scholarly journals Using patient–centered approach for improving adherence to treatment in DS/DR–TB patients in Ukraine

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Geliukh ◽  
V Tabunshchyk ◽  
N Kamenska ◽  
Z Islam
Keyword(s):  
Treatment Outcomes ◽  
Successful Treatment ◽  
Cohort Analysis ◽  
Scale Up ◽  
Adherence To Treatment ◽  
Patient Centered ◽  
Number Of Patients ◽  
Mdr Tb ◽  
Lost To Follow Up

Abstract Issue/problem Ukraine is among 30 high MDR-TB burden countries with about 6500 laboratory confirmed MDR-TB cases annually. Ukraine provides full coverage for first- and second-line TB drugs from the state budget. Nevertheless, successful treatment outcomes are one of the lowest in EECA region - 49% in MDR/RR-TB cases and 37% in XDR-TB. High rates of lost to follow-up (15.8%), treatment failed (18%) and died (15.9%) among MDR-TB cases contribute to unsuccessful treatment outcomes. Description of the problem A new intervention was introduced aimed at improving patients' adherence to treatment. Medical-psycho-social services (MPSS) provision based on patient-centered approach is provided to all patients. In 2018, project funded by GFATM was launched in 8 oblasts of Ukraine. All patients are assessed on treatment adherence before discharge from hospitals. Those with low adherence are referred to NGOs. MPSS starts from the patient's needs assessment followed by development of individual plan of support. MPSS is provided during the whole period of outpatient treatment and may include DOT/VOT, social workers' permanent support, food kits, psychologist counselling, transport and/or cell reimbursement, housing, documents restore, legal services and other services as per patients' needs. Electronic depersonalized database SyrEx is used for the project related notes. Results Total amount of TB/DR-TB patients treated in 2018-2019 is 8640 and 4246 accordingly. Cohort analysis is used for treatment outcomes assessment. Intervention allowed reducing the number of patients lost to follow up in DS/DR-TB (to 1.2% and 2.5% accordingly), treatment failed (to 5.4% and 10.9%) and number of died (to 2.1% and 3.2%) Lessons MPSS based on patient-centered approach improved successful treatment outcomes: to 91% in DS-TB patients and 82.3% in DR-TB. Further initiative scale-up is required as well as transition of MPSS services from donor funding to domestic.

scholarly journals High rates of culture conversion and low loss to follow-up in MDR-TB patients managed at Regional Referral Hospitals in Uganda

2019 ◽  
Author(s):  
Martin Kayitale Mbonye ◽  
John-Paul Otuba ◽  
Sara Riese ◽  
Hilary Alima ◽  
Frank Mugabe ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Initiation ◽  
Scale Up ◽  
Health Concern ◽  
Cross Sectional ◽  
Tb Treatment ◽  
Referral Hospitals ◽  
Mdr Tb ◽  
Lost To Follow Up

Abstract Background: Multi-drug resistant – tuberculosis (MDR-TB) is an emerging public health concern in Uganda. Prior to 2013, MDR-TB treatment in Uganda was only provided at the national referral hospital and two private-not-for profit clinics. From 2013, it was scaled up to seven regional referral hospitals (RRH). The aim of this study was to measure interim (six months) treatment outcomes among the first cohort of patients started on MDR-TB treatment at the RRH in Uganda. Methods: This was a cross-sectional study in which a retrospective descriptive analysis of data on a cohort of 69 patients started on MDR-TB treatment at 7 RRH between 1st April 2013 and 30th June 2014 and had been on treatment for at least nine months was conducted. Results: Of the 69 patients, 21 (30.4%) were female, 39 (56.5%) HIV-negative, 30 (43.5%) resistant to both isoniazid and rifampicin and 57 (82.6%) category 1 or 2 drug susceptible TB treatment failures. Median age at start of treatment was 35 years (Interquartile range (IQR): 27-45), median time-to-treatment initiation was 27.5 (IQR:6-89) days and of the 30 HIV-positive patients, 27 (90.0%) were on anti-retroviral treatment with a median CD4 count of 206 cells/microliter of blood (IQR: 113-364.5). Within six months of treatment, 59 (86.0%) patients culture converted, of which 45 (65.2%) converted by the second month and the other 14 (20.3%) by the sixth month; one (1.5%) did not culture convert; three (4.4%) died; and six (8.8%) were lost-to-follow up. Fifty (76.8%) patients experienced at least one drug adverse event, while 40 (67.8%) gained weight. Mean weight gained was 4.7 (standard deviation:3.2) kilograms. Conclusions: Despite MDR-TB treatment initiation delays, most patients had favourable interim treatment outcomes with majority culture converting early and very few getting lost to follow-up. These encouraging interim outcomes indicate a successful scale-up of MDR-TB treatment to RRH.

