scholarly journals Treatment outcomes of patients with MDR-TB in Nepal on a current programmatic standardised regimen: retrospective single-centre study

2020 ◽  
Vol 7 (1) ◽  
pp. e000606 ◽  
Author(s):  
Samiksha Ghimire ◽  
Samriddhi Karki ◽  
Bhagwan Maharjan ◽  
Jos G W Kosterink ◽  
Daan J Touw ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Retrospective Chart Review ◽  
Therapeutic Drug ◽  
Sputum Smear ◽  
Success Rates ◽  
Tb Treatment ◽  
Treatment Implementation ◽  
Good Treatment Outcome ◽  
Mdr Tb

ObjectivesThe objectives of this study were to evaluate treatment in patients on current programmatic multidrug-resistant tuberculosis (MDR-TB) regimen and verify eligibility for the 9-month regimen and therapeutic drug monitoring (TDM).MethodsWe performed a retrospective chart review of patients with MDR-TB receiving standardised regimen at the German Nepal TB Project Clinic, Nepal, between 2014 and 2016. Eligibility for the 9-month regimen and indications for TDM were evaluated.ResultsOut of 107 available patients’ medical records, 98 were included. In this centre, the MDR-TB treatment success rates were 69.0% in 2015, 86.6% in 2016 and 86.5% in 2017. The median time to sputum smear conversion was 60 days (60–90 IQR) and culture conversion was 60 days (60–90 IQR). Observed side effects did not impact treatment outcomes. No difference in treatment success rates was observed between patients with predisposing risk factors and those without. Only 49% (36/74) of patients were eligible for the 9-month regimen and 23 patients for TDM according to American Thoracic Society guideline criteria.ConclusionsNepalese patients with MDR-TB on ambulatory care had good treatment outcome after programmatic treatment. Implementation of the new WHO oral MDR-TB treatment regimen may further improve treatment results. The 9-month regimen and TDM should be considered as part of programmatic care.

Treatment Outcomes of the Standardized Shorter MDR-TB Regimen under Programmatic Setting: A Retrospective Study from a Tertiary Care Centre, India

2021 ◽  
Vol 17 ◽  
Author(s):  
Swathi Karanth M.P ◽  
Somashekar M ◽  
Anushree Chakraborty ◽  
Swapna R ◽  
Akshata J.S ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Sputum Smear ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Mdr Tb ◽  
Set Up

Background: The shorter regimen was widely accepted and advocated for MDR-TB treatment compared tothe conventional longer regimen. Evaluating the performance of both regimens in a programmatic setting will help in tailoring the treatment regimen of MDR-TB. Objectives: 1. To estimate the duration of sputum smear conversion in the shorter MDR-TB regimen. 2. To compare the treatment outcomes of the shorter MDR-TB regimen with that of the longer conventional MDR regimen in a programmatic set up in India. 3. To estimate the adverse drug reactions in the shorter MDR-TB regimen. Methods: A retrospective cross-sectional study was conducted on 320 patients enrolled under programmatic management of drug resistant tuberculosis (PMDT) from April 2017 to May 2019 at a nodal DRTB center and a tertiary care hospital in India. Demographic and clinical characteristics of those who received a shorter MDR-TB regimen were recorded. Treatment outcomes of both regimens were recorded. Treatment success is defined as ‘disease cured and treatment completed’, whereas treatment failure was considered when the treatment was either terminated or changed due to lack of bacteriological conversion at the end of an extended intensive phase or culture reversion in the continuation phase. Results: The treatment success observed in the shorter MDR-TB regimen was 61.25%, which was significantly higher than the conventional longer regimen (p=0.0007). Treatment failures were higher with a shorter MDR-TB regimen (p=0.0001). Conclusion: Treatment success with the shorter MDR-TB regimen though higher than the conventional regimen, is still way behind the target treatment success rate. Improving treatment adherence remains pivotal for achieving end TB targets.

