scholarly journals Diabetes mellitus among adults with tuberculosis in the USA, 2010–2017

2020 ◽  
Vol 8 (1) ◽  
pp. e001275
Author(s):  
Lori R Armstrong ◽  
J Steve Kammerer ◽  
Maryam B Haddad
Keyword(s):  
Patient Outcomes ◽  
Sputum Smear ◽  
Tb Treatment ◽  
Diabetes Status ◽  
Complete Treatment ◽  
National Tuberculosis ◽  
The Usa ◽  
Diabetes Trends ◽  
Design And Methods ◽  
Annual Proportion

IntroductionTo describe diabetes trends among adults with incident tuberculosis (TB) disease and examine diabetes-associated TB characteristics and patient outcomes in the USA.Research design and methodsWe examined all 71 855 persons aged ≥20 years with incident TB disease reported to the National Tuberculosis Surveillance System during 2010–2017. We performed multivariable logistic regression, comparing characteristics and outcomes among patients with TB reported to have diabetes and those whose diabetes status was unknown.ResultsAn overall 18% (n=13 281) of the 71 855 adults with incident TB disease were reported as also having diabetes; the annual proportion increased from 15% in 2010 to 22% in 2017. Among patients aged ≥45 years with both TB and diabetes, the adjusted OR for cavitary or sputum smear-positive TB was 1.7 and 1.5, respectively (95% CIs 1.5 to 1.8 and 1.4 to 1.6). Patients with TB and diabetes had 30% greater odds of dying and took longer to achieve negative Mycobacterium tuberculosis cultures and complete treatment.ConclusionsThe prevalence of reported diabetes among adults with TB disease has increased. Having diabetes as a comorbidity negatively affects patient outcomes. In accordance with national recommendations, all patients aged ≥45 years and all younger patients who have risk factors for diabetes should be screened for diabetes at the start of TB treatment.

Treatment outcomes of adults with new onset pulmonary tuberculosis in Pretoria, South Africa

2020 ◽  
Vol 50 (2) ◽  
pp. 130-134
Author(s):  
Meisie A Nkoane ◽  
Adegoke O Adefolalu ◽  
Gboyega A Ogunbanjo
Keyword(s):  
South Africa ◽  
Treatment Outcomes ◽  
Healthcare Workers ◽  
Treatment Success ◽  
World Health ◽  
Sputum Smear ◽  
Standard Regimen ◽  
Tb Treatment ◽  
Complete Treatment ◽  
Cure Rates

A persistently high burden of tuberculosis (TB) and low cure rates in South Africa call for frequent assessment of the effectiveness of the TB programme. We conducted a retrospective cohort study to evaluate treatment outcomes and associated factors among new TB patients taking standard regimen 1 TB treatment during 2010 in Pretoria, using the World Health Organization’s six treatment outcomes classification. The 85 participants (of whom 59% were female) had co-infection with HIV in 70%. A total of 52% completed treatment, but only 15% were officially cured; 13% died and only 35% had an end-of-treatment sputum test. The treatment success rate (cured and complete treatment) was 67%. Completion of TB treatment was associated with HIV status ( P = 0.02) and TB diagnosis using only sputum smear test ( P = 0.02). Our results suggest non-compliance with standard TB guidelines by healthcare workers. We therefore advise future interventions should target both patients and healthcare workers.

scholarly journals A study to assess the association of various factors of adherence to treatment on the tuberculosis treatment outcome among new sputum smear positive pulmonary tuberculosis patients under Revised National Tuberculosis Control Programme in Bengaluru area

2019 ◽  
Vol 6 (10) ◽  
pp. 4344
Author(s):  
Ramya M. S. ◽  
Jyothi Jadhav ◽  
Ranganath T. S.
Keyword(s):  
Treatment Outcome ◽  
Alcohol Intake ◽  
Control Programme ◽  
Sputum Smear ◽  
Lower Socioeconomic Status ◽  
Tb Treatment ◽  
Lower Socioeconomic ◽  
Tuberculosis Control Programme ◽  
National Tuberculosis ◽  
Cure Rates