scholarly journals High rates of culture conversion and low loss to follow-up in MDR-TB patients managed at Regional Referral Hospitals in Uganda

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mbonye Kayitale Martin ◽  
Otuba John Paul ◽  
Riese Sara ◽  
Alima Hilary ◽  
Mugabe Frank ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Initiation ◽  
Scale Up ◽  
Health Concern ◽  
Cross Sectional ◽  
Tb Treatment ◽  
Referral Hospitals ◽  
Mdr Tb ◽  
Lost To Follow Up

Abstract Background Multi-drug resistant—tuberculosis (MDR-TB) is an emerging public health concern in Uganda. Prior to 2013, MDR-TB treatment in Uganda was only provided at the national referral hospital and two private-not-for profit clinics. From 2013, it was scaled up to seven regional referral hospitals (RRH). The aim of this study was to measure interim (6 months) treatment outcomes among the first cohort of patients started on MDR-TB treatment at the RRH in Uganda. Methods This was a cross-sectional study in which a descriptive analysis of data collected retrospectively on a cohort of 69 patients started on MDR-TB treatment at six of the seven RRH between 1st April 2013 and 30th June 2014 and had been on treatment for at least 9 months was conducted. Results Of the 69 patients, 21 (30.4%) were female, 39 (56.5%) HIV-negative, 30 (43.5%) resistant to both isoniazid and rifampicin and 57 (82.6%) category 1 or 2 drug susceptible TB treatment failures. Median age at start of treatment was 35 years (Interquartile range (IQR): 27–45), median time-to-treatment initiation was 27.5 (IQR: 6–89) days and of the 30 HIV-positive patients, 27 (90.0%) were on anti-retroviral treatment with a median CD4 count of 206 cells/microliter of blood (IQR: 113–364.5). Within 6 months of treatment, 59 (85.5%) patients culture converted, of which 45 (65.2%) converted by the second month and the other 14 (20.3%) by the sixth month; one (1.5%) did not culture convert; three (4.4%) died; and six (8.8%) were lost-to-follow up. Fifty (76.8%) patients experienced at least one drug adverse event, while 40 (67.8%) gained weight. Mean weight gained was 4.7 (standard deviation: 3.2) kilograms. Conclusions Despite MDR-TB treatment initiation delays, most patients had favourable interim treatment outcomes with majority culture converting early and very few getting lost to follow-up. These encouraging interim outcomes indicate the potential for success of a scale-up of MDR-TB treatment to RRH.

scholarly journals Childhood TB in Myanmar: trends in notification, profile and treatment outcomes in the private sector

2019 ◽  
Vol 9 (4) ◽  
pp. 135-141
Author(s):  
S. K. Thein ◽  
S. Satyanarayana ◽  
K. W. Y. Kyaw ◽  
S. Saw ◽  
T. N. Maung ◽  
...  
Keyword(s):  
Private Sector ◽  
Treatment Outcomes ◽  
Successful Treatment ◽  
Treatment Rate ◽  
National Tuberculosis ◽  
Childhood Tb ◽  
Public Private Mix ◽  
Lost To Follow Up ◽  
Annual Decline

