Effect of Global Fund financial support for patients with multidrug-resistant tuberculosis

2020 ◽  
Vol 24 (7) ◽  
pp. 686-693 ◽  
Author(s):  
T. Watthananukul ◽  
T. Liabsuetrakul ◽  
P. Pungrassami ◽  
V. Chongsuvivatwong
Keyword(s):  
Financial Support ◽  
Global Fund ◽  
Positive Impact ◽  
Multidrug Resistant ◽  
Drug Adherence ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Significant Difference ◽  
Mdr Tb ◽  
The Impact

SETTING: The Global Fund provides financial support for patients with multidrug-resistant tuberculosis (MDR-TB), patients' families and hospitals providing services for these patients in Thailand, but the impact of this support has not been evaluated.OBJECTIVE: To assess the impact of Global Fund financial support on drug adherence, out-of-pocket (OOP) payments, sputum culture conversion and the perception of the usefulness of this support.DESIGN: A retrospective cohort study was conducted in eight provincial hospitals with and without financial support in four regions of Thailand. MDR-TB patients aged ≥15 years registered in 2015–2016 who received treatment at these hospitals for at least 6 months were included.RESULTS: There was no significant difference in drug adherence rates. The OOP payments during treatment were significantly lower in patients who received financial support (P < 0.001). Although the supported group had higher positive culture rates at the beginning of treatment, sputum converted at a faster rate than for the unsupported group (P = 0.034). More than 80% of both groups perceived financial support as being useful, leading to faster diagnosis and improving follow-up compliance.CONCLUSION: Financial support for MDR-TB patients has a positive impact on treatment and should be continued.

scholarly journals Cochlear Dysfunction after Kanamycin Injection in Multidrug Resistant Tuberculosis Patients

2021 ◽  
Vol 56 (3) ◽  
pp. 216
Author(s):  
Aditya Brahmono ◽  
Nyilo Purnami ◽  
Bakti Surarso
Keyword(s):  
Hair Cells ◽  
Multidrug Resistant ◽  
Distortion Product Otoacoustic Emission ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Significant Difference ◽  
Mdr Tb ◽  
Specific Frequency ◽  
Frequency Area ◽  
Cochlear Dysfunction

Background: Longterm exposure to aminoglycoside such as kanamycin to cochlear cells is known to be associated with damage to outer hair cells in the organ Cortiand type 1 sensory hair cells in the vestibular organs which ultimately causes permanent damage to hair cells. Hair cell damage occurs from the basal cochlea (high frequency area) to the apex cochlea (low frequency area) and followed by damage from the auditory nerve. Evaluation of cochlear dysfunction on multidrug resistant tuberculosis (MDR TB) patients have been rarelyreported in the literature based on distortion product otoacoustic emission (DPOAE).Objectives: To prove cochlear dysfunction after kanamycin injection in MDR TB patient based on DPOAE examination of the overall frequencies and specific frequency.Methods: An observational longitudinal analytic with pre and post design without control group conducted in the infection division of MDR TB Outpatients Pulmonology Department and Otorhinolaryngology Community division of ORL-HNS Department Dr. Soetomo general hospital Surabaya, within 3 months in 2018, 15 ear with the best baseline examination were taken by consecutive sampling and statistical analysis for cochlear dysfunction based on overall  frequency and specific frequency DPOAE examination using Mc Nemar test.Results: Based on DPOAE examination of overall frequencies there was no cochlear dysfunction (p > 0.05) but a significant difference was found at frequency of 10,000 Hertz (Hz) (p = 0.002 ).Conclusion:On ototoxicity monitoring there was no cochlear dysfunction after 4 weeks  Kanamycin injection but cochlear dysfunction occurs at a specific frequency of 10,000 Hz.

scholarly journals Analysis of Smear Microscopy and Culture Conversion Results in Multidrug-Resistant Tuberculosis Patients with and without Type 2 Diabetes Mellitus

