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 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 Factors associated with unfavourable treatment outcomes in people with HIV-associated tuberculosis in Armenia, 2015 to 2019

2021 ◽  
Vol 91 (1) ◽  
Author(s):  
Lilit Gevorgyan ◽  
Ruzanna Grigoryan ◽  
Kostyantyn Dumchev ◽  
Kristina Akopyan ◽  
Anush Khachatryan ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Treatment Outcomes ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Unfavourable Outcome ◽  
Factors Associated ◽  
Risk Of Death ◽  
Tb Treatment ◽  
Lost To Follow Up

To evaluate factors associated with tuberculosis (TB) treatment outcomes in human Immunodeficiency Virus-Associated (HIV) TB patients in Armenia, we conducted a nation-wide cohort study using routine programmatic data of all HIV-associated TB patients receiving TB treatment with first- or second-line drugs from 2015 to 2019. Data were obtained from the TB and HIV electronic databases. We analysed occurrence of the combined unfavourable outcome (failure, lost to follow-up, death and not evaluated) and death separately, and factors associated with both outcomes using Cox regression. There were 320 HIV-associated TB patients who contributed a total of 351 episodes of TB treatment. An unfavourable TB treatment outcome was registered in 155 (44.2%) episodes, including 85 (24.2%) due to death, 38 (10.8%) lost to follow up, 13 (3.7%) failure and 19 (5.4%) not evaluated. Multivariable analysis showed that receipt of Antiretroviral Treatment (ART) [ART start before TB treatment: adjusted hazard ratio (aHR)=0.3, 95% confidence interval (CI): 0.2-0.5, aHR=, 95% CI:, 95% CI:, 95% CI:TB meningitis (aHR=4.4, 95% CI: 1.6-11.9) increased the risk. The risk of death was affected by the same factors as above in addition to the low BMI (aHR=2.5, 95% CI: 1.3-4.5) and drug resistance (aHR=2.3, 95% CI: 1.0-5.4). In the subsample of episodes receiving ART, history of interruption of ART during TB treatment increased the risk of unfavourable outcome (aHR=2.1 95% CI: 1.2-3.9), while ART start during TB treatment was associated with lower risk of both unfavourable outcome (within first 8 weeks: aHR: 0.5, 95% CI: 0.3-0.9; after 8 weeks: aHR: 0.4, 95% CI: 0.2-1.0) and death (within first 8 weeks: aHR: 0.2, 95% CI: 0.1-0.4; after 8 weeks: aHR: 0.1, 95% CI: 0.01-0.3). The rates of unfavourable TB treatment outcomes, and death in particular, among HIV-associated TB patients in Armenia are high. Our findings emphasize the protective effect of ART and the importance of proper management of cases complicated by drug resistance or meningitis.  

scholarly journals The impact of smoking on tuberculosis treatment outcomes: a meta-analysis

2020 ◽  
Vol 24 (2) ◽  
pp. 170-175 ◽  
Author(s):  
E. Y. Wang ◽  
R. A. Arrazola ◽  
B. Mathema ◽  
I. B. Ahluwalia ◽  
S. R. Mase
Keyword(s):  
Cigarette Smoking ◽  
Treatment Outcomes ◽  
Meta Analysis ◽  
Current Evidence ◽  
Cochrane Library ◽  
Loss To Follow Up ◽  
Tb Treatment ◽  
The Impact ◽  
Culture Conversion

