scholarly journals Treatment outcomes of patients with drug-sensitive tuberculosis under community-based versus facility-based directly observed treatment, short course strategy in Southwest Ethiopia: a prospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e048369
Author(s):  
Berhane Megerssa Ereso ◽  
Mette Sagbakken ◽  
Christoph Gradmann ◽  
Solomon Abebe Yimer
Keyword(s):  
Cohort Study ◽  
Treatment Failure ◽  
Treatment Outcomes ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Community Based ◽  
Southwest Ethiopia ◽  
Tb Treatment ◽  
Short Course ◽  
Directly Observed Treatment

ObjectiveTo compare tuberculosis (TB) treatment outcomes and associated factors among patients attending community-based versus facility-based directly observed treatment, short course (DOTS).DesignA prospective cohort study.SettingThe study was conducted in Southwest Ethiopia. There were seven hospitals (five primary, one general and one specialised), 120 health centres and 494 health posts.ParticipantsA total of 1161 individuals consented to participate in the study (387 patients under community-based DOTS (CB-DOTS) and 774 patients under facility-based DOTS (FB-DOTS)). Individuals who could not respond to the questions, mentally or critically ill patients, and those less than 15 years old, were excluded from the study.Primary outcome measureTB treatment outcomes were compared among patients under CB-DOTS versus FB-DOTS. Risk ratio (RR), risk difference (RD) and confidence interval (CI) were calculated among the study groups. In addition, χ2 or Fisher’s exact tests were used to compare group differences, with a p value of <0.05 considered statistically significant.ResultsPatients who opted for CB-DOTS were more likely to be cured by 12% than those who opted for FB-DOTS (RR=1.12, 95% CI=0.96 to 1.30). Patients under CB-DOTS had a lesser risk of death (RR=0.93, 95% CI=0.49 to 1.77) and a lower risk of treatment failure (RR=0.86, 95% CI=0.22 to 3.30) than those under FB-DOTS. Furthermore, patients who opted for CB-DOTS were less likely to have a positive sputum smear result at the end of the treatment period (p=0.042) compared with their counterparts.ConclusionThe study showed that CB-DOTS is more effective than FB-DOTS in terms of improving cure rate and sputum conversion rate, as well as lowering treatment failure rate. Our findings show the need for scaling up and a further decentralisation of CB-DOTS approach to improve access to TB treatment service for the rural community.

scholarly journals Nexus Between Tuberculosis and Diabetic Mellitus, A Prospective Cohort Study.

2020 ◽  
Author(s):  
Berhanu Elfu Feleke ◽  
Teferi Elfu Feleke ◽  
Melkamu Beyene Kassahun ◽  
Wondemu Gebrekirose Adane ◽  
Abere Genetu ◽  
...  
Keyword(s):  
Cohort Study ◽  
Treatment Outcome ◽  
Glycemic Control ◽  
Clinical Response ◽  
Treatment Outcomes ◽  
Median Time ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Hba1c Level ◽  
Tb Treatment

Abstract Background: This work aimed to describe the clinical presentation of TB in patient with DM, to determine the effects of DM on TB treatment outcomes, to identify the effects of TB on glycemic control, and to describe the lipid profile of TB and DM patients. Methods: This prospective cohort study design was conducted. The data were collected from September 2018 to June 2020 using patient interviews, examining the patients, chart review, and collecting blood samples. Binary logistic regression was used to identify the determinants of TB treatment outcomes in the context of DM. Kaplan Meier survival curve was used to see the effects of DM on TB clinical response. Linear regression was used to identify the determinants of the HbA1c level during TB infection. Results: A total of 1092 study participants were included giving for the response rate at 93.81 %. Good TB treatment outcome was observed in 72.5 % of the patients [95 % CI: 69 % - 76 %]. The odds of good TB treatment outcomes were at 75 % lower in the presence of DM (AOR 0.25 [95 % CI: 0.08 – 0.73]). The median time of clinical response in TB and DM patients was 45 days interquartile range (IQR) of 8 days; the median time of clinical response in DM free TB patients was 9 days [IQR 2 days]. TB increased the HbA1c level of DM patients by 1.22 % (B 1.22 [95% CI: 1.11 – 1.34]). In six months period, 60 % of TB and DM patients had got 3 episodes of acute complications. Conclusion: DM significantly decreases the favorable treatment outcome of DOTS. TB predisposed DM patients for bad glycemic control and increased episodes of acute DM complications.

