scholarly journals Socio-Demographic Profile and Prevalence of Tuberculosis (TB) Treatment Outcomes among Tuberculosis/Human Immunodeficiency Virus (TB/HIV) Co-Infected Patients in Kelantan

2021 ◽  
Vol 29 (4) ◽  
Author(s):  
Siti Romaino Mohd Nor ◽  
Mohd Rozi Husin ◽  
Mat Zuki Mat Jaeb ◽  
Nyi Nyi Naing
Keyword(s):  
Research Ethics ◽  
Treatment Outcomes ◽  
Treatment Success ◽  
Ethics Committee ◽  
World Health ◽  
Care Providers ◽  
Demographic Profile ◽  
Research Ethics Committee ◽  
Tb Treatment ◽  
The Mean

In Kelantan, the prevalence of Tuberculosis (TB) treatment success rate among TB/HIV co-infection is still below the success target of the World Health Organisation (WHO). Our objective was to assess the socio-demographic profile and determine the prevalence of TB treatment outcomes among TB/HIV co-infected patients in Kelantan. The cross-sectional study involved secondary data from the MyTB online system from January 2014 to December 2018, carried out at TB/Leprosy Sector, State Health Department of Kelantan. The data were analysed using SPSS version 25.0 and STATA version 14. The ethics approval was obtained from the UniSZA Human Research Ethics Committee (UHREC) and Medical Research Ethics Committee (MREC) of Ministry of Health (MOH). There were 6,313 TB cases in Kelantan. Of these, 703 (11.1%) cases were TB/HIV co-infection. However, 36 cases were excluded, and 667 cases were evaluated based on inclusion and exclusion criteria. The mean (SD) age was 38.7 (7.9) years, and the mean duration of TB treatment was 202.8 (131.27) days. The prevalence of successful treatment was 57.1%, with 19.8% cases were cured, and another 37.3% cases were completed treatment. While the unsuccessful were 42.9%, with 10.1% cases were defaulted, and 32.8% cases died. The successful outcomes were significantly associated with the educational level, the anatomy of TB location, smoking status, DOTS by health care providers, source of notification, the place of treatment and method of detection. This study provides the basic data of patient’s socio-demographic profiles, and the prevalence of TB treatment success in Kelantan is under international target by WHO of ≥ 90.0%.

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

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.

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

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.

scholarly journals Implementation of the Assistive Product List (APL) in Malawi through development of appropriate policy and systems: an action research protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e040281 ◽  
Author(s):  
Ikenna D Ebuenyi ◽  
Emma M Smith ◽  
Juba Kafumba ◽  
Monica Z Jamali ◽  
Alister Munthali ◽  
...  
Keyword(s):  
Action Research ◽  
Research Ethics ◽  
Low Income ◽  
Research Process ◽  
Ethics Committee ◽  
World Health ◽  
Low Income Countries ◽  
Persons With Disabilities ◽  
Research Ethics Committee ◽  
Assistive Product

IntroductionAssistive technology (AT) is important for the achievement of the sustainable development goals (SDGs) for persons with disabilities (PWD). Increasingly, studies suggest a significant gap between the need for and demand for and provisions of AT for PWD in low-income and middle-income settings. Evidence from high income countries highlights the importance of robust AT policies to the achievement of the recommendations of the World Health Assembly on AT. In Malawi, there is no standalone AT policy. The objectives of the Assistive Product List Implementation Creating Enablement of inclusive SDGs (APPLICABLE) project, are to propose and facilitate the development of a framework for creating effective national AT policy and specify a system capable of implementing such policies in low-income countries such as Malawi.Method and analysisWe propose an action research process with stakeholders in AT in Malawi. APPLICABLE will adopt an action research paradigm, through developing a shared research agenda with stakeholders and including users of AT. This involves the formation of an Action Research Group that will specify the priorities for practice—and policy-based evidence, in order to facilitate the development of contextually realistic and achievable policy aspirations on AT in Malawi and provide system strengthening recommendations that will ensure that the policy is implementable for their realisation. We will undertake an evaluation of this policy by measuring supply and support for specific AT prior to, and following the implementation of the policy recommendations.Ethics and disseminationThe study protocol was approved by Maynooth University Research Ethics Committee (SRESC-2019-2378566) and University of Malawi Research Ethics Committee (P.01/20/10). Findings from the study will be disseminated by publication in peer-reviewed journals, presentations to stakeholders in Malawi, Ireland and international audiences at international conferences.