BACKGROUND: Cigarette smoking contributes to tuberculosis (TB) epidemiology. However, limited evidence exists on how smoking impacts TB treatment outcomes such as treatment loss to follow-up and culture conversion.METHODS: This meta-analysis assessed current evidence of the impact of active cigarette smoking on TB treatment outcomes. PubMed, Scopus, Embase, and the Cochrane Library were searched for English-language articles published from database inception through 2017. Articles addressing active pulmonary TB and cigarette smoking were identified and data abstracted. Smokers were defined as those who smoked every day or some days at the time of interview/diagnosis. Non-smokers did not smoke at the time of interview/diagnosis. Unfavorable outcomes included any outcome other than cure or completion of TB treatment. Three different data sets were examined: 8 articles addressing unfavorable treatment outcomes, 9 analyzing only treatment loss to follow-up, and 5 addressing delayed smear or culture conversion. Studies that had <20 subjects or that addressed only populations with comorbidities were excluded.RESULTS: We identified 1030 studies; 21 studies fulfilled the inclusion/exclusion criteria. Smokers had greater odds of unfavorable outcomes (pooled odds ratio [pOR] 1.23, 95%CI 1.14–1.33), delayed smear or culture conversion (pOR 1.55, 95%CI 1.04–2.07), and treatment loss to follow-up (pOR 1.35, 95%CI 1.21–1.50).CONCLUSION: Cigarette smoking is associated with negative treatment results and delayed conversion to negative smear or culture, suggesting smoking is an important factor for consideration in TB elimination efforts.

scholarly journals Brazilian cohort study of risk factors associated with unsuccessful outcomes of drug resistant tuberculosis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Patricia Bartholomay ◽  
Rejane Sobrino Pinheiro ◽  
Fernanda Dockhorn ◽  
Daniele Maria Pelissari ◽  
Wildo Navegantes de Araújo
Keyword(s):  
Treatment Outcomes ◽  
Illicit Drugs ◽  
Multinomial Logistic Regression ◽  
Multidrug Resistant ◽  
Individual Characteristics ◽  
Drug Resistant ◽  
Factors Associated ◽  
Four Blocks ◽  
Lost To Follow Up

Abstract Background Treatment outcomes were evaluated of a cohort of new pulmonary tuberculosis (TB) cases that were rifampicin resistant, multidrug-resistant, or extensively resistant during 2013 and 2014 in Brazil. The objective of this study is to identify factors associated with unfavorable treatment outcomes for drug-resistant TB cases. Methods The Brazilian Special Tuberculosis Treatment Information System (SITE-TB) was the main data source. The independent variables were classified into four blocks (block I: individual characteristics; block II: clinical characteristics and proposed treatment; block III: treatment follow-up characteristics; and block IV: TB history). The category of successful therapeutic outcome was compared with lost to follow-up, failure, and death. Considering the multiple outcomes as the dependent variable, the odds ratios (OR) and its respective 95% confidence interval (95% CI) were estimated by multinomial logistic regression. Results After applying the exclusion criteria, 980 (98.8%) individuals were included in the study. Of these, 621 (63.4%) had successful treatment, 163 (16.6%) lost to follow-up, 76 (7.8%) failed, and 120 (12.2%) died. Important factors associated with lost to follow-up in the final model included use of illicit drugs (OR = 2.5 95% CI: 1.57–3.82). Outcome failure was associated with having disease in both lungs (OR = 2.0; 95% CI: 1.09–3.62) and using more than one or not using injectable medication (OR = 2.8; 95% CI: 1.05–7.69). Major factors for the death outcome were at least 60 years old (OR = 3.4; 95% CI: 1.90–6.03) and HIV positive (OR = 2.7; 95% CI: 1.45–4.83). Conclusions The factors associated with unfavorable treatment outcomes were different. Some of these factors are specific to each outcome, which reflects the complexity of providing care to these individuals.

scholarly journals Factors associated with treatment failure, dropout, and death in a cohort of tuberculosis patients in Recife, Pernambuco State, Brazil

2007 ◽  
Vol 23 (7) ◽  
pp. 1573-1582 ◽  
Author(s):  
Maria de Fátima Pessoa Militão de Albuquerque ◽  
Ricardo Arraes de Alencar Ximenes ◽  
Norma Lucena-Silva ◽  
Wayner Vieira de Souza ◽  
Andréa Tavares Dantas ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Treatment Outcomes ◽  
Group Treatment ◽  
Healthcare Access ◽  
Treatment Delay ◽  
Tuberculosis Treatment ◽  
Directly Observed Therapy ◽  
Factors Associated ◽  
Family Health Program ◽  
Tb Treatment

