scholarly journals Tuberculosis among economic migrants: A cross‐sectional study of the risk of poor treatment outcomes and impact of a treatment adherence intervention among temporary residents in an urban district in Ho Chi Minh City, Viet Nam

2020 ◽  
Author(s):  
Luan Nguyen Quang Vo ◽  
Andrew James Codlin ◽  
Rachel Jeanette Forse ◽  
Hoa Trung Nguyen ◽  
Thanh Nguyen Vu ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Cross Sectional Study ◽  
Urban District ◽  
Cross Sectional ◽  
Loss To Follow Up ◽  
Lower Treatment ◽  
Adherence Support ◽  
Poor Treatment

Abstract Background: Tuberculosis (TB) remains a major cause of avoidable deaths. Economic migrants represent a vulnerable population due to their exposure to medical and social risk factors. These factors expose them to higher risks for TB incidence and poor treatment outcomes. Methods: This cross-sectional study evaluated WHO-defined TB treatment outcomes among economic migrants in an urban district of Ho Chi Minh City, Viet Nam. We measured the association of a patient’s government-defined residency status with treatment success and loss to follow-up categories at baseline and performed a comparative interrupted time series (ITS) analysis to assess the impact of community-based adherence support on treatment outcomes. Key measures of interest of the ITS were the differences in step change (β6) and post-intervention trend (β7). Results: Short-term, inter-province migrants experienced lower treatment success (aRR=0.95 [95% CI: 0.92-0.99], p=0.010) and higher loss to follow-up (aOR=1.98 [95% CI: 1.44-2.72], p<0.001) than permanent residents. Intra-province migrants were similarly more likely to be lost to follow-up (aOR=1.86 [95% CI: 1.03-3.36], p=0.041). There was evidence that patients >55 years of age (aRR=0.93 [95% CI: 0.89-0.96], p<0.001), relapse patients (aRR=0.89 [95% CI: 0.84-0.94], p<0.001), and retreatment patients (aRR=0.62 [95% CI: 0.52-0.75], p<0.001) had lower treatment success rates. TB/HIV co-infection was also associated with lower treatment success (aRR=0.77 [95% CI: 0.73-0.82], p<0.001) and higher loss to follow-up (aOR=2.18 [95% CI: 1.55-3.06], p<0.001). The provision of treatment adherence support increased treatment success (IRR(β6)=1.07 [95% CI: 1.00, 1.15], p=0.041) and reduced loss to follow-up (IRR(β6)=0.17 [95% CI: 0.04, 0.69], p=0.013) in the intervention districts. Loss to follow-up continued to decline throughout the post-implementation period (IRR(β7)=0.90 [95% CI: 0.83, 0.98], p=0.019). Conclusions: Economic migrants, particularly those crossing provincial borders, have higher risk of poor treatment outcomes and should be prioritized for tailored adherence support. In light of accelerating urbanization in many regions of Asia, implementation trials are needed to inform evidence-based design of strategies for this vulnerable population.

scholarly journals Tuberculosis among economic migrants: A cross‐sectional study of the risk of poor treatment outcomes and impact of a treatment adherence intervention among temporary residents in an urban district in Ho Chi Minh City, Viet Nam

2019 ◽  
Author(s):  
Luan Nguyen Quang Vo ◽  
Andrew James Codlin ◽  
Rachel Jeanette Forse ◽  
Hoa Trung Nguyen ◽  
Thanh Nguyen Vu ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Cross Sectional Study ◽  
Urban District ◽  
Cross Sectional ◽  
Loss To Follow Up ◽  
Lower Treatment ◽  
Adherence Support ◽  
Poor Treatment

