scholarly journals Model Tatalaksana Komprehensif Tuberculosis Multidrug-Resistant (TB-MDR) Melalui Pendekatan Provider Pelayanan Kesehatan

2020 ◽  
Vol 1 (2) ◽  
pp. 51-57
Author(s):  
Okky Haidar Yahya Irawansa ◽  
Yudha Bhaskoro ◽  
Ahmad Rizki Maulana ◽  
Febri Endra Budi Setyawan
Keyword(s):  
Health Service ◽  
Health Services ◽  
Service Providers ◽  
Health Workers ◽  
Multidrug Resistant ◽  
Health Service Provider ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Long Term Treatment ◽  
Mdr Tb

Introduction: Tuberculosis is a highly contagious disease and requires long-term treatment and large amounts of medication. This can affect the high risk of Multidrug-Resistant Tuberculosis (MDR-TB). A health service approach in providing comprehensive management including promotive, preventive, curative, and rehabilitative is very necessary to overcome these cases. Aim of study: This article aims to determine interventions that can be carried out by health services in preventing the occurrence of multidrug-resistant tuberculosis (MDR-TB). Method: The method used is a literature review through national to international journals that examine the interventions that can be carried out by health services in preventing MDR-TB. The articles or data sources that have been obtained will be compared with one another so that the factors that most influence the occurrence of MDR-TB can be found. Results and Discussion: The literature search results show that health workers, especially doctors, have an important role in managing MDR-TB cases. Management of MDR-TB in a comprehensive manner is carried out through promotive, preventive, curative, and rehabilitative programs through a health service provider approach. Educational activities regarding TB, MDR-TB, or the possibility of drug resistance are important to do to prevent new cases of MDR-TB. Curative treatment is carried out to improve mental and social health. Furthermore, rehabilitative efforts are carried out as a means to improve health status recovery for MDR-TB sufferers. Conclusion: Health service providers can improve facilities, they can carry out promotive, curative rehabilitative management to reduce the incidence of MDR-TB.

scholarly journals Task-shifting directly observed treatment and multidrug-resistant tuberculosis injection administration to lay health workers: stakeholder perceptions in rural Eswatini

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Ernest Peresu ◽  
J. Christo Heunis ◽  
N. Gladys Kigozi ◽  
Diana De Graeve
Keyword(s):  
Healthcare Workers ◽  
Health Workers ◽  
Multidrug Resistant ◽  
Task Shifting ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Key Stakeholders ◽  
Mdr Tb ◽  
Directly Observed Treatment

Abstract Background Eswatini is facing a critical shortage of human resources for health (HRH) and limited access to multidrug-resistant tuberculosis (MDR-TB) treatment in rural areas. This study assessed multiple stakeholders’ perceptions of task-shifting directly observed treatment (DOT) supervision and administration of intramuscular MDR-TB injections to lay health workers (LHWs). Methods A mixed methods study comprising a cross-sectional survey using a semi-structured questionnaire with community treatment supporters (CTSs) and a focus group discussion with key stakeholders including representatives from the Eswatini Ministry of Health (MOH), donor organisations, professional regulatory institutions, nursing academia, civil society and healthcare providers was conducted in May 2017. Descriptive statistics, thematic content analysis and data triangulation aided in the interpretation of results. Results A large majority of CTSs (n = 78; 95.1%) were female and 33 (40.2%) were older than 50 years. Most (n = 7; 70.0%) key stakeholders had over 10 years of work experience in policy-making, advocacy in the fields of HRH or day-to-day practice in MDR-TB management. Task-shifting of MDR-TB injection administration was implemented without national policy guidance and regulation. Stakeholders viewed the strategy to be driven by the prevailing shortage of professional frontline HRH and limited access to MDR-TB treatment. Task-shifting was perceived to improve medication adherence, and reduce stigma and transport-related MDR-TB treatment access barriers. Frontline healthcare workers and implementing donor partners fully supported task-shifting. Policy-makers and other stakeholders accepted task-shifting conditionally due to fears of poor standards of care related to perceived incompetence of CTSs. Appropriate compensation, adequate training and supervision, and non-financial incentives were suggested to retain CTSs. A holistic task-shifting policy and collaboration between the MOH, academia and nursing council in regulating the practice were recommended. Conclusions Stakeholders generally accepted the delegation of DOT supervision and administration of intramuscular MDR-TB injections to LHWs as a strategy to increase access to treatment, albeit with some apprehension. Findings from this study stress that task-shifting is not a panacea for HRH shortages, but a short-term solution that must form part of an overall simultaneous strategy to train, attract and retain adequate numbers of professional healthcare workers in Eswatini. To address some of the apprehension and ambivalence about expanding access to MDR-TB services through task-shifting, attention should be paid to important aspects such as competence-based training, certification and accreditation, adequate supportive on-the-job supervision, recognition, compensation, and expediting policy and regulatory support for LHWs.

