Expanding the use of dolutegravir-based antiretroviral therapy in multidrug-resistant TB

2021 ◽  
Vol 25 (9) ◽  
pp. 696-700
Author(s):  
R. A. Murphy ◽  
B. Douglas-Jones ◽  
G. Mucinya ◽  
H. Sunpath ◽  
T. Govender
Keyword(s):  
Antiretroviral Therapy ◽  
Multidrug Resistant ◽  
Drug Resistant ◽  
Pill Burden ◽  
Hiv Therapy ◽  
Tb Treatment ◽  
Early Evidence ◽  
Mdr Tb

The wider availability of dolutegravir (DTG) containing HIV therapy for patients living with multidrug-resistant TB (MDR-TB) presents several advantages. DTG-based antiretroviral therapy (ART) has superior potency, reduces pill burden, and may reduce overall treatment-related toxicity, giving it the potential to improve outcomes in both diseases. While the uptake of DTG-based ART in programs where drug-resistant TB is treated remains unknown, there is early evidence from three programs that uptake is increasing. The use of DTG-based ART should be scaled-up, beginning with antiretroviral-naïve or virologically suppressed patients initiating MDR-TB treatment.

Time for a change: considering regimen changes in analyses of observational drug-resistant TB treatment cohort data

2020 ◽  
Vol 24 (11) ◽  
pp. 1151-1155
Author(s):  
M. F. Franke ◽  
C. D. Mitnick
Keyword(s):  
Observational Studies ◽  
Drug Exposure ◽  
Randomized Clinical Trials ◽  
Multidrug Resistant ◽  
Drug Resistant ◽  
Treatment Regimens ◽  
Tb Treatment ◽  
Mdr Tb ◽  
Therapeutic Research ◽  
Do So

Randomized clinical trials represent the gold standard in therapeutic research. Nevertheless, observational cohorts of patients treated for multidrug-resistant TB (MDR-TB) or rifampin-resistant TB (RR-TB) also play an important role in generating evidence to guide drug-resistant TB care. Generally, summary exposure classifications (e.g., ‘ever vs. never´, ‘exposed at baseline´) have been used to characterize drug exposure in the absence of detailed longitudinal data on MDR-TB regimen changes. These summary classifications, along with an absence of data on covariates that change throughout the course of treatment, constrain researchers´ ability to answer the most relevant questions while accounting for known biases. In this paper, we highlight the importance of regimen changes in improving inference from observational studies of longer MDR-TB treatment regimens, and offer an overview of the data and analytic strategies required to do so.

scholarly journals Patient treatment pathways of multidrug-resistant tuberculosis cases in coastal South India: Road to a drug resistant tuberculosis center

F1000Research ◽  
2020 ◽  
Vol 8 ◽  
pp. 498
Author(s):  
Priya Rathi ◽  
Kalpita Shringarpure ◽  
Bhaskaran Unnikrishnan ◽  
Abhinav Pandey ◽  
Abhirami Nair
Keyword(s):  
Multidrug Resistant ◽  
Diagnosis And Treatment ◽  
Patient Treatment ◽  
Drug Resistant ◽  
Treatment Pathways ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Government

Background: Delays in initiating multidrug-resistant tuberculosis (MDR TB) treatment adds risk to individual patients and the community due to disease progression, and on-going transmission. The Government of India offers free TB diagnosis and treatment, however many presumptive MDR TB patients wander within the Indian healthcare system and delay accessing the programme. To improve access to care, it is imperative to understand the treatment pathways taken by MDR TB patients. We aimed to describe the diagnostic and treatment pathway taken by presumptive MDR TB patients registered under Programmatic Management of Drug-resistant TB Program. Methods: We conducted a cross-sectional study amongst patients registered during August 2016 – April 2017 at one District Drug Resistance Tuberculosis centre of Dakshina Kannada district in Karnataka, India. A semi-structured questionnaire was used to collect the number, type (private and public sector), and dates of healthcare facilities (HCFs) visits prior to the initiation of MDR TB treatment. Delays in pathway were measured in days and summarised as median and interquartile range (IQR), from the date of onset of illness until the initiation of MDR TB treatment. Results: We found that patients preferred private HCFs; however, due to lack of treatment and unaffordability they shifted to public HCFs. Median delay to register under the program was more in private HCFs (180 days) in comparison with public HCFs (120 days). We also found that the detection rates were much higher in public HCFs (80%). Conclusion: The present study found that there was substantial patient delay and total delay in diagnosis and treatment of MDR TB patients. Private HCF was first point of contact for most of the patients; however the diagnostic rate was high in public HCF. The government should involve private HCFs to provide standard diagnostics and treatment to the patients seeking a private facility.

