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 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 (&lt;60%), average (60%-80%), and good (&gt;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 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 Patient treatment pathways of multidrug-resistant tuberculosis cases in coastal South India: Road to a drug resistant tuberculosis center

F1000Research ◽  
2020 ◽  
Vol 8 ◽  
pp. 498
Author(s):  
Priya Rathi ◽  
Kalpita Shringarpure ◽  
Bhaskaran Unnikrishnan ◽  
Abhinav Pandey ◽  
Abhirami Nair
Keyword(s):  
Multidrug Resistant ◽  
Diagnosis And Treatment ◽  
Patient Treatment ◽  
Drug Resistant ◽  
Treatment Pathways ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Government

Background: Delays in initiating multidrug-resistant tuberculosis (MDR TB) treatment adds risk to individual patients and the community due to disease progression, and on-going transmission. The Government of India offers free TB diagnosis and treatment, however many presumptive MDR TB patients wander within the Indian healthcare system and delay accessing the programme. To improve access to care, it is imperative to understand the treatment pathways taken by MDR TB patients. We aimed to describe the diagnostic and treatment pathway taken by presumptive MDR TB patients registered under Programmatic Management of Drug-resistant TB Program. Methods: We conducted a cross-sectional study amongst patients registered during August 2016 – April 2017 at one District Drug Resistance Tuberculosis centre of Dakshina Kannada district in Karnataka, India. A semi-structured questionnaire was used to collect the number, type (private and public sector), and dates of healthcare facilities (HCFs) visits prior to the initiation of MDR TB treatment. Delays in pathway were measured in days and summarised as median and interquartile range (IQR), from the date of onset of illness until the initiation of MDR TB treatment. Results: We found that patients preferred private HCFs; however, due to lack of treatment and unaffordability they shifted to public HCFs. Median delay to register under the program was more in private HCFs (180 days) in comparison with public HCFs (120 days). We also found that the detection rates were much higher in public HCFs (80%). Conclusion: The present study found that there was substantial patient delay and total delay in diagnosis and treatment of MDR TB patients. Private HCF was first point of contact for most of the patients; however the diagnostic rate was high in public HCF. The government should involve private HCFs to provide standard diagnostics and treatment to the patients seeking a private facility.

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 Primary Clofazimine and Bedaquiline Resistance among Isolates from Patients with Multidrug-Resistant Tuberculosis

2017 ◽  
Vol 61 (6) ◽  
Author(s):  
Jian Xu ◽  
Bin Wang ◽  
Minghao Hu ◽  
Fengmin Huo ◽  
Shaochen Guo ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Cross Resistance ◽  
Drug Resistant ◽  
Content Type ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Previously Treated ◽  
Alamarblue Assay

ABSTRACT Clofazimine has been repurposed for the treatment of tuberculosis, especially for multidrug-resistant tuberculosis (MDR-TB). To test the susceptibility to clofazimine of Mycobacterium tuberculosis clinical isolates, MICs of clofazimine were determined using the microplate alamarBlue assay (MABA) method for 80 drug-resistant isolates and 10 drug-susceptible isolates for comparison. For five clofazimine-resistant strains isolated from previously treated pre-extensively drug-resistant TB (pre-XDR-TB) and XDR-TB patients without prior exposure to clofazimine or bedaquiline, clofazimine MICs were ≥1.2 μg/ml. Four isolates with cross-resistance to bedaquiline had Rv0678 mutations. The other isolate with no resistance to bedaquiline had an Rv1979c mutation. This study adds to a recent study showing that 6.3% of MDR-TB patients without prior clofazimine or bedaquiline exposure harbored isolates with Rv0678 mutations, which raises concern that preexisting resistance to these drugs may be associated with prior TB treatment. Furthermore, we propose a tentative breakpoint of 1.2 μg/ml for clofazimine resistance using the MABA method. More-widespread surveillance and individualized testing for clofazimine and bedaquiline resistance, together with assessment of their clinical usage, especially among previously treated and MDR-TB patients, are warranted.

scholarly journals Patient treatment pathways of multidrug-resistant tuberculosis cases in coastal South India: Road to a drug resistant tuberculosis center

F1000Research ◽  
2021 ◽  
Vol 8 ◽  
pp. 498
Author(s):  
Priya Rathi ◽  
Kalpita Shringarpure ◽  
Bhaskaran Unnikrishnan ◽  
Abhinav Pandey ◽  
Abhirami Nair
Keyword(s):  
Multidrug Resistant ◽  
Diagnosis And Treatment ◽  
Patient Treatment ◽  
Drug Resistant ◽  
Treatment Pathways ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Government