Background: Tuberculosis (TB) is a top infectious disease killer worldwide. In India although Revised National Tuberculosis Control Programme (RNTCP) has seen significant success in TB treatment, patient non-adherence or lost to follow up continue to persist and are influenced by various factors. The present study aims to know the influence of adherence factors on TB treatment outcome among new sputum smear positive (NSSP) pulmonary TB patients under RNTCP. The objectives of the present study were to describe the distribution of socio-demographic factors, outcome patterns among NSSP patients and to assess the association of various adherence factors on TB-treatment outcome among NSSP patients.Methods: A prospective longitudinal study among 149 NSSP patients from selected TU’s of Bengaluru.Results: Among the 149 NSSP patients 107 (72%) were males and 42 (28%) were females. Treatment outcome is categorized as cured (120) and other treatment outcomes (defaulted-17 or treatment failure-3 or died-9). Among the various socio-demographic and adherence-factors: age >50years, illiteracy, male-gender, Hindu-religion, lower socioeconomic-status, poor-patient knowledge about TB, disbelief in TB-treatment, unwillingness to continue treatment with subsiding symptoms, smoking, alcohol intake, presence of diabetes or hypertension or COPD or HIV, patient’s un-satisfaction with treatment-availability or accessibility or contact-timings, no-encouragement from family members, other marital status and absence of stigma showed lower cure rates. Of these factors illiteracy, lower socioeconomic-status, poor patient’s knowledge on tuberculosis, smoking, alcohol intake, HIV positive status, un-satisfaction with TB-treatment availability and other marital-status showed statistical significance on the TB treatment outcome.Conclusions: With the observed associations of the above factors on TB-treatment outcome, Further measures like improving patient’s knowledge on tuberculosis, health-services and patient-provider relationship; appropriate TB-HIV care and encouragement to quit smoking or alcohol intake, could improve TB-treatment cure rates. 

scholarly journals Risk Factors for Unfavorable Treatment Outcomes among the Human Immunodeficiency Virus-Associated Tuberculosis Population in Tashkent City, Uzbekistan: 2013–2017

2021 ◽  
Vol 18 (9) ◽  
pp. 4623
Author(s):  
Sherali Massavirov ◽  
Kristina Akopyan ◽  
Fazlkhan Abdugapparov ◽  
Ana Ciobanu ◽  
Arax Hovhanessyan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
Treatment Outcomes ◽  
Sputum Smear ◽  
People Living With Hiv ◽  
Tb Treatment ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Immunodeficiency Virus ◽  
Positive Sputum Smear

Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection poses a growing clinical challenge. People living with HIV have a higher chance of developing TB, and once the disease has progressed, are at greater risk of having unfavorable TB treatment outcomes. Data on TB treatment outcomes among the HIV-associated TB population in Uzbekistan are limited. Thus, we conducted a cohort study among 808 adult patients with HIV-associated TB registered at the Tashkent TB referral hospital from 2013–2017 to document baseline characteristics and evaluate risk factors for unfavorable TB treatment outcomes. The data were collected from medical records and ambulatory cards. About 79.8% of the study population had favorable treatment outcomes. Antiretroviral therapy (ART) coverage at the admission was 26.9%. Information on CD4-cell counts and viral loads were largely missing. Having extrapulmonary TB (aOR 2.21, 95% CI: 1.38–3.53, p = 0.001), positive sputum smear laboratory results on admission (aOR 1.62, 95% CI: 1.07–2.40), diabetes (aOR 5.16, 95% CI: 1.77–14.98), and hepatitis C (aOR 1.68, 95% CI: 1.14–2.46) were independent risk factors for developing unfavorable TB treatment outcomes. The study findings provide evidence for targeted clinical management in co-infected patients with risk factors. Strengthening the integration of TB/HIV services may improve availability of key data to improve co-infection management.

scholarly journals Baseline Xpert MTB/RIF ct values predict sputum conversion during the intensive phase of anti-TB treatment in HIV infected patients in Kampala, Uganda: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Juliet Namugenyi ◽  
Joseph Musaazi ◽  
Achilles Katamba ◽  
Joan Kalyango ◽  
Emmanuel Sendaula ◽  
...  
Keyword(s):  
Bacterial Load ◽  
Sputum Smear ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Cut Point ◽  
Ct Value ◽  
Tb Treatment ◽  
Drug Concentrations ◽  
Unit Increase ◽  
Sputum Conversion