Abstract Background: Tuberculosis (TB) remains a major cause of avoidable deaths. Economic migrants represent an underserved population due to their exposure to medical and social risk factors, which can affect their health. Methods: This cross-sectional study evaluated WHO-defined TB treatment outcomes among economic migrants in an urban district of Ho Chi Minh City, Viet Nam. We measured the association of a patient’s government-defined residency status with treatment success and loss to follow-up categories at baseline and performed a comparative interrupted time series analysis to assess the impact of community-based adherence support on treatment outcomes. Results: Short-term, inter-province migrants experienced lower treatment success (aRR=0.95 [0.92-0.99], p=0.010) and higher loss to follow-up (aOR=1.98 [1.44-2.72], p<0.001) than permanent residents. Intra-province migrants were similarly more likely to be lost to follow-up (aOR=1.86 [1.03-3.36], p=0.041). There was evidence that patients >55 years of age (aRR=0.93 [0.89-0.96], p<0.001), relapse patients (aRR=0.89 [0.84-0.94], p<0.001), and retreatment patients (aRR=0.62 [0.52-0.75], p<0.001) had lower treatment success rates. TB/HIV co-infection was also associated with lower treatment success (aRR=0.77 [0.73-0.82], p<0.001) and higher loss to follow-up (aOR=2.18 [1.55-3.06], p<0.001). The provision of treatment adherence support increased treatment success (IRR(β6)=1.07 [1.00, 1.15], p=0.041) and reduced loss to follow-up (IRR(β6)=0.17 [0.04, 0.69], p=0.013) in the intervention districts. Loss to follow-up continued to decline throughout the post-implementation period (IRR(β7)=0.90 [0.83, 0.98], p=0.019). Conclusions: Economic migrants, particularly those crossing provincial borders, have higher risk of poor treatment outcomes and should be prioritized for tailored adherence support. In light of accelerating urbanization in many regions of Asia, implementation trials are needed to inform evidence-based design of strategies for this vulnerable population.

scholarly journals Tuberculosis among economic migrants: A cross‐sectional study of the risk of poor treatment outcomes and impact of a treatment adherence intervention among temporary residents in an urban district in Ho Chi Minh City, Viet Nam

2020 ◽  
Author(s):  
Luan Nguyen Quang Vo ◽  
Andrew James Codlin ◽  
Rachel Jeanette Forse ◽  
Hoa Trung Nguyen ◽  
Thanh Nguyen Vu ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Cross Sectional Study ◽  
Urban District ◽  
Cross Sectional ◽  
Loss To Follow Up ◽  
Lower Treatment ◽  
Adherence Support ◽  
Poor Treatment

Abstract Background: Tuberculosis (TB) remains a major cause of avoidable deaths. Economic migrants represent a vulnerable population due to their exposure to medical and social risk factors. These factors expose them to higher risks for TB incidence and poor treatment outcomes. Methods: This cross-sectional study evaluated WHO-defined TB treatment outcomes among economic migrants in an urban district of Ho Chi Minh City, Viet Nam. We measured the association of a patient’s government-defined residency status with treatment success and loss to follow-up categories at baseline and performed a comparative interrupted time series analysis to assess the impact of community-based adherence support on treatment outcomes. Results: Short-term, inter-province migrants experienced lower treatment success (aRR=0.95 [0.92-0.99], p=0.010) and higher loss to follow-up (aOR=1.98 [1.44-2.72], p<0.001) than permanent residents. Intra-province migrants were similarly more likely to be lost to follow-up (aOR=1.86 [1.03-3.36], p=0.041). There was evidence that patients >55 years of age (aRR=0.93 [0.89-0.96], p<0.001), relapse patients (aRR=0.89 [0.84-0.94], p<0.001), and retreatment patients (aRR=0.62 [0.52-0.75], p<0.001) had lower treatment success rates. TB/HIV co-infection was also associated with lower treatment success (aRR=0.77 [0.73-0.82], p<0.001) and higher loss to follow-up (aOR=2.18 [1.55-3.06], p<0.001). The provision of treatment adherence support increased treatment success (IRR(β 6 )=1.07 [1.00, 1.15], p=0.041) and reduced loss to follow-up (IRR(β 6 )=0.17 [0.04, 0.69], p=0.013) in the intervention districts. Loss to follow-up continued to decline throughout the post-implementation period (IRR(β 7 )=0.90 [0.83, 0.98], p=0.019). Conclusions: Economic migrants, particularly those crossing provincial borders, have higher risk of poor treatment outcomes and should be prioritized for tailored adherence support. In light of accelerating urbanization in many regions of Asia, implementation trials are needed to inform evidence-based design of strategies for this vulnerable population.

scholarly journals Tuberculosis among economic migrants: A cross‐sectional study of the risk of poor treatment outcomes and impact of a treatment adherence intervention among temporary residents in an urban district in Ho Chi Minh City, Viet Nam

2020 ◽  
Author(s):  
Luan Nguyen Quang Vo ◽  
Andrew James Codlin ◽  
Rachel Jeanette Forse ◽  
Hoa Trung Nguyen ◽  
Thanh Nguyen Vu ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Cross Sectional Study ◽  
Urban District ◽  
Cross Sectional ◽  
Loss To Follow Up ◽  
Lower Treatment ◽  
Adherence Support ◽  
Poor Treatment

