scholarly journals Adherence to the MDR-TB intensive phase treatment protocol amongst individuals followed up at central and peripheral health care facilities in Uganda - a descriptive study

2020 ◽  
Vol 20 (2) ◽  
pp. 625-632
Author(s):  
Joseph Mukasa ◽  
Edward Kayongo ◽  
Ismael Kawooya ◽  
Deus Lukoye ◽  
Alfred Etwom ◽  
...  

Background: Following initiation of MDR-TB treatment, patients have a choice to receive follow up DOT supervision at either the central initiating facility or at a peripheral facility. Objectives: We describe the adherence patterns of MDR-TB patients undergoing DOT supervision at the two health facility categories during intensive phase of treatment. Methods: We used a retrospective cohort of patients initiated on MDR TB treatment at Mulago National Referral Hospital between 2014 and 2016. We extracted data from the National Tuberculosis and Leprosy Program records and analysed these using STATA V14. Results: Majority (84.01%) of the patients received their DOT supervision from the peripheral facilities. Males made up 62.1% of patients, and 91.2% had had their household contacts screened for MDR-TB. 26.5% of the patients on peripheral DOT supervision had good adherence to treatment protocol compared to 0% among patients on central initiating health fa- cility DOT supervision. Among the patients with good adherence, 24.1% had contacts screened for MDR-TB as compared to 3.6% with poor adherence. Conclusion: More patients preferred MDR-TB DOT supervision at peripheral facilities, which had better adherence to the treatment protocol compared to the central initiating facility. Younger people and those with household contacts screened had better adherence to the treatment protocol, highlighting areas for targeted interventional programs for MDR-TB in resource limited settings. Keywords: MDR-TB; adherence; central initiating; peripheral health facility; DOTS; SORT IT.

2019 ◽  
Vol 12 (8) ◽  
pp. e230628 ◽  
Author(s):  
Christian Francisco ◽  
Mary Ann Lansang ◽  
Edsel Maurice Salvana ◽  
Katerina Leyritana

Tuberculosis (TB) is common among persons living with HIV. This public health concern is aggravated by infection with multidrug-resistant organisms and adverse effects of polypharmacy. There are few published cases of multidrug-resistant tuberculosis (MDR-TB) in multidrug-resistant HIV (MDR-HIV) infected patients. We report a case of a 29-year-old Filipino man with HIV on zidovudine (AZT)-containing antiretroviral therapy (ART) but was eventually shifted to tenofovir due to anaemia. He presented with left flank tenderness, which was found to be due to an MDR-TB psoas abscess, and for which second-line anti-TB treatment was started. HIV genotyping showed MDR-HIV infection susceptible only to AZT, protease inhibitors and integrase inhibitors. Subsequently, he developed neck abscess that grew Mycobacterium avium complex and was treated with ethambutol and azithromycin. ART regimen was revised to AZT plus lamivudine and lopinavir/ritonavir. Erythropoietin was administered for recurrent AZT-induced anaemia. Both abscesses resolved and no recurrence of anaemia was noted.


2020 ◽  
Vol 29 (2) ◽  
pp. 198-203
Author(s):  
Ibnu Mas'ud ◽  
Ujainah Zaini Nasir ◽  
Ceva Wicaksono Pitoyo ◽  
Ikhwan Rinaldi

BACKGROUND Based on the regulation of the Indonesian Ministry of Health No. 15 of 2016 about health istithaah for the Hajj, patients with tuberculosis (TB) can be categorized into ineligible or temporarily ineligible pilgrims. This study aimed to know the characteristics of pilgrims with TB and determined their level of fitness for fulfilling the health istithaah. METHODS A cross-sectional study of pilgrims from Jakarta who were receiving TB treatment during the Hajj in 2018 was conducted with consecutive sampling. The secondary data was collected from the Hajj Integrated Computer Health System 2018, TB registered form, and six-minute walk test (the fitness level data) conducted by the District Hajj Health Team at district health centers in DKI Jakarta and Pondok Gede before the Hajj embarkation in June–July 2018. The questionnaire to the Indonesian Hajj Health Team during pilgrimage was also included as additional data. RESULTS Thirty-one pilgrims received TB treatment and completed the intensive phase of TB treatment, but 29 pilgrims had no symptoms. Among them, 2 patients had MDR-TB. Most of them were male aged ≥40 years old. Twelve pilgrims with TB have a sufficient fitness. All pilgrims were able to run the pillars of the Hajj. CONCLUSIONS Pilgrims with TB, including MDR-TB, who had completed the intensive phase with a negative sputum smear test were declared eligible for the Hajj with assistance.