Background: Delays in initiating multidrug-resistant tuberculosis (MDR TB) treatment adds risk to individual patients and the community due to disease progression, and on-going transmission. The Government of India offers free TB diagnosis and treatment, however many presumptive MDR TB patients wander within the Indian healthcare system and delay accessing the programme. To improve access to care, it is imperative to understand the treatment pathways taken by MDR TB patients. We aimed to describe the diagnostic and treatment pathway taken by presumptive MDR TB patients registered under Programmatic Management of Drug-resistant TB Program. Methods: We conducted a cross-sectional study amongst patients registered during August 2016 – April 2017 at one District Drug Resistance Tuberculosis centre of Dakshina Kannada district in Karnataka, India. A semi-structured questionnaire was used to collect the number, type (private and public sector), and dates of healthcare facilities (HCFs) visits prior to the initiation of MDR TB treatment. Delays in pathway were measured in days and summarised as median and interquartile range (IQR), from the date of onset of illness until the initiation of MDR TB treatment. Results: We found that patients preferred private HCFs; however, due to lack of treatment and unaffordability they shifted to public HCFs. Median delay to register under the program was more in private HCFs (180 days) in comparison with public HCFs (120 days). We also found that the detection rates were much higher in public HCFs (80%). Conclusion: The present study found that there was substantial patient delay and total delay in diagnosis and treatment of MDR TB patients. Private HCF was first point of contact for most of the patients; however those visited public HCF diagnosed earlier as compared to others. The government should involve private HCFs to provide standard diagnostics and treatment to the patients seeking a private facility.

scholarly journals Patient treatment pathways of multidrug-resistant tuberculosis cases in coastal South India: Road to a drug resistant tuberculosis center

F1000Research ◽  
2020 ◽  
Vol 8 ◽  
pp. 498
Author(s):  
Priya Rathi ◽  
Kalpita Shringarpure ◽  
Bhaskaran Unnikrishnan ◽  
Abhinav Pandey ◽  
Abhirami Nair
Keyword(s):  
Multidrug Resistant ◽  
Diagnosis And Treatment ◽  
Patient Treatment ◽  
Drug Resistant ◽  
Treatment Pathways ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Government

Background: Delays in initiating multidrug-resistant tuberculosis (MDR TB) treatment adds risk to individual patients and the community due to disease progression, and on-going transmission. The Government of India offers free TB diagnosis and treatment, however many presumptive MDR TB patients wander within the Indian healthcare system and delay accessing the programme. To improve access to care, it is imperative to understand the treatment pathways taken by MDR TB patients. We aimed to describe the diagnostic and treatment pathway taken by presumptive MDR TB patients registered under Programmatic Management of Drug-resistant TB Program. Methods: We conducted a cross-sectional study amongst patients registered during August 2016 – April 2017 at one District Drug Resistance Tuberculosis centre of Dakshina Kannada district in Karnataka, India. A semi-structured questionnaire was used to collect the number, type (private and public sector), and dates of healthcare facilities (HCFs) visits prior to the initiation of MDR TB treatment. Delays in pathway were measured in days and summarised as median and interquartile range (IQR), from the date of onset of illness until the initiation of MDR TB treatment. Results: We found that patients preferred private HCFs; however, due to lack of treatment and unaffordability they shifted to public HCFs. Median delay to register under the program was more in private HCFs (180 days) in comparison with public HCFs (120 days). We also found that the detection rates were much higher in public HCFs (80%). Conclusion: The present study found that there was substantial patient delay and total delay in diagnosis and treatment of MDR TB patients. Private HCF was first point of contact for most of the patients; however those visited public HCF diagnosed earlier as compared to others. The government should involve private HCFs to provide standard diagnostics and treatment to the patients seeking a private facility.

scholarly journals FACTORS RELATED TO THE SUCCESS OF THE TREATMENT PROGRAM OF MULTIDRUG-RESISTANT TUBERCULOSIS IN POLYCLINIC OF MDR-TB OF THE GENERAL HOSPITAL OF UNDATA PALU, INDONESIA

2017 ◽  
Vol 3 (4) ◽  
pp. 162-166
Author(s):  
Muhammad Ryman Napirah ◽  
Bertin Ayu Wandira ◽  
Ana Aulia
Keyword(s):  
Side Effects ◽  
General Hospital ◽  
Multidrug Resistant ◽  
Drug Control ◽  
Drug Side Effects ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Government

