scholarly journals Barriers to Directly Observed Treatment for Multi Drug Resistant Tuberculosis Patients in Nepal - Qualitative Study

2018 ◽  
Vol 16 (1) ◽  
pp. 6-18
Author(s):  
R.P. Bichha ◽  
K.B. Karki ◽  
K.K. Jha ◽  
V.S. Salhotra ◽  
A.P. Weerakoon
Keyword(s):  
Qualitative Study ◽  
Health Workers ◽  
Previous History ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Major Barrier ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb

Introduction: To prevent the multi drug resistant tuberculosis (MDR-TB) is important to adhere long duration of drug regimen. There are many factors or barriers that are likely to affect adherence to the long treatment regimen. Objectives: To find out the barriers for adherence to MDR –TB treatment. Methods: The study was conducted as an institutional based qualitative study, using a convenient sampling technique. Data was collected from 50 current MDR-TB patients by trained field health workers using semi structured interviewer administered questionnaire in all regions in Nepal. Twenty five focus group discussions (FGD) were also conducted with MDR-TB patients, cured MDR-TB patients, DOTS Committee Members, health workers and close relatives of MDR-TB patients to supplement the findings. Results: Out of 50 respondents 19 were females and 31 were males. Their age varied from 22 years to 61 years. Majority of patients had a previous history of irregular TB treatment. Forty out of fifty patients (80%) were living in either rented houses or hostels (in Mid Western Region). Knowledge about TB and MDR-TB was satisfactory in majority of participants in both studies. Majority of participants were satisfied with facilities and services provided by MDR-TB clinics. There is a very little stigma associated with MDR-TB in Nepal. FGD revealed the onset of MDR-TB was attributed to causes such as smoking, alcohol abuse, poor nutrition, and contact with TB patients. Lack of money to go to health facility daily for treatment was reported as major barriers to adhere to MDR-TB treatment. Conclusion: Financial constraints were the major barrier for these patients. To sustain proper MDRTB programme, Government of Nepal and other organization should provide social support to these patients.  

scholarly journals Prevalence and factors associated with non-adherence to multi-drug resistant tuberculosis (MDR-TB) treatment at Mulago National Referral Hospital, Kampala, Uganda

2021 ◽  
Vol 21 (1) ◽  
pp. 238-47
Author(s):  
Charles Batte ◽  
Martha S Namusobya ◽  
Racheal Kirabo ◽  
John Mukisa ◽  
Susan Adakun ◽  
...  
Keyword(s):  
Mulago Hospital ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Factors Associated ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb ◽  
History Of ◽  
Previously Treated

Background: In Uganda, 12% of previously treated TB cases and 1.6% of new cases have MDR-TB and require specialized treatment and care. Adherence is crucial for improving MDR-TB treatment outcomes. There is paucity of information on the extent to which these patients adhere to treatment and what the drivers of non-adherence are. Methods: We conducted a cohort study using retrospectively collected routine program data for patients treated for MDR- TB between January 2012 – May 2016 at Mulago Hospital. We extracted anonymized data on non-adherence (missing 10% or more of DOT), socio-economic, demographic, and treatment characteristics of the patients. All participants were sen- sitive to MDR-TB drugs after second line Drug Susceptible Testing (DST) at entry into the study. Factors associated with non-adherence to MDR-TB treatment were determined using generalized linear models for the binomial family with log link and robust standard errors. We considered a p- value less than 0.05 as statistically significant. Results: The records of 227 MDR- TB patients met the inclusion criteria, 39.4% of whom were female, 32.6% aged be- tween 25 – 34 years, and 54.6% living with HIV/AIDS. About 11.9% of the patients were non-adherent. The main driver for non-adherence was history of previous DR-TB treatment; previously treated DR-TB patients were 3.46 (Adjusted prev- alence ratio: 3.46, 95 % CI: 1.68 - 7.14) times more likely to be non-adherent. Conclusion: One in 10 MDR-TB patients treated at Mulago hospital is non-adherent to treatment. History of previous DR- TB treatment was significantly associated with non-adherence in this study. MDR-TB program should strengthen adherence counselling, strengthen DST surveillance, and close monitoring for previously treated DR-TB patients. Keywords: Non-adherence; multi-drug resistant tuberculosis; treatment.

scholarly journals Adverse Drug Reactions in Patients put on Multi Drug Resistant Tuberculosis (MDR-TB) Treatment in Seven Districts of Central Gujarat