Abstract Background: Tuberculosis (TB) remains a major cause of avoidable deaths. Economic migrants represent a vulnerable population due to their exposure to medical and social risk factors. These factors expose them to higher risks for TB incidence and poor treatment outcomes. Methods: This cross-sectional study evaluated WHO-defined TB treatment outcomes among economic migrants in an urban district of Ho Chi Minh City, Viet Nam. We measured the association of a patient’s government-defined residency status with treatment success and loss to follow-up categories at baseline and performed a comparative interrupted time series (ITS) analysis to assess the impact of community-based adherence support on treatment outcomes. Key measures of interest of the ITS were the differences in step change (β6) and post-intervention trend (β7). Results: Short-term, inter-province migrants experienced lower treatment success (aRR=0.95 [95% CI: 0.92-0.99], p=0.010) and higher loss to follow-up (aOR=1.98 [95% CI: 1.44-2.72], p<0.001) than permanent residents. Intra-province migrants were similarly more likely to be lost to follow-up (aOR=1.86 [95% CI: 1.03-3.36], p=0.041). There was evidence that patients >55 years of age (aRR=0.93 [95% CI: 0.89-0.96], p<0.001), relapse patients (aRR=0.89 [95% CI: 0.84-0.94], p<0.001), and retreatment patients (aRR=0.62 [95% CI: 0.52-0.75], p<0.001) had lower treatment success rates. TB/HIV co-infection was also associated with lower treatment success (aRR=0.77 [95% CI: 0.73-0.82], p<0.001) and higher loss to follow-up (aOR=2.18 [95% CI: 1.55-3.06], p<0.001). The provision of treatment adherence support increased treatment success (IRR(β6)=1.07 [95% CI: 1.00, 1.15], p=0.041) and reduced loss to follow-up (IRR(β6)=0.17 [95% CI: 0.04, 0.69], p=0.013) in the intervention districts. Loss to follow-up continued to decline throughout the post-implementation period (IRR(β7)=0.90 [95% CI: 0.83, 0.98], p=0.019). Conclusions: Economic migrants, particularly those crossing provincial borders, have higher risk of poor treatment outcomes and should be prioritized for tailored adherence support. In light of accelerating urbanization in many regions of Asia, implementation trials are needed to inform evidence-based design of strategies for this vulnerable population.

scholarly journals Predictors of loss to follow-up in art experienced patients in Nigeria: a 13 year review (2004–2017)

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Ahmad Aliyu ◽  
Babatunde Adelekan ◽  
Nifarta Andrew ◽  
Eunice Ekong ◽  
Stephen Dapiap ◽  
...  
Keyword(s):  
Patient Adherence ◽  
Cross Sectional Study ◽  
Emergency Plan ◽  
Cross Sectional ◽  
Loss To Follow Up ◽  
Viral Loads ◽  
Review Period ◽  
Lost To Follow Up ◽  
Differentiated Care

Abstract Background Expanded access to antiretroviral therapy (ART) leads to improved HIV/AIDS treatment outcomes in Nigeria, however, increasing rates of loss to follow-up among those on ART is threatening optimal standard achievement. Therefore, this retrospective cross-sectional study is aimed at identifying correlates and predictors of loss to follow-up in patients commencing ART in a large HIV program in Nigeria. Methods Records of all patients from 432 US CDC Presidents Emergency Plan for AIDS Relief (PEPFAR) supported facilities across 10 States and FCT who started ART from 2004 to 2017 were used for this study. Bivariate and multivariate analysis of the demographic and clinical parameters of all patients was conducted using STATA version 14 to determine correlates and predictors of loss to follow-up. Results Within the review period, 245,257 patients were ever enrolled on anti-retroviral therapy. 150,191 (61.2%) remained on treatment, 10,960 (4.5%) were transferred out to other facilities, 6926 (2.8%) died, 2139 (0.9%) self-terminated treatment and 75,041 (30.6%) had a loss to follow-up event captured. Males (OR: 1.16), Non-pregnant female (OR: 4.55), Patients on ≥ 3-monthly ARV refills (OR: 1.32), Patients with un-suppressed viral loads on ART (OR: 4.52), patients on adult 2nd line regimen (OR: 1.23) or pediatric on 1st line regimen (OR: 1.70) were significantly more likely to be lost to follow-up. Conclusion Despite increasing access to anti-retroviral therapy, loss to follow-up is still a challenge in the HIV program in Nigeria. Differentiated care approaches that will focus on males, non-pregnant females and paediatrics is encouraged. Reducing months of Anti-retroviral drug refill to less than 3 months is advocated for increased patient adherence.

