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

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.

scholarly journals 9-12 months short treatment for patients with MDR-TB increases treatment success in Kyrgyzstan

2021 ◽  
Vol 15 (09.1) ◽  
pp. 66S-74S
Author(s):  
Elena Zhdanova ◽  
Olga Goncharova ◽  
Hayk Davtyan ◽  
Sevak Alaverdyan ◽  
Aelita Sargsyan ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Individualized Treatment ◽  
Sputum Culture ◽  
The Other ◽  
Favorable Outcome ◽  
Short Treatment ◽  
Sputum Culture Conversion ◽  
Mdr Tb ◽  
Culture Conversion

Introduction: MDR/RR-TB is a growing problem in Kyrgyzstan. In 2005, the country introduced standard or individualized treatment for 20-24 months. Because of poor treatment outcomes, in 2017 a short treatment with strict eligibility criteria was introduced. The aim of this study was to compare characteristics and treatment outcomes of MDR/RR-TB patients receiving short (9-12 months) treatment in 2017 with those receiving standard or individualized (20-24 months) treatment in 2016/2017. Methodology: A comparative cohort study using routine programmatic data. Characteristics, sputum culture conversion and treatment outcomes were compared between those on short treatment with those on standard/individualized treatment using the chi-square test, crude and adjusted risk ratios (RR and aRR). Results: The study included 274, 82 and 132 patients on standard, individualized and short treatment, respectively. There were more females, fewer migrants/homeless and unemployed and more new TB patients on short treatment compared with the other two groups. A favorable outcome (cure and treatment completed) was significantly higher in short treatment patients (83%) compared with those on standard (50%) or individualized (59%) treatment (p < 0.001). There was higher 1-month sputum culture conversion with short treatment (35%) compared with the other two groups (19% and 24%, p < 0.05). Short treatment (aRR 1.6, 1.4-1.8), female gender (aRR 1.2, 1.1-1.4), not being homeless (aRR 12.9, 4.5-17.3) and having new TB (aRR 1.3, 1.0-1.5) were independently associated with a favorable outcome. Conclusions: The treatment success was higher in selected MDR-TB patients given short treatment in Kyrgyzstan: this regimen should be scaled-up to all MDR-TB patients.

scholarly journals Predictors of Intensive Phase Treatment Outcomes among Patients with Multi-Drug Resistant Tuberculosis in Zaria, North-Western Nigeria

2020 ◽  
Vol 32 (2) ◽  
pp. 95-107
Author(s):  
A. Oyefabi ◽  
B. Adelekan ◽  
E. Adetiba ◽  
L. Emmanuel ◽  
O. Jimoh
Keyword(s):  
Treatment Outcome ◽  
Treatment Outcomes ◽  
Successful Treatment ◽  
Treatment Success ◽  
Case Fatality ◽  
Training Centre ◽  
Intensive Phase ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Mdr Tb

Background: The emergence of multidrug-resistant tuberculosis (MDR-TB) is a threat to successful TB treatment outcomes in developing nations like Nigeria. This study determined the predictors of intensive phase treatment outcomes in MDR-TB patients in Zaria, Nigeria.Methods: This was a retrospective cross-sectional review of the records of 124 MDR-TB patients registered between September 2012 and August 2017 at the National Tuberculosis and Leprosy Training Centre, Saye, Zaria. Data were analyzed using IBM SPSS version 25.0 and the StataCorp STATA/SE 14.Results: The median age (IQR) of the respondents was 32 (15) years. The gene Xpert test detected Mycobacterium Tuberculosis (MTB) and rifampicin resistance (RIF) in 119 (96.0%) cases. The treatment success rate was 97 (78.2%). MDR-TB and HIV co-infection rate was 17 (13.7%) while the case fatality rate was 16.1%. Bivariate analysis showed that being male (p=0.001), not currently in marital union (p=0.01) and positive smear results at 1 month (p=0.027)) were significantly associated with treatment success. Multivariate logistic regression showed that the odds for successful treatment outcome was 4 times higher for the MDR-TB patients who were employed than the unemployed (AOR= 3.98, 95% CI= 1.15-13.74). No significant relationship between MDR-TB-HIV comorbidity (AOR=1.89, 95% CI=0.44-8.19), MDR-TB susceptible to Isoniazid (AOR= 0.49, 95% CI =0.15-1.56) and successful treatment outcome.Conclusion: Unemployment was a predictor of poor treatment outcome in this study. Cause-specific mortality due to the MDR TB was high in this setting. We advocate for optimization of access to treatment and social support system, especially for the female patients. Keywords: Gene Xpert; Intensive phase; MDR-TB; Treatment outcomes; Nigeria.

