Health System and Policy Perspectives of Multidrug-resistant Tuberculosis (MDR-TB) Control in India

2017 ◽  
Vol 3 (1) ◽  
pp. 1-15
Author(s):  
Janmejaya Samal
Keyword(s):  
Decision Making ◽  
Surveillance System ◽  
Epidemiological Studies ◽  
Multidrug Resistant ◽  
Control Programme ◽  
Tb Control ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Right

Despite the lack of reliable information on multidrug-resistant tuberculosis (MDR-TB) epidemiology, research shows an increasing trend of MDR-TB incidence in India. Of several determinants attributable to the rising trend of MDR-TB, health systems and policy (HSP) determinants play a pivotal role. With this article, an attempt has been made to unravel the HSP challenges for the control of MDR-TB and recommend strategies to overcome that. Ten different strategies have been recommended in this article that includes operations research (OR), molecular epidemiological studies, drug susceptibility test (DST), surveillance system, advocacy communication and social mobilisation (ACSM), nutrition and livelihood support, contribution of private practitioners (PPs), human resources for health (HRH), social determinants of health and information systems. Methods of OR with the right technical expertise can help in decision-making and evaluation of the TB control programme. Molecular epidemiological studies further help identify the right strain and can help in institutionalising the right therapeutic regimen. Similarly, the DST allows extended treatment strategies, including second-line drugs. A proper surveillance system can enable the availability of the right information for public health decision-making. Communication enables and empowers the community in accessing health services and helps policymakers take informed decisions. Nutrition and livelihood support are essential in TB control as it mostly affects the poor and people in the productive age group. Further, tapping PPs is equally important as more than 50 per cent of TB patients visit them. Proper orientation of the PPs about the TB control programme is non-negotiable given these facts. The HRH issues are pertinent—staff members lack the required motivation owing to delay in payment of salaries and the lack of job promotion. The HRH form the backbone of any health system, as the mere presence of drugs, technologies and infrastructure do not suffice for the provision of healthcare. Attention on the neglected social determinants of health is required as well. Finally, all these suggestions need to be implemented in coordination with each other to bring down the scourge of MDR-TB in India.

scholarly journals Pharmacokinetics of Second-Line Antituberculosis Drugs in Children with Multidrug-Resistant Tuberculosis in India

2018 ◽  
Vol 62 (5) ◽  
Author(s):  
Agibothu Kupparam Hemanth Kumar ◽  
Alok Kumar ◽  
Thiruvengadam Kannan ◽  
Rakesh Bhatia ◽  
Dipti Agarwal ◽  
...  
Keyword(s):  
High Performance ◽  
Linear Regression Analysis ◽  
Multidrug Resistant ◽  
Control Programme ◽  
Second Line ◽  
Time Curve ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Government

ABSTRACTWe studied the pharmacokinetics of levofloxacin (LFX), pyrazinamide (PZA), ethionamide (ETH), and cycloserine (CS) in children with multidrug-resistant tuberculosis (MDR-TB) who were being treated according to the Revised National TB Control Programme (RNTCP) guidelines in India. This observational, pharmacokinetic study was conducted in 25 children with MDR-TB at the Sarojini Naidu Medical College, Agra, India, who were being treated with a 24-month daily regimen. Serial blood samples were collected after directly observed administration of drugs. Estimations of plasma LFX, PZA, ETH, and CS were undertaken according to validated methods by high-performance liquid chromatography. Adverse events were noted at 6 months of treatment. The peak concentration (Cmax) of LFX was significantly higher in female than male children (11.5 μg/ml versus 7.3 μg/ml;P= 0.017). Children below 12 years of age had significantly higher ETH exposure (area under the concentration-time curve from 0 to 8 h [AUC0–8]) than those above 12 years of age (17.5 μg/ml · h versus 9.4 μg/ml;P= 0.030). Multiple linear regression analysis showed significant influence of gender onCmaxof ETH and age onCmaxand AUC0–8of CS. This is the first and only study from India reporting on the pharmacokinetics of LFX, ETH, PZA, and CS in children with MDR-TB treated in the Government of India program. More studies on the safety and pharmacokinetics of second-line anti-TB drugs in children with MDR-TB from different settings are required.

scholarly journals Prevalence of Multidrug-Resistant Tuberculosis and Associated Factors in Ethiopia: A Systematic Review