2021 ◽  
Vol 15 (09.1) ◽  
pp. 7S-16S
Author(s):  
Bobojon Pirmahmadzoda ◽  
Katrina Hann ◽  
Kristina Akopyan ◽  
Ruzanna Grigoryan ◽  
Evgenia Geliukh ◽  
...  

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.


2020 ◽  
Vol 32 (2) ◽  
pp. 95-107
Author(s):  
A. Oyefabi ◽  
B. Adelekan ◽  
E. Adetiba ◽  
L. Emmanuel ◽  
O. Jimoh

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.


2019 ◽  
Vol 4 (1) ◽  
pp. 1
Author(s):  
RR Dian Tristiana ◽  
Richa Kumalasari ◽  
Makhfudli Makhfudli

Introduction: Pulmonary TB clients who undergoing intensive phase treatment often feel sad, bored, reject conditions, useless and helpless, complaining about changes in conditions experienced. This study aims to describe the experience of pulmonary TB clients who undergoing intensive phase treatment in Taji Community Health Center of Magetan DistrictMethod: This research used qualitative research design of phenomenological approach with in-depth interview method on 15 participants with inclusion criteria for pulmonary TB clients aged ≥16 years, new clients were diagnosed with pulmonary TB, clients had undergone intensive phase pulmonary TB treatment for 1 month. While the exclusion criteria for pulmonary TB clients who are pregnant, TB-HIV, MDR TB, extrapulmonary TB, clients with comorbidities such as diabetes mellitus, hypertension, schizophrenia, and other chronic diseases. Data analysis in this study used technique nine steps Colaizzi.Result: This research used qualitative research design of phenomenological approach with in-depth interview method on 15 participants with inclusion criteria for pulmonary TB clients aged ≥16 years, new clients were diagnosed with pulmonary TB, clients had undergone intensive phase pulmonary TB treatment for 1 month. While the exclusion criteria for pulmonary TB clients who are pregnant, TB-HIV, MDR TB, extrapulmonary TB, clients with comorbidities such as diabetes mellitus, hypertension, schizophrenia, and other chronic diseases. Data analysis in this study used technique nine steps Colaizzi.Conclusion: The experience of pulmonary TB clients who undergoing intensive phase treatment needs of various support from themselves and others such as family, neighbors, friends, and health workers to overcome the obstacles transversed. It is hoped that this research could be the basis for further research on health promotion and sustainable accompaniment to pulmonary TB clients who undergoing intensive phase treatment by involving family and community.


2016 ◽  
Vol 10 (04) ◽  
pp. 423-426 ◽  
Author(s):  
Margaretha L. Sariko ◽  
Stellah G. Mpagama ◽  
Jean Gratz ◽  
Riziki Kisonga ◽  
Queen Saidi ◽  
...  

Introduction: World Health Organization recommendations of bidirectional screening for tuberculosis (TB) and diabetes have been met with varying levels of uptake by national TB programs in resource-limited settings. Methodology: Kibong’oto Infectious Diseases Hospital (KIDH) is a referral hospital for TB from northern Tanzania, and the national referral hospital for multidrug-resistant (MDR)-TB. Glycated hemoglobin (HgbA1c) testing was done on patients admitted to KIDH for newly diagnosed TB, retreatment TB, and MDR-TB, to determine the point prevalence of diabetes (HgbA1c ≥ 6.5%) and prediabetes (HgbA1c 5.7%–6.4%). Results: Of 148 patients hospitalized at KIDH over a single week, 59 (38%) had no prior TB treatment, 22 (15%) were retreatment cases, and 69 (47%) had MDR-TB. Only 3 (2%) had a known history of diabetes. A total of 144 (97%) had successful screening, of which 110 (77%) had an HgbA1c ≤ 5.6%, 28 (19%) had ≥ 5.7 < 6.5, and 6 (4%) had ≥ 6.5. Comparing subjects with prediabetes or diabetes to those with normal A1c levels, retreatment patients were significantly more likely to have a A1c ≥ 5.7% (odds ratio: 3.2, 95% CI: 1.2–9.0; p = 0.02) compared to those without prior TB treatment. No retreatment case was a known diabetic, thus the number needed to screen to diagnose one new case of diabetes among retreatment cases was 11. Conclusions: Diabetes prevalence by HgbA1c was less common than expected, but higher HgA1c values were significantly more frequent among retreatment cases, allowing for a rational, resource-conscious screening approach.


2019 ◽  
Vol 4 (Suppl 3) ◽  
pp. A51.3-A52
Author(s):  
Bassirou Diarra ◽  
B Aissata ◽  
Tom Decroo ◽  
Marie L Keita ◽  
Boureima Degoga ◽  
...  

