scholarly journals Patients’ Perception of a Community Pharmacist-Managed Multidrug-Resistant Tuberculosis Program in Peru: A Public Health Perspective

2017 ◽  
Vol 8 (3) ◽  
pp. 11 ◽  
Author(s):  
Sean O'Brien ◽  
Jacy Downey
Keyword(s):  
Public Health ◽  
Community Pharmacist ◽  
Community Pharmacists ◽  
Multidrug Resistant ◽  
Perceived Barriers ◽  
The Public ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb

Objectives: The primary objective is to investigate the public’s perception about the role of the community pharmacist in Peru’s directly observed treatment, short course (DOTS) program. The secondary objective is to assess perceived barriers that would prevent the public from utilizing community pharmacists in order to identify future opportunities for community pharmacists to increase adherence to multidrug-resistant tuberculosis (MDR-TB) therapy. Design: Qualitative study comprised of an 8 close-ended survey questionnaire. Setting: Healthcare clinics established by a medical mission group in Lima and surrounding communities, Peru, from July 13 to July 27, 2015. Participants: Patients 15 years of age and over who sought healthcare at the clinics. Main outcome measures: Public’s perception about the role of the community pharmacist in Peru and barriers that would prevent the public from seeking a community pharmacist. Results: Out of the 445 patients approached, 438 patients completed the survey, resulting in a 98% response rate. More than half (52%) of the respondents were likely to seek a community pharmacist to assist them in completing a MDR-TB medication regimen. Almost half (48%) of the respondents felt comfortable with assistance of a community pharmacist in completing an MDR-TB regimen. The physician was the first health care professional that was contacted for all medical situations, including drug-related questions (61%). Lack of privacy in the pharmacy (53%) and busyness of the pharmacists (52%) were the top perceived barriers for asking community pharmacists questions. Conclusion: This study highlights the need for pharmacist participation in Peru’s DOTS program. Furthermore, this investigation has identified several issues of concern related to current community pharmacy practice in Peru. Therefore, future efforts may be necessary to address these identified areas of opportunity to promote the community pharmacist’s role in health screening, drug therapy monitoring, and counseling to decrease the public health burden of MDR-TB. Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents or royalties.   Type: Original Research

scholarly journals Key factors influencing multidrug-resistant tuberculosis in patients under anti-tuberculosis treatment in two centres in Burundi: a mixed effect modelling study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arnaud Iradukunda ◽  
Gabin-Pacifique Ndayishimiye ◽  
Darlene Sinarinzi ◽  
Emmanuel Nene Odjidja ◽  
Nestor Ntakaburimvo ◽  
...  
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Close Contact ◽  
Multidrug Resistant ◽  
Key Factors ◽  
Mixed Effect ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb

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.

scholarly journals WHO publishes the third edition of guidelines for the prevention and control of air-travel-associated tuberculosis

2008 ◽  
Vol 13 (23) ◽  
Author(s):  
I Abubakar ◽  
K Fernandez de la Hoz
Keyword(s):  
Multidrug Resistant ◽  
Air Travel ◽  
Public Health Agencies ◽  
The Public ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Published Evidence ◽  
Health Agencies ◽  
Mdr Tb ◽  
And Control

Air travel has increased over the last few decades resulting in greater risk of the spread of infectious diseases carried by infectious travellers. The risk of transmission of pathogens is particularly important for airborne organisms raising concern among public health agencies and the public. Despite limited research on the risk of tuberculosis associated with air travel, several reports have published evidence of the transmission of tuberculosis infection, including multidrug-resistant tuberculosis (MDR-TB) [1, 2].

scholarly journals STUDI FENOMENOLOGI : DUKUNGAN TERHADAP KEPATUHAN MINUM OBAT PADA PENDERITA TUBERCULOSIS DENGAN MULTIDRUG-RESISTANT

2021 ◽  
Vol 8 (1) ◽  
pp. 12-20
Author(s):  
Murwanti Murwanti
Keyword(s):  
Health Services ◽  
Community Involvement ◽  
Sampling Technique ◽  
Phenomenological Approach ◽  
Multidrug Resistant ◽  
Spiritual Support ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb

Background: Tuberculosis is an infectious disease if the patient does not complete therapeutic treatment can cause multidrug-resistant tuberculosis (MDR-TB). The role of the environment is needed to support treatment.The study aims to explore more deeply the family's support for medication adherence in patients with multidrug-resistant tuberculosis (TBC-MDR). Method: This type of research is qualitative using a descriptive phenomenological approach, in-depth interviews of 5 participants based on purposive sampling technique. Results: The results of the study found the role of the family towards TB-MDR patients manifested in emotional, physical, instrumental, and spiritual support. emotional support consists of positive and negative emotional. Community involvement after counseling was supportive but there were some who could not accept even families of MDR-TB sufferers were also shunned. The role of health services is to convey information, prepare medicines, supervise, motivate treatment, remind check schedules, refer to more complete facilities when needed, visit homes and ensure patients take medication if unable to come to the public health service. Conclusion: This study found 3 main themes, namely the role of comprehensive family, community involvement and the role of health services in mentoring TB-MDR patients.