scholarly journals Effectiveness and Safety of Bedaquiline-containing Regimens for Treatment on Patients With Refractory Rifampicin/multidrug-resistant Tuberculosis: A Retrospective Cohort Study in East China

2021 ◽  
Author(s):  
Shao-Jun Zhang ◽  
Yan Yang ◽  
Wen-Wen Sun ◽  
Zhong-Shun Zhang ◽  
He-ping Xiao ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Multidrug Resistant ◽  
East China ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Conversion Rates ◽  
Mdr Tb ◽  
Culture Conversion ◽  
Closing Rate

Abstract Objective: To compare the effectiveness and safety of bedaquiline-containing and bedaquiline-free regimens for treatment of patients with refractory rifampicin-resistant/multidrug-resistant tuberculosis (RR/MDR-TB).Methods: Patients with refractory RR/MDR-TB receiving bedaquiline-containing regimens (bedaquiline group, n=102) and bedaquiline-free regimens (non-bedaquiline group, n=100) were included in this retrospective historical control study across East China. The culture conversion, end-of-treatment outcomes, cavity closing rate, and adverse events (AEs) were compared between the two groups. Univariate and multivariate analyses were performed to identify independent predictors of treatment success and culture reversion.Results: The baseline characteristics of the patients were well balanced between the two groups. The culture conversion rates in the bedaquiline group at month 3 (89.2% vs. 66.0%), month 6 (90.2% vs. 72.0%), month 9 (91.2% vs. 66.0%), and month 12 (94.1% vs. 65.0%) were all significantly higher than those in the non-bedaquiline group (all p<0.001). Similar results were observed in the cavity closing rate at month 9 (19.6% vs. 8.0%, p=0.017) and month 12 (39.2% vs. 15.0%, p<0.001). Patients receiving bedaquiline-containing regimens had more treatment success than those receiving bedaquiline-free regimens (p<0.001; cure rate, 69.6% vs. 45.0%; complete the treatment, 22.5% vs. 18.0%; treatment success, 92.2% vs. 63.0%). The use of bedaquiline was identified as an independent predictor of both treatment success (OR=7.356, 95% CI: 2.920–18.530, p<0.001) and culture reversion (OR=0.124, 95% CI: 0.035–0.452, p<0.001). AEs were similarly reported in 26.5% of patients in the bedaquiline group and 19.0% in the non-bedaquiline group (p=0.206).Conclusions: Bedaquiline-containing regimens resulted in better treatment outcomes and similar safety relative to bedaquiline-free regimens for patients with refractory pulmonary RR/MDR-TB.

Impact of bedaquiline on treatment outcomes of multidrug-resistant tuberculosis in a high-burden country

2020 ◽  
pp. 2002544
Author(s):  
Dumitru Chesov ◽  
Jan Heyckendorf ◽  
Sofia Alexandru ◽  
Ana Donica ◽  
Elena Chesov ◽  
...  
Keyword(s):  
Propensity Score ◽  
Treatment Outcomes ◽  
Multidrug Resistant ◽  
High Burden ◽  
Republic Of Moldova ◽  
Treatment Regimens ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Republic

Evaluation of novel anti-tuberculosis (TB) medicines for the treatment of multidrug-resistant (MDR)-TB continues to be of high interest on the TB research agenda. We assessed treatment outcomes in patients with pulmonary MDR-TB who received bedaquiline containing treatment regimens in the Republic of Moldova, a high-burden country of MDR-TB.MethodWe systematically analysed the “SIMETB” national electronic TB database in the Republic of Moldova and performed a retrospective propensity score matched comparison of treatment outcomes in a cohort of patients with MDR-TB who started treatment during 2016–2018 with a bedaquiline-containing regimen (bedaquiline cohort) and a cohort of patients treated without bedaquiline (non-bedaquiline cohort).ResultsFollowing propensity score matching, 114 patients were assigned to each cohort of MDR-TB patients. Patients in the bedaquiline cohort had a higher 6 month sputum culture conversion rate than those in the non-bedaquiline cohort, (66.7% versus 40.3%, p<0.001). Patients under bedaquiline containing regimens had a higher cure rate assessed by both WHO and TBNET definitions (55.3% versus 24.6%, p=0.001 and 43.5% versus 19.6% p=0.004, correspondingly), as well, a lower mortality rate (8.8% versus 20.2%, p<0.001, by WHO and 10.9% versus 25.2%, p=0.01, by TBNET). In patients who previously failed on MDR-TB treatment, more than 40% of patients achieved cure with a bedaquiline-containing regimen.ConclusionsBedaquiline-based MDR-TB treatment regimens result in better disease resolution when compared to bedaquiline-sparing MDR-TB treatment regimens under programmatic conditions in a country with a high-burden of MDR-TB.