Abstract Background In resource-limited settings, sputum smear conversion is used to document treatment response. Many People living with HIV (PLHIV) are smear-negative at baseline. The Xpert MTB/RIF test can indirectly measure bacterial load through cycle threshold (ct) values. This study aimed to determine if baseline Xpert MTB/RIF could predict time to culture negativity in PLHIV with newly diagnosed TB. Methods A subset of 138 PLHIV from the ‘SOUTH’ study on outcomes related to TB and antiretroviral drug concentrations were included. Bacterial load was estimated by Mycobacterium Growth Indicator Tubes (MGIT) culture time-to-positivity (TTP) and Lowenstein Jensen (LJ) colony counts. Changes in TTP and colony counts were analyzed with Poisson Generalised Estimating Equations (GEE) and multilevel ordered logistic regression models, respectively, while time to culture negativity analysed with Cox proportional hazard models. ROC curves were used to explore the accuracy of the ct value in predicting culture negativity. Results A total of 81 patients (58.7%) were males, median age 34 (IQR 29  ̶ 40) years, median CD4 cell count of 180 (IQR 68  ̶ 345) cells/μL and 77.5% were ART naive. The median baseline ct value was 25.1 (IQR 21.0  ̶ 30.1). A unit Increase in the ct value was associated with a 5% (IRR = 1.05 95% CI 1.04  ̶ 1.06) and 3% (IRR = 1.03 95% CI 1.03  ̶ 1.04) increase in TTP at week 2 and 4 respectively. With LJ culture, a patient’s colony grade was reduced by 0.86 times (0R = 0.86 95% CI 0.74  ̶ 0.97) at week 2 and 0.84 times (OR = 0.84 95% CI 0.79  ̶ 0.95 P = 0.002) at week 4 for every unit increase in the baseline ct value. There was a 3% higher likelihood of earlier conversion to negativity for every unit increase in the ct value. A ct cut point ≥28 best predicted culture negativity at week 4 with a sensitivity of 91. 7% & specificity 53.7% while a cut point ≥23 best predicted culture negativity at week 8. Conclusion Baseline Xpert MTB/RIF ct values predict sputum conversion in PLHIV on anti-TB treatment. Surrogate biomarkers for sputum conversion in PLHIV are still a research priority.

scholarly journals Perspective Of Stakeholders On The Sustainability Of Tuberkulosis Program

2020 ◽  
Vol 9 (1) ◽  
pp. 224-240
Author(s):  
Indasah Indasah ◽  
Dedi Saifulah ◽  
Anita Restu Korbaffo
Keyword(s):  
Prevention And Control ◽  
Case Study Research ◽  
Qualitative Approach ◽  
Service Program ◽  
Tb Control ◽  
Descriptive Research ◽  
Tb Treatment ◽  
Complete Treatment ◽  
And Control

This research is a type of descriptive research using a qualitative approach design using a case study research design. Funding for the TB program in Pasuruan Regency was sourced from the APBD and also Health Operational Assistance sourced from the Special Allocation Fund decreased. The budget for TB prevention prevention programs is absorbed entirely But the performance of achieving the discovery targets is still not significant. Still not found the whole case, complete treatment has not been maximized, some even DO. TB control activities allocated for TB prevention and control services appear to be relatively small compared to the TB treatment budget. Based on all the challenges faced, a strategy was formulated to eliminate TB within the next 5 years by strengthening the leadership of a quality TB service program with a sustainable program across stakeholders

scholarly journals Predictor Keberhasilan Pengobatan Tuberkulosis Tahun 2018 di Indonesia

2020 ◽  
Vol 2 (2) ◽  
pp. 62
Author(s):  
Riezky Febiola ◽  
Mondastri Korib Sudaryo ◽  
Sri Ulfa Alriani
Keyword(s):  
Female Gender ◽  
Infectious Agents ◽  
Chi Square ◽  
Tb Treatment ◽  
Complete Treatment ◽  
Cohort Study Design ◽  
Study Population ◽  
New Treatment ◽  
The Relationship ◽  
Hiv Negative

Tuberculosis is still a major cause of health problems and death due to infectious agents. The success rate of TB treatment varies globally where Asia is 81.6% the second highest after Oceania 83.9%. The prevalence of tuberculosis with bacteriological confirmation in Indonesia is 759 per 100,000 population. This study aims to determine the relationship between the independent variabel with the success of TB treatment in Indonesia in 2018. Methods This study was conducted using a retrospective cohort study design. The study population was all TB Drug Sensitive patients who started treatment in 2018 and were recorded on SITT. Data analysis was performed using Chi Square. 392,706 TB patients were included in the analysis of 476,744 patients. With treatment results 45.2% recovered, 43.35% complete treatment, 3% died, 0.8% failed, 5.6% dropped out of treatment, 2.1% people moved. Age> 45 years RR 1,028 (95% CI; 1,009-1,049), female gender 1,022 (95% CI; 1,004-1,041), HIV negative 1,229 (95% CI; 1,169-1,292), patients with new treatment status RR 1,072 (95% CI; 1.033-1.112) and did not have a DM RR comorbid 1.027 (95% CI; 1.003-1.051) were predictors of the success of TB treatment. The results of this study indicate that patients who do not have HIV or DM co-morbidities are more likely to succeed in TB treatment.