scholarly journals Primary Clofazimine and Bedaquiline Resistance among Isolates from Patients with Multidrug-Resistant Tuberculosis

2017 ◽  
Vol 61 (6) ◽  
Author(s):  
Jian Xu ◽  
Bin Wang ◽  
Minghao Hu ◽  
Fengmin Huo ◽  
Shaochen Guo ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Cross Resistance ◽  
Drug Resistant ◽  
Content Type ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Previously Treated ◽  
Alamarblue Assay

ABSTRACT Clofazimine has been repurposed for the treatment of tuberculosis, especially for multidrug-resistant tuberculosis (MDR-TB). To test the susceptibility to clofazimine of Mycobacterium tuberculosis clinical isolates, MICs of clofazimine were determined using the microplate alamarBlue assay (MABA) method for 80 drug-resistant isolates and 10 drug-susceptible isolates for comparison. For five clofazimine-resistant strains isolated from previously treated pre-extensively drug-resistant TB (pre-XDR-TB) and XDR-TB patients without prior exposure to clofazimine or bedaquiline, clofazimine MICs were ≥1.2 μg/ml. Four isolates with cross-resistance to bedaquiline had Rv0678 mutations. The other isolate with no resistance to bedaquiline had an Rv1979c mutation. This study adds to a recent study showing that 6.3% of MDR-TB patients without prior clofazimine or bedaquiline exposure harbored isolates with Rv0678 mutations, which raises concern that preexisting resistance to these drugs may be associated with prior TB treatment. Furthermore, we propose a tentative breakpoint of 1.2 μg/ml for clofazimine resistance using the MABA method. More-widespread surveillance and individualized testing for clofazimine and bedaquiline resistance, together with assessment of their clinical usage, especially among previously treated and MDR-TB patients, are warranted.

scholarly journals Availability, price and affordability of anti-tuberculosis drugs in Europe: a TBNET survey

2014 ◽  
Vol 45 (4) ◽  
pp. 1081-1088 ◽  
Author(s):  
Gunar Günther ◽  
Gabriela B. Gomez ◽  
Christoph Lange ◽  
Stephan Rupert ◽  
Frank van Leth
Keyword(s):  
National Level ◽  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Drug Resistant ◽  
Cross Sectional ◽  
Treatment Regimens ◽  
Tb Treatment ◽  
Mdr Tb ◽  
Domestic Products ◽  
Major Impediment

Data on availability and cost of anti-tuberculosis (TB) drugs in relation to affordability at national level are scarce.We performed a cross-sectional study on availability and cost of anti-TB drugs at major TB-reference centres in 37 European countries. Costs of standardised treatment regimens used for pan-sensitive TB, multidrug-resistant (MDR) TB, pre-extensively drug-resistant (XDR) TB, and XDR-TB were compared using a purchasing power analysis. Affordability was evaluated in relation to monthly national gross domestic products per capita (GDP).At least one second-line injectable and either moxifloxacin or levofloxacin were available in all countries. Linezolid and clofazimine were available in 79% and 46% of the countries, respectively. Drug cost for XDR-TB was three-times more expensive than those for MDR-TB. The average price of treatment for pan-sensitive TB represented a maximum of 8.5% of the monthly GDP across countries, while for standard MDR-TB treatment this was <30% in only six countries and more than 100% in four countries. Treatment of XDR-TB represented more than 100% of a month's GDP in all countries where the regimen was available.High cost and limited availability of drugs for treatment of drug-resistant TB, particularly beyond resistance to first-line drugs, are a major impediment to successful TB control in Europe.