scholarly journals Treatment outcomes of patients with MDR-TB in Nepal on a current programmatic standardised regimen: retrospective single-centre study

2020 ◽  
Vol 7 (1) ◽  
pp. e000606 ◽  
Author(s):  
Samiksha Ghimire ◽  
Samriddhi Karki ◽  
Bhagwan Maharjan ◽  
Jos G W Kosterink ◽  
Daan J Touw ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Success ◽  
Retrospective Chart Review ◽  
Therapeutic Drug ◽  
Sputum Smear ◽  
Success Rates ◽  
Tb Treatment ◽  
Treatment Implementation ◽  
Good Treatment Outcome ◽  
Mdr Tb

ObjectivesThe objectives of this study were to evaluate treatment in patients on current programmatic multidrug-resistant tuberculosis (MDR-TB) regimen and verify eligibility for the 9-month regimen and therapeutic drug monitoring (TDM).MethodsWe performed a retrospective chart review of patients with MDR-TB receiving standardised regimen at the German Nepal TB Project Clinic, Nepal, between 2014 and 2016. Eligibility for the 9-month regimen and indications for TDM were evaluated.ResultsOut of 107 available patients’ medical records, 98 were included. In this centre, the MDR-TB treatment success rates were 69.0% in 2015, 86.6% in 2016 and 86.5% in 2017. The median time to sputum smear conversion was 60 days (60–90 IQR) and culture conversion was 60 days (60–90 IQR). Observed side effects did not impact treatment outcomes. No difference in treatment success rates was observed between patients with predisposing risk factors and those without. Only 49% (36/74) of patients were eligible for the 9-month regimen and 23 patients for TDM according to American Thoracic Society guideline criteria.ConclusionsNepalese patients with MDR-TB on ambulatory care had good treatment outcome after programmatic treatment. Implementation of the new WHO oral MDR-TB treatment regimen may further improve treatment results. The 9-month regimen and TDM should be considered as part of programmatic care.

scholarly journals Analysis of treatment outcome in multi-drug resistant tuberculosis patients treated under programmatic conditions

2017 ◽  
Vol 5 (6) ◽  
pp. 2401 ◽  
Author(s):  
A. K. Janmeja ◽  
Deepak Aggarwal ◽  
Ruchika Dhillon
Keyword(s):  
Treatment Outcome ◽  
Success Rate ◽  
Treatment Adherence ◽  
Treatment Success ◽  
Treatment Practice ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Culture Conversion

Background: Programmatic management of MDR-TB has taken over the un-standardized and unsupervised treatment practice in India. However, despite being implemented in whole of country, the data on the program surveillance is scarce.  Hence the present study was sought to evaluate the treatment outcome in patients with MDR TB in Chandigarh being treated under programmatic conditions.Methods: A retrospective study was carried out by enrolling all MDR-TB patients registered between January 2012 to December 2014. Medical records of 140 patients were scrutinized for necessary information on demographic, clinical parameters and previous TB treatment. Treatment outcomes to Cat IV anti-TB therapy, any interruptions in treatment, adverse drug reactions, culture conversion etc. were evaluated from the records.Results: Of the 140 patients, 77 (55%) were declared cured, 11 (7.9%) completed treatment, 23 patients (16.4%) died, 13 (9.3%) defaulted on treatment, 5 (3.6%) had treatment failure and 11 (7.9%) were shifted to Cat V therapy. On comparison, BMI, haemoglobin, treatment outcome in previous ATT, treatment adherence and time to sputum culture conversion were significantly different in different treatment outcome groups.Conclusions: The treatment success rate of MDR‑TB patients have shown improvement under programmatic conditions. Interventions to improve BMI and treatment adherence might further help to improve the success rate.

scholarly journals What is the best culture conversion prognostic marker for patients treated for multidrug-resistant tuberculosis?

