Current Preventive Therapy: Preventive Treatment Mechanisms

Abstract Background Pediatric tuberculosis (TB), human immunodeficiency virus (HIV), and TB-HIV co-infection are health problems with evidence-based diagnostic and treatment algorithms that can reduce morbidity and mortality. Implementation and operational barriers affect adherence to guidelines in many resource-constrained settings, negatively affecting patient outcomes. This study aimed to assess performance in the pediatric HIV and TB care cascades in Mozambique. Methods A retrospective analysis of routine PEPFAR site-level HIV and TB data from 2012 to 2016 was performed. Patients 0–14 years of age were included. Descriptive statistics were used to report trends in TB and HIV indicators. Linear regression was done to assess associations of site-level variables with performance in the pediatric TB and HIV care cascades using 2016 data. Results Routine HIV testing and cotrimoxazole initiation for co-infected children in the TB program were nearly optimal at 99% and 96% in 2016, respectively. Antiretroviral therapy (ART) initiation was lower at 87%, but steadily improved from 2012 to 2016. From the HIV program, TB screening at the last consultation rose steadily over the study period, reaching 82% in 2016. The percentage of newly enrolled children who received either TB treatment or isoniazid preventive treatment (IPT) also steadily improved in all provinces, but in 2016 was only at 42% nationally. Larger volume sites were significantly more likely to complete the pediatric HIV and TB care cascades in 2016 (p value range 0.05 to < 0.001). Conclusions Mozambique has made significant strides in improving the pediatric care cascades for children with TB and HIV, but there were missed opportunities for TB diagnosis and prevention, with IPT utilization being particularly problematic. Strengthened TB/HIV programming that continues to focus on pediatric ART scale-up while improving delivery of TB preventive therapy, either with IPT or newer rifapentine-based regimens for age-eligible children, is needed.

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The New National Headache Management System is an easy solution to provide more efficient and evidence-based headache services

Advances in Clinical Neuroscience & Rehabilitation ◽

10.47795/wltd2936 ◽

2021 ◽

Vol 20 ◽

Author(s):

Alexander Gordon ◽

◽

Daniel Lashley ◽

Stuart Weatherby ◽

◽

...

Keyword(s):

Patient Care ◽

Adult Population ◽

Significant Proportion ◽

Preventive Treatment ◽

Headache Disorder ◽

Preventive Therapy ◽

Evidence Based ◽

Educational Approach ◽

Allied Health Professionals ◽

Clinical Resource

Headaches make up 30% of all Neurology outpatient consultations.1 There is distinct variability in the management of headaches by Neurologists, leading to unnecessary disparities in the standard of care and likelihood of response between patients. A significant proportion of patients with headache diagnoses do not receive the evidence-based treatments recommended in national or international guidelines,2 and substantial numbers of patients are not receiving preventive therapies.3 Ziegeler et al. found that a third of patients reporting to a tertiary headache centre had not received preventive therapy in line with guidelines, and half had never been prescribed a preventive treatment.2 Considering that 46% of the global adult population are estimated to have a headache disorder,4 this lack of a consistent, evidence-based approach is somewhat incongruent with the patient socio-economic impact. It is probable that lack of adherence to current headache guidelines is a multi-faceted issue. This variation in treatment (and therefore patient outcome), although unexplored,2 is not likely to be a simple educational issue. To add to this, an educational approach, in the form of seminars and workshops, does not have entirely positive evidence to support its use in implementing changes to patient care.5 It seems more probable that there are also structural issues within the health service that in some way preclude patients with headache disorders from gaining appropriate care. For example, using only doctors to care for patients with such a common condition may cause bottle-necking in access, and may not be an appropriate use of clinical resource. The current context of a global pandemic has shown us the importance of using the skillsets of all NHS staff working together for patient care. For headache care this could involve greater use of nursing colleagues or allied health professionals such as Pharmacists. To facilitate such an aim, an easily used and standardised approach is essential. We believe that the guidelines from the British Association for the Study of Headache (BASH),6 could facilitate such an approach.