2020 ◽  
Vol 26 (3) ◽  
Author(s):  
Henny Fauziah ◽  
Aprianti S. ◽  
Handayani I. ◽  
Kadir NA
Keyword(s):  
Diabetes Mellitus ◽  
Multidrug Resistant ◽  
World Health ◽  
Smear Microscopy ◽  
Tuberculosis Patients ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Significant Difference ◽  
Mdr Tb ◽  
Culture Conversion

  The World Health Organization (WHO) recommended microscopic AFB smear examination and culture as follow-ups to the response of MDR TB therapy. Analyzed the results of microscopic AFB smear and culture conversion as well as treatment outcome in Multidrug-Resistant Tuberculosis (MDR-TB) patients with and without Diabetes Mellitus (DM). This is a retrospective study involved 70 MDR-TB patients with (27 patients) with DM and without DM (43 patients) who had microscopic AFB smear and culture results at the start of the follow-up therapy. This research was conducted at Labuang Baji Regional Public Hospital, Makassar, from June to July 2019, used medical records of MDR-TB patients the period of June 2016 to December 2017. The results showed that 52 out of 70 MDR-TB patients had microscopic AFB smear and culture conversion in MDR-TB with DM (21 patients) and without DM (31 patients). The duration of microscopic AFB smear conversion in MDR TB patients with DM (3.33±0.54 months) was longer than patients without DM (2.07±0.05 months), p=0.001. While in culture conversion, there was no significant difference between MDR-TB with DM (1.28±0.64 months) and without DM (1.25±0.59), p=0.648. The recovery outcome between MDR-TB with (48.1%) and without DM (48.8%) was not significantly different. However, the output of treatment failure was greater in DM (11.2%) than without DM (2.3%), although statistically, there was no significant difference (p=0.568). Multidrug-resistant tuberculosis patients with DM experienced slower microscopic AFB smear conversion than MDR-TB patients without DM. However, in culture, there was no significant difference in the conversion period between the two groups. MDR-TB patients, both of with and without DM, had the same chance of recovery.

scholarly journals Cochlear Dysfunction after Kanamycin Injection in Multidrug Resistant Tuberculosis Patients

2020 ◽  
Vol 56 (3) ◽  
pp. 216
Author(s):  
Aditya Brahmono ◽  
Nyilo Purnami ◽  
Bakti Surarso
Keyword(s):  
Hair Cells ◽  
Multidrug Resistant ◽  
Distortion Product Otoacoustic Emission ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Significant Difference ◽  
Mdr Tb ◽  
Specific Frequency ◽  
Frequency Area ◽  
Cochlear Dysfunction

Long-term exposure to aminoglycoside such as kanamycin to cochlear cells is known to be associated with damage to outer hair cells in the organ Corti and type 1 sensory hair cells in the vestibular organs which ultimately causes permanent damage to hair cells. Hair cell damage occurs from the basal cochlea (high frequency area) to the apex cochlea (low frequency area) and followed by damage from the auditory nerve. Evaluation of cochlear dysfunction on multidrug resistant tuberculosis (MDR TB) patients have been rarely reported in the literature based on distortion product otoacoustic emission (DPOAE). Objectives: To prove cochlear dysfunction after kanamycin injection in MDR TB patient based on DPOAE examination of the overall frequencies and specific frequency. This was an observational longitudinal analytic with pre and post design without control group conducted in the infection division of MDR TB Outpatients Pulmonology Department and Otorhinolaryngology Community division of ORL-HNS Department, Dr. Soetomo General Hospital, Surabaya, within 3 months in 2018, 15 ear with the best baseline examination were taken by consecutive sampling and statistical analysis for cochlear dysfunction based on overall frequency and specific frequency DPOAE examination using Mc Nemar test. Based on DPOAE examination of overall frequencies there was no cochlear dysfunction (p>0.05) but a significant difference was found at frequency of 10,000 Hertz (Hz) (p=0.002). On ototoxicity monitoring there was no cochlear dysfunction after 4 weeks Kanamycin injection but cochlear dysfunction occurs at a specific frequency of 10,000 Hz.

scholarly journals Assessing the impacts of short-course multidrug-resistant tuberculosis treatment in the Southeast Asia Region using a mathematical modeling approach