A cohort of cases initiating tuberculosis treatment from May 2001 to July 2003 was followed in Recife, Pernambuco State, Brazil, to investigate biological, clinical, social, lifestyle, and healthcare access factors associated with three negative tuberculosis treatment outcomes (treatment failure, dropout, and death) separately and as a group. Treatment failure was associated with treatment delay, illiteracy, and alcohol consumption. Factors associated with dropout were age, prior TB treatment, and illiteracy. Death was associated with age, treatment delay, HIV co-infection, and head of family's income. Main factors associated with negative treatment outcomes as a whole were age, HIV co-infection, illiteracy, alcoholism, and prior TB treatment. We suggest the following strategies to increase cure rates: further training of the Family Health Program personnel in TB control, awareness-raising on the need to tailor their activities to special care for cases (e.g., literacy training); targeting use of directly observed therapy for higher risk groups; establishment of a flexible referral scheme to handle technical and psychosocial problems, including alcoholism; and increased collaboration with the HIV/AIDS program.

scholarly journals Death With Tuberculosis in California, 1994–2008

2014 ◽  
Vol 1 (3) ◽  
Author(s):  
Lisa Pascopella ◽  
Pennan M. Barry ◽  
Jennifer Flood ◽  
Kathryn DeRiemer
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Treatment Regimens ◽  
Risk Of Death ◽  
Tb Treatment ◽  
Treatment Processes ◽  
Abnormal Chest ◽  
Patients At Risk

Abstract Background.  Identifying factors associated with tuberculosis (TB) deaths will inform efforts to prevent deaths. Methods.  We examined deaths among patients with culture-confirmed TB reported to the California TB Registry during 1994–2008. We calculated the age-adjusted percentage of deaths before and during TB treatment and estimated trends. We constructed multivariable logistic regression models to identify factors associated with death during treatment. Results.  Of 40 125 patients with culture-confirmed TB, 4565 (11%) died: 1146 (25%) died before treatment started, and 3419 (75%) died during treatment. The age-adjusted percentage of patients who died before and during treatment declined from 1994 to 2008 (3.5% to 2%, and 10.4% to 7.2%, respectively, both P &lt; .0001). We identified several risk factors for death that may be addressed with public health efforts: acquired multidrug resistance (adjusted odds ratio [aOR] = 4.67; 95% confidence interval [CI], 2.09–10.45); care in the private sector (aOR = 3.08; 95% CI, 2.75–3.44); and an initial treatment regimen of &lt;3 drugs (aOR = 2.07; 95% CI, 1.63–2.64). We identified other risk factors for death that could be used as markers for intensified diagnostic and treatment processes in hospital: human immunodeficiency virus coinfection; meningeal, peritoneal, and disseminated TB; substance use; and abnormal chest radiograph without cavities. Conclusions.  In California, 1 in 9 TB patients died with a potentially curable disease. Public health departments might prevent deaths in patients with TB by strengthening partnerships with private providers, intensifying diagnostic and treatment processes for patients at risk of death in hospital, optimizing treatment regimens for patients with comorbidities, and preventing the acquisition of drug resistance.

scholarly journals How Soon Should Patients with Smear-Positive Tuberculosis Be Released from Inpatient Isolation?