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Solomon Weldegebreal Asgedom ◽  
Mebrahtu Teweldemedhin ◽  
Hailay Gebreyesus
Keyword(s):  
Systematic Review ◽  
Risk Factor ◽  
Associated Factors ◽  
Multidrug Resistant ◽  
Previous Exposure ◽  
Tb Control ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Antituberculosis Treatment ◽  
Mdr Tb

Background. Multidrug-resistant tuberculosis (MDR-TB) has continued to be a challenge for tuberculosis (TB) control globally. Ethiopia is one of the countries with high MDR-TB burden. Objective. The main purpose of this study was to determine the prevalence of MDR-TB and associated factors in Ethiopia. Methods. A systematic review of the literatures on prevalence of MDR-TB and associated factors was conducted in the country. Results. In our electronic search, 546 citations were depicted. Among the total 546 citations described, a total of 22 articles met eligibility criteria and were included in the review article. According to our review, the prevalence of MDR-TB ranged from 0 to 46.3%. The average mean rate of MDR-TB in Ethiopia was found to be 12.6±15.9%. The overall prevalence of MDR-TB in all TB cases was estimated to be 1.4%. From a total of 3849 patients studied, 527 had MDR-TB. Previous exposure to antituberculosis treatment was the most commonly identified risk factor of MDR-TB in Ethiopia. Conclusion. Despite relative decline in incidence of MDR-TB, the distribution and prevalence of MDR-TB continued to be a serious challenge for TB control in Ethiopia. Previous exposure to antituberculosis treatment was also the most common risk factor for MDR-TB. Therefore, strong TB and MDR-TB treatment along with tight introduction of follow-up strategies should be applied for better TB control.

scholarly journals Performance of Multidrug-Resistant Tuberculosis Surveillance in Yemen: Interview Study (Preprint)

2019 ◽  
Author(s):  
Jihan Abdulmughni ◽  
Esam Mohammed Mahyoub ◽  
Abdulaziz Thabit Alaghbari ◽  
Abdulwahed Abdelgabar Al Serouri ◽  
Yousef Khader
Keyword(s):  
Surveillance System ◽  
Multidrug Resistant ◽  
Sentinel Surveillance ◽  
Surveillance Systems ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Previously Treated ◽  
Overall Performance ◽  
The Government

BACKGROUND Multidrug-resistant tuberculosis (MDR-TB) is a major challenge to ending TB occurrence by 2035. In Yemen, the 2011 survey showed an MDR-TB prevalence of 1.4% among new cases and 14.4% among previously treated cases. The National Tuberculosis Control Program (NTCP) established four MDR-TB sentinel surveillance sites in 2013 to monitor the MDR-TB situation. In Yemen, the 2011 survey showed an MDR-TB prevalence of 1.4% among new cases and 14.4% among previously treated cases. The NTCP established four MDR-TB sentinel surveillance sites in 2013 to monitor the MDR-TB situation. OBJECTIVE This study aimed to assess the performance of MDR-TB surveillance and determine its strengths and weaknesses. METHODS We used the updated Center for Diseases Control and Prevention guidelines for evaluating public health surveillance systems. Interviews were conducted with NTCP managers and Regional MDR-TB centers’ staff using a semistructured questionnaire. We used a 5-point Likert scale to assess the usefulness and other attributes (eg, simplicity and flexibility). The mean percentage was calculated for each attribute and used for the final rank of the performance: poor (<60%), average (60%-80%), and good (>80%). RESULTS The MDR-TB surveillance system achieved good performance in usefulness (87%), acceptability (82%), and data quality (91%); average performance in flexibility (61%) and simplicity (72%); and poor performance in stability (55%). The overall performance score was average (74%). Although strong commitment, good monitoring, and well-trained staff are the main strengths, depending on an external fund is a major weakness along with unavailability of the MDR-TB unit at the governorate level. CONCLUSIONS Although the MDR-TB surveillance system has achieved an average overall performance, more efforts are required to improve its stability by ensuring constant power supply to enable laboratories to perform necessary diagnostic and follow-up tests. Gradual replacement of donors’ funds by the government is recommended. Scaling up of MDR-TB services and removing access barriers are crucial.

scholarly journals Retrospective analysis of multidrug-resistant tuberculosis case notifications in Australia (1999–2018)

