Tuberculosis and associated risk factors among children and adolescent population in Serbia: 12 year’s retrospective study

Introduction: Recognition and epidemiological control of childhood and adolescent tuberculosis (TB) is essential to achieve effective control of TB in general as it presents high risk for transmission in the community. The aim of the study is to provide a descriptive and analytic overview of the trends in childhood and adolescent TB notifications and treatment outcomes and to identify factors associated with treatment success in a twelve-year period in Serbia. Methodology: We performed a retrospective trend analysis and analysis of treatment outcomes of 596 child and adolescent TB cases notified in Serbia in the period 2005–2016 from all health facilities, as well as logistic regression analysis to identify predictors of treatment success. Results: Factors independently associated with treatment success were: new TB (OR=2.60; 95% CI: 1.45–3.74), male sex (OR=2.55; 95% CI: 2.09–3.00), pulmonary TB (OR=3.34; 95% CI: 2.34–4.34), comorbidities (OR=2.58; 95% CI: 2.24–2.91), age below 5 years (OR=0.37; 95% CI: 0.32–0.43), and social vulnerability (OR=0.40; 95% CI: 0.34–0.46). Conclusions: In order to improve TB treatment outcomes among children and adolescent population in Serbia, it is important to focus on female, age group 5-18, EPTB, retreatment cases and socially vulnerable groups.

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Effect of using electronic medication monitors on tuberculosis treatment outcomes in China: a longitudinal ecological study

Infectious Diseases of Poverty ◽

10.1186/s40249-021-00818-3 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Ni Wang ◽

Lei Guo ◽

Hemant Deepak Shewade ◽

Pruthu Thekkur ◽

Hui Zhang ◽

...

Keyword(s):

Success Rate ◽

Treatment Outcomes ◽

Treatment Success ◽

Coverage Rate ◽

Treatment Success Rate ◽

County Level ◽

Time Data ◽

Tb Treatment ◽

Random Intercept ◽

Relative Change

Abstract Background In China, an indigenously developed electronic medication monitor (EMM) was designed and used in 138 counties from three provinces. Previous studies showed positive results on accuracy, effectiveness, acceptability, and feasibility, but also found some ineffective implementations. In this paper, we assessed the effect of implementation of EMMs on treatment outcomes. Methods The longitudinal ecological method was used at the county level with aggregate secondary programmatic data. All the notified TB cases in 138 counties were involved in this study from April 2017 to June 2019, and rifampicin-resistant cases were excluded. We fitted a multilevel model to assess the relative change in the quarterly treatment success rate with increasing quarterly EMM coverage rate, in which a mixed effects maximum likelihood regression using random intercept model was applied, by adjusting for seasonal trends, population size, sociodemographic and clinical characteristics, and clustering within counties. Results Among all 69 678 notified TB cases, the treatment success rate was slightly increased from 93.5% [95% confidence interval (CI): 93.0–94.0] in second quarter of 2018 to 94.9% (95% CI: 94.4–95.4) in second quarter of 2019 after implementing EMMs. There was a statistically significant effect between quarterly EMM coverage and treatment success rate after adjusting for potential confounders (P = 0.0036), increasing 10% of EMM coverage rate will lead to 0.2% treatment success rate augment. Besides, an increase of 10% of elderly or bacteriologically confirmed TB will lead to a decrease of 0.4% and 0.9% of the treatment success rate. Conclusions Under programmatic settings, we found a statistically significant effect between increasing coverage of EMM and treatment success rate at the county level. More prospective studies are needed to confirm the effect of using EMM on TB treatment outcomes. We suggest performing operational research on EMMs that provides real-time data under programmatic conditions in the future.

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Operational Research to Assess the Real-Time Impact of COVID-19 on TB and HIV Services: The Experience and Response from Health Facilities in Harare, Zimbabwe

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6020094 ◽

2021 ◽

Vol 6 (2) ◽

pp. 94

Author(s):

Pruthu Thekkur ◽

Kudakwashe C. Takarinda ◽

Collins Timire ◽

Charles Sandy ◽

Tsitsi Apollo ◽

...