scholarly journals Patient treatment pathways of multidrug-resistant tuberculosis cases in coastal South India: Road to a drug resistant tuberculosis center

F1000Research ◽  
2021 ◽  
Vol 8 ◽  
pp. 498
Author(s):  
Priya Rathi ◽  
Kalpita Shringarpure ◽  
Bhaskaran Unnikrishnan ◽  
Abhinav Pandey ◽  
Abhirami Nair
Keyword(s):  
Multidrug Resistant ◽  
Diagnosis And Treatment ◽  
Patient Treatment ◽  
Drug Resistant ◽  
Treatment Pathways ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Government

Background: Delays in initiating multidrug-resistant tuberculosis (MDR TB) treatment adds risk to individual patients and the community due to disease progression, and on-going transmission. The Government of India offers free TB diagnosis and treatment, however many presumptive MDR TB patients wander within the Indian healthcare system and delay accessing the programme. To improve access to care, it is imperative to understand the treatment pathways taken by MDR TB patients. We aimed to describe the diagnostic and treatment pathway taken by presumptive MDR TB patients registered under Programmatic Management of Drug-resistant TB Program. Methods: We conducted a cross-sectional study amongst patients registered during August 2016 – April 2017 at one District Drug Resistance Tuberculosis centre of Dakshina Kannada district in Karnataka, India. A semi-structured questionnaire was used to collect the number, type (private and public sector), and dates of healthcare facilities (HCFs) visits prior to the initiation of MDR TB treatment. Delays in pathway were measured in days and summarised as median and interquartile range (IQR), from the date of onset of illness until the initiation of MDR TB treatment. Results: We found that patients preferred private HCFs; however, due to lack of treatment and unaffordability they shifted to public HCFs. Median delay to register under the program was more in private HCFs (180 days) in comparison with public HCFs (120 days). We also found that the detection rates were much higher in public HCFs (80%). Conclusion: The present study found that there was substantial patient delay and total delay in diagnosis and treatment of MDR TB patients. Private HCF was first point of contact for most of the patients; however those visited public HCF diagnosed earlier as compared to others. The government should involve private HCFs to provide standard diagnostics and treatment to the patients seeking a private facility.

scholarly journals Patient treatment pathways of multidrug-resistant tuberculosis cases in coastal South India: Road to a drug resistant tuberculosis center

F1000Research ◽  
2020 ◽  
Vol 8 ◽  
pp. 498
Author(s):  
Priya Rathi ◽  
Kalpita Shringarpure ◽  
Bhaskaran Unnikrishnan ◽  
Abhinav Pandey ◽  
Abhirami Nair
Keyword(s):  
Multidrug Resistant ◽  
Diagnosis And Treatment ◽  
Patient Treatment ◽  
Drug Resistant ◽  
Treatment Pathways ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Government

Background: Delays in initiating multidrug-resistant tuberculosis (MDR TB) treatment adds risk to individual patients and the community due to disease progression, and on-going transmission. The Government of India offers free TB diagnosis and treatment, however many presumptive MDR TB patients wander within the Indian healthcare system and delay accessing the programme. To improve access to care, it is imperative to understand the treatment pathways taken by MDR TB patients. We aimed to describe the diagnostic and treatment pathway taken by presumptive MDR TB patients registered under Programmatic Management of Drug-resistant TB Program. Methods: We conducted a cross-sectional study amongst patients registered during August 2016 – April 2017 at one District Drug Resistance Tuberculosis centre of Dakshina Kannada district in Karnataka, India. A semi-structured questionnaire was used to collect the number, type (private and public sector), and dates of healthcare facilities (HCFs) visits prior to the initiation of MDR TB treatment. Delays in pathway were measured in days and summarised as median and interquartile range (IQR), from the date of onset of illness until the initiation of MDR TB treatment. Results: We found that patients preferred private HCFs; however, due to lack of treatment and unaffordability they shifted to public HCFs. Median delay to register under the program was more in private HCFs (180 days) in comparison with public HCFs (120 days). We also found that the detection rates were much higher in public HCFs (80%). Conclusion: The present study found that there was substantial patient delay and total delay in diagnosis and treatment of MDR TB patients. Private HCF was first point of contact for most of the patients; however those visited public HCF diagnosed earlier as compared to others. The government should involve private HCFs to provide standard diagnostics and treatment to the patients seeking a private facility.

