scholarly journals Comparison of first-line tuberculosis treatment outcomes between previously treated and new patients: a retrospective study in Machakos subcounty, Kenya

2020 ◽  
Author(s):  
Johannes Ndambuki ◽  
Joseph Nzomo ◽  
Lucy Muregi ◽  
Chris Mutuku ◽  
Francis Makokha ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Treatment Outcomes ◽  
Adverse Outcome ◽  
Previous Treatment ◽  
First Line ◽  
Adherence Support ◽  
Previously Treated Patients ◽  
Previously Treated ◽  
Lost To Follow Up

Abstract Background Since 2016, patients with rifampicin-susceptible tuberculosis (TB) have been treated with the 6-month first-line regimen, regardless of treatment history. We assessed treatment outcomes of previously treated and new patients in Machakos subcounty, Kenya. Methods We performed a retrospective cohort study in patients started on first-line treatment between 2016 and 2017. Firth's logistic regression was used to estimate the effect of previous treatment on having a programmatic adverse outcome (either lost to follow-up, death, failure) and treatment failure vs treatment success (either cure or completion). Results Of 1024 new and 79 previously treated patients, 88.1% and 74.7% were treated successfully, 6.5% and 7.6% died, 4.2% and 10.1% were lost to follow-up and 1.2% and 7.6% had treatment failure, respectively. Previous treatment predicted having a programmatic adverse outcome (adjusted odds ratio [aOR] 2.4 [95% confidence interval {CI} 1.4 to 4.2]) and treatment failure (aOR 7.3 [95% CI 2.6 to 20.4]) but not mortality. Similar correlations were found in 334 new and previously treated patients with confirmed baseline rifampicin susceptibility. Conclusion Previously treated patients were more at risk of experiencing a poor treatment outcome, mainly lost to follow-up and treatment failure. Adherence support may reduce lost to follow-up. Rifampicin drug susceptibility testing coverage should increase. More robust retreatment regimens may reduce treatment failure.

scholarly journals Determinants of first line antiretroviral therapy treatment failure among adult patients on ART at central Ethiopia: un-matched case control study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Diriba Mulisa ◽  
Mulugeta Tesfa ◽  
Getachew Mullu Kassa ◽  
Tadesse Tolossa
Keyword(s):  
Logistic Regression ◽  
Treatment Failure ◽  
Case Control Study ◽  
Case Control ◽  
First Line ◽  
Matched Case ◽  
Lost To Follow Up ◽  
Matched Case Control Study ◽  
Control Study

Abstract Background In 2018 in Ethiopia, magnitude of human immunodeficiency virus Acquired Immunodeficiency Syndrome treatment failure was 15.9% and currently the number of patient receiving second line antiretroviral therapy (ART) is more increasing than those taking first line ART. Little is known about the predictors of treatment failure in the study area. Therefore; more factors that can be risk for first line ART failure have to identified to make the patients stay on first line ART for long times. Consequently, the aim of this study was to identify determinants of first line ART treatment failure among patients on ART at St. Luke referral hospital and Tulubolo General Hospital, 2019. Methods A 1:2 un-matched case-control study was conducted among adult patients on active follow up. One new group variables was formed as group 1 for cases and group 0 for controls and then data was entered in to Epi data version 3 and exported to STATA SE version 14 for analysis. From binary logistic regression variables with p value ≤0.25 were a candidate for multiple logistic regression. At the end variables with a p-value ≤0.05 were considered as statistically significant. Result A total of 350 (117 cases and 233 controls) patients were participated in the study. Starting ART after 2 years of being confirmed HIV positive (AOR = 3.82 95% CI 1.37,10.6), nevirapine (NVP) based initial ART (AOR = 2.77,95%CI 1.22,6.28) having history of lost to follow up (AOR 3.66,95%CI 1.44,9.27) and base line opportunistic infection (AOR = 1.97,95%CI 1.06,3.63), staying on first line ART for greater than 5 years (AOR = 3.42,95%CI 1.63,7.19) and CD4 less than100cell/ul (AOR = 2.72,95%CI 1.46,5.07) were independent determinants of first line ART treatment failure. Conclusion Lost to follow up, staying on first line ART for greater than 5 years, presence of opportunistic infections, NVP based NNRT, late initiation of ART are determinant factors for first line ART treatment failure. The concerned bodies have to focus and act on those identified factors to maintain the patient on first line ART.