Keyword(s):

Hiv Testing ◽

Treatment Outcomes ◽

Real Time ◽

Treatment Success ◽

Health Facilities ◽

Case Detection ◽

Monthly Data ◽

Hiv Services ◽

Tb Treatment ◽

Set Up

When COVID-19 was declared a pandemic, there was concern that TB and HIV services in Zimbabwe would be severely affected. We set up real-time monthly surveillance of TB and HIV activities in 10 health facilities in Harare to capture trends in TB case detection, TB treatment outcomes and HIV testing and use these data to facilitate corrective action. Aggregate data were collected monthly during the COVID-19 period (March 2020–February 2021) using EpiCollect5 and compared with monthly data extracted for the pre-COVID-19 period (March 2019–February 2020). Monthly reports were sent to program directors. During the COVID-19 period, there was a decrease in persons with presumptive pulmonary TB (40.6%), in patients registered for TB treatment (33.7%) and in individuals tested for HIV (62.8%). The HIV testing decline improved in the second 6 months of the COVID-19 period. However, TB case finding deteriorated further, associated with expiry of diagnostic reagents. During the COVID-19 period, TB treatment success decreased from 80.9 to 69.3%, and referral of HIV-positive persons to antiretroviral therapy decreased from 95.7 to 91.7%. Declining trends in TB and HIV case detection and TB treatment outcomes were not fully redressed despite real-time monthly surveillance. More support is needed to transform this useful information into action.

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Effects of social protection on tuberculosis treatment outcomes in low or middle-income and in high-burden countries: systematic review and meta-analysis

Cadernos de Saúde Pública ◽

10.1590/0102-311x00153116 ◽

2018 ◽

Vol 34 (1) ◽

Cited By ~ 9

Author(s):

Kaio Vinicius Freitas de Andrade ◽

Joilda Silva Nery ◽

Ramon Andrade de Souza ◽

Susan Martins Pereira

Keyword(s):

Treatment Outcomes ◽

Social Protection ◽

Meta Analysis ◽

Treatment Success ◽

Qualitative Synthesis ◽

Middle Income ◽

High Burden ◽

Tb Treatment ◽

Protection Strategies ◽

Meta Analyses

Tuberculosis (TB) is a poverty infectious disease that affects millions of people worldwide. Evidences suggest that social protection strategies (SPS) can improve TB treatment outcomes. This study aimed to synthesize such evidences through systematic literature review and meta-analysis. We searched for studies conducted in low- or middle-income and in high TB-burden countries, published during 1995-2016. The review was performed by searching PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect and LILACS. We included only studies that investigated the effects of SPS on TB treatment outcomes. We retained 25 studies for qualitative synthesis. Meta-analyses were performed with 9 randomized controlled trials, including a total of 1,687 participants. Pooled results showed that SPS was associated with TB treatment success (RR = 1.09; 95%CI: 1.03-1.14), cure of TB patients (RR = 1.11; 95%CI: 1.01-1.22) and with reduction in risk of TB treatment default (RR = 0.63; 95%CI: 0.45-0.89). We did not detect effects of SPS on the outcomes treatment failure and death. These findings revealed that SPS might improve TB treatment outcomes in lower-middle-income economies or countries with high burden of this disease. However, the overall quality of evidences regarding these effect estimates is low and further well-conducted randomized studies are needed.

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Tuberculosis in native Israeli Arabs and Jews: trends and treatment outcomes, 1999–2011

Epidemiology and Infection ◽

10.1017/s0950268815000382 ◽

2015 ◽

Vol 143 (15) ◽

pp. 3203-3210 ◽

Cited By ~ 1

Author(s):

H. BISHARA ◽

D. GOLDBLATT ◽

E. RORMAN ◽

Z. MOR

Keyword(s):