Background: Incidence of Multi Drug Resistant Tuberculosis remains high in Indonesia. Thus, understanding the factors related to the success of the Government Program on the treatment of Multidrug-resistant is necessity. Objective: This study aims to determine the factors related to the success of government programs on the treatment of MDR-TB patients in Polyclinic of MDR-TB of Undata Palu Hospital.Methods: This was a correlational study with cross-sectional design conducted in the polyclinic of MDR-TB of the General Hospital of Undata Palu from October 2016 to November 2016. There were 46 patients recruited by total sampling. Chi-square was used for data analysis.Results: Findings showed that there were statistically significant correlations between knowledge (p = 0.002), the regularity of treatment (p = 0.000), the role of drug control (p = 0.010), drug side effects (p = 0.000) and quality of service of health workers (p = 0.001) with the success of multidrug-resistant tuberculosis program. There was no correlation between distance to health facilities (p = 0.315) and the success of the treatment.Conclusion: There were significant relationships between knowledge, regularity of treatment, drug control, drug side effects, quality of health staffs and the success of multidrug-resistant tuberculosis program. These factors could be considered important for the government to the success of multidrug-resistant tuberculosis program, especially in the polyclinic of MDR-TB of the General Hospital of Undata Palu.

scholarly journals Prevalence of Multidrug Resistant Tuberculosis (MDR-TB) in East Africa: a Systematic Review and Meta- Analysis

2021 ◽  
Author(s):  
Kindu Alem
Keyword(s):  
Systematic Review ◽  
East Africa ◽  
Meta Analysis ◽  
Multidrug Resistant ◽  
Newly Diagnosed ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Pooled Prevalence ◽  
Mdr Tb ◽  
Previously Treated

Abstract Background: The rate of multidrug resistant tuberculosis is increasing at an alarming rate throughout the world. It is becoming an emerging public health problem in East Africa. Prevalence of MDR-TB among TB positive individuals in the region has not been synthesized. Determining the pooled prevalence of MDR-TB among newly diagnosed and previously treated TB cases in East Africa is the main objective of this review.Methods: In this systematic review and meta-analysis, the researcher searched six electronic databases: Google scholar, PubMed, EMBASE, Scopus, Science direct and Web of Science. Funnel plot symmetry visualization confirmed by Egger’s regression asymmetry test and Begg rank correlation methods was used to assess publication bias. The pooled prevalence estimate was calculated using Der Simonian and Laird’s random Effects model. A total of 16 articles published in East Africa from 2007 and 2019 were included in this study. STATA software (version 14, Texas, USA) was used for analysis. Results: Out of 1025 articles identified citations, a total of 16 articles published in East Africa from 2007 and 2019 were included in this meta-analysis. The pooled prevalence of MDR-TB among newly diagnosed TB cases and previously treated TB patients to be 4% (95%CI=2-5%) and 21% (95%CI: 14-28%), respectively. Living conditions, lifestyles (smoking, alcohol use, and drug abuse), previous medical history, diabetes history and HIV infection risk factors contribute to higher prevalence of MDR-TB in East Africa.Conclusion: An early diagnosis of tuberculosis and rapid detection of drug resistant Mycobacterium tuberculosis is a serious concern to identify patients who are not responding to the standard treatment and to avoid spreading of resistant strains. It is also very essential to strengthen tuberculosis control and improved monitoring of chemotherapy.

scholarly journals Patient treatment pathways of multidrug-resistant tuberculosis cases in coastal South India: Road to a drug resistant tuberculosis center

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 498 ◽  
Author(s):  
Priya Rathi ◽  
Kalpita Shringarpure ◽  
Bhaskaran Unnikrishnan ◽  
Abhinav Pandey ◽  
Abhirami Nair
Keyword(s):  
Multidrug Resistant ◽  
Patient Treatment ◽  
Drug Resistant ◽  
Detection Rates ◽  
Treatment Pathways ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Government

Background: Delays in initiating multidrug-resistant tuberculosis (MDR TB) treatment adds risk to individual patients and the community due to disease progression, and on-going transmission.  The Government of India offers free TB diagnosis and treatment, however many presumptive MDR TB patients wander within the Indian healthcare system and delay accessing the programme. To better improve access to care, it is imperative to understand the treatment pathways taken by MDR TB patients. We aimed to describe the diagnostic and treatment pathway taken by presumptive MDR TB patients registered in the Programmatic Management Drug-resistant TB Program (PMDT). Methods: We conducted a cross-sectional study of all patients registered during August 2016 – April 2017 at one PMDT center of a district in Karnataka, India. A semi-standardized questionnaire collected the number, type (private vs public sector), and dates of healthcare facilities (HCFs) visits prior to the initiation of MDR TB treatment.  Delays were the number of days, expressed in medians and interquartile range (IQR), from the date of onset of illness until the date of initiation of MDR TB treatment. Results: We found that patients preferred private HCFs; however, due to lack of treatment and unaffordability they shifted to public HCFs. Median delay to register under the program was more in private HCFs (180days) in comparison with public HCFs (120 days). We also found that the diagnosis of MDR among presumptive MDR cases (detection rates) were much higher (80%) in public HCFs. Conclusion: Awareness regarding the availability of free standard diagnosis and appropriate treatment under the TB program should be increased in the general population and private practitioners. The government should involve private HCFs to provide standard diagnostics and treatment to the patients seeking a private facility.

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