scholarly journals Depressed Gamma Interferon Responses and Treatment Outcomes in Tuberculosis Patients: a Prospective Cohort Study

2018 ◽  
Vol 56 (10) ◽  
Author(s):  
Jia-Yih Feng ◽  
Sheng-Wei Pan ◽  
Shiang-Fen Huang ◽  
Ying-Ying Chen ◽  
Yung-Yang Lin ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cohort Study ◽  
Treatment Outcomes ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Gamma Interferon ◽  
Tb Treatment ◽  
Ifn Γ ◽  
Treatment Mortality ◽  
Culture Conversion

ABSTRACT Immunosuppression induced by Mycobacterium tuberculosis is important in the pathogenesis of active tuberculosis (TB). However, the impact of depressed TB-specific and non-TB-specific gamma interferon (IFN-γ) response on the treatment outcomes of TB patients remains uncertain. In this prospective cohort study, culture- or pathology-proven active TB patients were enrolled and QuantiFERON-TB Gold In-Tube (QFT-GIT) assays were performed before the initiation of anti-TB treatment. TB-specific IFN-γ responses (TB antigen tube subtracted from the nil tube) and non-TB-specific IFN-γ responses (mitogen tube subtracted from the nil tube) were measured and associated with treatment outcomes, including 2-month culture conversion and on-treatment mortality. A total of 212 active TB patients were included in the analysis. We observed a close correlation between decreased lymphocyte count and lower non-TB-specific IFN-γ responses but not TB-specific IFN-γ responses. Patients with lower non-TB-specific IFN-γ responses had lower 2-month culture conversion rate (71.1% versus 84.7%, respectively; P = 0.033) and higher on-treatment mortality (22.6% versus 5.7%, respectively; P = 0.001) than those with higher non-TB-specific IFN-γ responses. In multivariate analysis, depressed non-TB-specific IFN-γ response was an independent factor associated with 2-month sputum culture nonconversion (odds ratio [OR], 2.49; 95% CI [95% confidence interval], 1.05 to 5.90) and on-treatment mortality (hazard ratio [HR], 2.76; 95% CI, 1.15 to 6.62). In contrast, depressed TB-specific IFN-γ responses were significantly associated with higher on-treatment mortality in univariate analysis but not in multivariate analysis. Our findings suggest that depressed non-TB-specific responses, but not TB-specific IFN-γ responses, as measured by QFT-GIT before the initiation of anti-TB treatment, were significantly associated with worse treatment outcomes in TB patients.

scholarly journals Tuberculosis clinical presentation and treatment outcomes in pregnancy: a prospective cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Brittney J. van de Water ◽  
Meredith B. Brooks ◽  
Chuan-Chin Huang ◽  
Letizia Trevisi ◽  
Leonid Lecca ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pregnant Women ◽  
Treatment Outcomes ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Clinical Presentation ◽  
Drug Susceptibility ◽  
Successful Outcome ◽  
Childbearing Age ◽  
Tb Treatment