2015 ◽  
Vol 7 (4s) ◽  
pp. 425-431 ◽  
Author(s):  
Sangita Vashrambhai Patel ◽  
Nimavat Kapil Bhikhubhai ◽  
Alpesh Bhimabhai patel ◽  
Kalpita Samrat Shringarpure ◽  
Kedar Gautambhai Mehta ◽  
...  
Keyword(s):  
Adverse Drug Reactions ◽  
Drug Resistant ◽  
Drug Reactions ◽  
Drug Resistant Tuberculosis ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb

scholarly journals Prevalence and risk factors of multi-drug resistant tuberculosis in Dalian, China

2017 ◽  
Vol 45 (6) ◽  
pp. 1779-1786 ◽  
Author(s):  
Xin-Tong Lv ◽  
Xi-Wei Lu ◽  
Xiao-Yan Shi ◽  
Ling Zhou
Keyword(s):  
Risk Factors ◽  
Population History ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Previously Treated Patients ◽  
Previously Treated

Objectives To investigate the prevalence and risk factors associated with multi-drug resistant tuberculosis (MDR–TB) in Dalian, China. Methods This was a retrospective review of data from patients attending a TB clinic in Dalian, China between 2012 and 2015. Demographic and drug susceptibility data were retrieved from TB treatment cards. Univariate logistic analysis was used to assess the association between risk factors and MDR–TB. Results Among the 3552 patients who were smear positive for Mycobacterium tuberculosis (MTB), 2918 (82.2%) had positive MTB cultures and 1106 (31.1%) had isolates that showed resistance to at least one drug. The overall prevalence of MDR–TB was 10.1% (359/3552; 131/2261 [5.8%] newly diagnosed and 228/1291 [17.7%] previously treated patients). Importantly, 75 extensively drug-resistant TB isolates were detected from 25 newly treated and 50 previously treated patients. In total, 215 (6.1%) patients were infected with a poly-resistant strain of MTB. Previously treated patients and older patients were more likely to develop MDR–TB. Conclusions The study showed a high prevalence of MDR–TB among the study population. History of previous TB treatment and older age were associated with MDR–TB.

scholarly journals S2 Multi-drug Resistant Tuberculosis (MDR-TB) treatment in the UK: a survey of injectable use and toxicity in practice

Thorax ◽  
2010 ◽  
Vol 65 (Suppl 4) ◽  
pp. A4-A5
Author(s):  
A. Sturdy ◽  
A. Goodman ◽  
R. J. Jose ◽  
A. Loyse ◽  
M. O'Donoghue ◽  
...  
Keyword(s):  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Uk

scholarly journals Brief psychotherapy administered by non-specialised health workers to address risky substance use in inpatients with multi-drug resistant tuberculosis: A feasibility and acceptability study

2020 ◽  
Author(s):  
Gregory Calligaro ◽  
Zani De Wit ◽  
Jacqui Cirota ◽  
Catherine Orrell ◽  
Bronwyn Myers ◽  
...  
Keyword(s):  
Substance Use ◽  
Psychological Distress ◽  
Functional Impairment ◽  
Health Workers ◽  
Qualitative Interviews ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb

Abstract Background:Only 55% of multi-drug resistant tuberculosis (MDR-TB) cases worldwide complete treatment, with problem substance use a risk for default and treatment failure. Nevertheless, there is little research on psychotherapeutic interventions for reducing substance use among MDR-TB patients in general, and on their delivery by non-specialist health workers in particular.Objectives:To explore the feasibility and acceptability of a non-specialist health worker-delivered 4-session brief motivational interviewing and relapse prevention (MI-RP) intervention for problem substance use and to obtain preliminary data on the effects of this intervention on substance use severity, depressive symptoms, psychological distress and functional impairment at 3 months after hospital discharge.Methods:Between December 2015 and October 2016, consenting MDR-TB patients admitted to Brewelskloof Hospital who screened at moderate to severe risk for substance-related problems on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were enrolled, and a baseline questionnaire administered. In the four weeks prior to planned discharge, trained counsellors delivered the MI-RP intervention. The baseline questionnaire was re-administered three-months post-discharge and qualitative interviews were conducted with a randomly selected sample of participants (n=10).Results:Sixty patients were screened: 40 (66%) met inclusion criteria of which 39 (98%) were enrolled. Of the enrolled patients, 26 (67%) completed the counselling sessions and the final assessment. Qualitative interviews revealed participants’ perceptions of the value of the intervention. From baseline to follow-up, patients reported reductions in substance use severity, symptoms of depression, distress and functional impairment.Conclusion:In this feasibility study, participant retention in the study was moderate. We found preliminary evidence supporting the benefits of the intervention for reducing substance use and symptoms of psychological distress, supported by qualitative reports of patient experiences. Randomised studies are needed to demonstrate efficacy of this intervention before considering potential for wider implementation.Trial registration: South African National Clinical Trials Register (DOH-27-0315-5007) on 01/04/2015 (http://www.sanctr.gov.za).

