scholarly journals Decentralized, Community-Based Treatment for Drug-Resistant Tuberculosis: Bangladesh Program Experience

2018 ◽  
Vol 6 (3) ◽  
pp. 594-602 ◽  
Author(s):  
Paul Daru ◽  
Refiloe Matji ◽  
Hala Jassim AlMossawi ◽  
Krishnapada Chakraborty ◽  
Neeraj Kak
Keyword(s):  
Drug Resistant ◽  
Community Based ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis

Tuberculosis Preventive Therapy for Individuals Exposed to Drug-resistant Tuberculosis: Feasibility and Safety of a Community-based Delivery of Fluoroquinolone-containing Preventive Regimen

2019 ◽  
Vol 70 (9) ◽  
pp. 1958-1965 ◽  
Author(s):  
Amyn A Malik ◽  
Junaid Fuad ◽  
Sara Siddiqui ◽  
Farhana Amanullah ◽  
Maria Jaswal ◽  
...  
Keyword(s):  
Preventive Therapy ◽  
Positive Tuberculin Skin Test ◽  
Urban Setting ◽  
Drug Resistant ◽  
Community Based ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Infection Treatment ◽  
Immunodeficiency Virus

Abstract Background Observational studies have demonstrated the effectiveness of a fluoroquinolone-based regimen to treat individuals presumed to be infected with drug-resistant tuberculosis (DR-TB). We sought to assess the feasibility of this approach in an urban setting in South Asia. Methods From February 2016 until March 2017, all household contacts of DR-TB patients enrolled at the Indus Hospital were screened for TB symptoms at home. Children aged 0–17 years, symptomatic adults, and those with an immunocompromising condition (human immunodeficiency virus, diabetes, or malnutrition) were evaluated for TB disease. Contacts diagnosed with TB disease were started on treatment. Contacts without TB disease aged <5 years, contacts aged between 5 and 17 years with either a positive tuberculin skin test or an immunocompromising condition, or contacts aged ≥18 years with an immunocompromising condition were offered 6 months of treatment with a fluoroquinolone. Results One hundred households with 800 contacts were enrolled: 353 (44.1%) individuals aged ≤17 years with a median age of 19 years (interquartile range, 10–32); 423 (52.9%) were males. In total, 737 (92.1%) individuals were screened, of which 8 were already on treatment for TB (1.1%); another 3 (0.4%) contacts were diagnosed with TB disease and started on treatment. Of 215 eligible for infection treatment, 172 (80.0%) contacts initiated and 121 (70.3%) completed treatment. No TB disease or significant adverse events were observed during 12 months of follow-up. Conclusions Fluoroquinolone-based treatment for contacts with presumed DR-TB infection is feasible and well tolerated in a high TB burden setting.

scholarly journals Developing a Patient-Centered Community-Based Model for Management of Multi-Drug Resistant Tuberculosis in Uganda: A Mixed Methods Study

2021 ◽  
Author(s):  
Rita Makabayi-Mugabe ◽  
Joseph Musaazi ◽  
Stella Zawedde-Muyanja ◽  
Enock Kizito ◽  
Hellen Namwanje ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Patient Preferences ◽  
Mixed Methods Study ◽  
Drug Resistant ◽  
Community Based ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis ◽  
Mdr Tb ◽  
At Home

Abstract Background: The advent of all-oral regimens for the management of multi-drug resistant tuberculosis (MDR-TB) makes the implementation of community-based directly observed therapy (CB-DOT) a possibility for this group of patients. We set out to determine patient preferences for different attributes of a community-based model for the management of MDR-TB in Uganda. Methods: The study was conducted at five tertiary referral hospitals. We used a parallel convergent mixed methods study design. To collect quantitative data, we conducted a discrete choice experiment (DCE) with three different attributes of community-based care (provider type, location of care, and type of support) combined into eight choice sets, each with two options and an opt-out. We collected additional qualitative data by eliciting patient reasons for selection of each choice set. We fitted a mixed logit choice model to determine patient preferences for different attributes of community-based care. Thematic analysis using NVivo12 was done to understand the reasons for the choices made. Results: From December 2019 to January 2020, we interviewed 103 patients with MDR-TB. Majority (58.3%) were male; 61.2% were HIV negative; and the median age was 37 (IQR 30-47) years. Two thirds (65.1%) earned less than $1 per day. Study participants preferred at least one of the CB-DOT models of care to none (current standard of care). The most preferred model consisted of a community health worker (CHW) giving DOT at home and travel vouchers to enable attendance at monthly clinic follow-up visits. Qualitative interviews revealed that patients perceived CHWs as knowledgeable and able to offer psychosocial support. Patients also indicated a preference for taking medication at home because it saves both time and money and presents a lower risk of being stigmatized. Conclusion: People with MDR-TB prefer to be supported to take their medicine at home by a member of their community. The effectiveness of this model of care will be further evaluated.

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