Facility-based directly observed therapy (DOT) for tuberculosis during COVID-19: A community perspective

Tuberculosis is a chronic infection, most often affecting the lungs, which usually manifests after a latency period from primary infection with Mycobacterium tuberculosis. Symptoms are generally nonspecific, with fever, cough, weight loss and malaise. The diagnosis is based on microscopic examination of sputum smear and rapid diagnostic molecular tests, which are increasingly used today. Genotypic tests for establishing the strain involved and phenotypic antibiograms for early detection of drug resistance should guide the initiation of treatment but are still expensive. Treatment of active tuberculosis is done with combination of antimycobacterial drugs, administered for at least 6 months. The antituberculosis treatment has several purposes: to cure the patient, to reduce the risk of recurrence, to prevent the installation of chemo-resistance, to prevent complications and to reduce mortality, as well as to limit the spread of the infection. Drug combinations are used to prevent the development of resistance. The administration is long-lasting in order to achieve the sterilization of foci that are difficult to access by medicines, ensuring healing and relapse prevention. Generally, standard pharmacological protocols are used. In order to increase the adherence to the treatment and its completion, often the anti-tuberculosis treatment is done under direct observation, in what is called directly observed therapy. Undesirable effects of anti-tuberculosis drugs should be detected early and managed appropriately. Recently, many cases of tuberculosis are resistant to the first-line drugs isoniazid and rifampicin (multidrug-resistant tuberculosis), or to these drugs, fluoroquinolones and at least one injectable antimycobacterial drugs (extensively drug-resistant tuberculosis). Especially the treatment of the latter is difficult to do, because there are not currently too many therapeutic options. That is why it is important to detect the resistance early and to establish the appropriate treatment. Treatment of latent tuberculosis usually involves the administration of isoniazid for 9 months. BCG vaccination is an active immunization method used in countries with high incidence of tuberculosis (Romania being the country of the European Union with the highest incidence of tuberculosis), protecting mainly against miliary tuberculosis, a spread form of tuberculosis, severe especially in children.

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Study of Truvada for HIV Pre Exposure Prophylaxis Using Daily Directly Observed Therapy to Look at Potential Interactions Between Truvada and Hormone Therapy

Case Medical Research ◽

10.31525/ct1-nct04050371 ◽

2019 ◽

Author(s):

Keyword(s):

Hormone Therapy ◽

Directly Observed Therapy ◽

Exposure Prophylaxis ◽

Potential Interactions

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Faculty Opinions recommendation of Prolonged infectiousness of tuberculosis patients in a directly observed therapy short-course program with standardized therapy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.4363956.4189054 ◽

2010 ◽

Author(s):

Willem J Wiersinga ◽

Gavin Koh

Keyword(s):

Directly Observed Therapy ◽

Tuberculosis Patients ◽

Short Course

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An Integrated Review of Directly Observed Therapy for Tuberculosis in Latin America

Hispanic Health Care International ◽

10.1891/1540-4153.13.1.46 ◽

2015 ◽

Vol 13 (1) ◽

pp. 46-54 ◽

Cited By ~ 1

Author(s):

Julie Ann Zuñiga

Keyword(s):

Latin America ◽

Directly Observed Therapy

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Determinants of self-management behaviors among pulmonary tuberculosis patients: a path analysis

Infectious Diseases of Poverty ◽

10.1186/s40249-021-00888-3 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Jin Li ◽

Jie Pu ◽

Jiaqing Liu ◽

Qingya Wang ◽

Rui Zhang ◽

...

Keyword(s):

Health Education ◽

Path Analysis ◽

Family Support ◽

Indirect Effects ◽

Pearson Correlation ◽

Self Management ◽

Directly Observed Therapy ◽

Enabling Factors ◽

Reinforcing Factors ◽

Study Sites

Abstract Background Tuberculosis (TB) is one of the top 10 causes of death in the world. Since Directly Observed Therapy (DOT) as a core strategy for the global TB control are not applicable to all types of TB patients, and self-management of TB patients (SMTP) as a patient-centered supervision type is a supplement to DOT and can improve TB case management. However, the factors related to SMTP are complex and need more study. This study aimed at identifying the determinants of SMTP and examining the direct/indirect effects of these determinants. Methods The purposive sampling technique was used to select study sites and participants were recruited from the study sites by the consecutive sampling method. The PRECEDE model was used as the framework to analyze the determinants of SMTP. The responses of TB patients were acquired via a questionnaire survey for data collection. A Pearson correlation analysis was used to define the relationship between the predisposing, enabling, reinforcing factors with SMTP behaviors. A regression-based path analysis was used to determine the action paths of the predisposing, enabling, and reinforcing factors on SMTP behaviors. Results The predisposing (TB knowledge), enabling [health education and healthcare workers (HCWs) support], reinforcing factors (family support) had significant positive correlations with SMTP behaviors (P < 0.05). The predisposing, enabling, reinforcing factors were positively correlated with each other (r = 0.123‒0.918, P < 0.05), except for family support and HCWs support. The predisposing factors (TB knowledge, β = 0.330) and the enabling factors (HCWs support, β = 0.437) had direct effects on SMTP behaviors. The enabling factors (health education and HCWs support) and the reinforcing factors (family support) had indirect effects on SMTP behaviors. Conclusions This study revealed the effects and action path of TB knowledge, health education, HCWs support, and family support on SMTP behaviors via a path analysis. Assessing patient’s needs for SMTP along with promoting effective TB health education and providing firm support from HCWs and family members are potential strategies to promote SMTP behaviors. Graphic abstract

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Prolonged Infectiousness of Tuberculosis Patients in a Directly Observed Therapy Short‐Course Program with Standardized Therapy

Clinical Infectious Diseases ◽

10.1086/655127 ◽

2010 ◽

Vol 51 (4) ◽

pp. 371-378 ◽

Cited By ~ 34

Author(s):

Sean P. Fitzwater ◽

Luz Caviedes ◽

Robert H. Gilman ◽

Jorge Coronel ◽

Doris LaChira ◽

...