scholarly journals Group counselling for adherence support among young people failing first-line antiretroviral therapy in Zimbabwe

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Bahati Kasimonje ◽  
Tinei Shamu ◽  
Tinahe Mudzviti ◽  
Ruedi Luethy
Keyword(s):  
Antiretroviral Therapy ◽  
Young People ◽  
Group Intervention ◽  
People Living With Hiv ◽  
First Line ◽  
Viral Loads ◽  
Adherence Support ◽  
Adherence Counselling ◽  
Lost To Follow Up

Background: Sub-optimal adherence to antiretroviral therapy (ART) is reportedly worse amongst young people living with HIV (YPLHIV). Group adherence counselling can be useful to improve adherence.Objectives: We evaluated an enhanced adherence counselling group intervention (EACGI) amongst YPLHIV failing a non-nucleoside reverse transcriptase (NNRTI)-based first-line ART regimen.Method: This was a retrospective cohort study using routinely collected data of YPLHIV failing NNRTI-based first-line ART. Patients with confirmed virological failure were referred for EACGI, a 12-week curriculum of weekly, 1.5-h sessions accommodating 8–15 people per group. It aimed to facilitate readiness to switch to second-line ART and improve adherence through a mental health intervention. Viral loads of HIV were measured pre-EACGI; at baseline; 3, 6 and 12 months post switch.Results: Fifty-seven patients aged 13–25 years were invited to EACGI and followed for up to 48 weeks. Thirty-three (58%) patients attended at least four sessions, whilst 24 (42%) attended none. Amongst those who attended none, two (8%) were transferred out, three (13%) were lost to follow-up and two (8%) had died by week 48 of follow-up, whilst all who attended were still in care. By week 48, amongst patients still in care, 29%, 44% and 67% of those who attended no sessions, 4–9 and 10–12 sessions, respectively, had viral loads of 50 copies/mL.Conclusion: An EACGI is a promising intervention for YPLHIV failing ART prior to treatment switch, leading to improved adherence. This study’s findings support the need for further enquiry into rigorous, evidence-based multilevel adherence interventions that are acceptable and effective for YPLHIV.

Late Responders to Imatinib: Is Timing of Achievement of Complete Cytogenetic and Molecular Responses the Same in Previously Treated as Compared to the Newly Diagnosed CML Patients?

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4266-4266
Author(s):  
Vanesa Scholl ◽  
Roberta Bitencourt ◽  
Arthur Moellmann ◽  
Rocio Hassan ◽  
Moises Rocha ◽  
...  
Keyword(s):  
Chronic Phase ◽  
Previous Treatment ◽  
Molecular Data ◽  
Newly Diagnosed ◽  
Gold Standard Method ◽  
Previously Treated Patients ◽  
Previously Treated ◽  
The Moment ◽  
Off Time

