scholarly journals The Relationship between Previous Tuberculosis Treatment and HIV Status with Multidrug-Resistant Tuberculosis

2019 ◽  
Vol 14 (3) ◽  
pp. 347-352
Author(s):  
Dyan Kunthi Nugrahaeni ◽  
Salma Zaqiya

Multidrug-resistant tuberculosis (MDR-TB) is becoming major public health issues in the world. Among the causes are history of previous TB treatment and increased co-infection of TB-HIV (Human Immunodeficiency Virus). This study aimed to identify the relationship between history of previous TB treatment and HIV status with MDR-TB. This is a case control study. The sample case was patients with MDR-TB, while sample control was patient who have drug-sensitive TB. Secondary data was obtained from patient medical records and laboratory results at Rotinsulu Pulmonary Hospital Bandung. Data were analyzed using chi-square. Multiple logistic regression was used to identify the dominant factor that influence the occurrence of MDR-TB. This study showed that the history of previous TB treatment was statistically significant with MDR-TB (p value= 0.001; OR= 18.889; 95% CI= 4.093-87.172) and it is the dominant factor that influence MDR-TB (p value= 0.0001; OR= 56.84; 95% CI= 6.9- 468.87). HIV infection at control group (who contracted drug-sensitive TB) was 26.1% (p value= 0.022). This finding suggested that HIV testing should be performed to each TB and MDR-TB patients and increased collaboration TB-HIV program between the other health care facilities should ensue. Drug sensitivity testing should be conducted at the start of TB treatment for patients with previous TB treatment and TB-HIV co-infection.

2019 ◽  
Author(s):  
Le Hong Van ◽  
Phan Trieu Phu ◽  
Dao Nguyen Vinh ◽  
Vo Thanh Son ◽  
Nguyen Thi Hanh ◽  
...  

Abstract Background Multidrug resistant tuberculosis (MDR-TB) remains a serious public health problem with poor treatment outcome. Predictors of poor outcomes vary in different health-care settings. Vietnam is among the 30 countries with high burden of MDR-TB. We aim to describe demographic characteristics and identify risk factors for poor outcome of MDR-TB in Ho Chi Minh City (HCMC), the most populous city in Vietnam. Methods This retrospective study included 2,267 patients who initiated MDR-TB treatment from 2011 to 2015 in HCMC. Treatment outcomes were available in 2,241 patients. Data was collected from standardized paper-based treatment cards and electronic records. Statistical analysis was performed using R program. Results Among 2,267 eligible cases, 60.2% were failure of category I or II regimen, 57.7% were underweight, 30.2% had diabetes mellitus and 9.6% were HIV positive. Notification rate increased 24.7% from 2011 to 2015.Treatment success rate was 73.3%. Risk factors for poor treatment outcome included HIV co-infection (odds ratio (OR): 2.92), advanced age (OR: 1.47 for every increase of 5 years for patients older than 60), having history of MDR-TB treatment (OR: 5.65), sputum smear grade scanty and 1+ (OR: 1.48), smear grade 2+ or 3+ (OR: 2.07), low BMI (OR: 0.84 for every increase of 1kg/m2 of BMI for patients with BMI<21). Conclusion Our study describes the increasing burden of MDR-TB in HCMC and the need for better drug resistance screening for all TB patients. Patients with HIV, high smear grade, malnutrition and history of previous MDR-TB treatment should receive additional care.


2021 ◽  
Author(s):  
Rika Yuliwulandari ◽  
Kinasih Prayuni ◽  
Intan Razari ◽  
Retno W Susilowati ◽  
Yenni Zulhamidah ◽  
...  

Background: Owing to the high resistance rate of tuberculosis (TB) to isoniazid, which is metabolized by N-acetyltransferase 2 (NAT2), we investigated the associations between NAT2 variants and multidrug-resistant (MDR)-TB. Materials & methods: The acetylator status based on NAT2 haplotypes of 128 patients with MDR-TB in Indonesia were compared with our published data from patients with anti-TB drug-induced liver injury (AT-DILI), TB and the general population. Results: NAT2*4 was more frequent in the MDR-TB group than in the AT-DILI group, TB controls and general controls. NAT2*4/*4 was significantly more frequent in patients with MDR-TB than in those with AT-DILI. NAT2*5B/7B, *6A/6A and *7B/*7B were detected at lower frequencies in patients with AT-DILI. Rapid acetylators were significantly more frequent in patients with MDR-TB than in those with AT-DILI. Conclusion: These results provide an initial data for optimizing TB treatment in the Indonesian population, and suggest that NAT2 genotyping may help to select appropriate treatment by predicting TB-treatment effect.