Keyword(s):

Directly Observed Therapy ◽

Tuberculosis Patients ◽

Short Course

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1643. A scoping review of pediatric latent tuberculosis care cascades: Initial steps are lacking

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1823 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S811-S811

Author(s):

Jeffrey Campbell ◽

Thomas Sandora ◽

Jessica Haberer

Keyword(s):

Treatment Initiation ◽

Latent Tuberculosis ◽

Peer Counseling ◽

Treatment Recommendation ◽

Directly Observed Therapy ◽

Initial Test ◽

Improve Medication Adherence ◽

Care Cascade ◽

Published Evidence ◽

Facilitators And Barriers

Abstract Background Each year an estimated 1 million children develop and ~200,000 die from tuberculosis (TB). The WHO has named identification and treatment of latent tuberculosis infection (LTBI) one of the cornerstones of efforts to eliminate TB by 2030. Identification and treatment of pediatric LTBI requires completion of a complex care cascade. While attention has been given to LTBI care cascades in adults, to date there has been no attempt to map literature on the pediatric LTBI care cascade. Facilitators and barriers to retention in steps of the pediatric LTBI care cascade Methods We systematically searched PubMed, CINAHL, Cochrane and Embase databases for papers and abstracts describing screening, diagnosis, and treatment of pediatric LTBI. We categorized literature using seven step-offs in the pediatric LTBI care cascade, extrapolated from prior studies focused on adults: 1) intention to screen to initial test, 2) initial test to receipt of results, 3) receipt to referral for evaluation, 4) referral to completion of evaluation, 5) completion to treatment recommendation, 6) recommendation to treatment acceptance/initiation, and 7) initiation to treatment completion. Our aim was to assess factors that facilitated and inhibited completion of each cascade step, and to identify knowledge gaps in this literature. Results We identified 137 studies that met inclusion criteria. Most studies described multiple step-offs in the care cascade, although the focus of most (120/137 studies) was on initiation and completion of LTBI therapy (the final step in the care cascade). Several effective strategies to improve medication adherence were described, including selective use of nursing visits, directly observed therapy, shorter treatment regimens, and peer counseling. Reports of facilitators and barriers for retention in upstream step-offs in the cascade were scarce, revealing a lack of published evidence for how to retain children from pre-screening to treatment initiation (Table). Conclusion While existing literature describes LTBI treatment initiation and completion in children, our analysis reveals a lack of data guiding retention of children from LTBI screening through treatment initiation. This review highlights the need to further understand early steps of the care cascade, in order to help alleviate the burden of TB in children. Disclosures Jessica Haberer, MD, MS, Merck (Consultant)

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Adherence to Direct-Acting Antiviral Therapy in People Actively Using Drugs and Alcohol: The INCLUD Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa564 ◽

2020 ◽

Author(s):

Kristina M Brooks ◽

Jose R Castillo-Mancilla ◽

Mary Morrow ◽

Samantha MaWhinney ◽

Sarah E Rowan ◽

...

Keyword(s):

Drug Use ◽

Linear Models ◽

Virologic Response ◽

Directly Observed Therapy ◽

Hcv Treatment ◽

Open Label ◽

Direct Acting Antiviral ◽

Intention To Treat ◽

Adherence Data ◽

Direct Acting

Abstract Background HCV treatment in persons who use drugs (PWUD) is often withheld due to adherence and reinfection concerns. Here, we report treatment outcomes, technology-based adherence data, and adherence predictors in PWUD and/or alcohol. Methods INCLUD was a prospective, open-label study of ledipasvir/sofosbuvir for 12 weeks in PWUD aged 18-70 years. Participants were randomized to wireless (WOT, Wisepill®) or video-based directly observed therapy (vDOT, Emocha®). Drug use was assessed every 2 weeks. Sustained virologic response (SVR) was examined by intention-to-treat and as-treated. Factors associated with missing ≥1 dose(s) between visits were examined using generalized linear models. Results Sixty participants received ≥1 ledipasvir/sofosbuvir dose (47 HIV/HCV, 13 HCV only; 78% male; 22% Black; 25% cirrhotic). Substance use occurred at 94% of person-visits: 60% marijuana, 56% alcohol, 37% methamphetamine, 22% opioids, 17% cocaine, and 20% injection drug use. SVR by intention-to-treat was 86.7% (52/60) and as-treated was 94.5% (52/55). Confirmed failures included 1 relapse, 1 reinfection, and 1 unknown (suspected reinfection). Median (IQR [range]) total adherence was 96% (85-100% [30-101%]) and between-visit adherence was 100% (86-100% [0-107%]). Odds [95% CI] of missing ≥1 dose between visits increased with HIV coinfection (2.94 [1.37, 6.32], p=0.006), Black race (4.09 [1.42, 11.74], p=0.009), methamphetamine use (2.51 [1.44, 4.37], p=0.0.001) and cocaine use (2.12 [1.08, 4.18], p=0.03), and decreased with marijuana use (0.34 [0.17, 0.70], p=0.003) and vDOT (0.43 [0.21, 0.87], p=0.02). Conclusions PWUD achieved high SVR rates with high, but variable, ledipasvir/sofosbuvir adherence using technology-based methods. These findings support efforts to expand HCV treatment in PWUD.

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