Treatment Outcomes ◽

Clinical Laboratory ◽

Treatment Success ◽

Developed Countries ◽

National Average ◽

Success Rates ◽

Pulmonary Tb ◽

Tb Treatment ◽

Lower Treatment ◽

Israeli Arabs

SUMMARYThe incidence of tuberculosis (TB) in native ethnic minorities remains high in developed countries. Arabs, the major ethnic minority in Israel, comprise 21% of its population. This retrospective study compared TB incidence, demographic, clinical, laboratory, genotyping characteristics and treatment outcomes in all Israeli-born citizens diagnosed with TB between 1999 and 2011 by ethnicity, i.e. Israeli-born Arabs (IA) and Jews (IJ). A total of 831 Israeli-born TB patients were reported. Of those, there were 530 (64%) IJ and 301 (36%) IA, with an average annual TB rate of 1·1 and 1·6 cases/100 000 population, respectively, lower than the national average (7·0 cases/100 000 population). TB rates in IA and IJ declined and converged to 1 case/100 000 residents. IA TB patients were more likely to be older, have more pulmonary TB and have lower treatment success rates than IJ. Older age and HIV co-infection, but not ethnicity, were predictive of non-success in TB treatment. Ten mixed IA–IJ clades were detected by spoligotyping and three mixed IA–IJ clusters were identified by MIRU-VNTR typing. Only one IA–IJ couple recalled mutual contact. In conclusion, TB rate in IA was higher than in IJ, but declined and converged in both to 1 case/100 000. Treatment success was high in both groups, and was unrelated to ethnicity.

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Tuberculosis Treatment Outcomes: A Fifteen Year Retrospective Study in Jos North and Mangu, Plateau State, North – Central Nigeria

10.21203/rs.2.11227/v4 ◽

2020 ◽

Author(s):

Comfort Nanbam Sariem ◽

Patricia Odumosu ◽

Maxwell Patrick Dapar ◽

Jonah Musa ◽

Luka Ibrahim ◽

...

Keyword(s):

Treatment Failure ◽

Treatment Outcomes ◽

Descriptive Analysis ◽

Treatment Success ◽

Infectious Agent ◽

Success Rates ◽

North Central ◽

Tuberculosis Patients ◽

Tb Treatment ◽

Plateau State

Abstract Background: Globally, tuberculosis (TB) is the leading cause of death from a single infectious agent. Adherence to TB therapy is an important factor in treatment outcomes, which is a critical indicator for evaluating TB treatment programs. This study assessed TB treatment outcomes using a fifteen-year record of tuberculosis patients who received treatment in Jos North and Mangu Local Government Areas of Plateau State, North-Central Nigeria. Methods: The retrospective facility based study was done in five TB treatment centers which account for more than half of data for tuberculosis patients in Plateau State. Data were collected from 10156 TB patient’s health records between 2001 and 2015. Treatment outcomes were categorized as successful (cured, treatment completed) or unsuccessful (non-adherent, treatment failure or death). A descriptive analysis was done to assess the factors associated with treatment outcomes. Relevant bivariable and multivariable logistic regression were done. All statistical analyses were performed on Stata version 11, College station, Texas, USA.Results: During the study period, 58.1% (5904/10156) of the TB patients who received treatment were males. The Mean age ±SD was 35.5 ±15.5 years. The overall treatment success rate was 67.4%; non-adherence/defaulting rate was 18.5%, with majority of patients defaulting at the end of intensive phase of treatment. The sputum conversion rate was 72.8% and mortality rate was 7.5%. A decrease in successful treatment outcomes rate from 83.8% in 2001 to 64.4% in 2015 was observed. After adjusting for sex, and TB category, being HIV positive was 2.8 times (95% CI: 1.11-6.83, p=0.028) more likely to be associated with treatment success than having an unknown status. Treatment after loss to follow-up, relapse and treatment failure were less likely associated with treatment success than newly diagnosed TB patients.Conclusion: With the decrease in treatment success rates, underlying reasons for medication non-adherence and treatment failure should be resolved through adherence counseling involving the patient and treatment supporters, with education on voluntary counseling and testing for HIV among TB patients.

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Treatment outcomes of patients with tuberculosis in war affected region of Khyber Pakhtunkhwa, Pakistan

10.21203/rs.2.9219/v3 ◽

2020 ◽

Author(s):

TAUSEEF AHMAD ◽

Muhammad Ayub Jadoon ◽

Muhammad Khan ◽

Haroon ◽

Muhammad Mumtaz Khan ◽

...