2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Mareta Dea Rosaline ◽  
Santi Herlina

Tuberculosis control in Indonesia is still not optimal. The problem of MDR TB (Multidrug-Resistant Tuberculosis) is an obstacle to controlling TB in Indonesia. MDR TB is caused by no response from TB germs to treatment isoniazid and rifampicin, anti-tuberculosis drugs. TB incidence rate in Serang district ranks second in Banten Province after Tangerang. The number of pulmonary TB cases is due to the lack of public knowledge and awareness about pulmonary TB disease. To reduce the adverse effects of MDR TB requires the involvement of cadres or family members who controlling drug ingestion (PMO). The form of activities carried out through the formation of cadres to care for TB through the KAMI-PMO TB (Education and Assistance for TB Medication Supervisors) in Desa Baros, Kabupaten Serang. The purpose is to increase the commitment, ability, and knowledge of cadres as coordinator of PMO (Drug Swallow Supervisor) to control MDR TB. The method of implementing activities is counseling, demonstrations, and assistance to cadres. The media used were PPT, WE-PMO TB Booklet, and educational videos. The result of the training was an increase in the ability of cadres in providing PMO counseling by 87%. The Paired T-Test analysis results showed a p-value of 0.000, which means that the training conducted affected cadres' knowledge of PMO TB. In conclusion, education and assistance to cadres have a good influence in increasing knowledge and abilities. The expected result is TB care cadres can provide aid and become the coordinator of TB PMO (Drug Ingestion Supervisor).  ABSTRAK:Pengendalian Tuberculosi di Indonesia masih belum optimal.Permasalahan MDR TB (Multidrug Resistant Tuberculosis) merupakan hambatan pengendalian TB di Indonesia. MDR TB disebabkan tidak ada respon kuman TB terhadap pengobatan isoniazid dan rifampizin yang merupakan obat anti tuberculosis. Angka kejadian TB di kabupaten Serang menempati urutan kedua di Provinsi Banten setelah Tangerang, dan banyaknya kasus TB Paru dikarenakan pengetahuan dan kesadaran masyarakat tentang penyakit TB Paru masih kurang. Untuk mengurangi dampak buruk MDR TB dibutuhkan keterlibatan peran serta kader peduli TB atau anggota keluarga yang berperan dalam pengawasan menelan obat (PMO). Bentuk kegiatan yang dilakukan sebagai bentuk pemberdayaan masyarakat melalui pembentukan kader peduli TB  melalui KAMI-PMO TB (Edukasi dan Pendampinga Pengawas Menelan Obat TB) di Desa Baros Kabupaten Serang. Tujuan dari pengabdian masyarakat adalah meningkatkan komitmen, kemampuan dan pengetahuan kader sebagai koordinator PMO (Pengawas Menelan Obat) dalam upaya pengendalian MDR TB. Metode pelaksanaan kegiatan adalah penyuluhan, demontrasi, dan pendampingan kader. Media yang digunakan yaitu PPT, Booklet KAMI-PMO TB , dan video edukasi. Hasil dari kegiatan adalah meningkatnya kemampuan kader dalam memberikan penyuluhan PMO cukup tinggi sebesar 87%. Hasil analisis uji Paired T- Test didapatkan nilai p value 0,000 yang artinya ada pengaruh pelatihan yang dilakukan terhadap pengetahuan kader tentang PMO TB. Kesimpulannya edukasi dan pendampingan kepada kader memiliki pengaruh yang baik  dalam meningkatkan pengetahuan dan kemampuan, sehingga hasil yang diharapkan kader peduli TB dapat melakukan pendampingan pada pasien TB dan menjadi koordinator PMO (Pengawas Menelan Obat) TB dalam upaya pengendalian MDR TB


2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Y. Hu ◽  
L. Xu ◽  
Y. L. He ◽  
Y. Pang ◽  
N. Lu ◽  
...  