Setting: Myanmar National Tuberculosis (TB) programme (NTP).Objective: To describe 1) the trends in childhood TB (aged 14 years) notification from 2014 to 2017 and quantify the private sector contribution to this notification; and 2) the profile and treatment outcomes of childhood TB managed in the private sector in 2016.Study design: This was an observational study involving the review of routine records and reports of the NTP public-private mix (PPM) projects managed by the Myanmar Medical Association and Population Service International.Results: The total number of childhood TB notified has declined from 36 314 in 2014 to 28 723 in 2017 (average annual decline = 2607 cases per year). The private sector contribution to the notification remained between 17% and 19%. Of the 5616 childhood TB cases diagnosed and treated under the two PPM projects in 2016, 99% were clinically diagnosed and 5459 (97.7%) had successful treatment outcomes. Children aged 10 years, males, those with bacteriologically confirmed TB, those treated in the regions or states of Mandalay, Chin and Shan had a higher risk of an unfavourable outcome (lost to follow-up, death, move to second-line treatment and not evaluated).Conclusion: Childhood TB notification is showing a declining trend. One of five notified childhood TB cases was diagnosed and treated in the private sector, where the successful treatment rate was high.

scholarly journals Adverse treatment outcomes in multidrug resistant tuberculosis go beyond the microbe-drug interaction: Results of a multiple correspondence analysis.

Biomédica ◽  
2020 ◽  
Vol 40 (4) ◽  
pp. 616-625
Author(s):  
Ángela Tobón ◽  
Johana Rueda ◽  
Diego H. Cáceres ◽  
Gloria I. Mejía ◽  
Elsa M. Zapata ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Multidrug Resistant ◽  
Chronic Obstructive ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Poor Outcomes ◽  
Lost To Follow Up

Introduction: Multidrug-resistant tuberculosis treatment is effective in 50% of patients due to several factors including antibiotic susceptibility of the microorganism, adverse treatment reactions, social factors, and associated comorbidities.Objectives: In this study, we describe the demographics, clinical characteristics, and factors associated with treatment outcomes in multidrug-resistant tuberculosis (MDR-TB) patients in Medellín, Colombia.Materials and methods: We conducted a retrospective analysis using data from patients diagnosed with MDR-TB attending Hospital La María in Medellín, Colombia, for treatment between 2010 and 2015. Patients were categorized as having successful (cured) or poor (failure, lost to follow-up, and death) treatment outcomes. Associations between demographic, clinical factors, laboratory results, treatment outcomes, and follow-up information were evaluated by univariate, multivariate, and multiple correspondence analyses.Results: Of the 128 patients with MDR-TB, 77 (60%) had successful outcomes. Of those with poor outcomes, 26 were lost to follow-up, 15 died, and 10 were treatment failures. Irregular treatment, the presence of comorbidities, and positive cultures after more than two months of treatment were associated with poor outcomes compared to successful ones (p<0.05 for all). The multiple correspondence analyses grouped patients who were lost to follow-up, had HIV, and drug addiction, as well as patients with treatment failure, irregular treatment, and chronic obstructive pulmonary disease.Conclusion: The recognition of factors affecting treatment is essential and was associated with treatment outcomes in this series of patients. Early identification of these factors should increase the rates of treatment success and contribute to MDR-TB control.

scholarly journals Do catastrophic costs impact treatment outcomes in people with rifampicin-resistant tuberculosis in the Republic of Moldova?

2021 ◽  
Vol 91 (1) ◽  
Author(s):  
Valeriu Plesca ◽  
Ana Ciobanu ◽  
Yuliia Sereda ◽  
Andrei Dadu
Keyword(s):  
Treatment Outcome ◽  
Treatment Outcomes ◽  
Outcome Variable ◽  
Republic Of Moldova ◽  
Tb Treatment ◽  
The World ◽  
Mdr Tb ◽  
The Republic ◽  
Lost To Follow Up