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.

scholarly journals Brief psychotherapy administered by non-specialised health workers to address risky substance use in patients with multidrug-resistant tuberculosis: a feasibility and acceptability study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Gregory L. Calligaro ◽  
Zani de Wit ◽  
Jacqui Cirota ◽  
Catherine Orrell ◽  
Bronwyn Myers ◽  
...  
Keyword(s):  
Substance Use ◽  
Psychological Distress ◽  
Functional Impairment ◽  
Health Workers ◽  
Qualitative Interviews ◽  
Multidrug Resistant ◽  
Baseline Questionnaire ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb

Abstract Background Only 55% of multidrug-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 amongst 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 4 weeks prior to planned discharge, trained counsellors delivered the MI-RP intervention. The baseline questionnaire was re-administered 3 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 Influence of Decentralization and Type of patient on Lost to follow-up in Multidrug-Resistant Tuberculosis Patients in Indonesia 2014-2015: A Survival Analysis

2019 ◽  
Vol 13 (3) ◽  
Author(s):  
Noerfitri Noerfitri ◽  
R. Sutiawan ◽  
Tri Yunis Miko Wahyono ◽  
Pratiwi Ayuningtyas Hartono
Keyword(s):  
Health Workers ◽  
Multidrug Resistant ◽  
Patient Type ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Republic ◽  
In The Beginning ◽  
Lost To Follow Up

Drug resistant TB patients had a greater risk of LTFU than drug-sensitive TB patients due to longer treatment duration. The aims of this study were to determine the influence of decentralization and type of patient to LTFU in MDR-TB patients in Indonesia. This study was conducted in May-June 2018 at Sub Directorate of TB - Ministry of Health of the Republic of Indonesia. The study design was retrospective cohort. Samples were taken in total sampling with a total of 961 patients. 86.3% of patients were decentralized. Based on the type, the patient consists of 35.17% relapse, 5.52% new, 13.94% after LTFU, 23.10% failure category 1, 20.29% failure category 2, 1.9 % other patients. In multivariate analysis revealed that decentralization reduced the probability of LTFU up to 46% (HR 0.54, 95% CI 0.35-0.84). For patient type, treatment after LTFU, failure category 2 and others increased the probability of LTFU by 50% (HR 2,02; 95% CI 1,18-3,45), 53% (HR 2,13; 95% CI 1,24-3,66), and 74% (HR 3,80; 95% CI 1,54-9,36) consecutively compared with the type of relapse patients (baseline). Health workers were suggested to spend more time in communicating, informing and educating about TB treatment and the benefits of decentralization to MDR-TB patients. Moreover, it is suggested to conduct patient type screening in the beginning of the treatment to be able to identify the risk of LTFU.

scholarly journals TREATMENT OUTCOMES OF MULTIDRUG RESISTANT TUBERCULOSIS PATIENTS IN EAST JAVA FROM 2014 TO 2017

2020 ◽  
Vol 8 (2) ◽  
pp. 141
Author(s):  
Lailatul Fitriya ◽  
Kurnia Dwi Artanti
Keyword(s):  
Treatment Outcomes ◽  
Health Workers ◽  
Treatment Success ◽  
Public Health Problem ◽  
Secondary Data ◽  
Multidrug Resistant ◽  
Major Public Health Problem ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb

Background: Multidrug resistant tuberculosis (MDR TB) is a major public health problem marked by the Mycobacterium tuberculosis strain that is resistant to first line anti TB drugs, including rifampicin and isoniazid simultaneously. A patient confirmed as having MDR TB can transmit this form of TB to other individuals. Therefore, treatment success is the main target when addressing MDR TB. Purpose: This study aimed to assess the treatment outcomes of MDR TB patients in East Java Province from 2014 to 2017. Method: This is a quantitative-descriptive study using the secondary data of drug resistant TB patients sourced from the e-TB Manager website in the East Java Province Health Office. Results: The results show that the average MDR TB patients was 47 years old, 57.44% were male, 37.52% had a negative HIV status, 44.87% were relapse patients, 71.95% had undergone two or less previous treatments, and 69.24% had sputum culture conversion. The treatment outcomes included 161 patients (31.14%) confirmed as cured, 27 patients (5.22%) completing treatment, 174 patients (33.65%) defaulting, two patients (0.38%) confirmed as having failed treatment, and 59 patients (11.41%) dying during the treatment period. Conclusion: The treatment success rate was low and the number of defaults was high. Therefore, it is hoped that there will be support from those closest to the patient and health workers who will maintain and increase the patient's motivation to complete the treatment.

scholarly journals Knowledge and practice of health workers about control and prevention of multidrug-resistant tuberculosis in referral hospitals, Ethiopia: a cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e022948 ◽  
Author(s):  
Kefyalew Addis Alene ◽  
Akilew Awoke Adane ◽  
Sisay Yifiru ◽  
Bikes Destaw Bitew ◽  
Aynishet Adane ◽  
...  
Keyword(s):  
Health Workers ◽  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
History Of ◽  
The Mean ◽  
Knowledge And Practice

ObjectiveThe aim of this study was to assess the knowledge and practice of health workers about multidrug-resistant tuberculosis (MDR-TB) prevention and control.Study design and settingsA cross-sectional study was conducted at Gondar University Referral Hospital and Felege Hiwot Referral Hospital.ParticipantsRandomly selected health workers (ie, medical doctor, nurse, health officer, pharmacy, medical laboratory and midwifery) were the study participants.Outcome measuresThe main outcomes were knowledge and self-reported practice of health workers about MDR-TB.ResultsA total of 377 health workers (with a response rate of 93.7%) participated in the study. The majority of respondents were nurses (52.5%, n=198) and medical doctors (15.6%, n=59). The mean knowledge score was seven out of 10; 149 (39.5%) of respondents scored seven or more which was considered as good knowledge. MDR-TB knowledge of health workers was significantly associated with having a postgraduate degree (adjusted odds ratio (AOR)=5.78; 95% CI 2.33 to 14.33), taking infection prevention training (AOR=1.79; 95% CI 1.00, to 3.17) and having a history of tuberculosis (TB) (AOR=1.85; 95% CI 1.12, to 3.03). The mean self-reported practice score was four out of seven; one-fifth (19.6%) of respondents scored four or more which was considered as good practice. Self-reported practice of health workers was significantly associated with working at internal medicine (AOR=4.64; 95% CI 1.99, to 10.81) and paediatrics (AOR=3.85; 95% CI 1.11, to 13.34) wards, being in the age groups of 26–30 years (AOR=2.70; 95% CI 1.27, to 5.76), and 30 years and above (AOR=4.42; 95% CI 1.77, to 11.00).ConclusionsThis study found low knowledge and self-reported practice score among health workers. MDR-TB knowledge of health workers was significantly associated with educational status, infection prevention training and previous history of TB. This finding highlights the potential of providing MDR-TB training for health workers to increase their knowledge about MDR-TB.

scholarly journals Identification and attribute analysis of key stakeholders who influence multidrug-resistant tuberculosis prevention and control in China

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Bin Chen ◽  
Hongdan Bao ◽  
Xinyi Chen ◽  
Kui Liu ◽  
Ying Peng ◽  
...  
Keyword(s):  
Service Providers ◽  
Stakeholder Analysis ◽  
Multidrug Resistant ◽  
Tb Control ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Key Stakeholders ◽  
Mdr Tb ◽  
Control And Prevention ◽  
And Control