2019 ◽  
Vol 23 (10) ◽  
pp. 1060-1067 ◽  
Author(s):  
M. Bastard ◽  
E. Sanchez-Padilla ◽  
A. Hayrapetyan ◽  
K. Kimenye ◽  
S. Khurkhumal ◽  
...  
Keyword(s):  
Prognostic Marker ◽  
Multinomial Logistic Regression ◽  
Treatment Success ◽  
Surrogate Marker ◽  
Multidrug Resistant ◽  
Trial Duration ◽  
Tb Treatment ◽  
Mdr Tb ◽  
And Performance ◽  
Culture Conversion

INTRODUCTION: Identification of good prognostic marker for tuberculosis (TB) treatment response is a necessary step on the path towards a surrogate marker to reduce TB trial duration.METHODS: We performed a retrospective analysis on routinely collected data in 6 drug-resistant TB (DRTB) programs. Culture conversion, defined as two consecutive negative cultures, was assessed, and performance of culture conversion at Month 2 and Month 6 to predict treatment success were explored. To explore factors associated with positive predicted value (PPV) and the specificity of culture conversion, a multinomial logistic regression was fitted.RESULTS: This study included 634 patients: 68.5% were males; the median age was 35 years, 75.2% were previously treated for TB, 59.4% were resistant only to isoniazid and rifampicin and 18.1% resistant to fluoroquinolones. Culture conversion at Month 2 and 6 showed similar PPV while specificity was much higher for culture conversion at Month 2: 91.3% (95%CI 86.1–95.1). PPV of culture conversion at Month 2 did not vary strongly according to patients' characteristics, while specificity was slightly higher among patients with fluoroquinolone-resistant strains.CONCLUSION: Culture conversion at Month 2 is an acceptable prognostic marker for MDR-TB treatment. Considering the advantage of using an earlier marker, further evaluation as a surrogate marker is warranted to shorten TB trials.

scholarly journals Bedaquiline and delamanid result in low rates of unfavourable outcomes among TB patients in Eswatini

2020 ◽  
Vol 24 (10) ◽  
pp. 1095-1102 ◽  
Author(s):  
D. Vambe ◽  
A. W. Kay ◽  
J. Furin ◽  
A. A. Howard ◽  
T. Dlamini ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Hazard Ratio ◽  
Factors Associated ◽  
Treatment Regimens ◽  
Tb Treatment ◽  
Combined Use ◽  
New Treatment ◽  
Parametric Survival ◽  
Lost To Follow Up ◽  
Culture Conversion

SETTING: Since 2015, Eswatini has been scaling up bedaquiline (BDQ) and delamanid (DLM) based drug-resistant TB treatment regimens under programmatic conditions.OBJECTIVE: Identification of factors associated with treatment outcomes in patients receiving BDQ and/or DLM either as a new treatment initiation or drug substitution.DESIGN: This is a retrospective cohort study of patients receiving BDQ and/or DLM in Eswatini between March 2015 and October 2018. We describe factors associated with unfavourable treatment outcomes (death, lost to follow-up, treatment failure and amplification of resistance) and culture conversion using multivariable flexible parametric survival and competing-risks regression analyses.RESULTS: Of 352 patients receiving BDQ and/or DLM, 7.8% and 21.2% had an unfavourable treatment outcome at 6 and 24 months, respectively. Predictors were age ≥ 60 years (adjusted hazard ratio aHR 4.49, 95%CI 1.61–12.57) vs. age 20–39 years, and a treatment regimen combining both drugs (aHR 4.49, 95%CI 1.61–12.57) vs. BDQ only. The probability of culture conversion was increased for two health facilities and patients with a poly resistance profile (adjusted sub-hazard ratio 2.01, 95%CI 1.13–3.59) vs. multidrug resistance.CONCLUSION: Single use of BDQ or DLM was associated with low rates of unfavourable outcomes, suggesting that these medications may be effectively adopted at scale under routine programmatic conditions. Combined use of BDQ and DLM was a risk factor for unfavourable outcomes and should prompt for collection of more data on the combined use of these medications.