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Risk Factors for Developing Active Tuberculosis After the Treatment of Latent Tuberculosis in Adults Infected With Human Immunodeficiency Virus

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu120 ◽

2015 ◽

Vol 2 (1) ◽

Cited By ~ 12

Author(s):

Kojo Amoakwa ◽

Neil A. Martinson ◽

Lawrence H. Moulton ◽

Grace L. Barnes ◽

Reginah Msandiwa ◽

...

Keyword(s):

Risk Factors ◽

Human Immunodeficiency Virus ◽

Latent Tuberculosis ◽

Preventive Treatment ◽

Preventive Therapy ◽

Active Tuberculosis ◽

Baseline Viral Load ◽

Test Size ◽

Immunodeficiency Virus ◽

Independent Risk Factors

Abstract Tuberculosis is the leading cause of death among adults infected with human immunodeficiency virus (HIV), and rates of tuberculosis remain high even after preventive therapy. Among 908 HIV-infected adults in a trial of preventive treatment, we found self-reported alcohol consumption, low baseline CD4 count, high baseline viral load, and tuberculin skin test size >15 mm as independent risk factors for incident tuberculosis.

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The need for preventive therapy in primary headaches

Headache Medicine ◽

10.48208/headachemed.2011.10 ◽

2011 ◽

pp. 46-49

Author(s):

Mario Fernando Prieto Peres ◽

Daniel Krempel Amado ◽

André Leite Gonçalves ◽

Reinaldo Ribeiro ◽

Jorge Roberto Pagura ◽

...

Keyword(s):

Preventive Treatment ◽

Primary Headache ◽

Preventive Therapy ◽

Tension Type Headache ◽

Primary Headaches ◽

Correct Treatment ◽

Treatment Type ◽

Geographical Regions ◽

Probable Migraine ◽

Type Headache

Introduction: Primary headaches are common conditions. In Brazil, the prevalence of migraine is 15.2%, tension-type headache 13% and chronic daily headache (CDH) 6.9%. Although frequent disorders a proportion of patients are undertreated. Patients patterns of headache care can trend toward acute medication only and those in need of prevention may not receive it. Objective: To estimate the rates of preventive treatment in primary headache sufferers. Methods: A telephone interview containing questions about headache and socio-demographic characteristics was applied to 3,848 people from 27 States of Brazil, in its five geographical regions. We considered MIDAS > 10 points as a marker for the need of preventive treatment. Patients were asked if they were taking any medication on a daily basis or any treatment to prevent headaches from happening. Subjects were divided into: 1. Those who responded positively for the question regarding preventive treatment regardless of the treatment type. 2. Those who responded positively for the question, but only medications or treatments studied for migraine prevention, labeled as "Correct treatment" 3. Those who responded positively for the question, but only medications or treatments from the prevention consensus (Brazilian Headache Society), labeled as "Consensus treatment" Results: In total, 12.8% of primary headache sufferers had MIDAS higher than 10, meeting criteria for prophylactic treatment, but only 8.4% of them reported it, 3.9% were using a right preventive treatment. The percentage of patients in need for prevention was 24.7% in migraine, 15.6 % in probable migraine, 5 % for tension-type headache (TTH) and 4% for probable TTH. Only 2.6% of migraineurs, 7.5% of probable migraine patients, 4.3% of tension-type headache and 0% of probable TTH received proper preventive treatment Conclusion: Primary headaches are common, debilitating conditions but a substantial proportion of those who might need prevention do not receive it. Patient education, public health initiatives in order to deliver migraine and other primary headaches treatment for the general population should be considered not only in Brazil, but worldwide.