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248846
Author(s):  
Win Min Han ◽  
Wiriya Mahikul ◽  
Thomas Pouplin ◽  
Saranath Lawpoolsri ◽  
Lisa J. White ◽  
...  
Keyword(s):  
Southeast Asia ◽  
Treatment Initiation ◽  
Multidrug Resistant ◽  
Treatment Regimens ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Short Course ◽  
Mdr Tb ◽  
The Impact

This study aimed to predict the impacts of shorter duration treatment regimens for multidrug-resistant tuberculosis (MDR-TB) on both MDR-TB percentage among new cases and overall MDR-TB cases in the WHO Southeast Asia Region. A deterministic compartmental model was constructed to describe both the transmission of TB and the MDR-TB situation in the Southeast Asia region. The population-level impacts of short-course treatment regimens were compared with the impacts of conventional regimens. Multi-way analysis was used to evaluate the impact by varying programmatic factors (eligibility for short-course MDR-TB treatment, treatment initiation, and drug susceptibility test (DST) coverage). The model predicted that overall TB incidence will be reduced from 246 (95% credible intervals (CrI), 221–275) per 100,000 population in 2020 to 239 (95% CrI, 215–267) per 100,000 population in 2035, with a modest reduction of 2.8% (95% CrI, 2.7%–2.9%). Despite the slight reduction in overall TB infections, the model predicted that the MDR-TB percentage among newly notified TB infections will remain steady, with 2.4% (95% CrI, 2.1–2.9) in 2020 and 2.5% (95% CrI, 2.3–3.1) in 2035, using conventional MDR-TB treatment. With the introduction of short-course regimens to treat MDR-TB, the development of resistance can be slowed by 38.6% (95% confidence intervals (CI), 35.9–41.3) reduction in MDR-TB case number, and 37.6% (95% CI, 34.9–40.3) reduction in MDR-TB percentage among new TB infections over the 30-year period compared with the baseline using the standard treatment regimen. The multi-way analysis showed eligibility for short-course treatment and treatment initiation greatly influenced the impacts of short-course treatment regimens on reductions in MDR-TB cases and percentage resistance among new infections. Policies which promote the expansion of short-course regimens and early MDR-TB treatment initiation should be considered along with other interventions to tackle antimicrobial resistance in the region.

Treatment Outcome of a Shorter Regimen Containing Clofazimine for Multidrug-resistant Tuberculosis: A Randomized Control Trial in China

2019 ◽  
Vol 71 (4) ◽  
pp. 1047-1054 ◽  
Author(s):  
Yadong Du ◽  
Chao Qiu ◽  
Xiaohong Chen ◽  
Jing Wang ◽  
Wei Jing ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Sputum Culture ◽  
Control Group ◽  
Sputum Culture Conversion ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Significant Difference ◽  
Mdr Tb ◽  
Experimental Group ◽  
Culture Conversion

Abstract Background The emergence of multidrug-resistant tuberculosis (MDR-TB) poses a serious obstacle to global TB control programs. Methods We carried out a prospective, randomized, multicenter study in China that was focused on the potential of a shorter regimen containing clofazimine (CFZ) for the treatment of MDR-TB. There were 135 MDR-TB cases that met eligibility requirements and were randomly stratified into either the control group or experimental group. Patients in the control group received an 18-month treatment regimen, whereas patients in the experimental group received a 12-month treatment regimen containing CFZ. Results At the completion of the treatment period, the difference in sputum-culture conversion rates between the experimental group and the control group was not significant. Notably, by the end of 3 months of treatment, 68.7% patients receiving the experimental regimen had sputum-culture conversion, as compared with 55.9% of those receiving the control regimen; this was a significant difference, suggesting an early sputum conversion (P = .04). There were 67 adverse events reported in 56 patients in this study, including 32 in the control group and 35 in the experimental group. No significant difference in the overall incidences of adverse events was observed between the 2 groups. Conclusions The MDR-TB patients treated with the shorter regimen containing CFZ had a comparable successful outcome rate when compared to those with the standard regimen. The patients assigned to the experimental group achieved more rapid sputum-culture conversion, reflecting superior antimicrobial activity against MDR-TB. Clinical Trials Registration Chinese Clinical Trial Registry ChiCTR 1800020391.