2010 ◽  
Vol 31 (1) ◽  
pp. 78-84 ◽  
Author(s):  
David J. Horne ◽  
Catherine O. Johnson ◽  
Eyal Oren ◽  
Christopher Spitters ◽  
Masahiro Narita
Keyword(s):  
Survival Analysis ◽  
Confidence Interval ◽  
Pulmonary Tuberculosis ◽  
Patient Characteristics ◽  
Hazard Ratio ◽  
Bivariate Analysis ◽  
Sputum Smear ◽  
Patient Counseling ◽  
Factors Associated ◽  
Culture Conversion

Objective.In patients with smear-positive pulmonary tuberculosis who are hospitalized or reside in congregate settings, guidelines recommend airborne infection isolation until sputum smear results are negative. Studies have identified factors associated with delayed sputum smear and culture conversion in patients with tuberculosis. Because these studies did not use methods of survival analysis, estimates of time to sputum smear conversion that are based on initial patient characteristics are not available. The ability to predict time to sputum smear conversion could be useful for programmatic planning and patient counseling.Methods.We performed a cohort study using survival analysis to identify factors associated with time to sputum smear and culture conversion. We defined the time to sputum smear conversion as the time elapsed from the start of treatment to the first date of sustained conversion.Results.Ninety-eight patients had sputum smear samples positive for acid-fast bacilli. Lower initial smear grade (on 1+ to 4+ scale) and absence of cavitation on chest radiograph were associated with earlier sputum smear conversion in bivariate analysis. In multiple regression analysis, initial smear grade (hazard ratio, 0.45; 95% confidence interval, 0.35-0.57) and drug resistance (hazard ratio, 2.30; 95% confidence interval, 1.08-4.89) remained statistically significant; a model comprising only initial smear grade performed almost as well. Predictors of sputum culture conversion were similar.Conclusions.Initial smear grade was the strongest predictor of time to sputum smear and culture conversion in patients with pulmonary tuberculosis and may be a useful predictor for programmatic planning and patient counseling.

scholarly journals Trends of Tuberculosis Treatment Outcomes of Notified Cases in Three Refugee Camps in Sudan: A Four-year Retrospective Analysis, 2014–2017

2021 ◽  
Author(s):  
Tsegay Legesse ◽  
Mohammed Hussein Elduma ◽  
Nagi Masoud Awad ◽  
Mousab Siddig Elhag ◽  
Israa Abushama ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Success Rate ◽  
Treatment Outcomes ◽  
Treatment Success ◽  
Treatment Success Rate ◽  
Refugee Camps ◽  
Historical Cohort ◽  
Tb Treatment ◽  
Unsuccessful Treatment ◽  
Lost To Follow Up

Background: Refugees are vulnerable to tuberculosis (TB) infection. Tracking of program performance is needed to improve TB care and prevention. The objective of this study was to assess the trends of TB treatment outcomes of notified cases in three refugee camps in Sudan from 2014 to 2017. Methods: This study was a historical cohort study. Sex, age, type of TB, TB patient category, and treatment outcome of all TB cases registered in three refugee camps (Al Kashafa, Shagarab, Wadsherify) from January 1, 2014 to December 31, 2017 were collected from the TB register. Multivariable logistic regression was performed to explore factors for unsuccessful TB treatment. Results: A total of 710 TB cases of which 53.4% were men, 22.1% children (<15 years), and 36.2% extrapulmonary TB (EPTB) were registered. Overall, the TB treatment success rate was 75.7% with a declining trend from 86.2% in 2015 to 63.5% in 2017. On average, 11.4% were lost to follow-up (LTFU), 6.6% died, 5.9% were not evaluated, and in 0.3% the treatment failed. Being 15–24 years old and having EPTB were significantly associated with unsuccessful treatment outcome. Conclusion: The treatment success rate in the refugee camp in 2017 (63.5%) was far lower than the national treatment success rate (78%) and the End TB global target (≥90%) that needs to be improved. LTFU, died, and not evaluated outcomes were high which indicated the necessity to improve the TB treatment program.

scholarly journals A five-year audit of gaps in HIV testing and associations with TB treatment outcomes in Armenia, 2015-2019