Tuberculosis in native Israeli Arabs and Jews: trends and treatment outcomes, 1999–2011

2015 ◽  
Vol 143 (15) ◽  
pp. 3203-3210 ◽  
Author(s):  
H. BISHARA ◽  
D. GOLDBLATT ◽  
E. RORMAN ◽  
Z. MOR
Keyword(s):  
Treatment Outcomes ◽  
Clinical Laboratory ◽  
Treatment Success ◽  
Developed Countries ◽  
National Average ◽  
Success Rates ◽  
Pulmonary Tb ◽  
Tb Treatment ◽  
Lower Treatment ◽  
Israeli Arabs

SUMMARYThe incidence of tuberculosis (TB) in native ethnic minorities remains high in developed countries. Arabs, the major ethnic minority in Israel, comprise 21% of its population. This retrospective study compared TB incidence, demographic, clinical, laboratory, genotyping characteristics and treatment outcomes in all Israeli-born citizens diagnosed with TB between 1999 and 2011 by ethnicity, i.e. Israeli-born Arabs (IA) and Jews (IJ). A total of 831 Israeli-born TB patients were reported. Of those, there were 530 (64%) IJ and 301 (36%) IA, with an average annual TB rate of 1·1 and 1·6 cases/100 000 population, respectively, lower than the national average (7·0 cases/100 000 population). TB rates in IA and IJ declined and converged to 1 case/100 000 residents. IA TB patients were more likely to be older, have more pulmonary TB and have lower treatment success rates than IJ. Older age and HIV co-infection, but not ethnicity, were predictive of non-success in TB treatment. Ten mixed IA–IJ clades were detected by spoligotyping and three mixed IA–IJ clusters were identified by MIRU-VNTR typing. Only one IA–IJ couple recalled mutual contact. In conclusion, TB rate in IA was higher than in IJ, but declined and converged in both to 1 case/100 000. Treatment success was high in both groups, and was unrelated to ethnicity.

scholarly journals Tuberculosis Treatment Outcomes: A Fifteen Year Retrospective Study in Jos North and Mangu, Plateau State, North – Central Nigeria

2020 ◽  
Author(s):  
Comfort Nanbam Sariem ◽  
Patricia Odumosu ◽  
Maxwell Patrick Dapar ◽  
Jonah Musa ◽  
Luka Ibrahim ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Treatment Outcomes ◽  
Descriptive Analysis ◽  
Treatment Success ◽  
Infectious Agent ◽  
Success Rates ◽  
North Central ◽  
Tuberculosis Patients ◽  
Tb Treatment ◽  
Plateau State

Abstract Background: Globally, tuberculosis (TB) is the leading cause of death from a single infectious agent. Adherence to TB therapy is an important factor in treatment outcomes, which is a critical indicator for evaluating TB treatment programs. This study assessed TB treatment outcomes using a fifteen-year record of tuberculosis patients who received treatment in Jos North and Mangu Local Government Areas of Plateau State, North-Central Nigeria. Methods: The retrospective facility based study was done in five TB treatment centers which account for more than half of data for tuberculosis patients in Plateau State. Data were collected from 10156 TB patient’s health records between 2001 and 2015. Treatment outcomes were categorized as successful (cured, treatment completed) or unsuccessful (non-adherent, treatment failure or death). A descriptive analysis was done to assess the factors associated with treatment outcomes. Relevant bivariable and multivariable logistic regression were done. All statistical analyses were performed on Stata version 11, College station, Texas, USA.Results: During the study period, 58.1% (5904/10156) of the TB patients who received treatment were males. The Mean age ±SD was 35.5 ±15.5 years. The overall treatment success rate was 67.4%; non-adherence/defaulting rate was 18.5%, with majority of patients defaulting at the end of intensive phase of treatment. The sputum conversion rate was 72.8% and mortality rate was 7.5%. A decrease in successful treatment outcomes rate from 83.8% in 2001 to 64.4% in 2015 was observed. After adjusting for sex, and TB category, being HIV positive was 2.8 times (95% CI: 1.11-6.83, p=0.028) more likely to be associated with treatment success than having an unknown status. Treatment after loss to follow-up, relapse and treatment failure were less likely associated with treatment success than newly diagnosed TB patients.Conclusion: With the decrease in treatment success rates, underlying reasons for medication non-adherence and treatment failure should be resolved through adherence counseling involving the patient and treatment supporters, with education on voluntary counseling and testing for HIV among TB patients.

scholarly journals Treatment success using novel and adapted treatment regimens in registered DR-TB children in Dushanbe, Tajikistan, 2013-2019

2021 ◽  
Vol 15 (09.1) ◽  
pp. 7S-16S
Author(s):  
Bobojon Pirmahmadzoda ◽  
Katrina Hann ◽  
Kristina Akopyan ◽  
Ruzanna Grigoryan ◽  
Evgenia Geliukh ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Short Treatment ◽  
Female Ratio ◽  
Treatment Regimens ◽  
Tb Treatment ◽  
National Tuberculosis ◽  
Mdr Tb ◽  
Pediatric Tb ◽  
Culture Conversion