Keyword(s):

Treatment Outcome ◽

Success Rate ◽

Treatment Outcomes ◽

Successful Treatment ◽

Treatment Success ◽

Control Program ◽

Treatment Success Rate ◽

Khyber Pakhtunkhwa ◽

Tb Treatment ◽

Treatment Category

Abstract Background: Globally, tuberculosis (TB) remains the leading cause of death from a single infectious disease. TB treatment outcome is an indicator for the effectiveness of a national TB control program. This study aimed to assess treatment outcomes of TB patients and its determinants in Batkhela, Khyber Pakhtunkhwa, Pakistan. Methods: A retrospective cohort study was designed using all TB patients who were enrolled at District Head Quarter (DHQ) Hospital Batkhela, Pakistan, from January 2011 to December 2014. A binary logistic regression models were used to identify factors associated with successful TB treatment outcomes defined as the sum of cure and completed treatment. Results: A total of 515 TB patients were registered, of which 237 (46%) were males and 278 (53.98%) females. Of all patients, 234 (45.44%) were cured and 210 (40.77%) completed treatment. The overall treatment success rate was 444 (86.21%). Age 0-20 years (adjusted odds ratio, AOR= 3.47; 95% confidence interval, CI)= 1.54-7.81; P= 0.003), smear-positive pulmonary TB (AOR)= 3.58; 95% CI= 1.89-6.78; P= <0.001), treatment category (AOR= 4.71; 95% CI= 1.17-18.97; P= 0.029), and year of enrollment 2012 (AOR= 6.26; 95% CI= 2.52-15.59; P= <0.001) were significantly associated with successful treatment outcome. Conclusions: The overall treatment success rate is satisfactory but still need to be improved to achieve the international targeted treatment outcome. Type of TB, age, treatment category, and year of enrollment were significantly associated with successful treatment outcomes.

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Treatment success using novel and adapted treatment regimens in registered DR-TB children in Dushanbe, Tajikistan, 2013-2019

The Journal of Infection in Developing Countries ◽

10.3855/jidc.14798 ◽

2021 ◽

Vol 15 (09.1) ◽

pp. 7S-16S

Author(s):

Bobojon Pirmahmadzoda ◽

Katrina Hann ◽

Kristina Akopyan ◽

Ruzanna Grigoryan ◽

Evgenia Geliukh ◽

...

Keyword(s):

Treatment Outcomes ◽

Treatment Success ◽

Short Treatment ◽

Female Ratio ◽

Treatment Regimens ◽

Tb Treatment ◽

National Tuberculosis ◽

Mdr Tb ◽

Pediatric Tb ◽

Culture Conversion

Introduction: Approximately 3% of all pediatric TB cases develop MDR-TB, with only 3–4% of such children receiving MDR-TB treatment. In Tajikistan, children as a proportion of all DR-TB in the country increased from 4.3 to 7.5% during 2013-2018. Despite limited evidence on the use of new anti-TB drugs in children, WHO has updated its guidelines for DR-TB treatment for children, and Tajikistan did so in 2013 and 2017. Novel and adapted regimens included individual regimens for RR/MDR, XDR (with and without Bedaquiline and Delamanid) and short treatment regimens with and without injectables. It is important to document the outcomes of the treatment regimens. Therefore, the aim of this study was to describe characteristics of children receiving different treatment regimens for DR-TB, the culture conversion and treatment outcomes. Methodology: Cohort study of children enrolled in DR-TB treatment by the National Tuberculosis Program in Dushanbe, Tajikistan, January 2013 to July 2019. Results: The study included 60 DR-TB children. The male to female ratio was 1:2 and mean age 13.6 years. Median time to culture conversion was 66 days [IQR:31-103; Range:2-232]. In children with treatment outcomes (N = 58), 93% had favorable outcomes. There were four children (7%) with unfavorable treatment outcomes, all of whom were female 15-17 years, on standard (RR/MDR) treatment during 2013-2015. Favorable outcomes by DR-TB type were 91%, 90%, and 100% in RR/MDR, PreXDR, and XDR-TB patients, respectively. Conclusions: All children enrolled after the introduction of modified guidelines for novel and adapted regimens for DR-TB showed positive TB treatment outcomes.