Safety and Efficacy of Delamanid in the Treatment of Multidrug-Resistant Tuberculosis (MDR-TB)

2013 ◽  
Vol 5 ◽  
pp. CMT.S11675 ◽  
Author(s):  
Stephen K. Field
Keyword(s):  
Multidrug Resistant ◽  
Phase Iii ◽  
Drug Resistant ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Improved Outcomes ◽  
Resistance Patterns ◽  
Mdr Tb ◽  
Phase Iii Study

Globally, the incidence of tuberculosis (TB) is declining but the proportion of drug-resistant cases has increased. Strains resistant to both isoniazid and rifampin, and possibly other antibiotics, called multidrug-resistant (MDR), are particularly difficult to treat. Poorer outcomes, including increased mortality, occur in patients infected with MDR strains and the costs associated with treatment of MDR-TB are substantially greater. The recent recognition of MDR-TB and strains with more complex resistance patterns has stimulated the development of new TB medications including fluoroquinolones, oxazolidinones, diarylquinolines, nitroimidazopyrans, ethylenediamines, and benzothiazinones. Bedaquiline, a diarylquinoline, was approved for the treatment of MDR-TB in 2012. Addition of delamanid to WHO-approved treatment improved outcomes for MDR-TB and for extensively drug-resistant TB in a large randomized, controlled phase II clinical trial and is undergoing evaluation in a large international phase III study. This review will focus on MDR-TB and the role of delamanid in its treatment.

scholarly journals 769. An Outbreak of Multidrug-Resistant Tuberculosis, Minnesota 2016–2017

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S276-S276
Author(s):  
Malini Desilva ◽  
Nora Moore ◽  
Dzung Thai ◽  
Mary Beth Grimm ◽  
Nadya Sabuwala ◽  
...  
Keyword(s):  
Public Health ◽  
Monitoring Program ◽  
Multidrug Resistant ◽  
Infection Prevalence ◽  
Public Health Response ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Prevention Interventions ◽  
Adult Day Centers ◽  
Mdr Tb

Abstract Background Multidrug-resistant tuberculosis (MDR TB) is more difficult to treat and outcomes are worse than for drug-susceptible TB disease. MDR TB cases in Minnesota increased from zero in 2015 to nine in 2016. Case investigations suggested an outbreak. We describe the public health response, challenges of contact investigations (CIs), and ongoing management of contacts. Methods CDC performed whole-genome sequencing (WGS) to evaluate relatedness of MDR TB isolates. We conducted CIs for infectious cases. We created outbreak specific guidelines for screening and management of contacts, and partnered with various agencies to increase MDR TB awareness. Results WGS results were consistent with an MDR TB outbreak that included 10 cases (70% pulmonary) as of April 2018. Limited provider awareness about TB contributed to delayed diagnoses. CIs identified 588 contacts; 8.7% (n = 51) of contacts had previously documented positive TB infection test results, and 14% (n = 74) were newly positive for TB infection (median age: 72 years). Eight cases were epidemiologically linked to one Hmong adult day center. Sixty-two contacts started a fluoroquinolone for latent MDR TB infection. Contacts who declined treatment began a 2-year clinical monitoring program. Conclusion In this outbreak, delayed diagnoses resulted in long infectious periods and hundreds of contacts. WGS results were consistent with recent transmission. We discovered adult day centers are an overlooked congregate setting. CIs were complicated by limited public health funding and high underlying TB infection prevalence in the affected community. Increased community and provider awareness and intensified screening of contacts resulted in additional case finding and prevention interventions. Disclosures All authors: No reported disclosures.

scholarly journals Clofazimine as a Treatment for Multidrug-Resistant Tuberculosis: A Review

2021 ◽  
Vol 89 (2) ◽  
pp. 19
Author(s):  
Rhea Veda Nugraha ◽  
Vycke Yunivita ◽  
Prayudi Santoso ◽  
Rob E. Aarnoutse ◽  
Rovina Ruslami
Keyword(s):  
Multidrug Resistant ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Repurposed Drugs ◽  
Group 5 ◽  
Poor Outcomes ◽  
Group B