Introduction: Approximately 3% of all pediatric TB cases develop MDR-TB, with only 3–4% of such children receiving MDR-TB treatment. In Tajikistan, children as a proportion of all DR-TB in the country increased from 4.3 to 7.5% during 2013-2018. Despite limited evidence on the use of new anti-TB drugs in children, WHO has updated its guidelines for DR-TB treatment for children, and Tajikistan did so in 2013 and 2017. Novel and adapted regimens included individual regimens for RR/MDR, XDR (with and without Bedaquiline and Delamanid) and short treatment regimens with and without injectables. It is important to document the outcomes of the treatment regimens. Therefore, the aim of this study was to describe characteristics of children receiving different treatment regimens for DR-TB, the culture conversion and treatment outcomes. Methodology: Cohort study of children enrolled in DR-TB treatment by the National Tuberculosis Program in Dushanbe, Tajikistan, January 2013 to July 2019. Results: The study included 60 DR-TB children. The male to female ratio was 1:2 and mean age 13.6 years. Median time to culture conversion was 66 days [IQR:31-103; Range:2-232]. In children with treatment outcomes (N = 58), 93% had favorable outcomes. There were four children (7%) with unfavorable treatment outcomes, all of whom were female 15-17 years, on standard (RR/MDR) treatment during 2013-2015. Favorable outcomes by DR-TB type were 91%, 90%, and 100% in RR/MDR, PreXDR, and XDR-TB patients, respectively. Conclusions: All children enrolled after the introduction of modified guidelines for novel and adapted regimens for DR-TB showed positive TB treatment outcomes.

scholarly journals Predictors of Intensive Phase Treatment Outcomes among Patients with Multi-Drug Resistant Tuberculosis in Zaria, North-Western Nigeria

2020 ◽  
Vol 32 (2) ◽  
pp. 95-107
Author(s):  
A. Oyefabi ◽  
B. Adelekan ◽  
E. Adetiba ◽  
L. Emmanuel ◽  
O. Jimoh
Keyword(s):  
Treatment Outcome ◽  
Treatment Outcomes ◽  
Successful Treatment ◽  
Treatment Success ◽  
Case Fatality ◽  
Training Centre ◽  
Intensive Phase ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Mdr Tb

Background: The emergence of multidrug-resistant tuberculosis (MDR-TB) is a threat to successful TB treatment outcomes in developing nations like Nigeria. This study determined the predictors of intensive phase treatment outcomes in MDR-TB patients in Zaria, Nigeria.Methods: This was a retrospective cross-sectional review of the records of 124 MDR-TB patients registered between September 2012 and August 2017 at the National Tuberculosis and Leprosy Training Centre, Saye, Zaria. Data were analyzed using IBM SPSS version 25.0 and the StataCorp STATA/SE 14.Results: The median age (IQR) of the respondents was 32 (15) years. The gene Xpert test detected Mycobacterium Tuberculosis (MTB) and rifampicin resistance (RIF) in 119 (96.0%) cases. The treatment success rate was 97 (78.2%). MDR-TB and HIV co-infection rate was 17 (13.7%) while the case fatality rate was 16.1%. Bivariate analysis showed that being male (p=0.001), not currently in marital union (p=0.01) and positive smear results at 1 month (p=0.027)) were significantly associated with treatment success. Multivariate logistic regression showed that the odds for successful treatment outcome was 4 times higher for the MDR-TB patients who were employed than the unemployed (AOR= 3.98, 95% CI= 1.15-13.74). No significant relationship between MDR-TB-HIV comorbidity (AOR=1.89, 95% CI=0.44-8.19), MDR-TB susceptible to Isoniazid (AOR= 0.49, 95% CI =0.15-1.56) and successful treatment outcome.Conclusion: Unemployment was a predictor of poor treatment outcome in this study. Cause-specific mortality due to the MDR TB was high in this setting. We advocate for optimization of access to treatment and social support system, especially for the female patients. Keywords: Gene Xpert; Intensive phase; MDR-TB; Treatment outcomes; Nigeria.

scholarly journals Nutritional status and TB treatment outcomes in Addis Ababa, Ethiopia: An ambi-directional cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247945
Author(s):  
Zekariyas Sahile ◽  
Robel Tezera ◽  
Damen Haile Mariam ◽  
Jeffrey Collins ◽  
Jemal Haider Ali
Keyword(s):  
Body Mass Index ◽  
Cohort Study ◽  
Treatment Outcomes ◽  
Body Mass ◽  
Addis Ababa ◽  
Treatment Success ◽  
Sputum Smear ◽  
P Value ◽  
Tb Treatment ◽  
Unsuccessful Treatment