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Treatment outcomes of drug-resistant tuberculosis in people living with HIV in Odesa province, Ukraine, 2014-2016

The Journal of Infection in Developing Countries ◽

10.3855/jidc.11979 ◽

2020 ◽

Vol 14 (11.1) ◽

pp. 88S-93S

Author(s):

Svitlana Yesypenko ◽

Ruzanna Grigoryan ◽

Yulia Sereda ◽

Olga Denisuk ◽

Liana Kovtunovich ◽

...

Keyword(s):

Treatment Outcomes ◽

Urban Areas ◽

Treatment Success ◽

People Living With Hiv ◽

Drug Resistant ◽

Tb Treatment ◽

Total Prevalence ◽

The Mean ◽

Living With Hiv ◽

Mean Time

Introduction: Odesa province has the highest TB/HIV prevalence in Ukraine, exceeding the total prevalence in the country by 3 times. The objective of this study was to investigate the unfavorable treatment outcomes and associated factors in patient with drug-resistant (DR) TB in people living with HIV (PLH) in Odesa. Methodology: A cohort study with secondary data analysis was conducted among 373 PLH with confirmed pulmonary DR TB for 2014-2016. Results: About 2/3rd of the cohort were males from urban areas. Mean age and CD4 counts were 39 and 203, respectively. The overall treatment success was 44.2% with the most unfavorable treatment outcomes being observed in extensively and pre-extensively drug resistant (XDR and PreXDR) TB. The mean time between the results of GeneXpert (manufactured by Cepehid) and DR TB treatment based on GeneXpert was 1.3 days. However, the mean time between DR TB treatment based on GeneXpert and results of drug susceptibility test (DST) was 37.0 days referring to a late reporting of DST and to a late adjustment of previously prescribed treatment. The factors associated with the treatment unfavorable outcome included XDR and Pre-XDR TB, lack of antiretroviral treatment (ART), contrimoxazole preventive therapy (CPT) and CD4 test. Conclusions: The rate of successful DR TB treatment in PLH in Odesa remains low. The delayed reporting of DST contributes to lack of timely adjusted treatments. XDR and Pre-XDR TB, lack of ART and CPT are associated with unfavorable treatment outcomes. Additional studies would help to understand the temporal relationship between CD4 test and treatment outcomes.

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A systematic review and meta-analysis of the association between integrated tuberculosis and Human Immuno-deficiency Virus therapy and tuberculosis treatment outcomes among adults in sub-Saharan Africa

10.21203/rs.3.rs-21573/v1 ◽

2020 ◽

Author(s):

Benjamin Momo Kadia ◽

Noah Fongwen Takah ◽

Christian Akem Dimala ◽

Victoria Simms

Keyword(s):