2021 ◽  
Vol 15 (09.1) ◽  
pp. 43S-50S
Author(s):  
Arpine Abrahamyan ◽  
Katrina Hann ◽  
Kristina Akopian ◽  
Ruzanna Grigoryan ◽  
Ofelya Petrosyan ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Treatment Outcomes ◽  
Electronic Database ◽  
Hiv Status ◽  
Related Data ◽  
Tb Treatment ◽  
Effective Care ◽  
Immunodeficiency Virus ◽  
Key Indicators ◽  
Lost To Follow Up

Introduction: Poor human immunodeficiency virus (HIV) testing practices and underreporting of HIV-related data in TB information systems remain barriers to effective care for TB-HIV co-infected patients. HIV testing and recording practices in national TB program have not been formally evaluated in Armenia. This study aimed to assess the recording completeness of HIV testing and HIV status in the national TB program electronic database, and to determine trend in HIV testing and the association between HIV testing and treatment outcomes for all TB patients registered in Armenia (2015-2019). Methodology: A cohort study of TB patients using routine programmatic data from the national TB program of Armenia. Results: From 2015 to 2019, the electronic database was completed for HIV testing and HIV status by 48.1% and 97.5%, respectively. Of all registered TB patients 93.6% were tested for HIV. Of a total 4,674 patients, 1,085 (23.2%) had unsuccessful outcomes. Patients with HIV status “not tested” and “not recorded” compared to HIV “negatives” had 1.76 (95%CI 1.42-2.11) and 1.6 (95%CI 1.20-2.06) times higher risk of unsuccessful outcomes, respectively. Lost to follow-up was the most frequent unsuccessful outcome in HIV status “not tested” group. Conclusions: An analysis of nationwide data revealed incompleteness of the national TB electronic database for HIV data. Patients with HIV status “not tested” and “not recorded” had higher risk of unsuccessful TB treatment outcomes. Upgrade of the electronic database with information on key indicators of TB-HIV services will facilitate improved monitoring and reporting.

Factors Associated with Unsuccessful Outcomes of Tuberculosis Treatment in 125 Municipalities in Colombia 2014 to 2016

2021 ◽  
Author(s):  
Lizeth Andrea Paniagua-Saldarriaga ◽  
Daniele Maria Pelissari ◽  
Zulma Vanessa Rueda
Keyword(s):  
Risk Factors ◽  
Health Insurance ◽  
Treatment Success ◽  
Tuberculosis Treatment ◽  
People Living With Hiv ◽  
Surveillance Systems ◽  
Factors Associated ◽  
Tb Treatment ◽  
Lost To Follow Up

Our aim was to identify the risk factors associated with unsuccessful outcomes of tuberculosis (TB) treatment in patients diagnosed between 2014 and 2016 in the 125 municipalities of Antioquia, Colombia. We studied a retrospective cohort of patients with TB diagnosed between 2014 and 2016, from national routine surveillance systems, in 125 municipalities of Antioquia. Factors associated with unsuccessful tuberculosis treatment outcomes (treatment failed, lost to follow up, or death) were identified utilizing a Poisson regression with robust variance. Over 3 years, of the 6,739 drug-susceptible tuberculosis patients, 73.4% had successful treatment and 26.6% unsuccessful outcomes (17% lost to follow up, 8.9% deaths, and 0.7% treatment failures). Patients with subsidized health insurance (Relative risk [RR]: 2.4; 95% CI: 2.1–2.8) and without health insurance (RR: 2.5; 95% CI: 2.1–3.0) had a higher risk for unsuccessful tuberculosis treatment compared to those with contributive health insurance. Other risk factors included age over 15 years, male sex, homelessness, people living with HIV, previous treatment, and primary diagnosis during hospitalization. Protective factors were living in a rural area and extrapulmonary disease. It is important to generate strategies that improves tuberculosis diagnosis in primary healthcare institutions. In addition, it is imperative to initiate new research about the barriers and obstacles related to patients, healthcare workers and services, and the health system, including the analysis of urban violence, to understand why the goal of TB treatment success has not been reached.

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