Background Remaining underweight during Tuberculosis (TB) treatment is associated with a higher risk of unsuccessful TB treatment outcomes and relapse. Previous studies conducted in Ethiopia found that bodyweight not adjusted for height at the start of treatment is associated with poor treatment outcomes. However, the association of body mass index (BMI) and weight change during treatment with treatment outcomes has not been studied. We aimed to investigate the association of BMI at the time of diagnosis and after two months of treatment and TB treatment outcomes. Methods Using an ambi-directional cohort study design (retrospective and prospective), a total of 456 participants were enrolled among 30 randomly selected public health centers residing within six sub-cities of Addis Ababa, Ethiopia. Data were collected using medical chart abstraction and face to face interviews. We compared TB treatment outcomes in persons with a body mass index (BMI) <18.5kg/m2 (underweight) versus persons with BMI ≥18.5kg/m2 (normal or overweight) at treatment initiation and after two months of treatment. Treatment was classified as successful in persons who were free of symptoms and had a negative sputum smear for acid-fast bacilli at the end of the 6-month treatment course. We analysed outcomes using univariable and multivariable logistic regression with 95% CI and p value< 0.05. Results Of enrolled study participants, 184 (40.4%) were underweight and 272 (59.6%) were normal or overweight. Body mass index (BMI ≥18.5kg/m2) at the start and second month of treatment were independent predictors for successful treatment outcome (AOR = 2.15; 95% CI: 1.05, 4.39) and (AOR = 3.55; 95% CI: 1.29, 9.73), respectively. The probability of treatment success among patients with BMI≥18.5kg/m2 at the start and second month of treatment was 92.9% and 97.1%, respectively versus 86.5% and 91.7% in patients with BMI<18.5kg/m2. Bodyweight not adjusted for height and change in the bodyweight after the second and sixth months of treatment were not significantly associated with treatment success. Conclusion In persons treated for TB disease, being underweight at baseline and after two months of treatment was a predictor for unsuccessful treatment outcomes. Nutritional assessment, counselling, and management are important components of TB treatment programs with the potential to improve treatment outcomes.

Therapeutic strategies and outcomes of MDR and pre-XDR-TB in Italy: a nationwide study

2021 ◽  
Vol 25 (5) ◽  
pp. 395-399
Author(s):  
N. Riccardi ◽  
L. Saderi ◽  
E. Borroni ◽  
E. Tagliani ◽  
D. M. Cirillo ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Clavulanic Acid ◽  
Treatment Success ◽  
Multidrug Resistant ◽  
Primary Outcome Measure ◽  
Success Rates ◽  
Duration Of Treatment ◽  
Large Variability ◽  
Resistance Patterns ◽  
Mdr Tb

BACKGROUND: Treatment outcomes in multidrug‐resistant TB (MDR‐TB) patients are suboptimal in several low‐incidence countries.METHODS: The primary outcome measure was the proportion of successfully treated patients in Italy during an 18‐year period. Secondary outcomes were treatment outcomes in certain drug‐containing regimens and the possibility for the WHO shorter MDR‐TB regimen.RESULTS: In the 191 patients included (median age at admission: 33 years; 67.5% male, following drug‐resistance patterns were found: MDR‐TB in 68.6%, pre‐extensively drug‐resistant TB (pre‐XDR‐TB) in 30.4% and XDR‐TB in 1.1% patients. The most frequently prescribed drugs were fluoroquinolones in 84.6% cases, amikacin in 48.7%, linezolid in 34.6% and meropenem/clavulanic acid in 29.5%. The median duration of treatment was 18 months. Treatment success was achieved in 71.2% patients, of whom, 44% were cured and 27.2% completed treatment. Treatment success rates did not statistically differ between the MDR‐ (68.8%) and pre‐XDR‐TB (77.6%) groups (P = 0.26). Treatment success rates had large variability between North and South of Italy (81.3% vs. 53.3%). Only 22.5% of the cases would have been eligible for shorter MDR‐TB regimensCONCLUSION: Our study highlights variability in treatment outcomes in MDR‐ and pre‐XDR‐TB patients. Study findings confirmed the potential utility of linezolid and, for patients with limited oral options, meropenem/clavulanic acid and amikacin.