Treatment outcomes of adults with new onset pulmonary tuberculosis in Pretoria, South Africa

2020 ◽  
Vol 50 (2) ◽  
pp. 130-134
Author(s):  
Meisie A Nkoane ◽  
Adegoke O Adefolalu ◽  
Gboyega A Ogunbanjo
Keyword(s):  
South Africa ◽  
Treatment Outcomes ◽  
Healthcare Workers ◽  
Treatment Success ◽  
World Health ◽  
Sputum Smear ◽  
Standard Regimen ◽  
Tb Treatment ◽  
Complete Treatment ◽  
Cure Rates

A persistently high burden of tuberculosis (TB) and low cure rates in South Africa call for frequent assessment of the effectiveness of the TB programme. We conducted a retrospective cohort study to evaluate treatment outcomes and associated factors among new TB patients taking standard regimen 1 TB treatment during 2010 in Pretoria, using the World Health Organization’s six treatment outcomes classification. The 85 participants (of whom 59% were female) had co-infection with HIV in 70%. A total of 52% completed treatment, but only 15% were officially cured; 13% died and only 35% had an end-of-treatment sputum test. The treatment success rate (cured and complete treatment) was 67%. Completion of TB treatment was associated with HIV status ( P = 0.02) and TB diagnosis using only sputum smear test ( P = 0.02). Our results suggest non-compliance with standard TB guidelines by healthcare workers. We therefore advise future interventions should target both patients and healthcare workers.

scholarly journals Citizens, Research Ethics Committee Members and Researchers’ Attitude Toward Information and Consent for the Secondary Use of Health Data: Implications for Research Within Learning Health Systems

2021 ◽  
pp. 155626462199221
Author(s):  
Annabelle Cumyn ◽  
Roxanne Dault ◽  
Adrien Barton ◽  
Anne-Marie Cloutier ◽  
Jean-François Ethier
Keyword(s):  
Research Ethics ◽  
Health Systems ◽  
Ethics Committee ◽  
Health Data ◽  
Data Reuse ◽  
Fundamental Importance ◽  
Research Ethics Committee ◽  
Secondary Use ◽  
Public Perspectives ◽  
Advance Knowledge

A survey was conducted to assess citizens, research ethics committee members, and researchers’ attitude toward information and consent for the secondary use of health data for research within learning health systems (LHSs). Results show that the reuse of health data for research to advance knowledge and improve care is valued by all parties; consent regarding health data reuse for research has fundamental importance particularly to citizens; and all respondents deemed important the existence of a secure website to support the information and consent processes. This survey was part of a larger project that aims at exploring public perspectives on alternate approaches to the current consent models for health data reuse to take into consideration the unique features of LHSs. The revised model will need to ensure that citizens are given the opportunity to be better informed about upcoming research and have their say, when possible, in the use of their data.

scholarly journals Developing a policy to reduce the salt content of food consumed outside the home in Malaysia: protocol of a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e044628
Author(s):  
Mhairi Karen Brown ◽  
Suzana Shahar ◽  
Yee Xing You ◽  
Viola Michael ◽  
Hazreen Abdul Majid ◽  
...  
Keyword(s):  
Medical Research ◽  
Research Ethics ◽  
Salt Intake ◽  
Salt Content ◽  
Ethics Committee ◽  
Salt Reduction ◽  
Reduction Strategy ◽  
Research Ethics Committee ◽  
School Canteen ◽  
Medical Research Ethics