This study aimed to investigate the prevalence of multidrug-resistant tuberculosis (MDR-TB) isolates resistant to the second-line antituberculosis drugs (SLDs) and its association with resistant-related gene mutations inMycobacterium tuberculosis(M.tb) isolates from Southwest of China. There were 81 isolates resistant to at least one of the SLDs among 156 MDR-TB isolates (81/156, 51.9%). The rates of general resistance to each of the drugs were as follows: OFX (66/156, 42.3%), KAN (26/156, 16.7%), CAP (13/156, 8.3%), PTO (11/156, 7.1%), PAS (22/156, 14.1%), and AMK (20/156, 12.8%). Therefore, the most predominant pattern was resistant to OFX compared with other SLDs (P<0.001). The results of sequencing showed that 80.2% OFX-resistant MDR-TB isolates containedgyrAmutation and 88.5% KAN-resistant isolates hadrrsmutations with the most frequent mutation being A1401G. These results suggest that improper use of SLDs especially OFX is a real threat to effective MDR-TB treatment not only in China but also in the whole world. Furthermore the tuberculosis control agencies should carry out SLDs susceptibility testing and rapid screening in a broader population of TB patients immediately and the SLDs should be strictly regulated by the administration in order to maintain their efficacy to treat MDR-TB.


2019 ◽  
Vol 12 (8) ◽  
pp. e230628 ◽  
Author(s):  
Christian Francisco ◽  
Mary Ann Lansang ◽  
Edsel Maurice Salvana ◽  
Katerina Leyritana

Tuberculosis (TB) is common among persons living with HIV. This public health concern is aggravated by infection with multidrug-resistant organisms and adverse effects of polypharmacy. There are few published cases of multidrug-resistant tuberculosis (MDR-TB) in multidrug-resistant HIV (MDR-HIV) infected patients. We report a case of a 29-year-old Filipino man with HIV on zidovudine (AZT)-containing antiretroviral therapy (ART) but was eventually shifted to tenofovir due to anaemia. He presented with left flank tenderness, which was found to be due to an MDR-TB psoas abscess, and for which second-line anti-TB treatment was started. HIV genotyping showed MDR-HIV infection susceptible only to AZT, protease inhibitors and integrase inhibitors. Subsequently, he developed neck abscess that grew Mycobacterium avium complex and was treated with ethambutol and azithromycin. ART regimen was revised to AZT plus lamivudine and lopinavir/ritonavir. Erythropoietin was administered for recurrent AZT-induced anaemia. Both abscesses resolved and no recurrence of anaemia was noted.


2019 ◽  
Vol 23 (10) ◽  
pp. 1050-1054
Author(s):  
L. Guglielmetti ◽  
J. Jaffré ◽  
C. Bernard ◽  
F. Brossier ◽  
N. El Helali ◽  
...  

SETTING: The World Health Organization (WHO) recommends that multidrug-resistant tuberculosis (MDR-TB) treatment should be managed in collaboration with multidisciplinary advisory committees (consilia). A formal national Consilium has been established in France since 2005 to provide a centralised advisory service for clinicians managing MDR-TB and extensively drug-resistant (XDR-TB) cases.OBJECTIVE: Review the activity of the French TB Consilium since its establishment.DESIGN: Retrospective description and analysis of the activity of the French TB Consilium.RESULTS: Between 2005 and 2016, 786 TB cases or contacts of TB cases were presented at the French TB Consilium, including respectively 42% and 79% of all the MDR-TB and XDR-TB cases notified in France during this period. Treatment regimens including bedaquiline and/or delamanid were recommended for 42% of the cases presented at the French TB Consilium since 2009. Patients were more likely to be presented at the French TB Consilium if they were born in the WHO Europe Region, had XDR-TB, were diagnosed in the Paris region, or had resistance to additional drugs than those defining XDR-TB.CONCLUSION: The French TB Consilium helped supervise appropriate management of MDR/XDR-TB cases and facilitated implementation of new drugs for MDR/XDR-TB treatment.