scholarly journals Epidemiology of Drug Resistant Tuberculosis in Samtse General Hospital, Bhutan: A Retrospective Study

2019 ◽  
Vol 17 (1) ◽  
pp. 41-46
Author(s):  
Thinley Dorji
Keyword(s):  
General Hospital ◽  
Multidrug Resistant ◽  
Cross Sectional Study ◽  
Drug Resistant ◽  
Cross Sectional ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
High Prevalence ◽  
Mdr Tb

Introduction: Multidrug resistant tuberculosis (MDR-TB) is defined as a case of tuberculosis resistant to rifampicin and isoniazid which are the first line anti tuberculosis drugs. Globally emergences of MDR-TB possess a challenge to TB control. In Bhutan, the proportion of MDR-TB is high at par with the global level. This study will explore the predictors of MDR-TB and the trend at Samtse General Hospital which has high burden of tuberculosis. Methods: This was a retrospective cross sectional study. The data was extracted from TB treatment cards maintained at TB unit of Samtse General Hospital TB from January 2012 to June 2018. Results: The study showed the prevalence of drug resistant to at least one drug at 21% and MDR-TB prevalence at 16%. The patients with previous treatments (AOR: 4.59; 95% CI .03-.18) and patients under the age of 30 years (AOR: 2.7; 95% CI 1.01- 7.42) were significantly associated with MDR-TB. Conclusion: This study shows high prevalence of MDR-TB in Samtse. Better strategies and concrete actions need to be developed to combat the increase of MDR-TB.

scholarly journals Pharmacoepidemiology and pharmacoeconomics of multidrug- and extensively drug-resistant tuberculosis

2021 ◽  
Author(s):  
N. Yu. Nikolenko ◽  
D. А. Kudlay ◽  
N. P. Doktorova
Keyword(s):  
Pharmacoeconomic Analysis ◽  
Economic Effect ◽  
Multidrug Resistant ◽  
Point Of View ◽  
New Drugs ◽  
Drug Resistant ◽  
Treatment Regimens ◽  
Tb Treatment ◽  
Extensively Drug Resistant ◽  
Mdr Tb

Treatment of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) is a current problem worldwide. Currently, special attention is paid to the possibility of using new high-cost chemotherapy regimens in the treatment of MDR/XDR-TB. Numerous studies have shown that, from a clinical point of view, the effectiveness of MDR/XDR-TB therapy increases with the inclusion of bedaquiline, delamanid, linezolid, fluoroquinolones (moxifloxacin, levofloxacin), and pretomanid. At the same time, there is an assumption that the use of new and repurposed anti-tuberculosis drugs (ATDs) may be associated with an increase in overall costs. This paper demonstrates the potential of pharmacoepidemiology and pharmacoeconomics to evaluate the widespread introduction of new anti-tuberculosis drugs (ATDs), taking into account all the typical features of MDR/XDR-TB therapy. The authors analyzed studies of pharmacoeconomic feasibility of using expensive drugs in treatment regimens of pulmonary tuberculosis patients with MDR/XDR pathogen. It was shown that the use of chemotherapy regimens containing new high-cost and highly effective drugs (moxifloxacin, linizolid, and bedaquiline) in rational combinations with other drugs of the basic and reserve series, selected concerning drug resistance of the pathogen, is associated with a significant economic effect. From the applicability of pharmacoeconomic analysis point of view, the introduction of short-term MDR-TB treatment regimens is also a promising direction in phthisiology. The key link to achieve effective MDR/XDR-TB treatment is the use of new drugs. Considering the specificity of pharmacoeconomic analysis in phthisiology and results of existing clinical and economic studies, the authors have formed recommendations aimed at a more complete realization of pharmacoeconomic analysis potential in MDR- and XDR-TB treatment.