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Botulinum Toxin in the Treatment of Headache

Toxins ◽

10.3390/toxins12120803 ◽

2020 ◽

Vol 12 (12) ◽

pp. 803

Author(s):

Werner J. Becker

Keyword(s):

Botulinum Toxin ◽

Chronic Migraine ◽

Mechanism Of Action ◽

Recombinant Dna ◽

Botulinum Toxin Type A ◽

Preventive Treatment ◽

Botulinum Toxin Type ◽

Preventive Therapy ◽

Ongoing Research ◽

Recombinant Dna Techniques

Botulinum toxin type A has been used in the treatment of chronic migraine for over a decade and has become established as a well-tolerated option for the preventive therapy of chronic migraine. Ongoing research is gradually shedding light on its mechanism of action in migraine prevention. Given that its mechanism of action is quite different from that of the new monoclonal antibodies directed against calcitonin gene-related peptide (CGRP) or its receptor, it is unlikely to be displaced to any major extent by them. Both will likely remain as important tools for patients with chronic migraine and the clinicians assisting them. New types of botulinum toxin selective for sensory pain neurons may well be discovered or produced by recombinant DNA techniques in the coming decade, and this may greatly enhance its therapeutic usefulness. This review summarizes the evolution of botulinum toxin use in headache management over the past several decades and its role in the preventive treatment of chronic migraine and other headache disorders.

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Serial T-SPOT.TB in household contacts of tuberculosis patients: a 6-year observational study in China

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.18.0252 ◽

2019 ◽

Vol 23 (9) ◽

pp. 989-995 ◽

Cited By ~ 3

Author(s):

H-C. Zhang ◽

Q-L. Ruan ◽

J. Wu ◽

S. Zhang ◽

S-L. Yu ◽

...

Keyword(s):

Observational Study ◽

Preventive Treatment ◽

Preventive Therapy ◽

Interferon Gamma Release Assay ◽

Household Contacts ◽

Conversion Rates ◽

Ltbi Prevalence ◽

Release Assay ◽

Latent Tb Infection

BACKGROUND: Screening tuberculosis (TB) contacts is a priority for TB control; however, it remains inadequate in most regions of China.OBJECTIVE: To investigate the progression of latent TB infection (LTBI) using the interferon-gamma release assay (IGRA) in contacts of active TB patients.DESIGN: This longitudinal prospective observational study included 159 household contacts aged ≥14 years without preventive treatment who were followed up for 6 years to compare their conversion and reversion rates using the T-SPOT®.TB IGRA to diagnose LTBI.RESULTS: Among the 159 household contacts, LTBI positivity was 47.5%. Age was independently associated with LTBI (OR 3.6, 95%CI 1.81–7.14; P = 0.00). T-SPOT.TB conversion rates were respectively 29.4% and 18.8% at 3- and 6-year follow-up. The reversion rates were 9.4% of contacts during the 3-year follow-up period, which increased to 38.2% at the 6-year follow-up. A decreasing trend in spot-forming cells on T-SPOT.TB was observed in most patients at the 6-year follow-up.CONCLUSION: LTBI prevalence among household contacts was relatively high, particularly in elderly patients. Furthermore, serial IGRA testing was highly dynamic; however, this overall trend gradually decreased over time, even if preventive therapy was not prescribed.

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How could preventive therapy affect the prevalence of drug resistance? Causes and consequences

Philosophical Transactions of the Royal Society B Biological Sciences ◽

10.1098/rstb.2014.0306 ◽

2015 ◽

Vol 370 (1670) ◽

pp. 20140306 ◽

Cited By ~ 8

Author(s):

Amber Kunkel ◽

Caroline Colijn ◽

Marc Lipsitch ◽

Ted Cohen

Keyword(s):

Drug Resistance ◽

Intermittent Preventive Treatment ◽

Preventive Treatment ◽

Population Level ◽

Preventive Therapy ◽

Pilot Studies ◽

Potential Population ◽

General Mathematical Model ◽

Exposure Prophylaxis

Various forms of preventive and prophylactic antimicrobial therapies have been proposed to combat HIV (e.g. pre-exposure prophylaxis), tuberculosis (e.g. isoniazid preventive therapy) and malaria (e.g. intermittent preventive treatment). However, the potential population-level effects of preventative therapy (PT) on the prevalence of drug resistance are not well understood. PT can directly affect the rate at which resistance is acquired among those receiving PT. It can also indirectly affect resistance by altering the rate at which resistance is acquired through treatment for active disease and by modifying the level of competition between transmission of drug-resistant and drug-sensitive pathogens. We propose a general mathematical model to explore the ways in which PT can affect the long-term prevalence of drug resistance. Depending on the relative contributions of these three mechanisms, we find that increasing the level of coverage of PT may result in increases, decreases or non-monotonic changes in the overall prevalence of drug resistance. These results demonstrate the complexity of the relationship between PT and drug resistance in the population. Care should be taken when predicting population-level changes in drug resistance from small pilot studies of PT or estimates based solely on its direct effects.