Abstract Appropriate monitoring of the effect of tyrosine kinase (TK) therapy is a relevant issue for CML therapeutic strategy. Although cytogenetics is the gold-standard method for response evaluation, serial quantification of BCR-ABL levels by real time PCR (RQ-PCR) has shown accuracy in predicting therapeutic response. Optimal cytogenetic (CCyR) and molecular (MMR) responses for newly diagnosed chronic phase (CP) CML patients were defined within 12 and 18 months of Imatinib (IM) therapy. However, patients not achieving optimal responses (OpRes) within these times are classified as “late responders”. We evaluated a group of 142 patients (4 year follow up) treated with IM as 2nd line. Patients were classified in 3 groups according to previous treatment: IFN (n=90), SCT (n=11) and HU/IFN ≤3 months (n=41, considered as without treatment). BCR–ABL levels were measured every 3 months, at least 5 times/patient during follow-up. A laboratory-specific conversion factor of 1.33 was generated to convert the BCR-ABL/ABL% values to an International Scale (IS). At the moment, 90 patients are being followed (69 CP, 11 AP). Cytogenetics results were available in 80/90 cases, and 63/80 (79%) (55 CP, 8 AP) achieved CCyR. After 12 months of IM treatment, 30/63 cases (48%) obtained CCyR (early responders), and 33/63 (52%) were late responders. When 18 months were considered as a cut-off time to achieved OpRes, 46 (73%) were considered early and 17 (27%) late responders. Molecular data were available for 74 patients; 45/74 (61%) (40 CP, 5 AP) achieved MMR, and 20 (27%) also showed Complete MR. 10/45 cases (22%) were early responders, and 35/45 (78%) late at 18 months of IM. When evaluating at 24 months, 17 (38%) were early and 28 (62%) were late responders. When only CP patients that achieved CCyR (n=55) and MMR (n=40) were considered, these proportions were maintained. Attainment of CCyR/MMR was similar between patients with and without previous treatment (p=0,26;p=0,09). However, we found a delay in the timing of OpRes achievement in comparison with previous related work analyzing patients in 1st line IM. Thus, to achieve similar frequencies of CCyR/MMR obtained from the use of 1st line IM, previously treated patients needed an extension time of 6 months. Thus we suggest for the patients treated with IM as 2nd line a threshold of 18 months for CCyR and 24 for MMR for the establishment of the OpRes. This swap concept might be important in countries such as Brazil that postponed the introduction of IM as 1st line therapy for CML.

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 Tuberculosis among economic migrants: A cross‐sectional study of the risk of poor treatment outcomes and impact of a treatment adherence intervention among temporary residents in an urban district in Ho Chi Minh City, Viet Nam

2020 ◽  
Author(s):  
Luan Nguyen Quang Vo ◽  
Andrew James Codlin ◽  
Rachel Jeanette Forse ◽  
Hoa Trung Nguyen ◽  
Thanh Nguyen Vu ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Cross Sectional Study ◽  
Urban District ◽  
Cross Sectional ◽  
Loss To Follow Up ◽  
Lower Treatment ◽  
Adherence Support ◽  
Poor Treatment

Abstract Background: Tuberculosis (TB) remains a major cause of avoidable deaths. Economic migrants represent a vulnerable population due to their exposure to medical and social risk factors. These factors expose them to higher risks for TB incidence and poor treatment outcomes. Methods: This cross-sectional study evaluated WHO-defined TB treatment outcomes among economic migrants in an urban district of Ho Chi Minh City, Viet Nam. We measured the association of a patient’s government-defined residency status with treatment success and loss to follow-up categories at baseline and performed a comparative interrupted time series (ITS) analysis to assess the impact of community-based adherence support on treatment outcomes. Key measures of interest of the ITS were the differences in step change (β6) and post-intervention trend (β7). Results: Short-term, inter-province migrants experienced lower treatment success (aRR=0.95 [95% CI: 0.92-0.99], p=0.010) and higher loss to follow-up (aOR=1.98 [95% CI: 1.44-2.72], p<0.001) than permanent residents. Intra-province migrants were similarly more likely to be lost to follow-up (aOR=1.86 [95% CI: 1.03-3.36], p=0.041). There was evidence that patients >55 years of age (aRR=0.93 [95% CI: 0.89-0.96], p<0.001), relapse patients (aRR=0.89 [95% CI: 0.84-0.94], p<0.001), and retreatment patients (aRR=0.62 [95% CI: 0.52-0.75], p<0.001) had lower treatment success rates. TB/HIV co-infection was also associated with lower treatment success (aRR=0.77 [95% CI: 0.73-0.82], p<0.001) and higher loss to follow-up (aOR=2.18 [95% CI: 1.55-3.06], p<0.001). The provision of treatment adherence support increased treatment success (IRR(β6)=1.07 [95% CI: 1.00, 1.15], p=0.041) and reduced loss to follow-up (IRR(β6)=0.17 [95% CI: 0.04, 0.69], p=0.013) in the intervention districts. Loss to follow-up continued to decline throughout the post-implementation period (IRR(β7)=0.90 [95% CI: 0.83, 0.98], p=0.019). Conclusions: Economic migrants, particularly those crossing provincial borders, have higher risk of poor treatment outcomes and should be prioritized for tailored adherence support. In light of accelerating urbanization in many regions of Asia, implementation trials are needed to inform evidence-based design of strategies for this vulnerable population.