scholarly journals Impact of multidrug-resistant tuberculosis and its medications on adverse maternal and perinatal outcomes: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e034821 ◽  
Author(s):  
Kefyalew Addis Alene ◽  
Akilew Awoke Adane ◽  
Alemken Jegnie
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Perinatal Outcomes ◽  
Public Health Problem ◽  
Multidrug Resistant ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Impact

IntroductionMultidrug-resistant tuberculosis (MDR-TB) is a common public health problem affecting pregnant women. However, the impact of MDR-TB and its medication on pregnancy and perinatal outcomes has been poorly understood and inconsistently reported. Therefore, using the available literature, we aim to determine whether MDR-TB and its medications during pregnancy impact maternal and perinatal outcomes.Methods and analysisThis systematic review and meta-analysis will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systematic searches will be conducted in PubMed, Scopus and Web of Science on 10 February 2020 for studies that reported adverse maternal and perinatal outcomes due to MDR-TB and/or its medication. The search will be performed without language and time restrictions. Adverse birth outcomes include miscarriage or abortion, stillbirth, preterm birth, low birth weight, small and large for gestational age, and neonatal death. Two independent reviewers will screen search records, extract data and assess the quality of the studies. The Newcastle-Ottawa Quality Assessment Scale will be used to assess the methodological quality of the included studies. In addition to a narrative synthesis, a random-effects meta-analysis will be conducted when sufficient data are available. I2 statistics will be used to assess the heterogeneity between studies.Ethics and disseminationAs it will be a systematic review and meta-analysis based on previously published evidence, there will be no requirement for ethical approval. Findings will be published in a peer-reviewed journal and will be presented at various conferences.

scholarly journals The Role of IL-6 Gene Polymorphism in Multidrug-Resistant Tuberculosis Patients in Iraq

2020 ◽  
Vol 10 (01) ◽  
pp. 81-84
Author(s):  
Diyar K. Flaifel ◽  
Ibtisam H. Al-Azawi
Keyword(s):  
Gene Polymorphism ◽  
Multidrug Resistant ◽  
Multi Drug Resistance ◽  
Control Group ◽  
First Year ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Significant Difference ◽  
Mdr Tb ◽  
And Control

Background: Tuberculosis (TB) remains to be a leading cause of morbidity and mortality in developing countries, and the incidence of the disease is increasing in developed. One-third of the world’s population is infected by Mycobacterium tuberculosis (Mtb). Still, only about 5% of infected individuals develop the disease within the first year of infection, and another 5% develop the disease later in life. Aim of the study: Is to investigate the relationship between the levels of Interleukin 6 (IL-6) and detection of multidrug-resistant tuberculosis (MDR-TB) in Al-Diwaniyah population. Patients and methods: The current study included 120 patients with tuberculosis who were classified into two groups. The first group included 60 TB patients who were sensitive to anti TB drugs and 60 patients with multi-drug resistance (MDR) based on gene Xpert. The study also included 60 healthy individuals serving as a control group. Demographic characteristics of study and control groups were retrieved. IL-6 (-572G/C) genotype polymorphism was carried out using polymerase chain reaction (PCR) and according to the instruction of the providing company. Serum level of IL-6 was also measured by ELISA according to the instruction of the providing company. Results: It has been observed that genotype CC was more frequent in sensitive TB patients than both MDR TB patients and control subjects, 73.3 % versus 60 % and 61.7 %, respectively. Serum IL-6 level was significantly higher in MDR TB patients than in control group (p = 0.007), and there was no significant difference in its level between sensitive and MDR TB patients (p = 0.284). Conclusion: IL-6 gene polymorphism is not associated with multidrug resistance in TB patients; however, Serum IL-6 level was significantly higher in MDR TB patients than in the control group.

scholarly journals Risk of hearing loss among multidrug-resistant tuberculosis patients according to cumulative aminoglycoside dose