The Co-management of Tuberculosis-diabetes Co-morbidities in Indonesia Under the National Tuberculosis Control Program: Results From a Retrospective Cohort Study From 2017-2019

2021 ◽  
Author(s):  
Weixi Jiang ◽  
Fauziah Mauly Rahman ◽  
Adik Wibowo ◽  
Adhi Sanjaya ◽  
Permata Imani Ima Silitonga ◽  
...  
Keyword(s):  
Cohort Study ◽  
Low Income ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Control Program ◽  
Mixed Effect ◽  
Factors Associated ◽  
Tb Treatment ◽  
National Tuberculosis ◽  
The Government

Abstract Background: Indonesia suffers from a high burden of tuberculosis (TB) and diabetes (DM). The government initiated national TB-DM co-management activities under the National TB Control Program in 2017. This study investigates the detection and treatment outcomes of TB-DM in Jakarta after implementing these activities, and identifies the main factors associated with these outcomes. Methods: A retrospective cohort study was conducted using TB registry data in two districts of Jakarta, East Jakarta (low-income) and South Jakarta (high-income). A 5-step cascade analysis was used: diagnosed TB patients; TB patients tested for DM; diagnosed TB-DM patients; and patients received and completed TB treatment/cured. We conducted descriptive analyses to understand the characteristics of TB and TB-DM patients, and used a two-level mixed-effect logistic regression to explore factors associated with having a DM test and completing TB treatment/being cured. Results: Over the study period (2017-2019) 50.8% of the new pulmonary TB patients aged over 15 were tested for DM. The percentage increased from 41.7% in 2017-2018 to 60.1% in 2019. Of the TB patients tested for DM, 20.8% were diagnosed with DM. Over 90% of the detected TB-DM patients received standard TB treatment, 86.3% of whom completed treatment/were cured. Patients in East Jakarta were more likely to be tested for DM and to complete standard TB treatment/be cured than patients in South Jakarta (P<0.001). Bacteriologically positive TB patients were more likely to be tested for DM (OR=1.37, 95% CI 1.17,1.60). Patients diagnosed in sub-district level healthcare centers had a higher likelihood of being tested for DM than those in government and private hospitals (P<0.05). Receiving DM treatment was associated with a higher likelihood of completing TB treatment/being cured (OR=1.82, 95% CI 1.20, 2.77).Conclusions: TB-DM case detection significantly improved in 2019 after introducing TB-DM co-management activities in Jakarta, while gaps in TB-DM co-management existed between bacteriologically positive and clinically diagnosed TB patients, and across different types of health facilities. Collaboration between TB and DM departments should be strengthened, and more resources need to be mobilized to further improve the co-management of TB-DM in Indonesia.

scholarly journals Insulin pricing and other major diabetes-related concerns in the USA: a study of 46 407 tweets between 2017 and 2019

2020 ◽  
Vol 8 (1) ◽  
pp. e001190
Author(s):  
Adrian Ahne ◽  
Francisco Orchard ◽  
Xavier Tannier ◽  
Camille Perchoux ◽  
Beverley Balkau ◽  
...  
Keyword(s):  
Social Media ◽  
Positive Emotions ◽  
Negative Impact ◽  
Diabetes Distress ◽  
Social Media Data ◽  
Health Related ◽  
The Usa ◽  
Personal Content ◽  
Design And Methods ◽  
Media Data

IntroductionLittle research has been done to systematically evaluate concerns of people living with diabetes through social media, which has been a powerful tool for social change and to better understand perceptions around health-related issues. This study aims to identify key diabetes-related concerns in the USA and primary emotions associated with those concerns using information shared on Twitter.Research design and methodsA total of 11.7 million diabetes-related tweets in English were collected between April 2017 and July 2019. Machine learning methods were used to filter tweets with personal content, to geolocate (to the USA) and to identify clusters of tweets with emotional elements. A sentiment analysis was then applied to each cluster.ResultsWe identified 46 407 tweets with emotional elements in the USA from which 30 clusters were identified; 5 clusters (18% of tweets) were related to insulin pricing with both positive emotions (joy, love) referring to advocacy for affordable insulin and sadness emotions related to the frustration of insulin prices, 5 clusters (12% of tweets) to solidarity and support with a majority of joy and love emotions expressed. The most negative topics (10% of tweets) were related to diabetes distress (24% sadness, 27% anger, 21% fear elements), to diabetic and insulin shock (45% anger, 46% fear) and comorbidities (40% sadness).ConclusionsUsing social media data, we have been able to describe key diabetes-related concerns and their associated emotions. More specifically, we were able to highlight the real-world concerns of insulin pricing and its negative impact on mood. Using such data can be a useful addition to current measures that inform public decision making around topics of concern and burden among people with diabetes.