Abstract Background There is limited research to guide TB treatment specifically in pregnant women and few studies have described the presentation of TB in pregnant women. We aimed to understand TB presentation and treatment outcomes in pregnant women in a low HIV burden setting. We describe a cohort of women of childbearing age treated for TB disease in Lima, Peru, and compare clinical presentation and treatment outcomes among pregnant and non-pregnant women between 2009 and 2012, including 36 pregnant women. Methods This is a prospective cohort study. Subjects were recruited from across 106 public health centers in Lima, Peru. Baseline demographic, medical history, and drug-susceptibility test results were collected. We used descriptive statistics to describe demographic and clinical characteristics of the women using Pearson chi-squared, Fisher’s exact tests, or Kruskal-Wallis. Results Among 4500 individuals with pulmonary TB disease, 1334 women were included in analysis with 36 (2.69%) pregnant women. Pregnant women had similar demographics, past medical histories, and clinical presentation to non-pregnant women, except being more likely to be married (p = 0.01) and have cardiac disease (p = 0.04) and less likely to have weight loss (p = 0.05). Twenty (71.4%) pregnant women had pan-susceptible TB compared with 616 (63.1%) non-pregnant women; four (14.3%) pregnant women had mono-resistant TB compared with 154 (15.8%) non-pregnant women; and four (14.3%) pregnant women had multi-drug-resistant TB compared with 140 (14.3%) of non-pregnant women (p = 0.53). Twenty-eight (96.6%) pregnant women had a successful outcome (cure, completed treatment, treatment ended early by clinical team) while one (3.4%) had an unsuccessful outcome (treatment failed) and 1074 (97.3%) non-pregnant women had a successful outcome while 30 (2.7%) had an unsuccessful outcome (p = 0.56). Conclusion In this cohort with low HIV co-infection, we found high TB treatment success rates in both pregnant and non-pregnant women, irrespective of drug-susceptibility profiles. If treated appropriately, pregnant women with TB disease can have successful outcomes.

scholarly journals Substance use disorders and adherence to antituberculosis medications in Southwest Ethiopia: a prospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e043050
Author(s):  
Matiwos Soboka ◽  
Markos Tesfaye ◽  
Kristina Adorjan ◽  
Wolfgang Krahl ◽  
Elias Tesfaye ◽  
...  
Keyword(s):  
Substance Use ◽  
Cohort Study ◽  
Substance Use Disorders ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Southwest Ethiopia ◽  
Treatment Services ◽  
Tb Treatment ◽  
Khat Use

ObjectivesIn Ethiopia, little is known about the association between substance use disorders and adherence to antituberculosis (anti-TB) medications. Therefore, the objective of this study was to assess the effect of substance use disorders on adherence to anti-TB medications in Southwest Ethiopia.DesignProspective cohort study.SettingsPatients were recruited from 22 health centres and four hospitals in Southwest Ethiopia.ParticipantsThis study was conducted among 268 patients with TB, aged 18–80 in Southwest Ethiopia between October 2017 and October 2018. At baseline, patients who were exposed substance use disorders (134 patients) and unexposed to substance use disorders (134 patients) were recruited. Patients were followed for 6 months, and data were collected on three occasions.Main outcome measureAdherence to anti-TB medications.ResultsPatients with substance use disorders had consistently higher prevalence of non-adherence than those without, 16.4% versus 3.0% at baseline, 41.7% versus 14.4% at 2-month follow-up and 45.7% versus 10.8% at 6-month follow-up assessments. Patients with khat use disorder were 3.8 times more likely to be non-adherent to anti-TB medications than patients without khat use disorder (Adjusted odds ratio (aOR)=3.8, 95% CI 1.8 to 8.0). Patients who had alcohol use disorder (AUD) were also 3.2 times likely to have poor adherence compared with their counterparts (aOR=3.2, 95% CI 1.6 to 6.6). In addition, being educated (aOR=4.4, 95% CI 1.7 to 11.3), and being merchant (aOR=6.1, 95% CI 1.2 to 30.8) were associated with non-adherence to anti-TB medications.ConclusionKhat and AUDs predict greater likelihood of non-adherence to anti-TB medication. This implies the need to integrate the management for substance use disorders into the existing TB treatment services.

scholarly journals Diabetes Mellitus and Tuberculosis Treatment Outcomes in Pune, India

2021 ◽  
Author(s):  
Vidya Mave ◽  
Sanjay Gaikwad ◽  
Madhusudan Barthwal ◽  
Ajay Chandanwale ◽  
Rahul Lokhande ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cohort Study ◽  
Treatment Outcomes ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Hazard Ratio ◽  
Early Mortality ◽  
Adjusted Hazard Ratio ◽  
Tb Treatment ◽  
The Impact