scholarly journals Baseline predictors of antiretroviral treatment failure and lost to follow up in a multicenter countrywide HIV-1 cohort study in Ethiopia

PLoS ONE ◽  
2018 ◽  
Vol 13 (7) ◽  
pp. e0200505 ◽  
Author(s):  
Nigus Fikrie Telele ◽  
Amare Worku Kalu ◽  
Gaetano Marrone ◽  
Solomon Gebre-Selassie ◽  
Daniel Fekade ◽  
...  
Keyword(s):  
Cohort Study ◽  
Treatment Failure ◽  
Antiretroviral Treatment ◽  
Lost To Follow Up ◽  
Hiv 1 ◽  
Antiretroviral Treatment Failure

Treatment Outcomes of Childhood Tuberculosis in Three Districts of Balochistan, Pakistan: Findings from a Retrospective Cohort Study

2020 ◽  
Author(s):  
Abid Abdullah ◽  
Nafees Ahmad ◽  
Muhammad Atif ◽  
Shereen Khan ◽  
Abdul Wahid ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Treatment Outcomes ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
P Value ◽  
Childhood Tb ◽  
Study Sites ◽  
Lost To Follow Up

Abstract Background This study aimed to evaluate treatment outcomes and factors associated unsuccessful outcomes among pediatric tuberculosis (TB) patients (age ≤14 years). Methods This was a retrospective cohort study conducted at three districts (Quetta, Zhob and Killa Abdullah) of Balochistan, Pakistan. All childhood TB patients enrolled for treatment at Bolan Medical Complex Hospital (BMCH) Quetta and District Headquarter Hospitals of Zhob and Killa Abdullah from 1 January 2016 to 31 December 2018 were included in the study and followed until their treatment outcomes were reported. Data were collected through a purpose developed standardized data collection form and analyzed by using SPSS 20. A p-value &lt;0.05 was considered statistically significant. Results Out of 5152 TB patients enrolled at the study sites, 2184 (42.4%) were children. Among them, 1941 childhood TB patients had complete medical record were included in the study. Majority of the study participants were &lt;5 years old (66.6%) and had pulmonary TB (PTB; 65%). A total of 45 (2.3%) patients were cured, 1680 (86.6%) completed treatment, 195 (10%) lost to follow-up, 15 (0.8%) died, 5 (0.3%) failed treatment and 1 (0.1%) was not evaluated for outcomes. In multivariate binary logistic regression analysis, treatment at BMCH Quetta (OR = 25.671, p-value &lt; 0.001), rural residence (OR = 3.126, p-value &lt; 0.001) and extra-PTB (OR = 1.619, p-value = 0.004) emerged as risk factors for unsuccessful outcomes. Conclusion The study sites collectively reached the World Health Organization’s target of treatment success (&gt;85%). Lost to follow-up was the major reason for unsuccessful outcomes. Special attention to patients with identified risk factors for unsuccessful outcomes may improve outcomes further.

scholarly journals Recurrent or New Symptomatic Cerebral Aneurysm after Previous Treatment

2005 ◽  
Vol 11 (4) ◽  
pp. 341-348 ◽  
Author(s):  
S. Rothemeyer ◽  
D. Lefeuvre ◽  
A. Taylor
Keyword(s):  
Treatment Failure ◽  
Cerebral Aneurysm ◽  
Nerve Palsy ◽  
Cerebral Aneurysms ◽  
Previous Treatment ◽  
Primary Treatment ◽  
The Other ◽  
Endovascular Coiling ◽  
Previously Treated ◽  
Third Cranial Nerve Palsy

