion of treatment among TB patients under directly observed treatment strategy, in selected health facilities in Embu County, Kenya. Pan Afr Med J 2016; 25:234. [PMID: 28293350 PMCID: PMC5337264 DOI: 10.11604/pamj.2016.25.234.8761] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 07/18/2016] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The World Health Organization (WHO) promotes the Directly Observed Treatment (DOT) strategy as the standard to increase adherence to Tuberculosis (TB) medication. However, cases of retreatment and Multi Drug Resistant continue to be reported in many parts of Kenya. This study sought to determine the factors influencing the completion of tuberculosis medication among TB patients in Embu County, Kenya. METHODS A descriptive cross-sectional study was conducted on a population of tuberculosis patients under DOT attending selected TB treatment clinics in Embu County, in Kenya. One hundred and forty TB patients interviewed within a period of 3 months. Data were analyzed using SPSS version 17.0 and included Bivariate and Multivariate Analysis. The level of significance was p≤ 0.05. RESULTS The male and female participants were 61.4% and 38.6% respectively. The mean age of the respondents was 35±31.34-39.3 years. For the majority (52%) of the participants, the highest level of education was primary education. The unemployed participants formed the highest number of the respondent in the study (73%). The majorities (91.4%0) of the respondents were under the home-based DOT strategy (91.4%, 95% C.I: 85.5-95.5). Bivariate analysis using Chi-square showed that the level of education (p=0.003), patients feeling uncomfortable during supervision (p=0.01), and knowledge regarding the frequency of taking medication (p=0.004) were all significantly associated with knowledge regarding the importance of completion of medication. However, none of these factors was significant after multivariate analysis. CONCLUSION Most participants did not know the importance of completion of medication. TB programs should come up with better ways to educate TB patients on the importance of supervision and treatment completion during the treatment of TB. The education programs should focus on influencing the attitudes of patients and creating awareness about the importance of treatment completion. The TB programs should be designed towards eliminating the factors influencing the completion of TB medication.
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Affiliation(s)
- Joshua Muriuki Ndwiga
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, P.O.BOX 62000-00200 Nairobi, Kenya
| | - Gideon Kikuvi
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, P.O.BOX 62000-00200 Nairobi, Kenya
| | - Jared Odhiambo Omolo
- Field Epidemiology and Laboratory Training Program, Ministry of Public Health and Sanitation Kenya P.O. Box 225-00202 Nairobi, Kenya
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Snyder RE, Marlow MA, Phuphanich ME, Riley LW, Maciel ELN. Risk factors for differential outcome following directly observed treatment (DOT) of slum and non-slum tuberculosis patients: a retrospective cohort study. BMC Infect Dis 2016; 16:494. [PMID: 27647383 PMCID: PMC5029075 DOI: 10.1186/s12879-016-1835-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/14/2016] [Indexed: 12/03/2022] Open
Abstract
Background Brazil’s National Tuberculosis Control Program seeks to improve tuberculosis (TB) treatment in vulnerable populations. Slum residents are more vulnerable to TB due to a variety of factors, including their overcrowded living conditions, substandard infrastructure, and limited access to healthcare compared to their non-slum dwelling counterparts. Directly observed treatment (DOT) has been suggested to improve TB treatment outcomes among vulnerable populations, but the program’s differential effectiveness among urban slum and non-slum residents is not known. Methods We retrospectively compared the impact of DOT on TB treatment outcome in residents of slum and non-slum census tracts in Rio de Janeiro reported to the Brazilian Notifiable Disease Database in 2010. Patient residential addresses were geocoded to census tracts from the 2010 Brazilian Census, which were identified as slum (aglomerados subnormais -AGSN) and non-slum (non-AGSN) by the Census Bureau. Homeless and incarcerated cases as well as those geocoded outside the city’s limits were excluded from analysis. Results In 2010, 6,601 TB cases were geocoded within Rio de Janeiro; 1,874 (27.4 %) were residents of AGSN, and 4,794 (72.6 %) did not reside in an AGSN area. DOT coverage among AGSN cases was 35.2 % (n = 638), while the coverage in non-AGSN cases was 26.2 % (n = 1,234). Clinical characteristics, treatment, follow-up, cure, death and abandonment were similar in both AGSN and non-AGSN TB patients. After adjusting for covariates, AGSN TB cases on DOT had 1.67 (95 % CI: 1.17, 2.4) times the risk of cure, 0.61 (95 % CI: 0.41, 0.90) times the risk of abandonment, and 0.1 (95 % CI: 0.01, 0.77) times the risk of death from TB compared to non-AGSN TB cases not on DOT. Conclusion While DOT coverage was low among TB cases in both AGSN and non-AGSN communities, it had a greater impact on TB cure rate in AGSN than in non-AGSN populations in the city of Rio de Janeiro.
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Affiliation(s)
- Robert E Snyder
- Division of Infectious Diseases and Vaccinology and Division of Epidemiology, School of Public Health, University of California, Berkeley, 94720, CA, USA
| | - Mariel A Marlow
- Division of Infectious Diseases and Vaccinology and Division of Epidemiology, School of Public Health, University of California, Berkeley, 94720, CA, USA
| | | | - Lee W Riley
- Division of Infectious Diseases and Vaccinology and Division of Epidemiology, School of Public Health, University of California, Berkeley, 94720, CA, USA
| | - Ethel Leonor Noia Maciel
- Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Avenida Marechal Campos, 1468 Maruípe, Vitória, ES, Brazil.