Abstract Background There could be various stakeholders who influencing multidrug-resistant tuberculosis (MDR-TB) policy development and implementation, yet their attributes and roles remain unclear in practice. This study aimed to identify key stakeholders in the process of policy-making for MDR-TB control and prevention and to analyse the attributes and relationships of the stakeholders, providing evidence for further policy research on MDR-TB control. Methods This study was conducted from October 2018 to March 2019 and applied the stakeholder analysis guidelines and domestic stakeholder analysis. An initial candidate stakeholder list was developed by policy scanning. Ten experts were invited to identify these candidate stakeholders. The major attribute of these stakeholders were analysed using the Michell scoring method. Based on these results, the intertwined relationships among groups of stakeholders were analysed and mapped through a systematic scan of the policy and literature on MDR-TB control, as well as information obtained from the interviews. Results A list of 21 types of candidate stakeholders was developed after a literature review and policy scanning, of which 11 received 100% approval. After expert evaluation and identification (the total expert authority was 0.80), 19 categories of stakeholders were approved and included in the stakeholder analysis. We categorized all of the stakeholders into three groups: (i) definitive stakeholders who are mainly involved in administrative departments and the Provincial Center for Disease Control and Prevention (CDC); (ii) expectant stakeholders who are mainly involved with MDR-TB patients, clinical departments of TB hospitals at different levels, community health care facilities, prefectural CDC and charity organizations; and (iii) latent stakeholders who mainly involved family members and neighbours of MDR-TB patients and TB related products manufacturers. Government departments and higher-level CDCs have strong decision-making power in developing MDR-TB control policies whereas the recommendations from service providers and the concerns of patients should be considered. Conclusions The MDR-TB prevention system was a multistakeholder cooperation system that was mainly led by government stakeholders. Enhancing communications with front-line service providers and patients on their unmet needs and evidence-based suggestions would highly benefit policy-making of MDR-TB prevention and control. Graphical abstract

scholarly journals The epidemiologic impact and cost-effectiveness of new tuberculosis vaccines on multidrug-resistant tuberculosis in India and China

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Chathika K Weerasuriya ◽  
Rebecca C Harris ◽  
C Finn McQuaid ◽  
Fiammetta Bozzani ◽  
Yunzhou Ruan ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Multidrug Resistant ◽  
Second Line ◽  
Second Line Therapy ◽  
China And India ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Line Therapy ◽  
Mdr Tb

Abstract Background Despite recent advances through the development pipeline, how novel tuberculosis (TB) vaccines might affect rifampicin-resistant and multidrug-resistant tuberculosis (RR/MDR-TB) is unknown. We investigated the epidemiologic impact, cost-effectiveness, and budget impact of hypothetical novel prophylactic prevention of disease TB vaccines on RR/MDR-TB in China and India. Methods We constructed a deterministic, compartmental, age-, drug-resistance- and treatment history-stratified dynamic transmission model of tuberculosis. We introduced novel vaccines from 2027, with post- (PSI) or both pre- and post-infection (P&PI) efficacy, conferring 10 years of protection, with 50% efficacy. We measured vaccine cost-effectiveness over 2027–2050 as USD/DALY averted-against 1-times GDP/capita, and two healthcare opportunity cost-based (HCOC), thresholds. We carried out scenario analyses. Results By 2050, the P&PI vaccine reduced RR/MDR-TB incidence rate by 71% (UI: 69–72) and 72% (UI: 70–74), and the PSI vaccine by 31% (UI: 30–32) and 44% (UI: 42–47) in China and India, respectively. In India, we found both USD 10 P&PI and PSI vaccines cost-effective at the 1-times GDP and upper HCOC thresholds and P&PI vaccines cost-effective at the lower HCOC threshold. In China, both vaccines were cost-effective at the 1-times GDP threshold. P&PI vaccine remained cost-effective at the lower HCOC threshold with 49% probability and PSI vaccines at the upper HCOC threshold with 21% probability. The P&PI vaccine was predicted to avert 0.9 million (UI: 0.8–1.1) and 1.1 million (UI: 0.9–1.4) second-line therapy regimens in China and India between 2027 and 2050, respectively. Conclusions Novel TB vaccination is likely to substantially reduce the future burden of RR/MDR-TB, while averting the need for second-line therapy. Vaccination may be cost-effective depending on vaccine characteristics and setting.

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