Abstract Background Diabetes mellitus (DM) increases the risk of tuberculosis (TB) disease. Knowledge of the impact of DM on TB treatment outcomes is primarily based on retrospective studies. Methods We conducted a prospective cohort study of new pulmonary TB patients with and without DM (TB-DM and TB-only) in India. The association of DM with a composite unfavorable TB treatment outcome (failure, recurrence, mortality) over 18 months was determined and the effect of DM on all-cause mortality and early mortality (death during TB treatment) was assessed. Results Of 799 participants, 574(72%) had TB-only and 225(28%) had TB-DM. The proportion of patients with DM who experienced the composite outcome was 20% as compared to 21% for TB only participants (adjusted hazard ratio 1.13, 95% CI 0.75–1.70). Mortality was higher in participants with DM (10% vs. 7%), and early mortality was substantially higher among patients with DM (adjusted hazard ratio [aHR] 4.36; 95% CI:1·62–11.76). Conclusion DM was associated with early mortality in this prospective cohort study, but overall unfavorable outcomes were similar to participants without DM. Interventions to reduce mortality during TB treatment among people with TB-DM are needed.

The clinical utility of accurate NAFLD ultrasound grading: Results from a community-based, prospective cohort study

2021 ◽  
Vol 136 ◽  
pp. 109516
Author(s):  
Madunil Anuk Niriella ◽  
Dileepa Senajith Ediriweera ◽  
Anuradhani Kasturiratne ◽  
Deepa Gunasekara ◽  
Shamila Thivanshi De Silva ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Clinical Utility ◽  
Community Based

scholarly journals Village-to-village screening for hepatitis B and C using quantitative HBsAg and anti-HCV testing with reflex HCV core antigen tests in the remote communities of a resource-rich setting: a population-based prospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046115
Author(s):  
Te-Sheng Chang ◽  
Kao-Chi Chang ◽  
Wei-Ming Chen ◽  
Nien-Tzu Hsu ◽  
Chih-Yi Lee ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hepatitis B ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Population Based ◽  
Core Antigen ◽  
Remote Communities ◽  
Community Based ◽  
Patient Allocation ◽  
Hcv Testing

ObjectivesCommunity-based screening for hepatitis B virus (HBV) and hepatitis C virus (HCV) is essential for hepatitis elimination. This study attempted to increase screening accessibility and efficacy by using alternative tools.DesignPopulation-based prospective cohort study.SettingHepatitis elimination program at Yunlin County, Taiwan.ParticipantsAll 4552 individuals participated in 60 screening sessions of a community-based HBV and HCV screening project in five rural townships with approximately 95 000 inhabitants in central-western Taiwan.InterventionsTo increase accessibility, 60 outreach screening sessions were conducted in 41 disseminative sites. Quantitative HBV surface antigen (qHBsAg) and anti-HCV testing with reflex HCV core antigen (HCV Ag) tests were employed as alternative screening tools.Main outcome measuresCalculate village-specific prevalence of HBsAg, anti-HCV and HCV Ag and establish patient allocation strategies according to levels of qHBsAg HCV Ag and alanine aminotransferase (ALT).ResultsOf 4552 participants, 553, 697 and 290 were positive for HBsAg, anti-HCV and HCV Ag, respectively; 75 of them had both HBsAg and anti-HCV positivity. The average (range) number of participants in each screening session was 98 (31–150). The prevalence rates (range) of HBsAg, anti-HCV and HCV Ag were 12.1% (4.3%–19.4%), 15.3% (2.6%–52.3%) and 6.4% (0%–30.2%), respectively. The HCV Ag positivity rate among anti-HCV-positive participants was 42% (0%–100%). Using cut-off values of >200 IU/mL for qHBsAg, >3 fmol/L for HCV Ag and >40 IU/mL for ALT as criteria for patient referral, we noted an 80.2% reduction in referral burden. Three villages had high anti-HCV prevalences of 52.3%, 53.8% and 63.4% with corresponding viraemic prevalences of 23.2%, 30.1% and 22% and thus constituted newly identified HCV-hyperendemic villages.ConclusionOutreach hepatitis screening increases accessibility for residents in rural communities. Screening HBV and HCV through qHBsAg and HCV Ag tests provides information concerning viral activities, which might be conducive to precise patient allocation in remote communities.

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