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Reddy Satti SB, Kondagunta N. Risk Factors for DOTS Treatment Default Among New HIV-TB Coinfected Patients in Nalgonda (Dist.) Telangana (State): A Case Control Study. Indian J Community Med 2016; 41:120-5. [PMID: 27051086 PMCID: PMC4799634 DOI: 10.4103/0970-0218.177529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 11/15/2022] Open
Abstract
Background: The therapeutic regimens as recommended by the Revised National TB Control Programme (RNTCP) have been shown to be highly effective for both preventing and treating tuberculosis, but poor adherence to medication is a major barrier to its global control. Aim and Objectives: The study was conducted to assess the influence of patient related factors for DOTS Treatment Default among HIV-TB Co-infected cases. Setting and Design: This was a case control study conducted in Nalgond, Telangana. Materials and Methods: All new HIV-TB coinfected and DOTS-defaulted patients registered under RNTCP for the period from January 2010 to December 2012 were selected. Of the 154 patients, 23 had died and 11 could not be traced, and these were excluded. Thus the total number of available cases were 120 for those age- and sex-matched controls (HIV-TB coinfected patients and those who had completed the DOTS regimen successfully) were selected. Results: The mean age was 36.5 ± 9 years; the majority (23.3%) of patients defaulted during the second month of treatment. Significant risk factors associated with defaulting included unskilled occupation [adjusted odds ratio (AOR: 3.56; 95% confidence interval (CI): 1.1-11.56], lower middle class socioeconomic status (AOR: 17.16; 95% CI: 3.93-74.82), small family size (AOR: 21.3; 95% CI: 6.4-70.91), marital disharmony (AOR: 6.78; 95% CI: 1.93-23.76), not being satisfied with the conduct of health personnel (AOR: 7.38; 95% CI: 2.32-23.39), smoking (AOR: 8.5; 95% CI: 2.31-31.21), and side effects of drugs (AOR: 4.18; 95% CI: 1.35-12.9). Conclusion: Unskilled occupation, marital disharmony, small family size, lower middle class socioeconomic status, not being satisfied with the conduct of health personnel, smoking, and drug side effects were significantly associated with defaulting. Information on the pattern of tuberculosis (TB), the outcome of anti-tuberculosis treatment (ATT), and the factors associated with it will help in planning interventions to improve adherence to DOTS treatment.
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Affiliation(s)
| | - Nagaraj Kondagunta
- Department of Community Medicine, Kamineni Institute of Medical Sciences, Nalgonda, Telangana, India
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Abstract
BACKGROUND Most important cause of treatment failure and emergence of drug resistance in the treatment of tuberculosis is noncompliance. Compliance can be improved by direct observation of drug intake, intermittent therapy, and short-course treatment. The efficacy of Directly Observed Treatment Short Course (DOTS) strategy advocated by World Health Organization (WHO) in spinal tuberculosis is not yet proven. We conducted a prospective clinical study on a consecutive series of patients with spinal tuberculosis treated by Category I Revised National Tuberculosis Control Programme (RNTCP) regimen based on DOTS strategy of WHO from 2004 to 2007 to evaluate the efficacy. MATERIALS AND METHODS Forty-nine consecutive patients of spinal tuberculosis were treated with short-course intermittent chemotherapy under Category I RNTCP/DOTS strategy. Patients were followed up for a minimum period of 2 years. Surgery was done if the patient presented with significant neurologic deficit or when the drug treatment failed. Outcome was assessed by clinical, radiologic, and laboratory criteria, and graded into excellent, good, fair, and poor based on various parameters. RESULTS 63.4% (n=26) of the patients had excellent results. 14.6% (n=6) of the patients had good and fair results. Three patients (7.3%) had poor results 48.7% (n=20) of the patients had but only one of them was severe enough to warrant change of drug. CONCLUSIONS Efficacy of DOTS was comparable with other standard regimens. There was a significant reduction in adverse side effects when compared with daily regimens. Study showed that the outcome was better in those treated early.
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Affiliation(s)
- Rejith Valsalan
- Department of Orthopaedics, Medical College, Calicut, Kerala, India,Address for correspondence: Dr. Rejith Valsalan, Sree Valsam P.O. Chalad, Kannur - 670 014, Kerala, India. E-mail:
| | | | - MK Raveendran
- Department of Orthopaedics, Medical College, Calicut, Kerala, India
| | - Balaji Zacharia
- Department of Orthopaedics, Medical College, Calicut, Kerala, India
| | - Sibin Surendran
- Department of Orthopaedics, Medical College, Calicut, Kerala, India
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Abstract
Antimycobacterial chemotherapy is the mainstay of treatment for the majority of patients with genitourinary tuberculosis (GUTB). A large body of evidence from clinical trials suggests that short-course chemotherapy regimens, employing four drugs including rifampicin and pyrazinamide, achieve cure in most of the patients with tuberculosis (TB) and are associated with the lowest rates of relapse. Standard six-month regimens are adequate for the treatment of GUTB. Directly observed treatment, short-course (DOTS) is the internationally recommended comprehensive strategy to control TB, and directly observed treatment is just one of its five elements. DOTS cures not only the individual with TB but also reduces the incidence of TB as well as the prevalence of primary drug-resistance in the community. Corticosteroids have no proven role in the management of patients with GUTB. Errors in prescribing anti-TB drugs are common in clinical practice. Standardized treatment regimens at correct doses and assured completion of treatment have made DOTS the present-day standard of care for the management of all forms of TB including GUTB.
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Affiliation(s)
- Tamilarasu Kadhiravan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi - 110 608, India
| | - Surendra K. Sharma
- Department of Medicine, All India Institute of Medical Sciences, New Delhi - 110 608, India
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