The Republic of Moldova is among the 30 Rifampicin-Resistant and/or Multidrug-Resistant (RR/MDR) Tuberculosis (TB) high burden countries in the world. Despite free TB diagnostics and treatment, TB patients face substantial economic losses and this may impact overall treatment outcomes. We assessed if there is an association between TB-related catastrophic costs and TB treatment outcomes. We conducted a cohort study using data from patient records and a survey that quantified catastrophic costs among RR/MDR-TB affected households in the Republic of Moldova in 2016. We included adult patients (age ≥18 years) with RR/MDR-TB who had been in inpatient (intensive phase) or outpatient (continuous phase) treatment for at least 2 months. Unfavourable treatment outcome, such as failure, death or lost to follow-up, was the primary outcome variable. The definition of catastrophic TB-related costs followed the World Health Organisation (WHO) guidelines: costs due to TB ≥20% of annual household income. Log-binomial regression was used to assess association between the outcome and catastrophic TB-related costs adjusting for other socio-demographic, behavioural and clinical covariates.  In total 287 RR/MDR-TB patients (78% males, mean age 42 years) were included. Of them, 30% experienced catastrophic TB-related costs. Overall, one in five patients (21%) had unfavourable treatment outcome, such as treatment failure (5%), death (8%) or lost to follow-up (8%). The experience of catastrophic TB-related costs was not associated with unfavourable treatment outcome [adjusted relative risk (aRR)=0.88, 95% CI: 0.50–1.50]. Major factors independently associated with unfavourable TB treatment outcomes were poverty (aRR=2.07; 95% CI: 1.06-4.07), urban residence (aRR=1.99; 95% CI: 1.12-3.52) and positive HIV (Human Immunodeficiency Virus) status (aRR=2.61; 95% CI: 1.31-4.89). As a result, we failed to find an association between catastrophic costs and treatment outcomes of RR/MDR-TB patients in the Republic of Moldova. However, we found that patients from poor households and urban areas were twice more likely to achieve unfavourable TB treatment outcomes disregarding whether they experienced catastrophic costs or not. Also, TB/HIV patients and urban residents were identified as the most vulnerable groups with higher risk of unfavourable treatment outcome and TB-related costs.

scholarly journals High rate of successful treatment outcomes among childhood rifampicin/multidrug-resistant tuberculosis in Pakistan: a multicentre retrospective observational analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Farah Naz ◽  
Nafees Ahmad ◽  
Abdul Wahid ◽  
Izaz Ahmad ◽  
Asad Khan ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Treatment Outcomes ◽  
Successful Treatment ◽  
Multidrug Resistant ◽  
P Value ◽  
Factors Associated ◽  
Tb Treatment ◽  
Mdr Tb ◽  
History Of

Abstract Background There was a complete lack of information about the treatment outcomes of rifampicin/multidrug resistant (RR/MDR) childhood TB patients (age ≤ 14 years) from Pakistan, an MDR-TB 5th high burden country. Therefore, this study evaluated the socio-demographic characteristics, drug resistance pattern, treatment outcomes and factors associated with unsuccessful outcomes among childhood RR/MDR-TB patients in Pakistan. Methods This was a multicentre retrospective record review of all microbiologically confirmed childhood RR/MDR-TB patients (age ≤ 14 years) enrolled for treatment at seven units of programmatic management of drug-resistant TB (PMDT) in Pakistan. The baseline and follow-up information of enrolled participants from treatment initiation until the end of treatment were retrieved from electronic nominal recording and reporting system. World Health Organization (WHO) defined criterion was used for deciding treatment outcomes. The outcomes of “cured” and “treatment completed” were collectively grouped as successful, whereas “death”, “treatment failure” and “lost to follow-up” were grouped together as unsuccessful outcomes. Multivariable binary logistic regression analysis was used to find factors associated with unsuccessful outcomes. A p-value < 0.05 reflected statistically significant findings. Results A total of 213 children RR/MDR-TB (84 RR and 129 MDR-TB) were included in the study. Majority of them were females (74%), belonged to the age group 10–14 years (82.2%) and suffered from pulmonary TB (85.9%). A notable proportion (37.1%) of patients had no history of previous TB treatment. Patients were resistant to a median of two drugs (interquartile range: 1–4) and 23% were resistant to any second line anti-TB drug. A total of 174 (81.7%) patients achieved successful treatment outcomes with 144 (67.6%) patients being cured and 30 (14.1%) declared treatment completed. Among the 39 (18.3%) patients with unsuccessful outcomes, 35 (16.4%) died and 4 (1.9%) experienced treatment failure. In multivariable analysis, the use of ethambutol had statistically significant negative association with unsuccessful outcomes (odds ratio = 0.36, p-value = 0.02). Conclusions In this study, the WHO target of successful treatment outcomes (≥ 75%) among childhood RR/MDR-TB patients was achieved. The notable proportion of patients with no history of previous TB treatment (37.1%) and the disproportionately high number of female patients (74%) respectively stress for infection control measures and provision of early and high quality care for female drug susceptible TB patients.