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Clinical determinants of migraine preventive treatment: Contribution of SMILE, an observational survey of primary care migraine management in France

Cephalalgia ◽

10.1177/0333102409355661 ◽

2010 ◽

Vol 30 (10) ◽

pp. 1207-1213 ◽

Cited By ~ 5

Author(s):

D Valade ◽

M Lantéri-Minet ◽

F Radat ◽

C Mekies ◽

C Lucas ◽

...

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Observational Study ◽

Acute Treatment ◽

Medication Overuse ◽

Preventive Treatment ◽

Preventive Therapy ◽

The Other ◽

Main Factors ◽

Primary Care Medicine

Methods: SMILE was an observational study carried out in France among office-based general practitioners (GPs) and neurologists from November 2005 to July 2006 to assess the determinants of prescription of migraine preventive therapy in primary care medicine. A total of 1467 GPs and 83 neurologists were included, treating 5417 and 248 migraine sufferers, respectively. Results: The main factors leading physicians to deem a patient eligible for preventive treatment were perceived medication overuse and frequency of headaches, and secondarily, severity of headaches and functional impact. On the other hand, patient satisfaction with the acute treatment of attacks and triptan use, and secondarily, a long migraine history were found to influence patient eligibility negatively. Discussion/conclusion: Noticeably, psychiatric disorders (anxiety, stress) did not appear, aside from somatic factors, among the determinants that significantly influence physicians' judgment about the option of establishing a preventive treatment. However, they are important features of migraine condition and should be listed among the factors guiding choices about migraine preventive therapy.

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Caregivers’ knowledge and perceptions are associated with children’s TB preventive treatment completion

Public Health Action ◽

10.5588/pha.21.0009 ◽

2021 ◽

Vol 11 (2) ◽

pp. 85-90

Author(s):

J. Zeladita-Huaman ◽

C. M. Yuen ◽

R. Zegarra-Chapoñan ◽

M. Curisinche-Rojas ◽

V. Egusquiza-Pozo

Keyword(s):

Adverse Events ◽

Interpersonal Relationships ◽

Health Care Providers ◽

Preventive Treatment ◽

Preventive Therapy ◽

Care Providers ◽

Adjusted Risk ◽

Factors Associated ◽

Adjusted Risk Ratio ◽

Record Review

SETTING: Forty-six health centers in south Lima, Peru.OBJECTIVE: To assess the association between caregivers’ knowledge and perceptions around isoniazid preventive therapy (IPT) and whether their children complete IPT.DESIGN: We conducted a retrospective medical record review of children who initiated IPT during 2017–2018. We administered structured surveys to caregivers of the children about their knowledge about and perceptions of IPT. We used a modified Poisson regression to determine factors associated with IPT completion.RESULTS: We included 550 children, of whom 31% did not complete IPT. Independent factors associated with not completing IPT were low caregiver knowledge about TB and IPT (adjusted risk ratio [aRR] 1.41, 95% CI 1.06–1.78), low caregiver perception of the importance of IPT (aRR 1.76, 95% CI 1.30–2.39), low caregiver satisfaction with the health services (aRR 1.57, 95% CI 1.14–2.16), experience of adverse events (aRR 2.08, 95% CI 1.51–2.87), and living in a household with moderate or severe family dysfunction (aRR 1.53, 95% CI 1.07–2.19).CONCLUSION: IPT completion among children was associated with the knowledge and perceptions of their caregivers, as well as the experience of adverse events. To improve IPT completion among children, health care providers should prioritize education and counseling for caregivers, promote positive interpersonal relationships with them, and monitor adverse events.

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