IntroductionXpert MTB/RIF assay is used extensively for the detection of rifampicin-resistant TB (RR-TB). RR-TB treatment monitoring is culture-based, although, in resource-limited settings, access to TB culture is poor. Alternative methods are needed. We therefore conducted a pilot study to determine the performance of fluorescein di-acetate FDA vital staining, a microscopy-based test that shows viable bacilli, and Xpert threshold cycle value (Ct) changes when assessing culture conversion at the end of the intensive phase of RR-TB treatment.MethodsBetween December 2015 and April 2018, we prospectively followed patients with RR-TB during the 6-month intensive phase of a 21-month standardised WHO treatment regimen. Sputum was collected and tested monthly with Auramine, FDA, Xpert MTB/RIF, and culture (Manual MGIT). Culture was considered to have converted to negative when two consecutive cultures, taken at least 30 days apart, were negative, including at least one culture between 4–6 months of treatment.ResultsForty-one patients were included in this study, 80% were male and 7% were HIV-co-infected. Conversion could not be assessed in 12 (29%) patients. Among the remaining 29 patients, 9 (31%) converted, and 11 (38%) did not convert. All 9 who converted on culture had a negative FDA, and most (6) had a Ct trend that showed a reduction of excreted DNA (increasing Ct trend). Three of these were still positive on Auramine (excretion of dead bacilli?). Of 11 patients with positive cultures, 8 tested negative on FDA, 5 tested ‘MTB not detected’ on Xpert MTB/RIF, and another 2 showed a reduction of excreted DNA.ConclusionResults from culture, FDA, and Xpert MTB/RIF provide similar results among converters but contrasting results among non-converters. Longer follow-up time is needed to assess the value of these tests to predict treatment outcome.


2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Sakarn Charoensakulchai ◽  
Chaiyapun Lertpheantum ◽  
Chanapon Aksornpusitpong ◽  
Peeranut Trakulsuk ◽  
Boonsub Sakboonyarat ◽  
...  

Abstract Objective Tuberculosis (TB) is a major cause of morbidity and mortality globally. Despite efforts to eliminate TB in Thailand, the incidence rate has declined slowly. This study aimed to identify the incidence and risk factors of unsuccessful pulmonary TB treatment (failed, died and loss-to- follow up) in a community hospital in Chachoengsao Province, Thailand from 1st January 2013 to 31st December 2019. Results A total of 487 patients were eligible for the study. The incidence of unsuccessful treatment was 21.67/100 population person year. Risk factors of unsuccessful pulmonary TB treatment were unemployment (adjusted hazard ratio (AHR) 3.12, 95%CI 1.41–6.86), HIV co-infection (AHR 2.85, 95%CI 1.25–6.46), previous history of TB (AHR 2.00, 95%CI 1.04–3.81), positive sputum AFB at the end of the intensive phase (AHR 5.66, 95%CI 2.33–13.74), and sputum AFB was not performed at the end of the intensive phase (AHR 18.40, 95%CI 9.85–34.35). This study can be utilized to improve prevention and intervention of TB treatment by strengthening public health system on treatment quality especially TB patient monitoring tools or methods easy for accessing to patients in communities.


2019 ◽  
Vol 5 (1) ◽  
pp. 2
Author(s):  
Nang Thu Thu Kyaw ◽  
Aung Sithu ◽  
Srinath Satyanarayana ◽  
Ajay M. V. Kumar ◽  
Saw Thein ◽  
...  

Screening of household contacts of patients with multidrug-resistant tuberculosis (MDR-TB) is a crucial active TB case-finding intervention. Before 2016, this intervention had not been implemented in Myanmar, a country with a high MDR-TB burden. In 2016, a community-based screening of household contacts of MDR-TB patients using a systematic TB-screening algorithm (symptom screening and chest radiography followed by sputum smear microscopy and Xpert-MTB/RIF assays) was implemented in 33 townships in Myanmar. We assessed the implementation of this intervention, how well the screening algorithm was followed, and the yield of active TB. Data collected between April 2016 and March 2017 were analyzed using logistic and log-binomial regression. Of 620 household contacts of 210 MDR-TB patients enrolled for screening, 620 (100%) underwent TB symptom screening and 505 (81%) underwent chest radiography. Of 240 (39%) symptomatic household contacts, 71 (30%) were not further screened according to the algorithm. Children aged <15 years were less likely to follow the algorithm. Twenty-four contacts were diagnosed with active TB, including two rifampicin- resistant cases (yield of active TB = 3.9%, 95% CI: 2.3%–6.5%). The highest yield was found among children aged <5 years (10.0%, 95% CI: 3.6%–24.7%). Household contact screening should be strengthened, continued, and scaled up for all MDR-TB patients in Myanmar.


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