scholarly journals Find and treat or find and lose? Tuberculosis treatment outcomes among screened newly arrived asylum seekers in Germany 2002 to 2014

2018 ◽  
Vol 23 (11) ◽  
Author(s):  
Anna Kuehne ◽  
Barbara Hauer ◽  
Bonita Brodhun ◽  
Walter Haas ◽  
Lena Fiebig
Keyword(s):  
Treatment Outcome ◽  
Treatment Outcomes ◽  
Successful Treatment ◽  
Asylum Seekers ◽  
Treatment Success ◽  
Case Finding ◽  
Contact Tracing ◽  
Successful Treatment Outcome ◽  
Lost To Follow Up

Background Germany has a low tuberculosis (TB) incidence. A relevant and increasing proportion of TB cases is diagnosed among asylum seekers upon screening. Aim: We aimed to assess whether cases identified by screening asylum seekers had equally successful and completely reported treatment outcomes as cases diagnosed by passive case finding and contact tracing in the general population. Methods: We analysed characteristics and treatment outcomes of pulmonary TB cases notified in Germany between 2002 and 2014, stratified by mode of case finding. We performed three multivariable analyses with different dependent variables: Model A: successful vs all other outcomes, Model B: successful vs documented non-successful clinical outcome and Model C: known outcome vs lost to follow-up. Results: TB treatment success was highest among cases identified by contact tracing (87%; 3,139/3,591), followed by passive case finding (74%; 28,804/39,019) and by screening asylum seekers (60%; 884/1,474). Cases identified by screening asylum seekers had 2.4 times higher odds of not having a successful treatment outcome as opposed to all other outcomes (A), 1.4 times higher odds of not having a successful treatment outcome as opposed to known non-successful outcomes (B) and 2.3 times higher odds of loss to follow-up (C) than cases identified by passive case finding. Conclusion: Screened asylum seekers had poorer treatment outcomes and were more often lost to follow-up. Linking patients to treatment facilities and investigating potential barriers to treatment completion are needed to secure screening benefits for asylum seekers and communities.

scholarly journals High rates of culture conversion and low loss to follow-up in MDR-TB patients managed at Regional Referral Hospitals in Uganda

2019 ◽  
Author(s):  
Martin Kayitale Mbonye ◽  
John-Paul Otuba ◽  
Sara Riese ◽  
Hilary Alima ◽  
Frank Mugabe ◽  
...  
Keyword(s):  
Treatment Initiation ◽  
Descriptive Analysis ◽  
Scale Up ◽  
Health Concern ◽  
Tb Treatment ◽  
Referral Hospitals ◽  
Mdr Tb ◽  
Lost To Follow Up ◽  
Hiv Negative