scholarly journals Trends, Characteristics and Treatment Outcomes of Patients with Drug-Resistant Tuberculosis in Uzbekistan: 2013–2018

2021 ◽  
Vol 18 (9) ◽  
pp. 4663
Author(s):  
Khasan Safaev ◽  
Nargiza Parpieva ◽  
Irina Liverko ◽  
Sharofiddin Yuldashev ◽  
Kostyantyn Dumchev ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Outcomes ◽  
Treatment Success ◽  
National Level ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Loss To Follow Up ◽  
Resistant Tuberculosis ◽  
Mdr Tb

Uzbekistan has a high burden of drug-resistant tuberculosis (TB). Although conventional treatment for multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) has been available since 2013, there has been no systematic documentation about its use and effectiveness. We therefore documented at national level the trends, characteristics, and outcomes of patients with drug-resistant TB enrolled for treatment from 2013–2018 and assessed risk factors for unfavorable treatment outcomes (death, failure, loss to follow-up, treatment continuation, change to XDR-TB regimen) in patients treated in Tashkent city from 2016–2017. This was a cohort study using secondary aggregate and individual patient data. Between 2013 and 2018, MDR-TB numbers were stable between 2347 and 2653 per annum, while XDR-TB numbers increased from 33 to 433 per annum. At national level, treatment success (cured and treatment completed) for MDR-TB decreased annually from 63% to 57%, while treatment success for XDR-TB increased annually from 24% to 57%. On multivariable analysis, risk factors for unfavorable outcomes, death, and loss to follow-up in drug-resistant TB patients treated in Tashkent city included XDR-TB, male sex, increasing age, previous TB treatment, alcohol abuse, and associated comorbidities (cardiovascular and liver disease, diabetes, and HIV/AIDS). Reasons for these findings and programmatic implications are discussed.

scholarly journals Clinical pattern and predictors of stroke treatment outcome among hospitalised patients who had a stroke at Felege Hiwot comprehensive specialised hospital, northwest Ethiopia: a retrospective cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040238
Author(s):  
Belayneh Kefale ◽  
Amien Ewunetei ◽  
Mulugeta Molla ◽  
Gobezie Temesgen Tegegne ◽  
Amsalu Degu
Keyword(s):  
Treatment Outcome ◽  
Treatment Outcomes ◽  
Medical Records ◽  
Cross Sectional Study ◽  
Northwest Ethiopia ◽  
Cross Sectional ◽  
Stroke Treatment ◽  
Clinical Pattern ◽  
Hospitalised Patients ◽  
Poor Treatment

ObjectivesThis study aimed to assess the clinical pattern and predictors of stroke treatment outcomes among hospitalised patients in Felege Hiwot comprehensive specialised hospital (FHCSH) in northwest Ethiopia.DesignA retrospective cross-sectional study.SettingThe study was conducted medical ward of FHCSH.ParticipantsThe medical records of 597 adult patients who had a stroke were included in the study. All adult (≥18 years) patients who had a stroke had been admitted to the medical ward of FHSCH during 2015–2019 were included in the study. However, patients with incomplete medical records (ie, incomplete treatment regimen and the status of the patients after treatment) were excluded in the study.ResultsIn the present study, 317 (53.1%) were males, and the mean age of the study participants was 61.08±13.76 years. About two-thirds of patients (392, 65.7%) were diagnosed with ischaemic stroke. Regarding clinical pattern, about 203 (34.0%) of patients complained of right-side body weakness and the major comorbid condition identified was hypertension (216, 64.9%). Overall, 276 (46.2%) of them had poor treatment outcomes, and 101 (16.9%) of them died. Patients who cannot read and write (AOR=42.89, 95% CI 13.23 to 111.28, p<0.001), attend primary school (AOR=22.11, 95% CI 6.98 to 55.99, p<0.001) and secondary school (AOR=4.20, 95% CI 1.42 to 12.51, p<0.001), diagnosed with haemorrhagic stroke (AOR=2.68, 95% CI 1.62 to 4.43, p<0.001) and delayed hospital arrival more than 24 hours (AOR=2.92, 95% CI 1.83 to 4.66, p=0.001) were the independent predictors of poor treatment outcome.ConclusionsApproximately half of the patients who had a stroke had poor treatment outcomes. Ischaemic stroke was the most predominantly diagnosed stroke type. Education status, types of stroke and the median time from onset of symptoms to hospitalisation were the predictors of treatment outcome. Health education should be given to patients regarding clinical symptoms of stroke. In addition, local healthcare providers need to consider the above risk factors while managing stroke.

