scholarly journals Impacts of a Comprehensive TB Control Model on the Quality of Clinical Services and the Financial Burden of Treatment for Patients with Drug-resistant Tuberculosis in China: A Mixed-methods Evaluation

2020 ◽  
Author(s):  
Weixi Jiang ◽  
Zhipeng Li ◽  
Qi Zhao ◽  
Mengqiu Gao ◽  
Qian Long ◽  
...  
Keyword(s):  
Financial Burden ◽  
Control Model ◽  
Drug Resistant ◽  
Clinical Services ◽  
Drug Resistant Tuberculosis ◽  
Tb Control ◽  
Burden Of Treatment ◽  
Financing Policies ◽  
Resistant Tuberculosis

Abstract IntroductionDrug-resistant tuberculosis (DRTB) has become a critical challenge to ending TB efforts worldwide. To help address the burden in China, the China National Health Commission-Gates TB Project Phase III implemented a comprehensive TB control model which includes multiple interventions to improve the quality of clinical services and reduce the financial burden for DRTB patients.MethodsA mixed-methods approach was used to evaluate the effectiveness of interventions. The quantitative data included three sources: de-identified DRTB registered data from 2015-2018 in project provinces, medical records of DRTB patients registered in 2018 (n=106), and a structured DRTB patient survey in six sample prefectures. The quality of clinical services was evaluated using seven indicators across patient screening, diagnosis and treatment. Logistic regression was conducted to explore factors associated with the extremely high financial burden (defined as out-of-pocket medical expenditure in the first six months of treatment over 30% of annual household income). Key informant interviews with policymakers and focus group discussions with physicians and DRTB patients were conducted to understand the interventions implemented and their impacts.ResultsThe percentage of bacterially confirmed patients taking a drug susceptibility test (DST) increased significantly between 2015 and 2018: from 57.4% to 93.6% in Zhejiang, 12.5% to 86.5% in Jilin, and 29.7% to 91.4% in Ningxia. The treatment enrollment rate among diagnosed DRTB patients also increased significantly and varied from 73% to 82% in the three provinces in 2018. Over 90% of patients in Zhejiang and Jilin and 75% in Ningxia remained in treatment by the end of the first six months’ treatment. Among all survey respondents 77.5% incurred extremely high financial burden of treatment. Qualitative results showed that interventions on promoting rapid DST technologies and patient referral were successfully implemented, but the new financing policies for reducing patients’ financial burden were not implemented as planned.ConclusionsThe quality of DRTB related clinical services has been significantly improved following the comprehensive interventions, while the financial burden of DRTB patients remains high due to the delay in implementing financing policies. Stronger political commitment and leadership are required for multi-channel financing to provide additional financial support to DRTB patients.

scholarly journals Impacts of a comprehensive tuberculosis control model on the quality of clinical services and the financial burden of treatment for patients with drug-resistant tuberculosis in China: a mixed-methods evaluation

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Wei-Xi Jiang ◽  
Zhi-Peng Li ◽  
Qi Zhao ◽  
Meng-Qiu Gao ◽  
Qian Long ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Financial Burden ◽  
Control Model ◽  
Phase Iii ◽  
Drug Resistant ◽  
Clinical Services ◽  
Political Commitment ◽  
Burden Of Treatment ◽  
Financing Policies

Abstract Background The China National Health Commission-Gates TB Project Phase III implemented a comprehensive TB control model including multiple interventions to address the burden of drug-resistant TB (DRTB). This study aims to evaluate the quality of DRTB clinical services and assess the financial burden of DRTB patients during the intervention period. Methods A mixed-methods approach was used to evaluate the effectiveness of interventions in the three project provinces: Zhejiang, Jilin and Ningxia Hui Autonomous Region. The quantitative data included de-identified DRTB registry data during 2015–2018 in project provinces from China CDC, medical records of DRTB patients registered in 2018 (n = 106) from designated hospitals, and a structured DRTB patient survey in six sample prefectures in 2019. The quality of clinical services was evaluated using seven indicators across patient screening, diagnosis and treatment. Logistic regression was conducted to explore factors associated with the extremely high financial burden. Semi-structured in-depth interviews with policymakers and focus group discussions with physicians and DRTB patients were conducted to understand the interventions implemented and their impacts. Results The percentage of bacterially confirmed patients taking a drug susceptibility test (DST) increased significantly between 2015 and 2018: from 57.4 to 93.6% in Zhejiang, 12.5 to 86.5% in Jilin, and 29.7 to 91.4% in Ningxia. The treatment enrollment rate among diagnosed DRTB patients also increased significantly and varied from 73 to 82% in the three provinces in 2018. Over 90% of patients in Zhejiang and Jilin and 75% in Ningxia remained in treatment by the end of the first six months’ treatment. Among all survey respondents 77.5% incurred extremely high financial burden of treatment. Qualitative results showed that interventions on promoting rapid DST technologies and patient referral were successfully implemented, but the new financing policies for reducing patients’ financial burden were not implemented as planned. Conclusions The quality of DRTB related clinical services has been significantly improved following the comprehensive interventions, while the financial burden of DRTB patients remains high due to the delay in implementing financing policies. Stronger political commitment and leadership are required for multi-channel financing to provide additional financial support to DRTB patients.