scholarly journals Prolonged hospitalisation for immigrants and high risk patients with positive smear pulmonary tuberculosis

2015 ◽  
Vol 75 (2) ◽  
Author(s):  
R. Luzzati ◽  
M. Confalonieri ◽  
A. Cazzadori ◽  
P. Della Loggia ◽  
R. Cifaldi ◽  
...  
Keyword(s):  
High Risk ◽  
Disease Transmission ◽  
Illegal Immigrants ◽  
Sputum Smear ◽  
Prolonged Hospitalisation ◽  
Early Outcome ◽  
High Risk Patients ◽  
Tb Treatment ◽  
Conversion Rates ◽  
Risk Patients

Background and objective. Tuberculosis (TB) occurring in immigrants and resistance to drugs are major problems for TB control in Western countries. Directly observed therapy (DOT) reduces disease transmission, but this approach may have poor results among illegal immigrants. Our aim was to evaluate a prolonged hospitalisation programme to improve early outcome of TB treatment in high risk patients. Methods. All the consecutive adult patients with sputum smear-positive pulmonary TB admitted to 2 Italian referral TB Centres were evaluated. Hospital-based DOT was provided to high risk patients up-to smear conversion. Demographic, microbiological and clinical conditions, as potential factors associated with confirmed smear conversion at 60 and 90 days of anti-tuberculous therapy were evaluated. Results. 122 patients were studied, 45.9% of them were immigrants (20% illegal) from high-prevalence TB countries. HIV testing was negative in all cases. Twelve patients had M. tuberculosis resistant to ≥ 1 first-line anti-tuberculous agents. The rate of defaulting from TB treatment was 7.3%. Sputum smear became negative in 84.4% cases after 60 days and 93.3% cases after 90 days. At such time, smear conversion rates were similar among different high risk subgroups such as illegal immigrants (95.9%), legal foreign-born (92.5%) and Italian persons (94.8%). Persistent sputum smear positivity was independently correlated with the extent of pulmonary lesions at 60 (p&lt;0.0001) and 90 days (p=0.038) of hospital-based DOT. Conclusions. These findings suggest that prolonged hospitalisation for illegal immigrants and high risk TB patients, may positively influence the early outcome of TB treatment despite of drug resistance and legal status.

scholarly journals Screening diabetes mellitus patients for pulmonary tuberculosis: a multisite study in Indonesia, Peru, Romania and South Africa

2020 ◽  
Author(s):  
Bachti Alisjahbana ◽  
Susan M McAllister ◽  
Cesar Ugarte-Gil ◽  
Nicolae Mircea Panduru ◽  
Katharina Ronacher ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
South Africa ◽  
Clinical Symptoms ◽  
Economic Status ◽  
World Health ◽  
Diagnostic Tools ◽  
Sputum Smear ◽  
Tb Treatment ◽  
Chest X Ray ◽  
Health Organization

Abstract Background Diabetes mellitus (DM) patients are three times more likely to develop tuberculosis (TB) than the general population. Active TB screening in people with DM is part of a bidirectional approach. The aim of this study was to conduct pragmatic active TB screening among DM patients in four countries to inform policy. Methods DM patients were recruited in Indonesia (n=809), Peru (n=600), Romania (n=603) and South Africa (n=51). TB cases were diagnosed using an algorithm including clinical symptoms and chest X-ray. Presumptive TB patients were examined with sputum smear and culture. Results A total of 171 (8.3%) individuals reported ever having had TB (South Africa, 26%; Indonesia, 12%; Peru, 7%; Romania, 4%), 15 of whom were already on TB treatment. Overall, 14 (0.73% [95% confidence interval 0.40 to 1.23]) TB cases were identified from screening. Poor glucose control, smoking, lower body mass index, education and socio-economic status were associated with newly diagnosed/current TB. Thirteen of the 14 TB cases diagnosed from this screening would have been found using a symptom-based approach. Conclusions These data support the World Health Organization recommendation for routine symptom-based screening for TB in known DM patients in high TB-burden countries. DM patients with any symptoms consistent with TB should be investigated and diagnostic tools should be easily accessible.

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