With the establishment of endovascular coiling as a successful treatment for symptomatic cerebral aneurysms, attention is now being directed at the durability of this treatment. If this is to be accurately done it will be important to understand the causes of symptomatic aneurysm presentation after previous treatment. In order to assess this we undertook a retrospective review, covering the four year period from 2000 to 2004, of all patients re-presenting with a symptomatic saccular aneurysm after previous treatment. Seven patients were identified, six presenting with subarachnoid haemorrhage (SAH) and one with a third cranial nerve palsy. Three patients had incomplete clipping of their aneurysms and all presented within months of their initial treatment. The other four patients presented between five and 20 years after primary treatment and all were felt to have new cerebral aneurysms. Two of these patients had aneurysms develop at the same location as their previously treated lesions, however these were still felt to be new aneurysms rather than re-growth or recurrence because of their morphology. Based on our findings it would appear that development of a new cerebral aneurysm after clipping is more of a risk than aneurysm recurrence from treatment failure. This will need to be considered when evaluating re-presentation after treatment by either coiling or clipping and more importantly, perhaps we should be directing more attention to preventing disease progression rather than treatment failure.

scholarly journals MNGI-10. ATYPICAL MENINGIOMA: EARLY OUTCOMES WITH OR WITHOUT POSTOPERATIVE RADIATION

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi141-vi141
Author(s):  
Peter Pan ◽  
David Pisapia ◽  
Rohan Ramakrishna ◽  
Theodore Schwartz ◽  
Philip Stieg ◽  
...  
Keyword(s):  
Single Case ◽  
Previous Treatment ◽  
Progression Free Survival ◽  
Atypical Meningioma ◽  
Who Grade ◽  
Long Term Stability ◽  
Grade Ii ◽  
Atypical Meningiomas ◽  
Lost To Follow Up

Abstract BACKGROUND Adjuvant radiotherapy (RT) in atypical meningioma, especially for gross-totally resected tumors, remains controversial. METHODS We retrospectively identified histologically-confirmed cases of WHO Grade II atypical meningioma at a large academic institution from 2004–2018. Clinicodemographic, surgical, radiation therapy (RT), and histopathologic data were collected, as well as imaging and clinical outcomes, with a median follow-up time of 26 months (IQR 32). Patients were stratified by resection status and whether or not upfront RT was administered. Additionally, subanalyses were performed to compare external beam RT (EBRT) and stereotactic radiosurgery (SRS). Progression was defined by radiology report. RESULTS Of 122 patients, 45 were excluded for lacking adequate records of previous treatment, less than 3 months follow-up, or lacking MR imaging. Of 77 patients analyzed, 57% (44/77) were female; median 59-years-old. 48% (24/50) of gross-total-resections (GTR) received upfront RT – only a single case progressed, at 39 months. Of 26 GTR patients without upfront RT, 8/26 (31%) progressed at median 19.5 months – of these, 2 were lost to follow-up, 5 received salvage RT, and 1 had surgery alone. Adjuvant RT was associated with superior progression free survival (PFS) in GTR (Cox proportional hazard ratio 0.15, likelihood-ratio p=0.025; median PFS not reached). Of 15 subtotal resections (STR) receiving upfront RT, 11 received EBRT and 4 received SRS – 6 progressed (median 37 months), all after EBRT. Upfront SRS demonstrated superior PFS over EBRT following STR (p=0.036). Across the cohort there was one confirmed death, a GTR patient (without RT) who suffered an ischemic stroke at 11 months. CONCLUSION This large single-center retrospective analysis indicates adjuvant RT improves PFS in GTR atypical meningiomas, in concordance with prior studies. It is limited by short median follow-up, possibly related to long-term stability in treated patients. In STR tumors, SRS may contribute to improved PFS compared to EBRT.

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