scholarly journals A STUDY ON LIVER FUNCTION TEST PROFILE OF 2ND LINE DRUGS IN MULTI DRUG RESISTANT (MDR) AND EXTENSIVELY DRUG RESISTANT (XDR) TUBERCULOSIS CASES REGISTERED UNDER DR-TB CENTRE IN A TERTIARY CARE HOSPITAL

2020 ◽  
pp. 1-3
Author(s):  
Rupam Kumar Ta ◽  
Pronoy Sen
Keyword(s):  
Adverse Drug Reactions ◽  
Initial Period ◽  
Care Hospital ◽  
Drug Resistant ◽  
Drug Reactions ◽  
Drug Resistant Tuberculosis ◽  
Intensive Phase ◽  
Tb Control ◽  
Resistant Tuberculosis ◽  
Extensively Drug Resistant

BACKGROUND: The emergence of drug resistant mycobacterium has become a signicant public health problem creating an obstacle to effective Tuberculosis (TB) control. Freedom from TB is possible with timely, regular, complete treatment, with assurance, prevention and management of side effects of antitubercular drugs. Present study was conducted to evaluate common and rare adverse drug reactions (ADR) of CAT IV and CAT V to analyse demographic, radiological and bacteriological prole and treatment outcome in MDR &XDR patients. Aims and Objectives- To evaluate the common and rare adverse drug reactions of intensive phase treatment of Multi Drug Resistant Tuberculosis (MDR) and Extensively Drug Resistant Tuberculosis (XDR) as per WHO-UMC Causality Assessment Scale. METHODS: 76 patients of MDR and XDR Tuberculosis were admitted in DR-TB (Drug Resistant TB) centre, Burdwan Medical College and Hospital and the adverse drug reaction prole of 2nd line drugs were analysed during the intensive phase for a year after fullling the inclusion and exclusion criteria. Treatment was given as per guidelines by Revised National TB Control Program PMDT (Programmatic management of drug-resistant TB). RESULTS:Adverse drug reactions on GI system were nausea 73 patients (96.10%), vomiting 70 (92.10%), acidity 41 (53.9%), and sulphurous belching and hepatitis 1 (1.31%) each. CONCLUSIONS: The reactions were common in rst 60 days of the regimen and in patients with BMI ≤18. Hence vigilant monitoring is required for these types of patients during the initial period and sputum smear and culture conversion is very well correlated with clinical and radiological improvement.

scholarly journals Neuropsychiatric reactions induced by cycloserine in the treatment of multidrug-resistant tuberculosis: what an Indian female patient tells us

2019 ◽  
Vol 12 (12) ◽  
pp. e230993 ◽  
Author(s):  
Enrica Intini ◽  
Girija Kishore ◽  
Luca Richeldi ◽  
Zarir F Udwadia
Keyword(s):  
Adverse Events ◽  
Multidrug Resistant ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Health Crisis ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Group B

Multidrug-resistant tuberculosis continues to be a public health crisis. Urgent action is required to improve the coverage and quality of diagnosis, treatment and care for people affected by drug-resistant tuberculosis. To implement tuberculosis control, in 2018, WHO recommended cycloserine as one of the Group B drugs. Following this recommendation, cycloserine should be generally included in the starting line-up in the longer regimen for the treatment of multidrug-resistant tuberculosis. However, neurological toxicity associated with this drug concerns clinicians and limits its use. In this paper, we present a case of a 48-year-old woman with a diagnosis of multidrug-resistant tuberculosis treated with cycloserine, who developed psychiatric adverse events after 3 months of administration. This case shows the need for close psychiatric follow-up to promptly detect adverse events in patients receiving regimens for multi-drug resistant tuberculosis.

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