Abstract Background: Multi-drug resistant – tuberculosis (MDR-TB) is an emerging public health concern in Uganda, with only just over 200 new cases notified by 2014. Prior to 2013, MDR-TB treatment in Uganda was only being provided at the national referral hospital and two private-not-for profit clinics. From 2013, MDR-TB treatment was scaled up to seven regional referral hospitals (RRH). We analyzed data on the first cohort of patients started on MDR-TB treatment at the seven RRH. Methods: This study was a retrospective descriptive analysis of data collected on a cohort of 69 patients started on MDR-TB treatment at 7 RRHs between 1st April 2013 and 30th June 2014. Results: Of the 69 patients, 21 (30.4%) were female and 39 (56.5%) were HIV-negative. Thirty (43.5%) were resistant to both isoniazid and rifampicin and 57 (82.6%) were category 1 or 2 failures. Median age at the start of MDR-TB treatment was 35 years (SD 13.5), mean time-to-treatment initiation was 96.1 days and out of the 30 HIV-positive patients, 27 (90.0%) were on anti-retroviral treatment with a mean CD4 count of 258. Within six months of treatment, 59 (86.0%) patients’ culture converted, of which 45 (65.2%) converted by the second month and 14 (20.3%) by the sixth month, one (1.5%) did not culture convert, three (4.4%) died and six (8.8%) were lost-to-follow up. Thirty-two (46.4%) patients experienced at least one severe drug adverse event, while 40 (67.8%) gained weight (mean 4.7 kilograms). Conclusions: Despite MDR-TB treatment initiation delays, most patients culture converted early, while few were lost to follow-up. These interim outcomes indicate a successful scale-up of MDR-TB treatment at RRH. Reasons for the high proportion of HIV-negative patients on MDR-TB treatment should be investigated.

Status and Determinants of Treatment Outcomes Among New Tuberculosis Patients in South Korea: A Retrospective Cohort Study

2021 ◽  
pp. 101053952110005
Author(s):  
Hyunjin Son ◽  
Jeongha Mok ◽  
Miyoung Lee ◽  
Wonseo Park ◽  
Seungjin Kim ◽  
...  
Keyword(s):  
Cohort Study ◽  
South Korea ◽  
Success Rate ◽  
Treatment Outcomes ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Care Facilities ◽  
Tuberculosis Patients ◽  
Lost To Follow Up

This is a retrospective cohort study using notification data in South Korea. We evaluated the nationwide status, regional differences, and the determinants of treatment outcomes among tuberculosis patients. Treatment success rate improved from 77.0% in 2012 to 86.0% in 2015. The lost to follow-up rate was higher among older people, males, and foreign nationals. Health care facilities designated for the Public-Private Mix (PPM) project showed higher success rate and lower rate of lost to follow-up. Moreover, municipalities with low regional deprivation index had higher PPM project coverage. Since there is a large regional difference in the coverage of the PPM project, an additional community-based support program should be implemented, especially for tuberculosis patients residing in region with low PPM project coverage.

scholarly journals Trends, Characteristics and Treatment Outcomes of Patients with Drug-Resistant Tuberculosis in Uzbekistan: 2013–2018

2021 ◽  
Vol 18 (9) ◽  
pp. 4663
Author(s):  
Khasan Safaev ◽  
Nargiza Parpieva ◽  
Irina Liverko ◽  
Sharofiddin Yuldashev ◽  
Kostyantyn Dumchev ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Outcomes ◽  
Treatment Success ◽  
National Level ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Loss To Follow Up ◽  
Resistant Tuberculosis ◽  
Mdr Tb

Uzbekistan has a high burden of drug-resistant tuberculosis (TB). Although conventional treatment for multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) has been available since 2013, there has been no systematic documentation about its use and effectiveness. We therefore documented at national level the trends, characteristics, and outcomes of patients with drug-resistant TB enrolled for treatment from 2013–2018 and assessed risk factors for unfavorable treatment outcomes (death, failure, loss to follow-up, treatment continuation, change to XDR-TB regimen) in patients treated in Tashkent city from 2016–2017. This was a cohort study using secondary aggregate and individual patient data. Between 2013 and 2018, MDR-TB numbers were stable between 2347 and 2653 per annum, while XDR-TB numbers increased from 33 to 433 per annum. At national level, treatment success (cured and treatment completed) for MDR-TB decreased annually from 63% to 57%, while treatment success for XDR-TB increased annually from 24% to 57%. On multivariable analysis, risk factors for unfavorable outcomes, death, and loss to follow-up in drug-resistant TB patients treated in Tashkent city included XDR-TB, male sex, increasing age, previous TB treatment, alcohol abuse, and associated comorbidities (cardiovascular and liver disease, diabetes, and HIV/AIDS). Reasons for these findings and programmatic implications are discussed.

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