2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Ernest Peresu ◽  
J. Christo Heunis ◽  
N. Gladys Kigozi ◽  
Diana De Graeve

Abstract Background Eswatini is facing a critical shortage of human resources for health (HRH) and limited access to multidrug-resistant tuberculosis (MDR-TB) treatment in rural areas. This study assessed multiple stakeholders’ perceptions of task-shifting directly observed treatment (DOT) supervision and administration of intramuscular MDR-TB injections to lay health workers (LHWs). Methods A mixed methods study comprising a cross-sectional survey using a semi-structured questionnaire with community treatment supporters (CTSs) and a focus group discussion with key stakeholders including representatives from the Eswatini Ministry of Health (MOH), donor organisations, professional regulatory institutions, nursing academia, civil society and healthcare providers was conducted in May 2017. Descriptive statistics, thematic content analysis and data triangulation aided in the interpretation of results. Results A large majority of CTSs (n = 78; 95.1%) were female and 33 (40.2%) were older than 50 years. Most (n = 7; 70.0%) key stakeholders had over 10 years of work experience in policy-making, advocacy in the fields of HRH or day-to-day practice in MDR-TB management. Task-shifting of MDR-TB injection administration was implemented without national policy guidance and regulation. Stakeholders viewed the strategy to be driven by the prevailing shortage of professional frontline HRH and limited access to MDR-TB treatment. Task-shifting was perceived to improve medication adherence, and reduce stigma and transport-related MDR-TB treatment access barriers. Frontline healthcare workers and implementing donor partners fully supported task-shifting. Policy-makers and other stakeholders accepted task-shifting conditionally due to fears of poor standards of care related to perceived incompetence of CTSs. Appropriate compensation, adequate training and supervision, and non-financial incentives were suggested to retain CTSs. A holistic task-shifting policy and collaboration between the MOH, academia and nursing council in regulating the practice were recommended. Conclusions Stakeholders generally accepted the delegation of DOT supervision and administration of intramuscular MDR-TB injections to LHWs as a strategy to increase access to treatment, albeit with some apprehension. Findings from this study stress that task-shifting is not a panacea for HRH shortages, but a short-term solution that must form part of an overall simultaneous strategy to train, attract and retain adequate numbers of professional healthcare workers in Eswatini. To address some of the apprehension and ambivalence about expanding access to MDR-TB services through task-shifting, attention should be paid to important aspects such as competence-based training, certification and accreditation, adequate supportive on-the-job supervision, recognition, compensation, and expediting policy and regulatory support for LHWs.


2019 ◽  
Author(s):  
Le Hong Van ◽  
Phan Trieu Phu ◽  
Dao Nguyen Vinh ◽  
Vo Thanh Son ◽  
Nguyen Thi Hanh ◽  
...  

Abstract Background: Multidrug resistant tuberculosis (MDR-TB) remains a serious public health problem with poor treatment outcome. Predictors of poor outcomes vary in different regions. Vietnam is among the 30 countries with high burden of MDR-TB. We aim to describe demographic characteristics and identify risk factors for poor outcome of MDR-TB in Ho Chi Minh City (HCMC), the most populous city in Vietnam. Methods: This retrospective study included 2,266 patients who initiated MDR-TB treatment from 2011 to 2015 in HCMC. Treatment outcomes were available in 2,240 patients. Data was collected from standardized paper-based treatment cards and electronic records. Kruskal Wallis test was used to diagnose the change of median of age and body mass index (BMI) over 5 years, and Wilcoxon test to compare median BMI of patients with and without diabetes mellitus. Chi squared test was used to compare categorical variables. Multivariate logistic regression on multiple imputation was used to identify risk factors for poor outcomes. Statistical analysis was performed using R program. Results: Among 2,266 eligible cases, 60.2% were failure of category I or II regimen, 57.7% were underweight, 30.2% had diabetes mellitus and 9.6% were HIV positive. Notification rate increased 24.7% from 2011 to 2015.Treatment success rate was 73.3%. Risk factors for poor treatment outcome included HIV co-infection (adjusted odds ratio (aOR): 2.94), advanced age (aOR: 1.45 for every increase of 5 years for patients 60 years or older), having history of MDR-TB treatment (aOR: 5.53), sputum smear grade scanty and 1+ (aOR: 1.47), smear grade 2+ or 3+ (aOR: 2.06), low BMI (aOR: 0.83 for every increase of 1kg/m2 of BMI for patients with BMI<21). Conclusion: Our study describes the increasing cases of MDR-TB in HCMC during 2011 to 2015. Patients with HIV, high smear grade, malnutrition and history of previous MDR-TB treatment should receive additional care. Keywords: multidrug resistant tuberculosis; retrospective; treatment outcome; risk factors; Vietnam