Treatment Outcomes ◽

Meta Analysis ◽

Treatment Success ◽

Hiv Treatment ◽

Sub Saharan Africa ◽

P Value ◽

Human Immuno Deficiency Virus ◽

Tb Treatment ◽

All Cause Mortality ◽

Sub Saharan

Abstract Background: Despite the scale-up of programmes integrating treatment of tuberculosis (TB) and Human Immuno-deficiency Virus (HIV) in sub-Saharan Africa (SSA), TB treatment outcomes in TB/HIV co-infected patients in the region remain sub-optimal.Objective: To summarize the available evidence on the association between integrated TB/HIV treatment and TB treatment outcomes specifically, successful treatment and all-cause mortality in TB/HIV co-infected adults in SSA.Method: A systematic review of studies published between March 2004 and 10 July 2019 was performed. Seven electronic databases including Medline, Embase and Cochrane were searched to identify interventional and observational quantitative studies reporting on integrated TB/HIV treatment in SSA. Two investigators independently screened the search output, reviewed the eligible studies, and rated the quality of eligible studies using quality assessment tools of the National Heart Lung and Blood Institute. Pooled odds ratios (ORs) were derived using random-effects meta-analysis. Heterogeneity across studies was assessed using the I2 statistic. The confidence in the pooled ORs was rated using the GRADE. The final review was reported using the PRISMA.Results: Eleven studies including 4181 participants were retained. The studies were of moderate to good quality, with 10 being quasi-experimental and cohort. Pooling of relevant studies showed that the odds of treatment success with integration was 1.1 times (95% CI: 0.93-1.29; I2=74.5%; p-value for heterogeneity=0.001) the odds of treatment success without integration and the odds of mortality with integration was 1.27 (95% CI 1.02-1.59; I2=87.3%; p-value for heterogeneity<0.0001) times the odds of mortality without integration. On sensitivity analysis, the odds of mortality with integration decreased to 1.06 (95% CI: 0.83-1.34; I2=80.1%; p-value for heterogeneity<0.0001) times the odds of mortality without integration and there was strong evidence of an association between sample size variation and heterogeneity (p=0.01). Good quality studies (4/11) tended to support the effectiveness of integrated treatment in increasing successful outcomes and decreasing mortality. Certainty in the pooled ORs was low.Conclusion: Evidence on the effect of integrated TB/HIV treatment services on treatment success and all-cause mortality in TB/HIV co-infected patients in SSA is inconclusive but the few available good quality studies tend to favour the effectiveness of these services. More robust primary studies are warranted.

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The effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes

Scientific Reports ◽

10.1038/s41598-021-94153-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Osman Abdullahi ◽

Ngari Moses ◽

Deche Sanga ◽

Willetts Annie

Keyword(s):

Treatment Outcomes ◽

Treatment Success ◽

Clinical Signs ◽

World Health ◽

Routine Practice ◽

Public And Private ◽

Systematic Screening ◽

Tb Treatment ◽

Resource Limited ◽

Health Organization

AbstractThe World Health Organization (WHO) criteria for diagnosing and treating Tuberculosis (TB) includes clinical signs, therefore not requiring bacteriological laboratory confirmation. In resource-limited settings, including Kenya, this empirical TB treatment is routine practice however limited data exist on patient clinical outcomes when comparing the method of diagnosis. We evaluated TB treatment outcomes comparing clinically diagnosed and bacteriologically confirmed TB, 6 months after starting treatment of TB in a rural county in Kenya. Our analysis compared patients with a clinical versus a bacteriologically confirmed TB diagnosis. In this retrospective analysis, we included all adults (≥ 18 years) starting treatment of TB and followed up for 6 months, within the County TB surveillance database from 2012 to 2018. Patients included from both public and private facilities. The TB treatment outcomes assessed included treatment success, treatment failure, death, defaulted and transferred out. We used survival regression models to assess effect of type of diagnosis on TB treatment outcome defining time at risk from date of starting treatment to experiencing one of the treatment outcomes or completing 6-months of treatment. A total of 12,856 patients; median age 37 [IQR 28 − 50] years were included. 7639 (59%) were male while 11,339 (88%) were pulmonary TB cases. Overall, 11,633 (90%) were given first-line TB treatment and 3791 (29%) were HIV infected. 6472 (50%) of the patients were clinically diagnosed of whom 4521/6472 (70%) had a negative sputum/GeneXpert test. During the study 5565 person-years (PYs) observed, treatment success was 82% and 83% amongst clinically and bacteriologically diagnosed patients (P = 0.05). There were no significant differences in defaulting (P = 0.70) or transfer out (P = 0.19) between clinically and bacteriologically diagnosed patients. Mortality was significantly higher among clinically diagnosed patients: 639 (9.9%) deaths compared to 285 (4.5%) amongst the bacteriologically diagnosed patients; aHR 5.16 (95%CI 2.17 − 12.3) P < 0.001. Our study suggests survival during empirical TB treatment is significantly lower compared to patients with laboratory evidence, irrespective of HIV status and age. To improve TB treatment outcomes amongst clinically diagnosed patients, we recommend systematic screening for comorbidities, prompt diagnosis and management of other infections.

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