2020 ◽  
Vol 24 (1) ◽  
pp. 65-72 ◽  
Author(s):  
H. Hong ◽  
D. W. Dowdy ◽  
K. E. Dooley ◽  
H. W. Francis ◽  
C. Budhathoki ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Dose Group ◽  
Low Dose ◽  
Multidrug Resistant ◽  
Prognostic Impact ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Increased Risk ◽  
Mdr Tb ◽  
The Impact

SETTING: The ototoxic effects of aminoglycosides (AGs) lead to permanent hearing loss, which is one of the devastating consequences of multidrug-resistant tuberculosis (MDR-TB) treatment. As AG ototoxicity is dose-dependent, the impact of a surrogate measure of AG exposure on AG-induced hearing loss warrants close attention for settings with limited therapeutic drug monitoring.OBJECTIVE: To explore the prognostic impact of cumulative AG dose on AG ototoxicity in patients following initiation of AG-containing treatment for MDR-TB.DESIGN: This prospective cohort study was nested within an ongoing cluster-randomized trial of nurse case management intervention across 10 MDR-TB hospitals in South Africa.RESULTS: The adjusted hazard of AG regimen modification due to ototoxicity in the high-dose group (≥75 mg/kg/week) was 1.33 times higher than in the low-dose group (<75 mg/kg/week, 95%CI 1.09–1.64). The adjusted hazard of developing audiometric hearing loss was 1.34 times higher than in the low-dose group (95%CI 1.01–1.77). Pre-existing hearing loss (adjusted hazard ratio [aHR] 1.71, 95%CI 1.29–2.26) and age (aHR 1.16 per 10 years of age, 95%CI 1.01–1.33) were also associated with an increased risk of hearing loss.CONCLUSION: MDR-TB patients with high AG dose, advanced age and pre-existing hearing loss have a significantly higher risk of AG-induced hearing loss. Those at high risk may be candidates for more frequent monitoring or AG-sparing regimens.

scholarly journals Drug exposure and susceptibility of second-line drugs correlate with treatment response in patients with multidrug resistant tuberculosis: a multi-centre prospective cohort study in China

2021 ◽  
pp. 2101925
Author(s):  
Xubin Zheng ◽  
Lina Davies Forsman ◽  
Ziwei Bao ◽  
Yan Xie ◽  
Zhu Ning ◽  
...  
Keyword(s):  
Drug Exposure ◽  
Multidrug Resistant ◽  
Target Attainment ◽  
Cart Analysis ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Impact ◽  
Culture Conversion

BackgroundUnderstanding the impact of drug exposure and susceptibility on treatment response of multidrug-resistant tuberculosis (MDR-TB) will help to optimize treatment. This study aimed to investigate the association between drug exposure, susceptibility and response to MDR-TB treatment.MethodsDrug exposure and susceptibility for second-line drugs were measured for patients with MDR-TB. Multivariate analysis was applied to investigate the impact of drug exposure and susceptibility on sputum culture conversion and treatment outcome. Probability of target attainment was evaluated. Random Forest and classification and regression tree (CART) analysis was used to identify key predictors and their clinical targets among patients on WHO-recommended regimens.ResultsDrug exposure and corresponding susceptibility were available for 197 patients with MDR-TB. Target attainment was highly variable ranging from 0% for ethambutol to 97% for linezolid, while patients with fluoroquinolones above targets had higher probability of two-month culture conversion (56.3% versus 28.6%, OR 2.91, 95% CI 1.42–5.94) and favourable outcome (88.8% versus 68.8%, OR 2.89, 95% CI 1.16–7.17). Higher exposure values of fluoroquinolones, linezolid and pyrazinamide were associated with earlier sputum culture conversion. CART analysis selected moxifloxacin AUC/MIC of 231 and linezolid AUC/MIC of 287 as best predictors for six-month culture conversion in patients receiving identical Group A-based regimen. These association were confirmed in multivariate analysis.ConclusionsOur findings indicated that target attainment of TB drugs is associated with response to treatment. The CART-derived thresholds may serve as targets for early dose adjustment in a future randomized controlled study to improve the MDR-TB treatment outcome.

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