2021 ◽  
Vol 10 (1) ◽  
pp. 27
Author(s):  
Hema Malini ◽  
Emil Huriani ◽  
Devia Putri Lenggogeni ◽  
Shinta Herlina

The high incidence of multidrug-resistant tuberculosis (MDR-TB) in the community due to the lack of socialization or the provision of health education about MDR-TB. During this time, health education is only focused on tuberculosis (TB) generally. The purpose of this study was to determine the effect of health education on the behavior of MDR-TB prevention in patients with pulmonary tuberculosis in two Community Health Centers in Padang. This study design is quasi-experimental with pre and post-test groups only. The program intervention of health education was conducted for a month with lecture method and group discussion using flipchart and video as media. The sampling technique used purposive sampling were 29 patients with TB who are still in the phase of treatment. Data collection used a set of questionnaires. The data analysis in this study using statistical tests t-test. The results showed, there is a significance influence of health education on knowledge with p-value=0.000 (p≤0.05) and attitude with p-value=0.000 (p≤0.05). The result also showed that 65.5% of patients taking medication regularly. It was also that there is the effect of health education on the behavior of MDR-TB prevention in TB patients. It is expected that the providing of health education on the prevention of behavior on MDR-TB is emphasized on the motivation and self-efficacy of the patients and involvement of supervision on taking medication.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arnaud Iradukunda ◽  
Gabin-Pacifique Ndayishimiye ◽  
Darlene Sinarinzi ◽  
Emmanuel Nene Odjidja ◽  
Nestor Ntakaburimvo ◽  
...  

Abstract Background Despite the World Health Organization efforts to expand access to the tuberculosis treatment, multidrug resistant tuberculosis (MDR-TB) remains a major threat. MDR-TB represents a challenge for clinicians and staff operating in national tuberculosis (TB) programmes/centres. In sub-Saharan African countries including Burundi, MDR-TB coexists with high burden of other communicable and non-communicable diseases, creating a complex public health situation which is difficult to address. Tackling this will require targeted public health intervention based on evidence which well defines the at-risk population. In this study, using data from two referral anti-tuberculosis in Burundi, we model the key factors associated with MDR-TB in Burundi. Methods A case-control study was conducted from 1stAugust 2019 to 15th January 2020 in Kibumbu Sanatorium and Bujumbura anti-tuberculosis centres for cases and controls respectively. In all, 180 TB patients were selected, comprising of 60 cases and 120 controls using incidence density selection method. The associated factors were carried out by mixed effect logistic regression. Model performance was assessed by the Area under Curve (AUC). Model was internally validated via bootstrapping with 2000 replications. All analysis were done using R Statistical 3.5.0. Results MDR-TB was more identified among patients who lived in rural areas (51.3%), in patients’ residence (69.2%) and among those with a household size of six or more family members (59.5%). Most of the MDR-TB cases had already been under TB treatment (86.4%), had previous contact with an MDR-TR case (85.0%), consumed tobacco (55.5%) and were diabetic (66.6 %). HIV prevalence was 32.3 % in controls and 67.7 % among cases. After modelling using mixed effects, Residence of patients (aOR= 1.31, 95%C: 1.12-1.80), living in houses with more than 6 family members (aOR= 4.15, 95% C: 3.06-5.39), previous close contact with MDR-TB (aOR= 6.03, 95% C: 4.01-8.12), history of TB treatment (aOR= 2.16, 95% C: 1.06-3.42), tobacco consumption (aOR = 3.17 ,95% C: 2.06-5.45) and underlying diabetes’ ( aOR= 4.09,95% CI = 2.01-16.79) were significantly associated with MDR-TB. With 2000 stratified bootstrap replicates, the model had an excellent predictive performance, accurately predicting 88.15% (95% C: 82.06%-92.8%) of all observations. The coexistence of risk factors to the same patients increases the risk of MDR-TB occurrence. TB patients with no any risk factors had 17.6% of risk to become MDR-TB. That probability was respectively three times and five times higher among diabetic and close contact MDR-TB patients. Conclusion The relatively high TB’s prevalence and MDR-TB occurrence in Burundi raises a cause for concern especially in this context where there exist an equally high burden of chronic diseases including malnutrition. Targeting interventions based on these identified risk factors will allow judicious channel of resources and effective public health planning.


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