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 Tuberculosis Treatment Outcomes: A Fifteen Year Retrospective Study In Jos North And Mangu, Plateau State, North - Central Nigeria

2020 ◽  
Author(s):  
Comfort Nanbam Sariem ◽  
Patricia Odumosu ◽  
Maxwell Patrick Dapar ◽  
Jonah Musa ◽  
Luka Ibrahim ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Treatment Outcomes ◽  
Descriptive Analysis ◽  
Treatment Success ◽  
Infectious Agent ◽  
Success Rates ◽  
North Central ◽  
Tuberculosis Patients ◽  
Tb Treatment ◽  
Plateau State

Abstract Background: Globally, tuberculosis (TB) is the leading cause of death from a single infectious agent. Adherence to TB therapy is an important factor in treatment outcomes, which is a critical indicator for evaluating TB treatment programs. This study assessed TB treatment outcomes using a fifteen-year record of tuberculosis patients who received treatment in Jos North and Mangu Local Government Areas of Plateau State Nigeria. Methods: The retrospective facility based study was done in five TB treatment centers which account for more than half of data for tuberculosis patients in Plateau State, North-Central Nigeria. Data were collected from 10156 TB patient’s health records between 2001 and 2015. Treatment outcomes were categorized as successful (cured, treatment completed) or unsuccessful (non-adherent, treatment failure or death). A descriptive analysis was done to assess the factors associated with treatment outcomes. Relevant bivariable and multivariable logistic regression were done. All statistical analyses were performed on Stata version 11, College station, Texas, USA.Results: During the study period, 58.1% (5904/10156) of the TB patients who received treatment were males. The Mean age ±SD was 35.5±15.5 years. The overall treatment success rate was 67.4%; non-adherence/defaulting rate was 18.5%, with majority of patients defaulting at the end of intensive phase of treatment. The sputum conversion rate was 72.8% and mortality rate was 7.5%. A decrease in successful treatment outcomes rate from 83.8% in 2001 to 64.4% in 2015 was observed. After adjusting for sex, and TB category, being HIV positive was 2.8 times (95% CI: 1.11-6.83, p=0.028) more likely to be associated with treatment success than having an unknown status. Treatment after loss to follow-up, relapse and treatment failure were less likely associated with treatment success than newly diagnosed TB patients.Conclusion: With the decrease in treatment success rates, underlying reasons for medication non-adherence and treatment failure should be resolved through adherence counseling involving the patient and treatment supporters, with education on voluntary counseling and testing for HIV among TB patients.

scholarly journals Treatment success rates among tuberculosis patients notified from the private sector in West Bengal, India

2021 ◽  
Vol 91 (1) ◽  
Author(s):  
Vivek Sharma ◽  
Pruthu Thekkur ◽  
Poonam R. Naik ◽  
Brojo Kishore Saha ◽  
Niraj Agrawal ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
West Bengal ◽  
Treatment Success ◽  
Action Learning ◽  
Sputum Smear ◽  
Smear Microscopy ◽  
Adjusted Relative Risk ◽  
Limited Information ◽  
Success Rates ◽  
Successful Outcomes

In India, an estimated 50% of tuberculosis (TB) patients are diagnosed and managed by private providers (PPs). However, there is limited information on treatment outcomes among those treated by PPs largely because of a lack of systems for patient follow-up and documentation of the outcomes. Tuberculosis Health Action Learning Initiative (THALI) project implemented in six districts of West Bengal, supported PPs in managing TB patients and systematically documented the TB treatment outcomes of such patients. This provided us an opportunity to describe the treatment outcomes and assess factors associated with ‘unsuccessful outcomes’ among TB patients notified by PPs from January to April 2018. This was a retrospective cohort study using routinely collected data. During the study reference period, 2347 patients were notified from 389 PPs. The patient’s mean (SD) age was 39.9 (17.2) years and 61% were males. Of the total, about 86% had pulmonary TB, 95% were new cases, and 23% were microbiologically confirmed (either on sputum smear microscopy or Xpert assay). Among 2347 patients, 19% received free drugs from the National Tuberculosis Program (NTP) under the supervision of PPs while the rest purchased anti-TB drugs from the private pharmacies. The ‘successful outcomes’ (cured and treatment completed) were seen in 86.1% (95% confidence interval (CI), 84.6%-87.4%) patients and 8.6% were ‘not evaluated’. The patients who received free NTP drugs (adjusted relative risk-4.0 (95% CI: 3.1-5.0)) had a higher risk of ‘unsuccessful outcomes’ than those who availed of drugs from private pharmacies. The high ‘successful outcomes’ among TB patients treated by PPs are promising. However, higher ‘unsuccessful outcomes’ among patients on free NTP drugs need to be explored, and suitable corrective actions have to be taken.

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