scholarly journals Occurrence of psychiatric disorders in the patients of multi drug resistant tuberculosis under treatment

2018 ◽  
Vol 6 (11) ◽  
pp. 3538
Author(s):  
Anand Kumar ◽  
Dhananjay Chaudhari ◽  
Rahul Anand ◽  
Sanjay Kumar Verma ◽  
Avdhesh Kumar ◽  
...  
Keyword(s):  
Psychiatric Disorder ◽  
Psychiatric Disorders ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Major Barrier ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Dsm Iv ◽  
Psychiatric Complications

Background: Tuberculosis (TB) is considered as one of the leading causes of mortality worldwide. Even though fatality of TB is well known, treatment non-adherence is major barrier related to management of TB. Studies have shown that there is strong association between psychiatric disorders and treatment nonadherence to TB. Psychiatric issues present a challenge in the treatment of patients with multi drug-resistant tuberculosis (MDR-TB). Both baseline psychiatric disorders and development of psychiatric complications related to anti-tuberculosis drugs require aggressive management for better management of TB. The objective of the present endeavour was to study the occurrence of psychiatric complications in patients of MDR-TB during treatmentMethods: Patients of MDR-TB registered at PMDT centre situated at a tertiary level hospital were screened for psychiatric disorder by using GHQ-12 and assessment was done using structured clinical interview for DSM-IV-TR (SCID-1) research version. Diagnosis of psychiatric disorder was made on the basis of DSM-IV-TR.Results: Psychiatric disorders were already present in 8 (6.15%) patients before the start of MDR-TB treatment and development of psychiatric disorder in 12 (9.23%) patients after initiation of the treatment. Depressive disorder (n=9; 6.9%), anxiety disorder (n=5; 3.8%) and psychosis (n=4; 3.1%) were most frequent psychiatric disorders.Conclusions: GHQ-12 was found to be very useful screening instrument for detection of psychiatric disorders. The regimen IV anti tubercular drugs used for the treatment of MDR-TB drug resistant tuberculosis, significantly increases the risk of development of psychiatric disorders. 

scholarly journals Brief psychotherapy administered by non-specialised health workers to address risky substance use in inpatients with multi-drug resistant tuberculosis: A feasibility and acceptability study

2020 ◽  
Author(s):  
Gregory Calligaro ◽  
Zani De Wit ◽  
Jacqui Cirota ◽  
Catherine Orrell ◽  
Bronwyn Myers ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Substance Use ◽  
Psychological Distress ◽  
Health Workers ◽  
Qualitative Interviews ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb

Abstract Background: Only 55% of multi-drug resistant tuberculosis (MDR-TB) cases worldwide complete treatment, with problem substance use a risk for default and treatment failure. Nevertheless, there is little research on psychotherapeutic interventions for reducing substance use among MDR-TB patients in general, and on their delivery by non-specialist health workers in particular. Objectives: To explore the feasibility and acceptability of a non-specialist health worker-delivered 4-session brief motivational interviewing and relapse prevention (MI-RP) intervention for problem substance use and to obtain preliminary data on the effects of this intervention on substance use severity, depressive symptoms, psychological distress and functional impairment at 3 months after hospital discharge. Methods: Between December 2015 and October 2016, consenting MDR-TB patients admitted to Brewelskloof Hospital who screened at moderate to severe risk for substance-related problems on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were enrolled, and a baseline questionnaire administered. In the four weeks prior to planned discharge, trained counsellors delivered the MI-RP intervention. The baseline questionnaire was re-administered three-months post-discharge and qualitative interviews were conducted with a randomly selected sample of participants (n=10). Results: Sixty patients were screened: 40 (66%) met inclusion criteria of which 39 (98%) were enrolled. Of the enrolled patients, 26 (67%) completed the counselling sessions and the final assessment. Qualitative interviews revealed participants’ perceptions of the value of the intervention. From baseline to follow-up, patients reported reductions in substance use severity, symptoms of depression, distress and functional impairment. Conclusion: In this feasibility study, participant retention in the study was moderate. We found preliminary evidence supporting the benefits of the intervention for reducing substance use and symptoms of psychological distress, supported by qualitative reports of patient experiences. Randomised studies are needed to demonstrate efficacy of this intervention before considering potential for wider implementation. Trial registration: South African National Clinical Trials Register (DOH-27-0315-5007) on 01/04/2015 (http://www.sanctr.gov.za). Funding: National Institute for Drug Abuse (NIDA), AIDS Clinical Trials Group (ACTG).