scholarly journals Rifampin-resistant/multidrug-resistant Tuberculosis in Alberta, Canada: Epidemiology and treatment outcomes in a low-incidence setting

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246993
Author(s):  
Brett D. Edwards ◽  
Jenny Edwards ◽  
Ryan Cooper ◽  
Dennis Kunimoto ◽  
Ranjani Somayaji ◽  
...  
Keyword(s):  
Adverse Events ◽  
Treatment Success ◽  
Multidrug Resistant ◽  
Short Treatment ◽  
Oral Agents ◽  
Mdr Tb ◽  
The Mean ◽  
Low Incidence ◽  
Continuous And Discrete Variables ◽  
Culture Conversion

Treatment of rifampin-monoresistant/multidrug-resistant Tuberculosis (RR/MDR-TB) requires long treatment courses, complicated by frequent adverse events and low success rates. Incidence of RR/MDR-TB in Canada is low and treatment practices are variable due to the infrequent experience and challenges with drug access. We undertook a retrospective cohort study of all RR/MDR-TB cases in Alberta, Canada from 2007–2017 to explore the epidemiology and outcomes in our low incidence setting. We performed a descriptive analysis of the epidemiology, treatment regimens and associated outcomes, calculating differences in continuous and discrete variables using Student’s t and Chi-squared tests, respectively. We identified 24 patients with RR/MDR-TB. All patients were foreign-born with the median time to presentation after immigration being 3 years. Prior treatment was reported in 46%. Treatment was individualized. All patients achieved sputum culture conversion within two months of treatment initiation. The median treatment duration after culture conversion was 18 months (IQR: 15–19). The mean number of drugs utilized during the intensive phase was 4.3 (SD: 0.8) and during the continuation phase was 3.3 (SD: 0.9) and the mean adherence to medications was 95%. Six patients completed national guideline-concordant therapy, with many patients developing adverse events (79%). Treatment success (defined as completion of prescribed therapy or cure) was achieved in 23/24 patients and no acquired drug resistance or relapse was detected over 1.8 years of median follow-up. Many cases were captured upon immigration assessment, representing important prevention of community spread. Despite high rates of adverse events and short treatment compared to international guidelines, success in our cohort was very high at 96%. This is likely due to individualization of therapy, frequent use of medications with high effectiveness, intensive treatment support, and early sputum conversion seen in our cohort. There should be ongoing exploration of treatment shortening with well-tolerated, efficacious oral agents to help patients achieve treatment completion.

scholarly journals Trends, Characteristics and Treatment Outcomes of Patients with Drug-Resistant Tuberculosis in Uzbekistan: 2013–2018

2021 ◽  
Vol 18 (9) ◽  
pp. 4663
Author(s):  
Khasan Safaev ◽  
Nargiza Parpieva ◽  
Irina Liverko ◽  
Sharofiddin Yuldashev ◽  
Kostyantyn Dumchev ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Outcomes ◽  
Treatment Success ◽  
National Level ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Loss To Follow Up ◽  
Resistant Tuberculosis ◽  
Mdr Tb

Uzbekistan has a high burden of drug-resistant tuberculosis (TB). Although conventional treatment for multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) has been available since 2013, there has been no systematic documentation about its use and effectiveness. We therefore documented at national level the trends, characteristics, and outcomes of patients with drug-resistant TB enrolled for treatment from 2013–2018 and assessed risk factors for unfavorable treatment outcomes (death, failure, loss to follow-up, treatment continuation, change to XDR-TB regimen) in patients treated in Tashkent city from 2016–2017. This was a cohort study using secondary aggregate and individual patient data. Between 2013 and 2018, MDR-TB numbers were stable between 2347 and 2653 per annum, while XDR-TB numbers increased from 33 to 433 per annum. At national level, treatment success (cured and treatment completed) for MDR-TB decreased annually from 63% to 57%, while treatment success for XDR-TB increased annually from 24% to 57%. On multivariable analysis, risk factors for unfavorable outcomes, death, and loss to follow-up in drug-resistant TB patients treated in Tashkent city included XDR-TB, male sex, increasing age, previous TB treatment, alcohol abuse, and associated comorbidities (cardiovascular and liver disease, diabetes, and HIV/AIDS). Reasons for these findings and programmatic implications are discussed.

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