2020 ◽  
Vol 44 ◽  
Author(s):  
Hendrik S Camphor ◽  
Kerri Viney ◽  
Ben Polkinghorne ◽  
Kate Pennington
Keyword(s):  
Clinical Laboratory ◽  
Treatment Success ◽  
Multidrug Resistant ◽  
Current Data ◽  
Notification Rate ◽  
Tuberculosis Case ◽  
Tb Control ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb

This study describes the epidemiology and treatment outcomes of multidrug-resistant tuberculosis (MDR-TB) cases notified in Australia between 1999 and 2018, and investigates whether current data fields in the national tuberculosis (TB) dataset allow description and measurement of surveillance information pertaining to the diagnosis and clinical management of MDR-TB. In May 2019, de-identified demographic, clinical, laboratory, drug susceptibility, treatment, risk factor and outcome data for all MDR-TB case notifications were extracted from the Australian National Notifiable Disease Surveillance System. The dataset included ten treatment outcome categories, which were aggregated to four categorical outcomes for descriptive and inferential analyses. The majority of cases were overseas-born (91%). Absolute case numbers increased over time; however, the MDR-TB notification rate remained fairly stable during the study period. Treatment success was achieved in nearly two-thirds of cases (62.1%). Whilst timeframes between initial presentation, specimen collection, case notification and treatment commencement were calculated, current data fields in the national dataset precluded measurement and description of other parameters deemed important for MDR-TB surveillance. This study demonstrates that while Australia’s MDR-TB burden is low, cases will continue to occur until TB control improves in countries with which Australia shares cultural and migration links. Australia should continue to support national and regional TB control programmes to sustain progress towards national elimination of TB. This study’s findings support a review of data fields in the national TB dataset with potential expansion or adjustment to improve national data reporting, including the monitoring of evidence-based recommendations for the prevention and management of MDR-TB.

scholarly journals Trends in burden of multidrug-resistant tuberculosis in countries, regions, and worldwide from 1990 to 2017: results from the Global Burden of Disease Study

2020 ◽  
Author(s):  
Zejin Ou ◽  
Danfeng Yu ◽  
Yuanhao Liang ◽  
Wenqiao He ◽  
Yongzhi Li ◽  
...  
Keyword(s):  
Burden Of Disease ◽  
Multidrug Resistant ◽  
Global Burden Of Disease ◽  
Global Burden ◽  
Tb Control ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Disease Study ◽  
Increasing Trends

Abstract Background Antituberculosis-drug resistance is an important public health issue worldwide, and its epidemiological patterns has dramatically changed in recent decades. This study aimed to estimate the trends of multidrug-resistant tuberculosis (MDR-TB), which can provide an important reference to the strategies for TB control.Methods Data were collected from the Global Burden of Disease Study 2017. The estimated annual percentage changes (EAPCs) were calculated to quantify the trends of MDR-TB burden at global, regional, and national level from 1990 to 2017.Results Globally, the age-standardized rate (ASR)of MDR-TB burden including incidence, prevalence, death and disability-adjusted life years (DALYs) had pronounced increasing trends from 1990 to 1999, with the respective EAPCs were 17.63(95% confidence interval [CI]: 10.77 to 24.92), 17.57(95%CI: 11.51 to 23.95), 21.21(95%CI:15.96 to 26.69), and 21.90(95%CI: 16.55 to 27.50). Particularly, the largest increasing trends were seen in areas and countries with low and low-middle sociodemographic index (SDI). However, the trends in incidence, prevalence, death and DALYs of MDR-TB decreased globally from 2000 to 2017, with the respective EAPCs were −1.37(95%CI: −1.62 to −1.12), −1.32(95%CI: −1.38 to −1.26), −3.30(95%CI: −3.56 to −3.04) and −3.32(95%CI: −3.59 to −3.06). Decreasing trends of MDR-TB were observed in most regions and countries, particularly that of death and DALYs in Slovenia were −18.96(95%CI: −20.82 to −17.06) and −19.35 (95%CI: −21.10 to −17.55), respectively. Whereas increasing trends of MDR-TB occurred in Papua New Guinea, Singapore, and Australia.Conclusions The trends of MDR-TB pronouncedly decreased worldwide from 2000 to 2017. However, the MDR-TB burden remains a substantial challenge to the TB control globally, and requires effective control strategies and healthcare systems.

scholarly journals Performance of Multidrug-Resistant Tuberculosis Surveillance in Yemen: Interview Study