scholarly journals Factors Associated with Multi-Drug Resistant Tuberculosis among TB Patients in Selected Treatment Centers of Amhara Region: A Case-Control Study

2021 ◽  
Vol 31 (1) ◽  
Author(s):  
Getahun Yeshiwas Ambaye ◽  
Gebiyaw Wudie Tsegaye
Keyword(s):  
Case Control Study ◽  
Previous History ◽  
Drug Resistant ◽  
Amhara Region ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb ◽  
History Of ◽  
Control Study

BACKGROUND: Multi-drug Resistant Tuberculosis (MDR-TB) is found to be a major public health problem both in developed and developing countries. Ethiopia is one of the 30 high MDR-TB burden countries in the world. Although several studies were done to identify the determinants of MDR-TB, the reported findings are heterogeneous across the world.METHODS: Unmatched case-control study was conducted at Debre Markose Referral Hospital, Debre Birhan Referral Hospital, and Boru Media District Hospital in Amhara Region, Northern Ethiopia, from March 01/2019- April 30/2019. Cases were all tuberculosis patients with culture or line probe assay confirmed mycobacterium tuberculosis resistant to at least both Isoniazid and Rifampicin and registered on second-line TB treatment. Controls were all patients with Bacteriological (molecular) proven drug-susceptible TB strains and whose recent smears result were turned to negative and registered as cured from January 01/2014 – December 31/2018. A pre-tested checklist was used to collect the data.RESULT: Of the total reviewed documents (393), 98 cases and 295 controls were involved in this study. And, 54(55.1%) among cases and 162(54.9%) among controls were males. sixty nine(70.4%) among cases and 163(55.3) among controls were within the age group of 26-45 years. In the multivariable logistic regression analysis, age between 26-45years old (AOR=3.35; 95% CI: 1.15, 9.77), previous history of TB treatment (AOR= 14.2;95%CI: 7.8, 25.3) and being HIV positive (AOR=4.4; 95% CI:1.8, 10.4) were significantly associated with MDR-TB.CONCLUSION: Age between 26-45 years old, previously treated cases and TB/HIV co-infection were identified as the determinants of MDR-TB. Special attention should be given to age between 26-45 years old, previous history of TB treatment and TB/HIV co-infection to prevent and control MDR-TB in the local context.

scholarly journals Predicting the Outcomes of New Short-Course Regimens for Multi-Drug Resistant Tuberculosis Using Intrahost and Pharmacokinetic-Pharmacodynamic Modelling

2018 ◽  
Author(s):  
Tan N Doan ◽  
Pengxing Cao ◽  
Theophilus I Emeto ◽  
James M McCaw ◽  
Emma S McBryde
Keyword(s):  
Treatment Duration ◽  
Treatment Success ◽  
Empirical Evaluation ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Short Course ◽  
Mdr Tb

ABSTRACTShort-course regimens for multi-drug resistant tuberculosis (MDR-TB) are urgently needed. Limited data suggest that the new drug, bedaquiline (BDQ), may have the potential to shorten MDR-TB treatment to less than six months when used in conjunction with standard anti-TB drugs. However, the feasibility of BDQ in shortening MDR-TB treatment duration remains to be established. Mathematical modelling provides a platform to investigate different treatment regimens and predict their efficacy. We developed a mathematical model to capture the immune response to TB inside a human host environment. This model was then combined with a pharmacokinetic-pharmacodynamic model to simulate various short-course BDQ-containing regimens. Our modelling suggests that BDQ could reduce MDR-TB treatment duration to just 18 weeks (four months) while still maintaining a very high treatment success rate (100% for daily BDQ for two weeks, or 95% for daily BDQ for one week during the intensive phase). The estimated time to bacterial clearance of these regimens ranges from 27 to 33 days. Our findings provide the justification for empirical evaluation of short-course BDQ-containing regimens. If short-course BDQ-containing regimens are found to improve outcomes then we anticipate clear cost-savings and a subsequent improvement in the efficiency of national TB programs.

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