Multidrug-resistant tuberculosis (MDR-TB) is an infectious disease caused by Mycobacterium tuberculosis which is resistant to at least isoniazid and rifampicin. This disease is a worldwide threat and complicates the control of tuberculosis (TB). Long treatment duration, a combination of several drugs, and the adverse effects of these drugs are the factors that play a role in the poor outcomes of MDR-TB patients. There have been many studies with repurposed drugs to improve MDR-TB outcomes, including clofazimine. Clofazimine recently moved from group 5 to group B of drugs that are used to treat MDR-TB. This drug belongs to the riminophenazine class, which has lipophilic characteristics and was previously discovered to treat TB and approved for leprosy. This review discusses the role of clofazimine as a treatment component in patients with MDR-TB, and the drug’s properties. In addition, we discuss the efficacy, safety, and tolerability of clofazimine for treating MDR-TB. This study concludes that the clofazimine-containing regimen has better efficacy compared with the standard one and is also well-tolerated. Clofazimine has the potential to shorten the duration of MDR-TB treatment.

scholarly journals The Correlation Between Interleukin-10 1082G/A Gene Polimorphism Late Onset with Nephrotoxicity Secondary to Antituberculosis Treatment in Multidrug Resistant Tuberculosis Patients

2019 ◽  
Vol 39 (4) ◽  
pp. 215-219
Author(s):  
Harsini Harsini ◽  
Reviono Reviono ◽  
Umarudin Umarudin
Keyword(s):  
Late Onset ◽  
Interleukin 10 ◽  
Multidrug Resistant ◽  
Protective Role ◽  
Tuberculosis Patients ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Antituberculosis Treatment ◽  
Mdr Tb

Backgrounds: Tuberculosis controlling programme has become more complex with MDR-TB problem. Interleukin 10 (IL-10) 1082G/A gene polimorphism correlates with IL-10 secretion as anti-inflammatory cytokine which plays important role in pathogenesis of MDR-TB infection. The management of MDR-TB which used aminoglycosides could cause nephrotoxic effect to the patients. The protective role of IL-10 from IL-10 1082 G/A genotype to nephrotoxicity due to kanamycin still becomes a prolem nowadays. Methods: This study was a retorspective cohort study of MDR-TB patients who underwent treatment in Dr. Moewardi Hospital in 2011-2015. Results: Subjects of the study were 89 MDR-TB patients with IL-10 1082 G/A genotype polimorphism. The proportions of IL-10 1082 G/A genotype were AA genotype of 13.48%, GG of 4.49%, and GA of 82.2%. Statistic test showed that the onset of nephrotoxicity in GG genotype was faster than GA and AA genotype Conclusions: Interleukin 10 1082 G/A gene polymorphism had no significant correlation with nephrotoxicity onset in MDR-TB patients treated with kanamycin in Dr. Moewardi hospital. (J Respir Indo. 2019; 39(4): 215-9)

scholarly journals Multidrug-resistant tuberculosis and risk factors associated with its development: a retrospective study

2015 ◽  
Vol 9 (10) ◽  
pp. 1076-1085 ◽  
Author(s):  
Omar Sald Elmi ◽  
Habsah Hasan ◽  
Sarimah Abdullah ◽  
Mat Zuki Mat Jeab ◽  
Zilfalil Bin Alwi ◽  
...  
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Control Program ◽  
Previous Treatment ◽  
Multidrug Resistant ◽  
Peninsular Malaysia ◽  
Factors Associated ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb

Introduction: Multidrug-resistant tuberculosis (MDR-TB) has emerged as a major clinical public health threat and challenges the national TB control program in Malaysia. Data that elaborates on the risk factors associated with the development of MDR-TB is highly limited in this country. This study was aimed to determine the risk factors associated with the development of MDR-TB patients in peninsular Malaysia. Methodology: This was a case control study; the data were collected from medical records of all the registered MDR-TB patients at five referral TB hospitals in peninsular Malaysia from January 2010 to April 2014. The 105 cases were all confirmed by a positive sputum culture of Mycobacterium tuberculosis for MDR-TB and extensively drug-resistant (XDR)-TB. As a comparison, a total of 209 non-MDR-TB cases were randomly selected as controls. Results: A total of 105 MDR-TB and 209 non MDR-TB patients were studied. The risk factors associated with MDR-TB within the multivariate analysis were previous tuberculosis treatment, HIV infection, being an immigrant, and high load of positive for acid-fast bacillus (AFB) smear. Conclusions: The findings of this study revealed that patients who had received previous treatment for tuberculosis, were infected with HIV, were immigrants, and had a high burden of positive testing for AFB smear were more likely to have MDR-TB. An enhanced understanding of the risk factors associated with MDR-TB strains is imperative in the development of a national policy for public health interventions.

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