IntroductionCurrent salt intake in Malaysia is high. The existing national salt reduction policy has faced slow progress and does not yet include measures to address the out of home sector. Dishes consumed in the out of home sector are a known leading contributor to daily salt intake. This study aims to develop a salt reduction strategy, tailored to the out of home sector in Malaysia.Methods and analysisThis study is a qualitative analysis of stakeholder views towards salt reduction. Participants will be recruited from five zones of Malaysia (Western, Northern, Eastern and Southern regions and East Malaysia), including policy-makers, non-governmental organisations, food industries, school canteen operators, street food vendors and consumers, to participate in focus group discussions or in-depth interviews. Interviews will be transcribed and analysed using thematic analysis. Barriers will be identified and used to develop a tailored salt reduction strategy.Ethics and disseminationEthical approval has been obtained from the Universiti Kebangsaan Malaysia Medical Research Ethics Committee (UKM PPI/1118/JEP-2020–524), the Malaysian National Medical Research Ethics Committee (NMRR-20-1387-55481 (IIR)) and Queen Mary University of London Research Ethics Committee (QMERC2020/37) . Results will be presented orally and in report form and made available to the relevant ministries for example, Ministry of Health, Ministry of Education and Ministry of Trade to encourage adoption of strategy as policy. The findings of this study will be disseminated through conference presentations, peer-reviewed publications and webinars.

scholarly journals Early Moves: a protocol for a population-based prospective cohort study to establish general movements as an early biomarker of cognitive impairment in infants

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e041695
Author(s):  
Catherine Elliott ◽  
Caroline Alexander ◽  
Alison Salt ◽  
Alicia J Spittle ◽  
Roslyn N Boyd ◽  
...  
Keyword(s):  
At Risk ◽  
Cohort Study ◽  
Cognitive Impairment ◽  
Research Ethics ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Ethics Committee ◽  
Research Ethics Committee ◽  
National Implementation ◽  
General Movements

IntroductionThe current diagnostic pathways for cognitive impairment rarely identify babies at risk before 2 years of age. Very early detection and timely targeted intervention has potential to improve outcomes for these children and support them to reach their full life potential. Early Moves aims to identify early biomarkers, including general movements (GMs), for babies at risk of cognitive impairment, allowing early intervention within critical developmental windows to enable these children to have the best possible start to life.Method and analysisEarly Moves is a double-masked prospective cohort study that will recruit 3000 term and preterm babies from a secondary care setting. Early Moves will determine the diagnostic value of abnormal GMs (at writhing and fidgety age) for mild, moderate and severe cognitive delay at 2 years measured by the Bayley-4. Parents will use the Baby Moves smartphone application to video their babies’ GMs. Trained GMs assessors will be masked to any risk factors and assessors of the primary outcome will be masked to the GMs result. Automated scoring of GMs will be developed through applying machine-based learning to the data and the predictive value for an abnormal GM will be investigated. Screening algorithms for identification of children at risk of cognitive impairment, using the GM assessment (GMA), and routinely collected social and environmental profile data will be developed to allow more accurate prediction of cognitive outcome at 2 years. A cost evaluation for GMA implementation in preparation for national implementation will be undertaken including exploring the relationship between cognitive status and healthcare utilisation, medical costs, health-related quality of life and caregiver burden.Ethics and disseminationEthics approval has been granted by the Medical Research Ethics Committee of Joondalup Health Services and the Health Service Human Research Ethics Committee (1902) of Curtin University (HRE2019-0739).Trial registration numberACTRN12619001422112.

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

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.

scholarly journals 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

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.

scholarly journals A Call for Better, Not Faster, Research Ethics Committee Reviews in the Covid‐19 Era

2021 ◽  
Vol 43 (5) ◽  
pp. 42-44
Author(s):  
Leonardo Tamariz ◽  
Fred J. Hendler ◽  
John M. Wells ◽  
Annette Anderson ◽  
Stephen Bartlett
Keyword(s):  
Research Ethics ◽  
Ethics Committee ◽  
Research Ethics Committee
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