Anti-tuberculosis drug resistance patterns and trends in a tuberculosis referral hospital, 1997–2009

2011 ◽  
Vol 139 (12) ◽  
pp. 1909-1918 ◽  
Author(s):  
C. H. LIU ◽  
H. M. LI ◽  
L. LI ◽  
Y. L. HU ◽  
Q. WANG ◽  
...  
Keyword(s):  
Drug Susceptibility ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Drug Resistant ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
High Prevalence ◽  
Resistance Patterns ◽  
Mdr Tb ◽  
Increasing Trends

SUMMARYInformation about the changing epidemiology of drug-resistant tuberculosis (TB) in hospitals in China over the past decade remains largely unknown. This study examined the susceptibility patterns and trends of drug-resistant TB cases in the 309 Hospital in Beijing, China. Mycobacterium tuberculosis isolates were retrospectively identified, drug susceptibility test (DST) results and clinical data were analysed for the period 1997–2009. Of the 5523 culture-positive TB patients, 47·1% had resistance to any anti-TB drug, 14·8% had mono-resistant TB, 19·8% had poly-resistant TB, 19·4% had multidrug-resistant TB (MDR-TB), and 1·3% had extensively drug-resistant TB (XDR-TB). Drug-resistant TB was significantly associated with age group, residential situation, and TB treatment history (P<0·001). During 1997–2000, the percentage of TB patients with any resistance, mono-resistant TB, poly-resistant TB, MDR-TB and XDR-TB all increased significantly (P<0·001). During 2000–2003, the increasing trends of MDR-TB and XDR-TB cases were reversed. During 2004–2009, the percentage of TB patients with any resistance, mono-resistant TB, poly-resistant TB, MDR-TB and XDR-TB all declined significantly (P<0·001), but the prevalence of MDR-TB and poly-resistant TB cases remained high. Our study provides evidence demonstrating that intensive TB control measures have helped reverse the increasing trends of drug-resistant TB in China, but continuous surveillance of drug-resistant TB and better case management are still needed to further reduce the remaining high prevalence of drug-resistant TB.

scholarly journals Patient treatment pathways of multidrug-resistant tuberculosis cases in coastal South India: Road to a drug resistant tuberculosis center

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 498 ◽  
Author(s):  
Priya Rathi ◽  
Kalpita Shringarpure ◽  
Bhaskaran Unnikrishnan ◽  
Abhinav Pandey ◽  
Abhirami Nair
Keyword(s):  
Multidrug Resistant ◽  
Patient Treatment ◽  
Drug Resistant ◽  
Detection Rates ◽  
Treatment Pathways ◽  
Tb Treatment ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
The Government

Background: Delays in initiating multidrug-resistant tuberculosis (MDR TB) treatment adds risk to individual patients and the community due to disease progression, and on-going transmission.  The Government of India offers free TB diagnosis and treatment, however many presumptive MDR TB patients wander within the Indian healthcare system and delay accessing the programme. To better improve access to care, it is imperative to understand the treatment pathways taken by MDR TB patients. We aimed to describe the diagnostic and treatment pathway taken by presumptive MDR TB patients registered in the Programmatic Management Drug-resistant TB Program (PMDT). Methods: We conducted a cross-sectional study of all patients registered during August 2016 – April 2017 at one PMDT center of a district in Karnataka, India. A semi-standardized questionnaire collected the number, type (private vs public sector), and dates of healthcare facilities (HCFs) visits prior to the initiation of MDR TB treatment.  Delays were the number of days, expressed in medians and interquartile range (IQR), from the date of onset of illness until the date of initiation of MDR TB treatment. Results: We found that patients preferred private HCFs; however, due to lack of treatment and unaffordability they shifted to public HCFs. Median delay to register under the program was more in private HCFs (180days) in comparison with public HCFs (120 days). We also found that the diagnosis of MDR among presumptive MDR cases (detection rates) were much higher (80%) in public HCFs. Conclusion: Awareness regarding the availability of free standard diagnosis and appropriate treatment under the TB program should be increased in the general population and private practitioners. The government should involve private HCFs to provide standard diagnostics and treatment to the patients seeking a private facility.

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