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.

scholarly journals Mobile targeted screening for tuberculosis in Zimbabwe: diagnosis, linkage to care and treatment outcomes

2019 ◽  
Vol 9 (4) ◽  
pp. 159-165 ◽  
Author(s):  
T. Sengai ◽  
C. Timire ◽  
A. D. Harries ◽  
H. Tweya ◽  
F. Kavenga ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Linkage To Care ◽  
Positive Symptom ◽  
Loss To Follow Up ◽  
Care And Treatment ◽  
Pre Treatment ◽  
Tb 126 ◽  
The Relationship

Setting: Targeted active screening for tuberculosis (Tas4TB) using mobile trucks in the community was implemented in 15 high TB burden districts in Zimbabwe. At-risk populations were screened for TB based on symptoms and chest radiography (CXR) results. Those with any positive symptom and/or an abnormal CXR had sputum collected for investigation and diagnosis and were linked to care and treatment if found to have TB.Objective: To determine 1) the proportion and characteristics of those screened and diagnosed with TB; 2) the relationship between TB symptoms, CXR and diagnostic yields; and 3) the relationship between initiation of anti-TB treatment and treatment outcomes.Design: Cohort study using routinely collected dataResults: A total of 39 065 persons were screened, of whom 663 (1.7%) were diagnosed with TB; 126/663 (19.0%) were bacteriologically confirmed. The highest TB diagnostic yields were in symptomatic persons with CXRs suggestive of TB (19.4%), asymptomatic persons with CXRs suggestive of TB (8.4%) and persons at high-risk of TB (3.2%). For all diagnosed TB patients, pre-treatment loss to follow-up was 18.9% and treatment success was 59.9%.Conclusion: Tas4TB resulted in high diagnostic yields; however, linkage of diagnosis to care was poor. Reasons for loss to follow-up need to be better understood and rectified.

scholarly journals Patient predictors of poor drug sensitive tuberculosis treatment outcomes in Kyiv Oblast, Ukraine

F1000Research ◽  
2019 ◽  
Vol 6 ◽  
pp. 1873 ◽  
Author(s):  
Omowunmi Aibana ◽  
Andrej Slavuckij ◽  
Mariya Bachmaha ◽  
Viatcheslav Krasiuk ◽  
Natasha Rybak ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Good Treatment ◽  
Success Rates ◽  
Patient Factors ◽  
Increased Risk ◽  
Poor Treatment ◽  
Poor Outcomes ◽  
Lost To Follow Up

Background: Ukraine has high rates of poor treatment outcomes among drug sensitive tuberculosis (DSTB) patients, while global treatment success rates for DSTB remain high.     We evaluated baseline patient factors as predictors of poor DSTB treatment outcomes. Methods: We conducted a retrospective analysis of new drug sensitive pulmonary TB patients treated in Kyiv Oblast, Ukraine between November 2012 and October 2014. We defined good treatment outcomes as cure or completion and poor outcomes as death, default (lost to follow up) or treatment failure. We performed logistic regression analyses, using routine program data, to identify baseline patient factors associated with poor outcomes. Results: Among 302 patients, 193 (63.9%) experienced good treatment outcomes while 39 (12.9%) failed treatment, 34 (11.3%) died, and 30 (9.9%) were lost to follow up. In the multivariate analysis, HIV positive patients on anti-retroviral therapy (ART) [OR 3.50; 95% CI 1.46 – 8.42; p 0.005] or without ART (OR 4.12; 95% CI 1.36 – 12.43; p 0.01) were at increased risk of poor outcomes. Smear positivity (OR 1.75; 95% CI 1.03 - 2.97; p 0.04) was also associated with poor treatment outcomes. Conclusions: High rates of poor outcomes among patients with newly diagnosed drug sensitive TB in Kyiv Oblast, Ukraine highlight the urgent need for programmatic interventions, especially aimed at patients with the highest risk of poor outcomes.

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