10.2196/14294 ◽  
2019 ◽  
Vol 5 (4) ◽  
pp. e14294
Author(s):  
Jihan Abdulmughni ◽  
Esam Mohammed Mahyoub ◽  
Abdulaziz Thabit Alaghbari ◽  
Abdulwahed Abdelgabar Al Serouri ◽  
Yousef Khader
Keyword(s):  
Surveillance System ◽  
Multidrug Resistant ◽  
Sentinel Surveillance ◽  
Surveillance Systems ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Previously Treated ◽  
Overall Performance ◽  
The Government

Background Multidrug-resistant tuberculosis (MDR-TB) is a major challenge to ending TB occurrence by 2035. In Yemen, the 2011 survey showed an MDR-TB prevalence of 1.4% among new cases and 14.4% among previously treated cases. The National Tuberculosis Control Program (NTCP) established four MDR-TB sentinel surveillance sites in 2013 to monitor the MDR-TB situation. In Yemen, the 2011 survey showed an MDR-TB prevalence of 1.4% among new cases and 14.4% among previously treated cases. The NTCP established four MDR-TB sentinel surveillance sites in 2013 to monitor the MDR-TB situation. Objective This study aimed to assess the performance of MDR-TB surveillance and determine its strengths and weaknesses. Methods We used the updated Center for Diseases Control and Prevention guidelines for evaluating public health surveillance systems. Interviews were conducted with NTCP managers and Regional MDR-TB centers’ staff using a semistructured questionnaire. We used a 5-point Likert scale to assess the usefulness and other attributes (eg, simplicity and flexibility). The mean percentage was calculated for each attribute and used for the final rank of the performance: poor (<60%), average (60%-80%), and good (>80%). Results The MDR-TB surveillance system achieved good performance in usefulness (87%), acceptability (82%), and data quality (91%); average performance in flexibility (61%) and simplicity (72%); and poor performance in stability (55%). The overall performance score was average (74%). Although strong commitment, good monitoring, and well-trained staff are the main strengths, depending on an external fund is a major weakness along with unavailability of the MDR-TB unit at the governorate level. Conclusions Although the MDR-TB surveillance system has achieved an average overall performance, more efforts are required to improve its stability by ensuring constant power supply to enable laboratories to perform necessary diagnostic and follow-up tests. Gradual replacement of donors’ funds by the government is recommended. Scaling up of MDR-TB services and removing access barriers are crucial.

scholarly journals Pharmacokinetics of anti-tuberculosis drugs in multidrug resistant tuberculosis patients in India

2020 ◽  
Author(s):  
Kumar AK Hemanth ◽  
PL Natarajan ◽  
T Kannan ◽  
R Sridhar ◽  
S Kumar ◽  
...  
Keyword(s):  
Multivariate Logistic Regression Analysis ◽  
Multidrug Resistant ◽  
Control Programme ◽  
Combination Regimen ◽  
Indian Government ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Drug Concentrations ◽  
Optimal Drug ◽  
Mdr Tb

AbstractProgrammatic Management of multidrug resistant tuberculosis (MDR TB) services were introduced in the Indian TB control programme in 2007. A pharmacokinetic (PK) study of drugs used to treat MDR TB, namely levofloxacin (LFX), ethionamide (ETH), cycloserine (CS), pyrazinamide (PZA), moxifloxacin (MFX) and isoniazid (INH) was undertaken in adult MDR TB patients treated according to the prevailing guidelines in India. Factors influencing drug PK and end-of-intensive phase (IP) status were also determined. We recruited 350 MDR TB patients receiving anti-TB treatment (ATT) in the Indian Government programme in south India. At steady state, serial blood samples were collected, after supervised drug administration. Status at end of IP was noted from the programme records. Of the 303 patients for whom end-of-IP status was known, 214 were culture negative (responders), while 45 patients were either culture positive or required change of regimen or had died before completion of IP (non-responders). The median Cmax (2.0 vs 2.9μg/ml; p = 0.005) and AUC0-12 (12.2 vs 17.0μg/ml.h; p = 0.002) of ETH were significantly lower in non-responders than responders at IP. In multivariate logistic regression analysis, after excluding defaulters and adjusting for confounders, AUC0-12 of ETH significantly influenced end-of-IP status (aOR - 1.065; 95% CI: 1.001 - 1.134; p = 0.047). Drug doses used currently in the programme produced optimal drug concentrations in majority of patients. ETH played a major role in the MDR TB combination regimen and was a key determinant of end-of-IP status.

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